Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu 215006, China.
Injury. 2012 Oct;43(10):1698-703. doi: 10.1016/j.injury.2012.06.008. Epub 2012 Jul 4.
To retrospectively assess the optimal operating time for kyphoplasty as far as the cement leakage during kyphoplasty is concerned.
One hundred and six patients with a total of 117 osteoporotic vertebral compression fractures (VCFs) were enrolled in our study. According to the time of kyphoplasty, they were divided into two groups: group 1 (early operation group, who received the operation within 14 days after fracture, n=46) and group 2 (delayed operation group, who received the operation between 15 and 28 days after fracture, n=71). Preoperative and postoperative visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were compared 3 days after surgery within each group and between the two groups. The radiographic outcomes were evaluated by the restoration rate (RR) of the treated vertebrae. The outcome of cement leakage was assessed after surgery using X-ray and computed tomography (CT) scans. Leaks of cement were classified into three types: those via the basivertebral vein (type B), via the segmental vein (type S) and through a cortical defect (type C).
The mean VAS and ODI scores decreased significantly from pre-surgery to post-surgery in each group, as did the RR (p>0.05). There was no significant difference postoperatively on VAS and ODI scores (p>0.05) between the two groups. However, significant differences were observed postoperatively on RR (p=0.045) and vertebrae with leakage (p=0.038). In addition, there was a significant difference on leakage site of type C between the two groups (p=0.032).
Both early and delayed operations of kyphoplasty can achieve satisfactory clinical and radiographic outcomes for osteoporotic VCFs. The risk of cement leakage during kyphoplasty will decrease obviously in delayed operation; so delayed operation, perhaps 2 weeks after fracture, is more safe and optimal than early operation as far as cement leakage is concerned, especially for vertebrae with cortical defects. But early operation of kyphoplasty is more effective in vertebral height restoration.
回顾性评估经皮椎体后凸成形术（PKP）的最佳手术时机，主要关注骨水泥渗漏的问题。
本研究共纳入 106 例骨质疏松性椎体压缩骨折（OVCFs）患者，共 117 个椎体骨折。根据手术时间将患者分为两组：组 1（早期手术组，骨折后 14 天内手术，n=46）和组 2（延迟手术组，骨折后 15-28 天手术，n=71）。比较两组患者手术前后 3 天的视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分，评估术后 X 线和 CT 检查的影像学结果（通过测量患椎的高度恢复率 RR 评估），并评估骨水泥渗漏的结果。骨水泥渗漏分为经椎基底静脉（type B）、节段静脉（type S）和皮质缺损（type C）三种类型。
每组患者的 VAS 和 ODI 评分均从术前显著降低至术后，RR 也随之降低（p＞0.05）。两组患者术后 VAS 和 ODI 评分无显著差异（p＞0.05），但 RR（p=0.045）和存在渗漏的椎体（p=0.038）有显著差异。此外，两组患者的 type C 渗漏部位有显著差异（p=0.032）。
PKP 早期和延迟手术治疗骨质疏松性 VCFs 均能获得满意的临床和影像学结果。延迟手术可明显降低骨水泥渗漏的风险；因此，与早期手术相比，骨折后 2 周左右的延迟手术更安全、更理想，特别是针对有皮质缺损的椎体。但早期 PKP 手术在椎体高度恢复方面更有效。
