Efficacy Of Gelatin Sponge In Reducing Cement Leakage In OVCF With PVP

Objective:To explore the main risk factors of bone cement leakage(BCL)during percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fractures (OVCF)by Prospective analysis,and to evaluate the feasibility of using gelatin sponge(GS)to reduce BCL.Methods:The clinical data of 200 patients with PVP treated with single OVCF from September 2016 to September 2018 in Honghui Hospital Affiliated to Xi'an Jiaotong University were prospectively analyzed.Surgery was performed by the same chief physician.200 patients were randomly divided into groups A,B,C and D(opaque envelopes were extracted),and 50 patients were divided into groups.Group A was the control group without GS,while group B,C and D were the experimental groups with1/4,1/3 and 1/2 gelatin sponge,respectively.All operations were performed by the same chief physician and routine PVP was performed.The data of age,sex,integrity of endplate wall,bone mineral density,interval from injury to operation,visual analogue score(VAS),GS usage and the number of vertebral bodies with BCL were collected in Excel.According to the presence or absence of BCL,the injured vertebrae were divided into leakage group and non-leakage group.The data of age,sex,bone mineral density of lumbar spine,segment of injured vertebrae,integrity of injured vertebral endplate and volume of injected bone cement were analyzed,and the risk factors of BCL in PVP were discussed.Result:A total of 200 cases were included,191 cases were finally effective,the effective rate was 95.5%.There were 52 males and 139 females with an average age of 75.1 years(65-91 years).The average bone mineral density T value was-3.6SD(-4.9~2.6SD);of191 injured vertebrae,there were 163 cases of L1,244 Cases of L2,321 cases of L3,333cases of L4 and 530 cases of L5.All patients presented with lumbar and back pain accompanied by limited movement,and no nerve compression symptoms.All patients underwent X-ray,CT,MRI and bone mineral density examination before operation,and those with contraindication of MRI were replaced by ECT examination,which were consistent with the diagnosis of OVCF.The clinical manifestations were consistent with the results of imaging examination.The sex,age,integrity of vertebral endplate,bone mineral density and fracture segment of each group were comparable(P>0.05).There was a significant difference in the cement leakage rate between the four groups(P<0.05).There was no significant difference between the four groups(P>0.05).There was no significant difference in VAS between the four groups before and after operation(P>0.05);VAS improved significantly in each group after operation(P<0.05).There was no significant difference in ODI between the four groups before and after operation(P>0.05),while ODI in the four groups improved significantly after operation(P<0.05).Comparing the cement leakage rate of the four groups after operation,there was a statistical difference(P<0.05).There were significant differences in cement leakage rates between groups A and C(?~2=9.05,P<0.0083),D(?~2=9.99,P<0.0083),B and A(?~2=0.015,P>0.0083),but there was no statistical difference between group B and C(?~2=8.30,P<0.008),D(?~2=9.21,P<0.008).There was no significant difference between group C and group D(?~2=0.05,P>0.0083).There were 53 cases in the leakage group and 138 cases in the non-leakage group.There was no significant difference in age,sex,bone mineral density and fracture segment between the two groups(P>0.05).There were significant statistical differences in the integrity of the injured vertebral endplate and the volume of bone cement injected between the two groups(P<0.05),which was a risk factor for BCL.One patient in group A and D had persistent lumbar and back pain after operation.Postoperative CT showed that bone cement leaked to lumbar and dorsal muscles(not to psoas major muscle).After symptomatic treatment with non-steroidal drugs,both patients had good pain symptoms.One patient in group B had leakage of bone cement in spinal canal,which did not appear neurological symptoms and was not treated.There were no neurological symptoms in 191 patients after operation.In group A,1 patient had a history of diabetes mellitus and wound healing was not good.After controlling blood sugar,the wound healed well,and the wounds of other patients healed well.Conclusion:1.For patients with lumbar OVCF,GS is a safe and feasible method to reduce BCL during PVP,and 1/3 or 1/2 GS can reduce BCL.2.Age,sex,bone mineral density and BCL occurrence during PVP were not related,but the integrity of injured vertebral endplate and the amount of bone cement injection were the risk factors.