Decompressed percutaneous vertebroplasty: A secured bone cement delivery procedure for vertebral augmentation in osteoporotic compression fractures

被引:16
作者
Chu, William [1 ,2 ]
Tsuei, Yu-Chuan [2 ]
Liao, Pei-Hung [4 ]
Lin, Jiun-Hung [3 ]
Chou, Wen-Hsiang [2 ]
Chu, Woei-Chyn [1 ]
Young, Shuenn-Tsong [1 ,5 ]
机构
[1] Natl Yang Ming Univ, Inst Biomed Engn, Taipei 11221, Taiwan
[2] Cheng Hsin Gen Hosp, Dept Orthoped, Taipei, Taiwan
[3] Kun Shan Univ, Dept Elect Engn, Tainan, Taiwan
[4] Mackay Med Nursing & Management Coll, Dept Nursing, Taipei, Taiwan
[5] Taiwan Shoufu Univ, Tainan 72153, Taiwan
来源
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED | 2013年 / 44卷 / 06期
关键词
Percutaneous vertebroplasty; Osteoporosis; Vertebral fractures; Cement leakage; INTRAOSSEOUS VENOGRAPHY; CLINICAL-EXPERIENCE; MARROW EMBOLISM; PAIN RELIEF; POLYMETHYLMETHACRYLATE; KYPHOPLASTY; INJECTION; LEAKAGE; FAT; COMPLICATIONS;
D O I
10.1016/j.injury.2012.10.017
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
The purpose of this study was to assess the efficacy of a new assistive procedure for injecting cement in percutaneous vertebroplasty (PV). Percutaneous vertebroplasty is frequently used for treating patients with osteoporotic vertebral compression fractures. However, the leakage of bone cement during PV may lead to serious complications, such as spinal cord compression or pulmonary embolism. Herein we present a secure procedure designed to safely and effectively deliver the bone cement into the vertebral column. Materials and methods: Thirty-five patients with a total of 50 levels of osteoporotic compression fracture were consecutively recruited for the study. During a routine PV operation, acrylic cement was injected with a simultaneous application of a continuous negative pressure to the contralateral side of the vertebral body. This negative pressure exerts a pulling force that attracts the bone cement to flow within the vertebral body. Results: With the proposed decompressed PV procedure, cross-filling of the vertebrographys was achieved for all 50 fracture levels, with no paravertebral venous plexus leakage. Three of the 50 levels (6%) exhibited contrast-medium leakage into the intradisc or cortical defect regions. After decompressed cement injection, excellent cross-filling of bone cement deposition was achieved in 38 of the 50 levels (76%; cement cross-filling region >75%), good cross-filling deposition was achieved in 7 levels (14%; cement cross-filling region >50%), deposition was poor in 3 levels (6%; cement cross-filling region <50%), and deposition failed in 2 levels (4%; fixed cement with no sign of cross-filling). Routine postoperative reviews revealed that six fracture levels (12%) had minimal cement leakage, with two leaking into the disc and four into paravertebral cortical defect regions. Conclusions: Compared to the reported 20-88% cement leakage rate for the conventional PV procedure, the proposed decompressed PV procedure offers a more secure and effective way to perform cement injection, and reduces the likelihood of cement leakage. (C) 2012 Elsevier Ltd. All rights reserved.
引用
收藏
页码:813 / 818
页数:6
相关论文
共 47 条
[1]   Pressurization of vertebral bodies during vertebroplasty causes cardiovascular complications - An experimental study in sheep [J].
Aebli, N ;
Krebs, J ;
Schwenke, D ;
Davis, G ;
Theis, JC .
SPINE, 2003, 28 (14) :1513-1519
[2]   Cardiovascular changes during multiple vertebroplasty with and without vent-hole - An experimental study in sheep [J].
Aebli, N ;
Krebs, J ;
Schwenke, D ;
Davis, G ;
Theis, JC .
SPINE, 2003, 28 (14) :1504-1511
[3]   Fat embolism and acute hypotension during vertebroplasty - An experimental study in sheep [J].
Aebli, N ;
Krebs, J ;
Davis, G ;
Walton, M ;
Williams, MJA ;
Theis, JC .
SPINE, 2002, 27 (05) :460-466
[4]  
Aebli N, 2003, SPINE, V28, P1519
[5]  
Amro RR, 2001, U PENNSYLVANIA ORTHO, V14, P55
[6]   Percutaneous vertebroplasty and bone cement leakage: Clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures [J].
Anselmetti, Giovanni Carlo ;
Zoarski, Gregg ;
Manca, Antonio ;
Masala, Salvatore ;
Eminefendic, Haris ;
Russo, Filippo ;
Regge, Daniele .
CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 2008, 31 (05) :937-947
[7]   Percutaneous vertebroplasty for pain relief and spinal stabilization [J].
Barr, JD ;
Barr, MS ;
Lemley, TJ ;
McCann, RM .
SPINE, 2000, 25 (08) :923-928
[8]   Vertebral augmentation in osteoporotic fractures [J].
Barrocas, Alex M. ;
Eskey, Clifford J. ;
Hirsch, Joshua A. .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2007, 38 :88-96
[9]   Kyphoplasty for chronic painful osteoporotic vertebral compression fractures via unipedicular versus bipedicular approachment: A comparative study in early stage [J].
Chen, ChunMao ;
Chen, Liang ;
Gu, Yong ;
Xu, Yun ;
Liu, Yong ;
Bai, XiaoLiang ;
Zhu, XueSong ;
Yang, HuiLin .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2010, 41 (04) :356-359
[10]   Cardiovascular collapse and death during vertebroplasty [J].
Childers, JC .
RADIOLOGY, 2003, 228 (03) :902-902