Hypothermic manipulation of bone cement can extend the handling time during vertebroplasty

BMC Musculoskeletal Disorders

Wen-Jer Chen²  Lih-Huei Chen²  Tsai-Sheng Fu²  I-Ming Chu³  Ching-Lung Tai¹  Po-Liang Lai² 

[1] Graduate Institute of Medical Mechatronics, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan;Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan;Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan

关键词: Handling time;    Working time;    Ice bath;    Precooling;    Bone cement;   

Others  :  1138264
DOI  :  10.1186/1471-2474-13-198

 received in 2012-03-08, accepted in 2012-10-12,  发布年份 2012

【 摘 要 】

Background

Polymethylmethacrylate (PMMA) is commonly used for clinical applications. However, the short handling time increases the probability of a surgeon missing the crucial period in which the cement maintains its ideal viscosity for a successful injection. The aim of this article was to illustrate the effects a reduction in temperature would have on the cement handling time during percutaneous vertebroplasty.

Methods

The injectability of bone cement was assessed using a cement compressor. By twisting the compressor, the piston transmits its axial load to the plunger, which then pumps the bone cement out. The experiments were categorized based on the different types of hypothermic manipulation that were used. In group I (room temperature, sham group), the syringes were kept at 22°C after mixing the bone cement. In group 2 (precooling the bone cement and the container), the PMMA powder and liquid, as well as the beaker, spatula, and syringe, were stored in the refrigerator (4°C) overnight before mixing. In group 3 (ice bath cooling), the syringes were immediately submerged in ice water after mixing the bone cement at room temperature.

Results

The average liquid time, paste time, and handling time were 5.1 ± 0.7, 3.4 ± 0.3, and 8.5 ± 0.8 min, respectively, for group 1; 9.4 ± 1.1, 5.8 ± 0.5, and 15.2 ± 1.2 min, respectively, for group 2; and 83.8 ± 5.2, 28.8 ± 6.9, and 112.5 ± 11.3 min, respectively, for group 3. The liquid and paste times could be increased through different cooling methods. In addition, the liquid time (i.e. waiting time) for ice bath cooling was longer than for that of the precooling method (p < 0.05).

Conclusions

Both precooling (i.e. lowering the initial temperature) and ice bath cooling (i.e. lowering the surrounding temperature) can effectively slow polymerization. Precooling is easy for clinical applications, while ice bath cooling might be more suitable for multiple-level vertebroplasty. Clinicians can take advantage of the improved injectability without any increased cost.

【 授权许可】

   
2012 Lai et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Denaro L, Longo UG, Denaro V: Vertebroplasty and kyphoplasty: reasons for concern? Orthop Clin North Am 2009, 40(4):465-471.
• [2]McArthur N, Kasperk C, Baier M, Tanner M, Gritzbach B, Schoierer O, Rothfischer W, Krohmer G, Hillmeier J, Kock H-J, et al.: 1150 kyphoplasties over 7 years: indications, techniques, and intraoperative complications. Orthopedics 2009, 32(2):90.
• [3]Deramond H, Wright NT, Belkoff SM: Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone 1999, 25(2 Suppl):17S-21S.
• [4]Anselmetti GC, Zoarski G, Manca A, Masala S, Eminefendic H, Russo F, Regge D: Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures. Cardiovasc Intervent Radiol 2008, 31(5):937-947.
• [5]Lee MJ, Dumonski M, Cahill P, Stanley T, Park D, Singh K: Percutaneous treatment of vertebral compression fractures: a meta-analysis of complications. Spine 2009, 34(11):1228-1232.
• [6]Masala S, Mastrangeli R, Petrella MC, Massari F, Ursone A, Simonetti G: Percutaneous vertebroplasty in 1,253 levels: results and long-term effectiveness in a single centre. Eur Radiol 2009, 19(1):165-171.
• [7]Weisskopf M, Ohnsorge JAK, Niethard FU: Intravertebral pressure during vertebroplasty and balloon kyphoplasty: an in vitro study. Spine 2008, 33(2):178-182.
• [8]Belkoff SM, Molloy S: Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty. Spine 2003, 28(14):1555-1559.
• [9]Baroud G, Samara M, Steffen T: Influence of mixing method on the cement temperature mixing time history and doughing time of three acrylic cements for vertebroplasty. J Biomed Mater Res B Appl Biomater 2004, 68(1):112-116.
• [10]Teng MM, Cheng H, Ho DM, Chang CY: Intraspinal leakage of bone cement after vertebroplasty: a report of 3 cases. AJNR Am J Neuroradiol 2006, 27(1):224-229.
• [11]Sabuncuoğlu H, Dinçer D, Güçlü B, Erdoğan E, Hatipoğlu HG, Ozdoğan S, Timurkaynak E: Intradural cement leakage: a rare complication of percutaneous vertebroplasty. Acta Neurochir 2008, 150(8):811-815.
• [12]Chavali R, Resijek R, Knight SK, Choi IS: Extending polymerization time of polymethylmethacrylate cement in percutaneous vertebroplasty with ice bath cooling. AJNR Am J Neuroradiol 2003, 24(3):545-546.
• [13]Smeds S, Goertzen D, Ivarsson I: Influence of temperature and vacuum mixing on bone cement properties. Clin Orthop Relat Res 1997, 334:326-334.
• [14]Jiranek W: Thermal manipulation of bone cement. Orthopedics 2005, 28(8 Suppl):s863-s866.
• [15]James SL, Connell DA: The effect of temperature reduction on cement working time in percutaneous vertebroplasty. Clin Radiol 2006, 61(9):797-799.
• [16]Lee ST, Chen JF: A syringe compressor for vertebroplasty: technical note. Surg Neurol 2004, 61(6):580-584.
• [17]Nussbaum DA, Gailloud P, Murphy K: The chemistry of acrylic bone cements and implications for clinical use in image-guided therapy. J Vasc Interv Radiol 2004, 15(2 Pt 1):121-126.
• [18]Kuehn KD, Ege W, Gopp U: Acrylic bone cements: composition and properties. Orthop Clin North Am 2005, 36(1):17-28. v
• [19]Aebli N, Goss BG, Thorpe P, Williams R, Krebs J: In Vivo temperature profile of intervertebral discs and vertebral endplates during vertebroplasty: an experimental study in sheep. Spine 2006, 31(15):1674-1678.
• [20]Lai PL, Tai CL, Chen LH, Nien NY: Cement leakage causes potential thermal injury in vertebroplasty. BMC Musculoskelet Disord 2011, 12(1):116. BioMed Central Full Text
• [21]Loeffel M, Ferguson SJ, Nolte LP, Kowal JH: Vertebroplasty: experimental characterization of polymethylmethacrylate bone cement spreading as a function of viscosity, bone porosity, and flow rate. Spine 2008, 33(12):1352-1359.
• [22]Laidler KJ: The development of the Arrhenius equation. J Chem Educ 1984, 61(6):494.
• [23]Lo YP, Chen WJ, Chen LH, Lai PL: New vertebral fracture after vertebroplasty. J Trauma 2008, 65(6):1439-1445.
• [24]Chen LH, Lai PL, Chen WJ: Unipedicle percutaneous vertebroplasty for spinal intraosseous vacuum cleft. Clin Orthop Relat Res 2005, 435:148-153.
• [25]Parks ML, Walsh HA, Salvati EA, Li S: Effect of increasing temperature on the properties of four bone cements. Clin Orthos Relat Res 1998, 355:238-248.
• [26]Lewis G: Effect of mixing method and storage temperature of cement constituents on the fatigue and porosity of acrylic bone cement. J Biomed Mater Res 1999, 48(2):143-149.
• [27]Vallo CI: Theoretical prediction and experimental determination of the effect of mold characteristics on temperature and monomer conversion fraction profiles during polymerization of a PMMA-based bone cement. J Biomed Mater Res 2002, 63(5):627-642.
• [28]Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P: Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 2000, 39(12):1410-1414.
• [29]Heini PF, Berlemann U, Kaufmann M, Lippuner K, Fankhauser C, van Landuyt P: Augmentation of mechanical properties in osteoporotic vertebral bones–a biomechanical investigation of vertebroplasty efficacy with different bone cements. Eur Spine J 2001, 10(2):164-171.