Comparison Of PKP And PVP Combined With Manual Reduction In The Treatment Of Vertebral Osteoporotic Compression Fracture (OVCF)

Objective:To explore percutaneous kyphoplasty(PKP)and percutaneous vertebroplasty(PKP),Clinical effect of vertebral compression fracture(OVCF)treated in osteoporotic thoracic and lumbar vertebral compression fracture with combined manipulation.Methods:Retrospective analysis was performed on 92 patients admitted to our hospital for osteoporotic thoracolumbar compression fractures and received PKP or PVP surgery from January 2018 to January 2020.According to the data,they were divided into group A:31 cases with PKP combined manual reduction,and group B:61 cases with PVP combined manual reduction.The general data of patients in the two groups were compared:age,gender,bone mineral density,distribution of injured vertebrae;Visual analogue scale(VAS)for pain was recorded preoperatively and at 1,3,1 week,and 6 months after surgery.Height of anterior edge of injured vertebra,Cobb Angle of local kyphosis of injured vertebra and ODI dysfunction index before and 1 week after treatment,6 months after treatment;The diffusion type and composition ratio of bone cement,the leakage rate of bone cement and the incidence of refracture in 2 groups were analyzed.Results:(1)General information of patients in group A and B,including age,gender,bone mineral density and distribution of injured vertebrae,P>0.05,showed no statistical significance.(2)There were no significant differences in VAS scores and ODI scores between the two groups before and after 1,3,1 and 6 days(P>0.05).The height of anterior vertebral margin and Cobb Angle of the two groups were significantly improved 2 days after operation,and there were significant differences between the two groups before and after operation(P<0.05).After PKP and PVP combined manual reduction,the anterior edge height of the vertebral body was 19.92±0.73(mm),19.34±0.62(mm),and the corresponding Cobb angles were 15.43±0.61(degree)and 16.50±0.62(degree).(3)There was a difference in the diffusion composition ratio between PKP combined manipulation and PVP combined manipulation(P<0.05).The proportions of diffusion type,mass type and mixed type in PKP combined reduction were 6.5%,67.7%and 25.8%,respectively.The proportions of PVP combined reduction were 62.3%,14.8%and 22.9%,respectively.PKP combined manipulative reduction was mainly composed of lumpy and mixed types,while PVP combined manipulative reduction was mainly composed of diffusion and mixed types.(4)Different degrees of bone cement leakage were found in both group A and B.According to the diffusion type of bone cement,they were divided into three groups,and the comparison of the diffusion type between the three groups was statistically significant(P<0.05).40%in the dispersive group,13.33%in the lumpy group and 27.27%in the mixed group.(5)There were different probabilities of refracture in group A and group B within 1 year after surgery.Among the different cement diffusion types,the refracture rate of the vertebral body was 12.5%in the diffusion group,43.3%in the mass group and 18.18%in the mixed group,respectively.The comparison between the three groups showed statistical significance(P<0.05).Conclusion:PKP and PVP combined manipulation reduction in the treatment of OVCF,both of the two surgical methods have good therapeutic effects.The postoperative pain relief and the improvement of thoracolumbar function were similar.PKP combined with manual reduction was better than PVP combined with manual reduction in the recovery of vertebral height and correction of Cobb Angle.Among the diffusion types of bone cement,after PKP,the bulk type and mixed type were dominant,while after PVP,the diffusion type and mixed type were dominant.The former was more prone to refracture,while the latter was more prone to leakage.