Preventive measures for bone cement leakage

(1) Imaging examinations such as CT and MRI should be completed before the operation to clarify the responsible vertebral body and fully understand the damage of the vertebral body. If cortical bone damage is found, the operation must be careful;

(2) Clear intraoperative images are essential. If intraoperative visualization is unclear, a blind puncture will inevitably increase the risk of bone cement leakage. Once leakage occurs, it may not be clearly displayed. Special attention must be paid to patients with severe osteoporosis, such as intraoperative CT can help reduce the occurrence of bone cement leakage;

(3) Read the preoperative film to understand the condition of the pedicle of the vertebral body to be punctured, pay attention to the diameter and direction of the pedicle, strictly master the puncture technique, reduce repeated punctures, and try to avoid damage to the medial wall of the pedicle, especially the vertebral body For the connection part, if the puncture is inward, adjust the puncture direction as little as possible without puncturing the medial cortex of the pedicle, so as to avoid leakage of bone cement along the puncture channel to the spinal canal, because the diameter of the pedicles of L1 and L2 vertebrae is smaller than that of other vertebral bodies. PKP operation for L1 and L2 fractures needs to be more meticulous; some studies have shown that PKP unilateral puncture and bilateral puncture can improve the recovery effect of the anterior edge height of the injured vertebra, operation time and postoperative low back pain visual analog scale (visual analogue scale, VAS) There is no significant difference in the effect, but in the biomechanical balance of the spine and the avoidance of adjacent vertebral fractures, the uniform filling of bone cement on both sides has obvious advantages; therefore, bilateral puncture should be performed as much as possible during the operation. can not;

(4) Due to the thin cortical bone in patients with osteoporosis, poor control of the strength and depth of the wiretap and guide pin may easily lead to the rupture of the anterior vertebral cortex and bone cement extravasation. After the balloon is expanded, use a thin guide pin to probe Whether there is damage on the front side of the vertebral body, if there is damage, a small amount of gelatin sponge can be filled;

(5) Studies have shown that high-viscosity bone cement can effectively reduce the leakage rate of bone cement. Before surgery, you should fully understand the characteristics of bone cement from different manufacturers, and choose familiar high-viscosity bone cement products; pay attention to the time and amount of bone cement injection, If there is no damage to the vertebral cortex, it should be bolused in the wet sand stage or in the early stage of drawing, while in the case of damage to the vertebral cortex, it should be injected in the late stage of drawing or in the early stage of bolus;

(6) Pay attention to controlling the speed when injecting bone cement. Routinely, perform fluoroscopy for every 0.5mL bolus injection. If leakage is found, it is recommended to perform fluoroscopy every 0.2mL bolus injection. Once leakage is found, if there is leakage into the spinal canal If there is a leakage tendency or the bone cement injection volume has reached 1.5mL or more, stop the bone cement injection on the leakage side. If the bone cement volume is less than 1.5mL, the bone cement can be further solidified before bolus injection;

(7) The amount of bone cement injected and the filling percentage of bone cement in the vertebral body is not directly related to the clinical analgesic effect. It is not necessary to deliberately pursue as much bone cement filling as possible, generally within 3mL for the thoracic spine and within 5mL for the lumbar spine;

(8) After the bone cement injection is completed, rotating the push rod or replacing the empty injector into the channel can prevent the formation of the bone cement tail in the pedicle.

Various methods of preventing bone cement leakage have uneven effects, and there is no unified evaluation standard at present. Standardized surgical operation is an important means to solve the leakage of bone cement. Visualized bone cement injection, injector with constant pressure, the use of machines instead of manual preparation of bone cement and the application of new materials can prevent bone cement leakage to a certain extent.

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