Abstract:Objective To study the effect of intradiscal cement leakage on the degeneration of cement-leaking discs and the interim clinical efficacy after percutaneous kyphoplasty (PKP).Methods We retrospectively analyzed 188 cases of patients from March 2009 to September 2014 with the admittance to Liaoyang Central Hospital,diagnosed as thoracolumbar vertebral compression fractures,including 32 males and 156 females with average age of 69.1 years (range,62~78 years).All were treated by PKP,classified into 26 cases with intradiscal cement leakage (Study Group) and 162 cases without cement leakage (control group).All cases were followed with an average of 25.2 months.The degeneration of discs was assessed using anterior disc height and posterior disc height on standard lateral radiographs.Clinical efficacy was assessed using the Oswestry Disability Index scores(ODI) and Visual Analog Scale(VAS).The changes of disc height and the ODI and VAS score were compared between the two groups.Results Anterior disc height and posterior disc height of Study Group at the last follow-up:(5.65±2.21)mm、(2.94±0.89)mm;Those of control group:(7.36±2.43)mm、(3.77±1.84)mm.The disc height of the study group was significantly lower than the control group(P<0.05).The ODI and VAS score of two groups before surgery:(72.98±12.42)%、(7.50±1.05);(69.13±13.05)%、(7.44±0.97).The ODI and VAS score of two groups one day after surgery:(26.80±4.75)%、(2.45±0.63);(25.95±5.07)%、(2.47±0.77).The ODI and VAS score of two groups at the last follow-up:(31.12±3.58)%、(2.81±0.72);(29.75±4.32)%、(2.76±0.70).The ODI and VAS score of two groups were significantly improved after operation and continued to the last follow-up,and there was no significant difference between the two groups (P>0.05).Conclusion Intradiscal cement leakage can accelerate the degeneration of the intervertebral disc,but it does not affect the interim clinical efficacy after PKP.
卢海波,刘利群,吴长明,王立山. 椎体后凸成形术并发椎间隙骨水泥渗漏的临床研究[J]. 实用骨科杂志, 2017, 23(11): 966-969.
Lu Haibo,Liu Liqun,Wu Changming,et al. The Clinical Study of Intradiscal Cement Leakage after Percutaneous Kyphoplasty. sygkzz, 2017, 23(11): 966-969.
[1]Lin EP,Ekholm S,Hiwatashi A,et al.Vertebroplasty:cement leakage into the disc increases the risk of new fracture of adjacent vertebral body[J].Am J Neuroradiol,2004,25(2):175-180.
[2]费琦,李秋军,李东,等.椎体后凸成形术后骨水泥椎间盘渗漏对邻近节段力学影响的有限元分析[J].中华医学杂志,2011,91(1):51-55.
[3]刘仕友,路青林,郑伟,等.椎体后凸成形椎间盘骨水泥渗漏时行相邻椎体预防性强化的有限元分析[J].中国组织工程研究,2012,16(22):4001-4005.
[4]Pfirrmann CW,Metzdorf A,Zanetti M,et al.Magnetic resonance classification of lumbar intervertebral disc degeneration[J].Spine (Phila Pa 1976),2001,26(17):1873-1878.
[5]Fairbank JC,Coupe J,Davies JB,et al.The oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273.
[6]Zoarski GH,Snow P,Olan WJ,et al.Percutaneous vertebroplasty for osteoporetic compression fractures:quantitative prospective evaluation of longterm outcomes[J].J Vasc Interv Radiol,2002,13(2):139-148.
[7]章恺,王鸥,荚龙,等.椎体成形术和椎体后凸成形术术后骨水泥渗漏的临床观察及分析[J].实用骨科杂志,2015,121(8):679-682.
[8]张阳,单建林,李放,等.骨水泥椎间渗漏与椎体成形术术后再发椎体压缩骨折相关性研究[J].脊柱外科杂志,2013,11(5):279-282.
[9]Fu Z,Hu X,Wu Y,et al.Is There a dose-response relationship of cement volume with cement leakage and pain relief after vertebroplasty?[J].Dose Response,2016,14(4):1-6.
[10]Baroud G,Bohner M.Biomechanical impact of vertebroplasty.Postoperative biomechanics of vertebroplasty[J].Joint Bone Spine,2006,73(2):144-150.
[11]赵辉,倪才方,陈珑,等.骨水泥椎间盘渗漏后组织学和细胞凋亡的实验研究[J].中华放射学杂志,2007,41(12):1405-1408.
[12]Sonmez E,Yilmaz C,Caner H.Development of lumbar disc herniation following percutaneous vertebroplasty[J].Spine (Phila Pa 1976),2010,35(3):93-95.
[13]陈晓斌,任继鑫,张建政,等.PVP手术中骨水泥渗漏至椎间隙与术后疼痛恢复的关系[J].北京医学,2015,37(11):1040-1043.
[14]Zhan Y,Jiang J,Liao H,et al.Risk factors for cement leakage after vertebroplasty or kyphoplasty:a meta-analysis of published evidence[J].World Neurosurgery,2017,101(5):633-642.