[Comparative study on effectiveness of different puncture methods of flexible bone cement delivery device in treatment of osteoporotic vertebral upper 1/3 compression fractures]

Abstract

Objective: To compare the effectiveness of different puncture methods of the flexible bone cement delivery device in unilateral percutaneous curved vertebroplasty for osteoporotic vertebral upper 1/3 compression fractures.

Methods: A retrospective analysis was conducted on the clinical data of 67 patients with osteoporotic vertebral upper 1/3 compression fractures who were admitted and met the selection criteria between January 2023 and April 2024. The patients were divided into two groups based on the puncture method of the flexible bone cement delivery device: the oblique puncture group ( n=37) and the parallel puncture group ( n=30). There was no significant difference ( P>0.05) between the two groups in terms of gender, age, bone mineral density (T value), distribution of fractured vertebrae, time from injury to operation, and preoperative visual analogue scale (VAS) score for pain, Oswestry disability index (ODI), anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra. The following parameters were compared between the two groups: operation time, incidence of secondary puncture, incidence of bone cement leakage, volume of injected bone cement, bone cement distribution score, as well as VAS score, ODI, anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra at 1 day after operation and at last follow-up.

Results: Two cases in the oblique puncture group and 7 cases in the parallel puncture group underwent secondary puncture during operation, and the difference in the incidence of secondary puncture was significant ( P<0.05). No complications such as bone cement hypersensitivity, bone cement embolism, nerve injury, or epidural hematoma occurred in both groups. There was no significant difference in operation time, volume of injected bone cement, incidence of bone cement leakage, distribution score and rating of bone cement between the two groups ( P>0.05). All patients were followed up 6-18 months (mean, 12.0 months), and there was no significant difference in the follow-up time between the two groups ( P>0.05). No further fracture collapse or compression occurred in the fractured vertebra during follow-up. Both groups exhibited significant improvements in VAS score, ODI, anterior vertebral height, and Cobb angle of the fractured vertebra after operation compared to baseline ( P<0.05). There were also significant differences between the two time points after operation ( P<0.05). However, there was no significant difference in the above indicators between the two groups ( P>0.05).

Conclusion: For osteoporotic vertebral upper 1/3 compression fractures treated with unilateral percutaneous curved vertebroplasty, both oblique and parallel puncture methods of the flexible bone cement delivery device can effectively relieve pain, but the former is more conducive to reducing the incidence of secondary puncture.

Keywords: Percutaneous curved vertebroplasty; flexible bone cement delivery device; osteoporotic vertebral compression fracture; puncture method; upper 1/3 vertebral fracture.

图 1

Schematic diagram of the oblique puncture method 斜行穿刺示意图

图 2

Schematic diagram of the parallel puncture method 平行穿刺示意图

图 3

Change trends of clinical and radiological evaluation indicators in the two groups 两组临床与影像学评价指标变化趋势

图 4

A 73-year-old female patient with upper 1/3 compression fracture at T₁₂ in the parallel puncture group 平行穿刺组患者，女，73岁， T₁₂椎体上1/3压缩性骨折

图 5

A 74-year-old female patient with upper 1/3 compression fracture at L₃ in the oblique puncture group 斜行穿刺组患者，女，74岁， L₃椎体上1/3压缩性骨折