Li Dongyue, Tao Luming, Su Qingjun, Zhang Xinuo, Wu Xingrui
Orthopaedic Department, Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China.
Front Surg. 2025 Apr 11;12:1530495. doi: 10.3389/fsurg.2025.1530495. eCollection 2025.
Percutaneous kyphoplasty (PKP) has achieved good clinical efficacy in the treatment of Osteoporotic vertebral compression fractures (OVCFs). However, how to reduce the bone cement leakage rate and improve safety during PKP surgery remains an urgent issue to be addressed in clinical practice. Therefore, the aim of this study was to identify a line, called the "warning line", to determine whether there is leakage of bone cement during PKP surgery.
From February 2018 to September 2022, 88 patients and 106 vertebral bodies with OVCFs treated with PKP by a single surgeon at our center were included in the study. Clinical general data were recorded. Vertebral bodies with bone cement reaching the apex of the posterior margin depression without leakage were designated Group A, whereas those with leakage were designated Group B. The posterior vertebral wall was divided into three equal parts in the postoperative three-dimensional CT scans, and the leakage rates at different positions of the posterior vertebral wall were analysed. In Group A without leakage, line b, called the warning line, was marked as the apex of cement diffusion.
All 88 patients successfully underwent surgery, with a significant decrease in the postoperative VAS score. No neurological complications occurred. Bone cement leakage rate was 58.5%. There were 44 vertebral bodies in Group A and 62 in Group B. No significant differences were found between the two groups in terms of age, bone density, balloon pressure, contrast dose, or cement volume ( > 0.05). The bone cement leakage rates in the upper third, middle third, and lower third of the posterior vertebral wall were 25%, 61.1%, and 66.7%, respectively, with statistically significant differences ( < 0.05). In Group A without leakage, the warning line was approximately 6.8% of the sagittal diameter from the posterior vertebral margin.
PKP is a relatively safe treatment for OVCFs. Most bone cement leakage occurs in the middle and lower thirds of the posterior vertebral wall. When the apex of cement diffusion remains anterior to the warning line in PKP surgery, the posterior vertebral wall cement leakage rate is low.
经皮椎体后凸成形术（PKP）在骨质疏松性椎体压缩骨折（OVCFs）的治疗中取得了良好的临床疗效。然而，如何降低PKP手术中骨水泥渗漏率并提高安全性仍是临床实践中亟待解决的问题。因此，本研究的目的是确定一条称为“警戒线”的线，以判断PKP手术中是否存在骨水泥渗漏。
2018年2月至2022年9月，本中心一名外科医生采用PKP治疗的88例OVCFs患者及106个椎体纳入研究。记录临床一般资料。骨水泥到达后缘凹陷顶点且无渗漏的椎体为A组，有渗漏的椎体为B组。术后三维CT扫描将椎体后壁分为三等份，分析后壁不同位置的渗漏率。在无渗漏的A组中，将称为警戒线的线b标记为骨水泥扩散的顶点。
88例患者均成功手术，术后视觉模拟评分（VAS）显著降低。无神经并发症发生。骨水泥渗漏率为58.5%。A组有44个椎体，B组有62个椎体。两组在年龄、骨密度、球囊压力、造影剂剂量或骨水泥体积方面无显著差异（P＞0.05）。椎体后壁上三分之一、中三分之一和下三分之一的骨水泥渗漏率分别为25%、61.1%和66.7%，差异有统计学意义（P＜0.05）。在无渗漏的A组中，警戒线距椎体后缘约为矢状径的6.8%。
PKP是治疗OVCFs相对安全的方法。大多数骨水泥渗漏发生在椎体后壁的中三分之一和下三分之一。PKP手术中当骨水泥扩散顶点位于警戒线之前时，椎体后壁骨水泥渗漏率较低。
