The Prevention And Treatment Of The Leakage For Kyphoplasty

PartⅠThe development of the device measured perfusion pressure on minimally invasive cement augmentation for vertebralObjective: To design a device to directly measure the cement perfusion pressure on minimally invasive cement augmentation for vertebral and reduce the leakage of bone cement.Methods: The device of directly measuring the cement perfusion pressure was designed according to the special features of minimally invasive cement augmentation and vertebral structure.Results: The design and development of the device could directly measure perfusion pressure on minimally invasive cement augmentation for vertebral body (the national invention patent: ZL200910032273.3). Including micro-pressure sensors, push the tube, push the tube slide in the hollow plunger, the signal conditioning circuits and data acquisition zoom display instrument.Conclusion: The device for directly monitoring and measuring perfusion pressure on minimally invasive cement augmentation for vertebral body reduced cement leakage and risk of produres.PartⅡThe study of the cement perfusion pressure for kyphoplasty in vitroObjective: To seek legitimate and safe perfusion pressure to reduce the leakage of bone cement using the self-development device of directly measuring the cement perfusion pressure on kyphoplasty.Methods: 35 thoracolumbar osteoporotic vertebral bodies (T10-L4) were made of osteoporotic vertebral compression fracture model (28 vertebral compression height of the half of anterior vertebral height, 7 vertebrae compressed height of 2/3 of anterior vertebral height ).The vertebral body is divided into five groups, each 7 vertebrae, T1 groups respectively (room temperature is 20℃), T2 group (room temperature is 22℃), V1 group (bone cement viscosity for 50 Pa·S), V2 group (bone cement viscosity for 100 Pa·S) and F group(room temperature is 20℃, bone cement viscosity for 100 Pa·S). Bone cement used in the perfusion pressure measurement device independent research and determination of perfusion pressure. The data were statistically analyzed.Results: The bone cement at 20℃, the viscosity was 50 Pa·S is relatively more reasonable when the perfusion; ambient temperature of 22℃and 20℃, KP bone cement after perfusion pressure was significantly different (p = 0.007); viscosity is 50 Pa·S 100 Pa·S and when the infusion, KP differences in perfusion pressure during produres was significantly (p = 0.047); KP surgery, bone cement perfusion, type of fracture and vertebral sequence of perfusion pressure on the bone cement had significant effects.Conclusion: Cement perfusion pressure of kyphoplasty was affected by the operating rooms temperature, the bone cement viscosity, type of vertebral fractures, vertebral sequence and volume of bone cement; In KP patients, the operating rooms temperature controlled at 20℃, bone Cement viscosity been 50 Pa·S, less perfusion pressure been 0.5MPa, bone cement volume been not so mangy as 3ml , while was the relative safety. Large cracks caused by serious fractures was resulted in cement leakage easily.PartⅢThe Comparison of Cement Perfusion Pressure for Kyphoplasty and VertebroplastyObjective: To measure bone cement perfusion pressure of vertebroplasty and kyphoplasty, both compared and analyzed the significance of the difference.Methods: Osteoporotic thoracolumbar vertebral (T10-L4) of 28 vertebrae were made of osteoporotic vertebral compression fracture model (vertebral compression height be 1/2 of anterior vertebral height).The vertebral bodies were randomly divided into 4 groups 7 vertebrae, respectively V1 group (bone cement viscosity began to 50 Pa·S VP infusion technique), V2 group (bone cement viscosity began to 100 Pa·S VP perfusion technique ), K1 group (bone cement viscosity began to 50Pa ? S KP perfusion technique), K2 group (bone cement viscosity was 100 Pa·S KP began perfusion technique.) Perfusion temperature controlled at 20℃. There were unilateral for vertebroplasty and kyphoplasty. perfusion pressure and volume of bone cement were recorded by self-measuring device. The datas were statistically analyzed.Results: When the bone cement viscosity are 50 Pa·S and 100 Pa·S, KP and VP perfusion pressure and cement volume was significantly different (P = 0.021 and 0.000, respectively); There were significant differences about bone cement perfusion pressure of two produres (p = 0.017), vertebroplasty highly.Conclusion: The cement perfusion pressure of Kyphoplasty was significantly lower than that of vertebroplasty; effective and reasonable control of the perfusion pressure, temperature, bone cement viscosity, bone cement volume, comprehensive analysis of vertebral fracture type play an important role for the reduction cement leakage of kyphoplasty and vertebroplasty; The bone cement leakage of vertebroplasty occurred in fracture cracks easily.PartⅣThe Iatrogenic Factors of Affecting cement leakages of KyphoplastyObjactive:To analyze the iatrogenic factors of affecting effect for kyphoplasty.Methods : From January 2005 to December 2009, percutaneous bilateral transpedicular kyphoplasty with single balloon was performed in 38 patients with only painful osteoporotic vertebral compression fractures(OVCF). In the group, there were 9 males and 29 females, and the average age of the patients was 69.9 years with a range of 57 to 89 years. 38 osteoporotic vertebral fractures, which involved 2T10, 6T11, 10T12, 8L1, 6L2, 4L3, 2L4, , were treated. There were respectively 23 patients and 15 patients in standard surgery (SS) and nonstandard surgery (NSS) groups. MRI displayed low signal in T1WI and high signal in T2WI and STIR. Pain scores, vertebral body heights, Cobb’s angles, cement leakages were measured for all patients.Results:All patients experienced dramatic pain relief or disappearance after the procedures. In SS group and in NSS group, The main pain score (VAS) decreased from 8.8 and 8.6 preoperatively to 2.6 to 3.3 postoperatively (p>0.05), The vertebral body height restoration was 54.8%±32.6% and 46.5%±31.9% on the anterior border, 61.2%±22.4% and 60.1%±27.6% in the middle potion, The sagittal alignment was improved significantly, as the average correction of the Cobb’s angle reached 14.9°(0°～37°) and 7.6°(0°～27°), The rate of cement leakage was 8.7% and 33.3% in veins and soft tissues, around body, intervertebral(p<0.05). The average volume of cement in one vertebral body was 4.65±1.32(1.8～8.0ml) and 5.45±1.53(1.5～8.5ml).Conclusions:It is significantly effective to the effect of kyphoplasty for the surgical technique.It is important to increase the surgical security and clinical outcome for the standard surgical technique and normal professional training.