| Purpose:Through in vitro experiments of vertebroplasty on porcine spine specimens,to investigate a method of bone cement perfusion--root-cavity perfusion,and discuss the distribution of bone cement in vertebroplastythe,providing a new method for preventing leakage of bone cement and improving clinical efficacy in vertebroplasty.Method:Step 1:select 48 adult porcine lumbar spine specimens,both male and female,and rule out congenital disease,fracture,deformity or other lesions by X-ray.Step 2:bone mineral density was measured for all specimens,followed by decalcation treatment:0.4916mmol/L of edta-na2decalcation solution was prepared,all specimens were completely immersed in the decalcation solution,the decalcation solution was replaced once a day,and bone mineral density was measured again after15 days,and the trabeculae in the vertebral body were observed by X-ray scanning.Step 3:48 adult porcine lumbar spine specimens were randomly divided into bone cement with root cavity perfusion(group A,n=24)and bone cement with through perfusion(group B,n=24),two groups are made by kirschner wire(1.0 mm,1.5 mm and 2.0 mm),simulating of different degree of vertebral fractures,were recorded as A group(1.0mm),A(1.5 mm)group,A group(2.0 mm)and B(1.0 mm)group and B group(1.5 mm)and group B(2.0 mm),there were eight vertebral bodies in each group.Step 4:group A was operated with the root-cavity perfusion device,and group B was operated with the traditional straight-through device.The injection point of both groups was at the base of the vertebral arch,and it was unilateral.The number of vertebral bodies with the leakage bone cement was recorded in the two groups.After perfusion,all vertebral bodies were examined by X-ray and CT,and the distribution of bone cement in each vertebral body was scored.The original CT data were used to construct 3d models of each vertebra,and the volume fraction of bone cement in each vertebra was calculated by relevant software.Step 5:the number of leaky vertebral bodies,the distribution score of bone cement and the volume fraction of bone cement in the two groups were compared and analyzed.At the same time,according to the different fracture lines,the number of leaky vertebral body,the distribution score of bone cement and the volume fraction of bone cement in each group were compared and analyzed.Results:1.After 15 days of complete demineralization,bone mineral density of 48 vertebral specimens decreased from 1.151±0.026g/cm~3 before demineralization to 0.414±0.010g/cm~3.X-ray results suggested sparse trabeculae in the vertebral body and successful construction of in vitro osteoporotic vertebral specimens.2.Leakage in group A:no leakage was found in 24 samples;Leakage in group B:2 in group B(1.0mm),4 in group B(1.5mm),and 5 in group B(2.0mm).The total number of leakage in group A was significantly less than that in group B,and the difference were statistically significant(P<0.05).In different fracture situations,the number of leakage in each group A was smaller than that group B:in group A(1.0mm)0 vs B(1.0mm)2wasn`t statistically significant differences(P>0.05),in group A(1.5mm)0 vs B(1.5mm)4,and group A(2.0mm)0 vs B(2.0mm)5,and they were statistically significant differences(P<0.05).3.The distribution score of bone cement in group A was 8.75±0.74points,and that in group B was 5.13±1.15 points,the difference were statistically significant(P<0.05).In different fracture situations,the distribution score of bone cement in each group A was significantly greater than that in group B:A(1.0mm)8.75±0.71 points vs B(1.0mm)5.62±1.06 points,A(1.5mm)8.88±0.83 points vs B(1.5mm)5.13±0.99points,A(2.0mm)8.63±0.74 points vs B(2.0mm)4.63±1.30,the difference were statistically significant(P<0.05).4.The volume fraction of bone cement in group A was25.61±2.28%,while that in group B was 18.89±1.84%,the difference were statistically significant(P<0.05).In different fracture situations,the volume fraction of bone cement in each group in group A was significantly greater than that group B:A(1.0mm)26.76±2.82%vs B(1.0mm)19.71±1.56%,A(1.5mm)25.68±1.72%vs B(1.5mm)19.63±1.68%,A(2.0mm)24.17±0.63%vs B(2.0mm)17.31±1.27%,the difference were statistically significant(P<0.05).Conclusion:According to the experimental study of 48 adult porcine lumbar spine specimens,percutaneous vertebroplasty with root-cavity perfusion can significantly reduce the rate of bone cement leakage,and improve the distribution of bone cement in the vertebral body and the clinical effect of percutaneous vertebroplasty,reduce complications. |
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