Effects of different puncture pathways on outcomes and bone cement distribution in PVP treatment of Kümmell disease

Zhang Hongzhi; Wang Xiaoyu; Liu Shuang

doi:10.3969/j.issn.1009-4237.2024.06.006

Abstract：Objective To explore the role of different puncture pathways in percutaneous vertebroplasty ( PVP) treatment of Kümmell disease,and to analyze the impact on surgical outcomes and distribution of bone ce-ment in the injured vertebrae.Methods A retrospective analysis was conducted on clinical data of31 patients with traumatic vertebral osteonecrosis ( Kümmell disease) treated by PVP in the Department of Orthopedics,Shunyi Hos-pital,from Feb.2020 to Mar.2022,including 10 males and 21 females aged 61-72 (mean 67.9) years.There were 18 cases of falls,8 road traffic injuries,and 5 sprains.According to different surgical puncture pathways,16 patients were divided into extralacunar puncture group and 15 into intralacunar puncture group.The operation time,frequen-cy of intraoperative C-arm fluoroscopy,incidence of bone cement leakage and loosening,and bone cement morphology in the injured vertebrae were analyzed.The VAS score and Oswestry disability index ( ODI) before,1 d and 3 months after surgery were recorded.Results There was no statistically significant difference between the two groups in terms of age,gender,body mass index,bone density,Kümmell disease classification,or cause of injuries (all P>0.05).At the first day after surgery,both groups showed a decrease in VAS (extralacunar puncture group 8.8±0.5 vs.2.7±0.3,intralacunar puncture group 8.7±0.6 vs.2.9±0.4) and ODI (extralacunar puncture group 89.5％±3.6％ vs.35.8％±4.1％,intralacunar puncture group 91.4％±4.3％ vs.39.9％±3.4％,both P<0.05 compared with before surgery),but there was no statistically significant difference between the two groups (P>0.05).At 3 months of surgery,the extraluminal puncture group revealed a much lower VAS (1.0±0.2 vs.3.1±0.3) and ODI (18.7％±2.6％ vs.35.8％±3.1％),compared with the intraluminal puncture group (both P<0.05).Besides,the extraluminal puncture group showed a much lower incidence of bone cement leakage (18.8％vs.46.7％) and loosening (0 vs.26.7％,both P<0.05),but similar operation time (min,30.5±7.3 vs.31.3±9.1) and frequency of intraoperative C-arm fluoroscopy (28.3±3.1 vs.31.2±4.3,both P>0.05).In terms of the distribution of bone cement in the injured vertebrae,the extralacunar puncture group revealed 18.8％ mass type and 81.2％ compression type,while the intralacunar puncture group revealed 73.3％ mass type and 26.7％ compression type,with statistically significant difference between the two groups (P<0.05).Conclusion In the treatment of Kümmell's disease with PVP,the extralacunar puncture technique can improve the distribution of bone cement in the injured vertebrae,reduce the probability of bone cement leakage and loosening,and is worthy of clinical promotion.