骨填充网袋技术在伴椎体内裂隙征的骨质疏松性椎体压缩骨折治疗中对骨水泥渗漏的影响

The effect of bone-filled mesh bag technique on bone cement leakage in the treatment of osteoporotic vertebral compression fractures associated with intravertebral vacuum cleft

目的:探讨骨填充网袋技术在经皮球囊扩张椎体后凸成形术(PKP)治疗伴有椎体内裂隙征(IVC)的骨质疏松性椎体压缩骨折(OVCF)中对骨水泥渗漏的影响。方法:回顾性纳入2021年6月至2022年6月行PKP治疗的OVCF患者,且依据术前影像学检查结果诊断为椎体内裂隙征(IVC)。根据医院信息系统中的手术记录分为单纯PKP手术组和骨填充网袋PKP手术组。评估术后骨水泥渗漏情况及渗漏部位,并对术后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎高度压缩比、伤椎局部后凸角(LKA)等进行统计学分析。结果:共纳入91例伴IVC的OVCF患者,其中单纯PKP组48例、骨填充网袋PKP组43例。随访资料显示26例患者发现骨水泥渗漏,均未出现神经损伤、肺栓塞、心肌梗死、脑梗死等严重并发症。骨填充网袋PKP组渗漏率(11.63%)低于单纯PKP组渗漏率(43.75%)(P<0.01),两组术后第1日、6个月、12个月的VAS评分比较差异无统计学意义(P均>0.05);两组术后第1日、6个月的ODI比较差异无统计学意义(P均>0.05),但骨填充网袋PKP组术后12个月的ODI优于单纯PKP组(P<0.01);两组术后第1日的伤椎高度压缩比、伤椎LKA差异无统计学意义(P均>0.05),但骨填充网袋PKP组术后6、12个月的伤椎高度压缩比、伤椎LKA均优于单纯PKP组(P均<0.05)。结论:使用骨填充网袋技术在PKP治疗伴有IVC的OVCF患者中,对骨水泥向椎间隙及椎旁组织渗漏有较好的预防作用,同时对术后伤椎的椎体高度丢失与LKA丢失起到一定的预防作用。

Objective:To investigate the effect of bone-filled mesh bag technique on bone cement leakage in the treatment of osteoporotic vertebral compression fractures(OVCFs)with intravertebral vacuum cleft(IVC)using percutaneous kyphoplasty(PKP).Methods:A retrospective analysis was conducted on OVCF patients who underwent PKP treatment from June 2021 to June 2022.Patients were diagnosed with IVC based on the preoperative imaging findings.According to the surgical records in the hospital information system,patients were divided into the simple PKP group and the bone-filled mesh bag PKP group.Postoperative bone cement leakage and leakage sites were assessed.Statistical analyses were performed on the postoperative pain visual analogue scale(VAS),Oswestry Disability Index(ODI),compressed vertebral height ratio,and local kyphotic angle(LKA).Results:A total of 91 OVCF patients with IVC were included,with 48 cases in the simple PKP group and 43 cases in the bone-filled mesh bag PKP group.The follow-up data showed cement leakage in 26 patients,with no severe complications such as neural injury,pulmonary embolism,myocardial infarction,or cerebral infarction.The leakage rate in the bone-filled mesh bag PKP group(11.63%)was significantly lower than that in the simple PKP group(43.75%)(P<0.01).There were no statistically significant differences in VAS scores on postoperative day 1,6 months,or 12 months between the two groups(all P>0.05).Postoperative day 1 and 6-month ODI showed no statistical differences between the two groups(both P>0.05).However,at 12 months postoperatively,the ODI in the bone-filled mesh bag PKP group was significantly better than that in the simple PKP group(P<0.01).On the first day after the operation,the compressed vertebral height ratio and the LKA between the two groups had no significant statistical difference(both P>0.05),but at 6 and 12 months,the compressed vertebral height ratio and the LKA in the bone-filled mesh bag PKP group were better than those in the simple PKP group(all P<0.05).Conclusions:The use of bone-filled mesh bag technique in PKP treatment for OVCF patients with IVC has a better preventive effect on the leakage of bone cement into the intervertebral space and paravertebral tissue.Additionally,it plays a certain preventive role in the loss of vertebral height and LKA of the injured vertebrae after surgery.