Oh Jae-Sang, Doh Jae-Won, Shim Jai-Joon, Lee Kyeong-Seok, Yoon Seok-Mann, Bae Hack-Gun
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Korean J Spine. 2016 Jun;13(2):63-6. doi: 10.14245/kjs.2016.13.2.63. Epub 2016 Jun 30.
Preinjection gelfoam embolization during percutaneous vertebroplasty (PVP) has been thought alternative technique to prevent the leakage of bone cement. The goal of this study was to evaluate whether the gelfoam techniques are useful to reduce bone cement leakage.
Total 100 PVPs of osteoporotic spine compression fractures were performed by 1 spine surgeon who experienced more than 500 PVP cases under prospective control study. Operation was done in T-L junction (T10-L2) fractures with bi-transpedicular approach. Preinjection gelfoam PVP was done in the 50 levels. As control group, PVP without gelfoam was done in the 50 levels. We did not perform preoperative venography. We inserted normal saline-mixed gelfoam to the anterior third of vertebral body via PVP needle, and then 3mL of polymethylmetacrylate (PMMA) was injected. We prospectively evaluated the incidence and leakage pattern of PMMA by postoperative computed tomography.
Between gelfoam and control groups, there were 11 leaks (22%) versus 12 leaks (26%). The mean operation time was 7.00 minutes versus 6.30 minutes. In gelfoam group, there were 6 spinal canal leaks, 4 paravertebral venous leaks, and 1 soft tissue leaks. In control group, there were 4 spinal canal leaks, 8 paravertebral venous leaks, and 1 disc space leak. In spite of cement leakage, there was no symptomatic case in both groups. Statistically, gelfoam technique was not related to decrease the incidence of leakage (p=0.64).
Our prospective study showed that it did not significantly decrease cement leakage when vertebroplasty is performed by experienced spine surgeon.
经皮椎体成形术（PVP）期间的注射前明胶海绵栓塞术被认为是预防骨水泥渗漏的替代技术。本研究的目的是评估明胶海绵技术是否有助于减少骨水泥渗漏。
在一项前瞻性对照研究中，由一位有超过500例PVP手术经验的脊柱外科医生对100例骨质疏松性脊柱压缩骨折患者进行PVP手术。手术采用双椎弓根入路治疗胸腰段（T10-L2）骨折。50个椎体节段采用注射前明胶海绵PVP。作为对照组，50个椎体节段采用无明胶海绵的PVP。我们未进行术前静脉造影。通过PVP针将生理盐水混合的明胶海绵插入椎体前三分之一，然后注入3mL聚甲基丙烯酸甲酯（PMMA）。通过术后计算机断层扫描前瞻性评估PMMA的发生率和渗漏模式。
明胶海绵组和对照组分别有11例渗漏（22%）和12例渗漏（26%）。平均手术时间分别为7.00分钟和6.30分钟。明胶海绵组有6例椎管渗漏、4例椎旁静脉渗漏和1例软组织渗漏。对照组有4例椎管渗漏、8例椎旁静脉渗漏和1例椎间盘间隙渗漏。尽管有骨水泥渗漏，但两组均无有症状病例。统计学上，明胶海绵技术与降低渗漏发生率无关（p=0.64）。
我们的前瞻性研究表明，由经验丰富的脊柱外科医生进行椎体成形术时，明胶海绵技术并不能显著减少骨水泥渗漏。
