Research progress on risk factors and preventive measures of bone cement leakage after vertebroplasty
WANG Meng1 HU Xinglv2 LIU Shiruo2 WANG Yongqi2 WANG Chao1 WANG Xuan1 WANG Chen1 YIN Jichao3
1.The First Clinical Medical College, Shaanxi University of Chinese Medicine, Shaanxi Province, Xianyang 712046, China; 2.Departments of Spinal, Xi’an Traditional Chinese Medicine Hospital, Shaanxi Province, Xi’an 710000, China; 3.Department of Administration, Xi’an School of Health, Shaanxi Province, Xi’an 710000, China
Abstract:Osteoporotic and pathological fractures can be treated by vertebral augmentation, these techniques are widely applied in clinical practice. However, bone cement leakage during operation is the most common complication, which may lead to vascular embolism, nerve injury, and refracture of adjacent vertebrae. This article reviews the risk factors of bone cement leakage, including anatomy, fracture, surgery, bone cement, disease factors, and common preventive measures, such as optimal surgical methods and the use of novel materials. It also identifies the gaps and limitations in the existing research and suggests future research directions, aiming to provide guidance for clinical work and enhance surgical safety.
王 孟1 胡兴律2 刘诗若2 王墉琦2 王 超1 王 轩1 王 琛1 殷继超3. 椎体强化术后骨水泥渗漏危险因素及预防措施的研究进展[J]. 中国医药导报, 2023, 20(35): 54-57.
WANG Meng1 HU Xinglv2 LIU Shiruo2 WANG Yongqi2 WANG Chao1 WANG Xuan1 WANG Chen1 YIN Jichao3. Research progress on risk factors and preventive measures of bone cement leakage after vertebroplasty. 中国医药导报, 2023, 20(35): 54-57.
[1] Hoffmann J,Preston G,Whaley J,et al. Vertebral Augmentation in Spine Surgery [J]. J Am Acad Orthop Surg,2023,31(10):477-489. [2] Baoliang Z,Zhongqiang C. Clinical evaluation of the patterns and risk factors of bone cement leakage and its related risk factors secondary to vertebral augmentation [J]. Chinese J Orth- opaedics,2021,41(5):330-338. [3] Gao C,Zong M,Wang WT,et al. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral com- pression fractures [J]. Acta Radiologica (Stockholm,Sweden:1987),2018,59(5):577-585. [4] Arana-Guajardo AC,Cavazos-Aranda AL. Asymptomatic pul- monary embolism secondary to cement leakage after vertebroplasty [J]. Reumatologia Clinica,2021,17(5):302-303. [5] Zhang K,She J,Zhu Y,et al. Risk factors of postoperative bone cement leakage on osteoporotic vertebral compression fracture:a retrospective study [J]. J Orthop Surg Res,2021, 16(1):183. [6] 孙亦强,王秀双,李建军,等.椎体内裂隙征引起的椎体动态不稳与神经功能损伤的关系[J].中国组织工程研究,2020,24(18):2900-2905. [7] Tang B,Xu S,Chen X,et al. The impact of intravertebral cleft on cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures:a case-control study [J]. BMC musculoskelet disord,2021,22(1):805-811. [8] Yu W,Liang D,Yao Z,et al. The therapeutic effect of intravertebral vacuum cleft with osteoporotic vertebral compression fractures:A systematic review and meta-analysis [J]. Inter J Surg,2017,40:17-23. [9] 毕航川,段浩,王均,等.骨质疏松性椎体压缩骨折椎体强化术后骨水泥血管渗漏的危险因素分析[J].中华创伤杂志,2022,38(4):307-313. [10] Zhang S,Wang GJ,Wang Q,et al. A mysterious risk factor for bone cement leakage into the spinal canal through the Batson vein during percutaneous kyphoplasty:a case control study [J]. BMC musculoskelet disord,2019,20(1):423- 430. [11] Huang S,Zhu X,Xiao D,et al. Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors:a retrospective cohort study [J]. J Orthop Surg Res,2019,14(1):452-463. [12] 张翼,寇红伟,尚国伟,等.骨质疏松性椎体压缩骨折行经皮椎体成形术后骨水泥渗漏危险因素分析[J].中华创伤杂志,2022,38(5):396-400. [13] Tang B,Cui L,Chen X,et al. Risk Factors for Cement Leakage in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures:An Analysis of 1456 Vertebrae Augmented by Low-Viscosity Bone Cement [J]. Spine,2021, 46(4):216-222. [14] Li Y,Qian Y,Shen G,et al. Percutaneous mesh-container-plasty versus percutaneous kyphoplasty in the treatment of malignant thoracolumbar compression fractures:a retrospective cohort study [J]. Acta Orthop Traumatol Turc,2022, 56(6):395-401. [15] 陆兆华,孙天泽,张警,等.不同入路椎体后凸成形术治疗骨质疏松性椎体压缩骨折[J].中国组织工程研究,2023,27(36):5834-5839. [16] Chen W,Xie W,Xiao Z,et al. Incidence of Cement Leakage Between Unilateral and Bilateral Percutaneous Vertebral Augmentation for Osteoporotic Vertebral Compression Fractures:A Meta-Analysis of Randomized Controlled Trials [J]. World Neurosurg,2019,122(2):342-348. [17] Alhashash M,Shousha M,Barakat AS,et al. Effects of Polymethylmethacrylate Cement Viscosity and Bone Porosity on Cement Leakage and New Vertebral Fractures After Percutaneous Vertebroplasty:A Prospective Study [J]. Global Spine J,2019,9(7):754-760. [18] Zhang ZF,Huang H,Chen S,et al. Comparison of high- and low-viscosity cement in the treatment of vertebral compression fractures:A systematic review and meta-analysis [J]. Medicine,2018,97(12):e0184-e0192. [19] 李文乐,王浩胜,宁丽俊,等.骨质疏松患者经皮椎体成形后骨水泥渗漏风险分析及预测模型验证[J].中国组织工程研究,2022,26(10):1477-1482. [20] Wang M,Zhang L,Fu Z,et al. Selections of Bone Cement Viscosity and Volume in Percutaneous Vertebroplasty:A Retrospective Cohort Study [J]. World Neur,2021,150:e218- e227. [21] Chen JB,Xiao YP,Chen D,et al. Clinical observation of two bone cement distribution modes of percutaneous vertebroplasty in the treatment of thoracolumbar Kümmell’s disease [J]. J Orthop Surg Res,2020,15(1):250-258. [22] 吴永忠,徐斌,罗明华,等.Kümmell’s病椎体成形术骨水泥渗漏危险因素[J].中国矫形外科杂志,2022,30(23): 2129-2133. [23] Cui Y,Pan Y,Lin Y,et al. Risk factors for predicting cement leakage in percutaneous vertebroplasty for spinal metastases [J]. J Orthop Sci,2022,27(1):79-83. [24] 柏涛,纳强,张雄文,等.经皮椎体强化术中分次调配骨水泥、靶点封堵裂口防止经椎体前壁骨水泥渗漏的效果[J].中国骨与关节损伤杂志,2021,36(1):55-56. [25] 郭翔翔,王涛,马信龙,等.经皮弯角椎体成形术与单侧经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效比较[J].中华创伤杂志,2022,38(5):389-395. [26] Xu B,Wang XF,Ye XY,et al. Observation of the clinical efficacy of the bone filling bag vertebroplasty for the treatment of osteoporotic vertebral compression fractures [J]. Zhongguo Gu Shang,2018,31(11):993-997. [27] Wang P,Li J,Song Z,et al. Utilization of the directional balloon technique to improve the effectiveness of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures and reduction of bone cement leakage [J]. Medicine,2019,98(19):e15272-e15279. [28] Hao W,Yuan H,Bolong Z,et al. Efficacy evaluation of gelatin sponge in percutaneous vertebroplasty for lumbar osteoporosis compression fractures [J]. Chinese J Tra,2019,35(1):38-43. [29] Sun HB,Jing XS,Liu YZ,et al. The Optimal Volume Fraction in Percutaneous Vertebroplasty Evaluated by Pain Relief,Cement Dispersion,and Cement Leakage:A Prospective Cohort Study of 130 Patients with Painful Osteoporotic Vertebral Compression Fracture in the Thoracolumbar Vertebra [J]. World Neur,2018,114(3):e677-e688. [30] Inoue M,Sakane M,Taguchi T. Fabrication of reactive poly(vinyl alcohol) membranes for prevention of bone cement leakage [J]. J Bio Mat Res,2014,102(8):1786-1791. [31] Lu Q,Liu C,Wang D,et al. Biomechanical evaluation of calcium phosphate-based nanocomposite versus polymethylmethacrylate cement for percutaneous kyphoplasty [J]. Spine J,2019,19(11):1871-1884. [32] Leu TH,Wei Y,Hwua YS,et al. Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage [J]. Polymers,2019,11(12):1971-1987.