The Effectiveness Of Two Methods To Prevent The Bone Cement Leakage In PKP Surgery

Background:Bone Cement Leakage（BCL）is the most common complication of Percutaneous Kyphoplasty（PKP）surgery.Because the Leakage may cause spinal nerves injury,pulmonary embolism,adjacent vertebral fracture and other serious complications,it has been a difficult problem for clinicians.How to choose a simple and effective method to prevent BLC has become a hot topic in recent years.Objective:To explore the effectiveness and reliability of progressive injection of bone cement and gelatin sponge in preventing bone cement leakage during percutaneous kyphoplasty in patients with acute osteoporotic vertebral fracture with cortical disruption,and to provide a new idea for clinical optimization of surgical procedures.Methods:A retrospective study was conducted on 175 patients with acute osteoporotic vertebral fracture with cortical disruption who received PKP surgery in Honghui hospital from December 2016 to December 2018.According to the different injection methods of bone cement,there were divided into traditional bone cement injection group（group A,63 cases）,progressive injection of bone cement group（group B,58 cases）and GS pre-filled combined with cement injection group（group C,54cases）.Group A was used as the control group,group B and C as the observation group.There were no statistically significant difference in age,gender,body mass index（BMI）,bone mineral density（BMD）,fracture site,and time from injury to surgery among the three groups,suggesting comparability.The perioperative data of the three groups of patients were recorded,including operation time,fluoroscopy time,blood loss,bone cement volume and hospitalization time,and the data were used for statistical analysis.The VAS score,ODI index,sagittal Cobb Angle and anterior vertebral height ratio were compared to evaluate the postoperative efficacy.Postoperative X-ray and CT were used to evaluate the BCL status of patients in the three groups and to record the incidence of complications during the perioperative period and follow-up.Results:All patients were followed up for 12.34±3.05 months.There were no statistically significant difference in the fluoroscopy frequency,blood loss,bone cement volume and hospitalization time in the three groups（P>0.05）.The operation time of group A was compared with that of group C（P>0.05）.The operation time of group B was compared with that of the other two groups（P<0.01）.The VAS score,ODI index,sagittal Cobb Angle and anterior vertebral height ratio of 6h after operation、6 months after operation and the last follow-up in the three groups were significantly improved compared with those before surgery（P<0.05）,while there were no significant difference in the three groups at each time point（P>0.05）.There was significant difference in BCL rate between group A and group B（C）(P_AB=0.001,P_AC=0.002),there was no significant difference in BCL rate between group B and group C（P=0.877）.The rate of intervertebral leakage in group A was significantly different from that in group B（C）(P_AB=0.022,P_AC=0.028),and the rate of paravertebral leakage in group A was significantly different from that in group B（C）(P_AB=0.035,P_AC=0.018).The rate of bone cement vertebral canal（intervertebral foramen）in group B was significantly lower than that in group A（P=0.028）.There was no significant difference in the rate of bone cement vertebral canal（intervertebral foramen）between group C and group A（P=0.336）.There were no significant difference in the rates of bone cement paravertebral vessels leakage and mixed leakage between groups A and B、C（P>0.05）.The incidence of clinical symptoms due to BCL in group A was 26.92%（7/26）,the incidence of clinical symptoms caused by BCL in group B was 12.50%（1/8）,and there was no obvious discomfort in patients with BCL in group C.There were no significant difference in the incidence of symptoms among the three groups（P>0.05）,and all the patients were cured after conservative treatment.Conlusion:The methods of progressive injection of bone cement and GS pre-filled can be used in AOVF with anterior wall、lateral wall and endplate damage of vertebral body,which can effectively prevent the vertebral space and paravertebral leakage of bone cement.However,for AOVF with posterior wall damage,progressive injection of bone cement can effectively prevent the posterior leakage of bone cement during PKP,while GS has limited preventive effect.