The Clinical Research Of Over-extending Reduction Combined With Percutaneous Vertebroplasty For The Treatment Of Vertebral Compression Fractures With Intravertebral Clefts

Objective:To evaluate the therapeutic effect and mechanism of over-extending reduction and percutaneous vertebroplasty by treating osteoporotic vertebral compression fractures with intravertebral clefts with over-extending reduction combined with percutaneous vertebroplasty,and to provide more valuable evidence for the clinical treatment of this disease.Methods:The subjects of this research were all from the inpatient ward of spine surgery department of Qingyuan Hospital of Traditional Chinese Medicine from March 2018 to October 2019,and 74 patients with osteoporotic vertebral compression fractures with intravertebral clefts meeting the criterias were selected for the clinical research.The 74 patients were randomly divided into 2 groups:group A(treated with over-extending reduction combined with percutaneous vertebroplasty)and group B(treated with percutaneous vertebroplasty)and each group included 37 cases.We observed and recorded the VAS score,ODI index,Cobb Angle,anterior and central height compression ratio of the injured vertebra,the operation time,surgical bleeding,bone cement dosage,cement leakage rate,hospital stays in preoperative and follow-up period of each patient.The collected data were statistically analyzed through statistical software to evaluate the overall curative effect,and to compare the clinical efficacy of two treatments.Results:Among the 74 patients in this study,there were 3 cases dropped off in each group,and 68 subjects accepted operation successfully and completed the 3-month follow-up assessments.The general data(Sex,age,segmental distribution,bone mineral density,etc)of two groups were analyzed statistically,and the difference was not statistically significant(P>0.05),the two groups were considered comparable.On the third day and third month after the operation,the VAS score of both groups was significantly lower than that before the operation(P<0.01).Meanwhile,the median of postoperative VAS score of group A was significantly lower than that in group B(P<0.01).Group A was considered to be superior to group B in pain relief.On the third day and third month after the operation,the ODI index of both groups was significantly lower than that before the operation(P<0.01).Meanwhile,the mean postoperative ODI index of group A was significantly lower than that in group B(P<0.01).Group A was considered to be superior to group B in improving activity function.At the immediate postoperative moment and on the third month after the operation,the Cobb Angle of both groups decreased significantly compared with that before the surgery(P<0.01).Meanwhile,the mean postoperative Cobb Angle of group A was significantly lower than that in group B(P<0.01).It was suggested that group A was superior to group B in correcting kyphosis.At the immediate postoperative moment and on the third month after the operation,the anterior and central height compression ratio of the injured vertebra of both groups decreased significantly compared with that before the surgery(P<0.01).Meanwhile,the mean postoperative compression ratio of group A was significantly lower than that in group B(P<0.01).It was suggested that group A was superior to group B in restoring the vertebral height.On the third month after the operation,the Cobb Angle of group A showed no significant change compared with that at the immediate postoperative moment after the operation(P>0.05).However,the Cobb Angle of group B increased and the difference was statistically significant(P<0.01).On the third month after the operation,both of the anterior and central height compression ratio of the injured vertebra of group A showed no significant change compared with that at the immediate postoperative moment after surgery(P＞0.05).However,the compression ratio in group B increased and the difference was statistically significant(P<0.01).It was suggested that group A was superior to group B in maintaining the vertebral height.There were no statistically significant differences in hospital stay,surgical bleeding and cement leakage rate between two groups(P>0.05).The the median of the operation time of group A was significantly less than that in group B(P<0.05),and the median of bone cement dosage of group A were significantly more than that in group B(P<0.01).In terms of the overall curative efficacy,the total effective rate before and after treatment of group A(94.12%)was significantly higher than that in group B(76.47%)(P<0.05).It was suggested that the overall curative efficacy of A treatment was superior to B.Conclusion:Compared with percutaneous vertebroplasty alone,over-extending reduction combined with percutaneous vertebroplasty has an advantage in relieving the pain of osteoporotic vertebral compression fractures with intravertebral clefts patients,improving activity function,restoring and maintaining the vertebral height,correcting kyphosis,shortening the operation time and the overall curative efficacy.It indicates that the over-extending reduction combined with percutaneous vertebroplasty is safe and effective in the treatment of osteoporotic vertebral compression fractures with intravertebral clefts,and it’s worth popularizing in clinic.