[Effect of bone cement distribution on the clinical outcome of unilateral transpedicular puncture for spinal osteoporotic fractures].

OBJECTIVE: To investigate the effects of different bone cement morphology distribution on the clinical efficacy of unilateral percutaneous vertebroplasty(PVP) for spinal osteoporotic fractures. METHODS: The clinical data of 66 patients with osteoporotic vertebral compression fractures received unilateral PVP treatment from January 2019 to April 2020 were retrospectively analyzed. There were 16 males and 50 females, including 83 vertebral bodies, 45 thoracic vertebrae and 38 lumbar vertebrae, and 55 patients with single-segment, 6 double-segment, 4 three-segment and 1 four-segment. The age ranged from 60 to 93 years with an average of (76.83±8.65) years. The included patients were admitted to hospital 1 to 10 days after onset, and were diagnosed by anteroposterior and lateral X-rays, MRI and bone density examination before surgery. According to the shape of bone cement in postoperative X-ray, the patients were divided into O-shaped group (28 cases) and H-shaped group (38 cases). In O-shaped group, the bone cement presented agglomeration mass distribution in the affected vertebra in postoperative X-ray while the bone cement presented disseminated honeycomb distribution in the affected vertebrae in H-shaped group. Bone cement injection volume was collected in two groups. The intraoperative bone cement leakage and postoperative adjacent vertebral fractures were observed. The VAS of the two groups before operation and 1 day, 1 month, 6 months and 1 year after operation were compared;and ODI of the two groups 1 day, 6 months and 1 year after operation were compared. The kyphosis angle and anterior height of the affected vertebrae were measured before operation and 1 week, 1 year after operation. RESULTS: All 66 patients completed 1-year follow-up, and all patients healed well at the puncture site after surgery. There were 1 case and 8 cases of bone cement leakage in O-shaped group and H-shaped group during surgery respectively (P<0.05), but no serious complications occurred. One case occurred adjacent vertebral fracture in both groups during one-year follow-up (P>0.05). There was no statistical significance in injection amount of bone cement between the two groups (P>0.05). The VAS scores of O-shaped group and H-shaped group were 7.89±0.79, 2.75±1.08, 0.46±0.58, 0.36±0.49 and 8.00±1.04, 2.58±1.15, 0.53±0.56, 0.42±0.50 before operation, 1 day, 6 months, 1 year after operation respectively, and there was no statistical significance(P>0.05), and the VAS scores were 0.96±0.58 and 1.18±0.83 at 1 month after operation respectively, with statistical significance(P<0.05). The ODI scores of O-shaped group and H-shaped group were 12.43±3.78, 10.00±2.46, 8.43±1.50 and 12.11±3.68, 9.53±2.35, 8.32±1.51 at 1 day, 6 months and 1 year after surgery respectively, and there was no statistical significance between the two groups(P>0.05). There were no statistical significance in kyphotic angles and anterior height before surgery and 1 week, 1 year after surgery between two groups (P>0.05). CONCLUSION: No matter the distribution of bone cement is O-shape or H-shape, it can achieve good clinical effect, and the prognosis effect is equivalent. Therefore, when performing unilateral puncture PVP surgery, it is not necessary to deliberately increase the puncture angle of the puncture needle in order to achieve the full diffusion of the affected vertebrae, so as to reduce the risk of damaging important structures and bone cement leakage.

Clinical Observation of Intraosseous Anesthesia in Percutaneous Kyphoplasty.

Objective: Percutaneous kyphoplasty (PKP) is an effective minimally invasive technique in spine surgery in recent years. General anesthesia and local anesthesia are the main ways of anesthesia in PKP, and epidural anesthesia is also applied to PKP to some extent. However, all these three anesthetic methods have their respective advantages and disadvantages. It is essential to compare and evaluate the effects of different anesthesia methods on PKP for treating spinal fractures. Method: A total of 45 patients (53 vertebral bodies were included) were divided into two groups. Group A included 24 patients (29 vertebral bodies) with an average of 71 years old and Group B included 21 patients (24 vertebral bodies) with an average of 74 years old. Visual analogue scale (VAS) scores were recorded preoperatively; balloon expansion and bone cement injection were conducted intraoperatively. Then, they were recorded immediately after operation, 6 h postoperatively, to assess the pain level of the patient. Moreover, hospitalization time (days), operation duration (minutes), and bone cement injection amount (mL) had also been recorded. Results: There was no significant difference in preoperative general information and VAS score. However, the VAS scores were statistically significant at both the moment of balloon expansion and injection of bone cement. At the moment of immediate postoperation, the VAS scores showed no statistically significant difference, while it showed a statistically significant difference 6 h postoperatively. Conclusion: The anesthesia method by injection of 1% lidocaine hydrochloride (5 ml) into vertebral body can effectively relieve patients' pain in intraoperation and postoperation.