| Background: Percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)are currently the most frequently used treatments for osteoporotic thoracolumbar compression fracture(OTCF).In the past few years,there have been a large number of literatures on the comparison of the clinical efficacy of PVP and PKP in the treatment of OTCF,but almost all of them are for the whole vertebral body,and rarely for the specific involved parts of vertebral fractures.For OTCF,which involves the upper 1/3of the vertebral body,where there are most upper endplate injuries,the choice of which operation is more advantageous is a new problem,and further research is needed.Objective: To investigate the effectiveness and reliability of PVP and PKP in the treatment of OTCF involving the upper third of the vertebral body in the acute phase.To provide a more accurate and effective surgical plan for clinical treatment of OTCF involving the upper 1/3 of the vertebral body in the acute phase,so as to further optimize the minimally invasive surgical treatment of OTCF.Methods: A retrospective analysis of the clinical data of 123 patients with OTCF in the acute phase involving the upper third of the vertebral body who were admitted to Xi’an Honghui Hospital from January 2016 to December 2017,and divided into PVP group(group A,55 cases)and PKP group(group B,68 cases)according to different treatment methods.The age,gender,body mass index(BMI),fracture site,osteoporotic thoracolumbar injury classification and severity score(OTLICS),and time from injury to surgery between the two groups of patients has no significant difference and is comparable.The perioperative conditions(operating time,intraoperative blood loss,number of fluoroscopy,bone cement injection volume,hospital stay,follow-up time,and bone cement leakage rate)of the two groups of patients were recorded,as well as bone mineral density(BMD)at each time point,incidence of re-fracture,The percentage of the anterior height of the injured vertebrae,the sagittal kyphotic cobb angle,the pain visual analogue scale(VAS),and the Oswestry disability index(ODI)were statistically analyzed to evaluate and compare the efficacy of PVP and PKP in the treatment of acute OTCF involving the upper 1/3 of the vertebral body.Results: Patients in group A and group B were followed up.The follow-up time was 34.62±7.54(range: 22～46)and 35.31±8.06(range: 22～46)months,and there was no statistically significant difference(P>0.05).Compared with group A and group B during the perioperative period,group A had shorter operation time(group A:26.65±3.61 min vs.group B: 32.59±4.22min)and less intraoperative blood loss(group A: 15.36±2.67 ml vs.group B: 17.49±2.68ml),fewer intraoperative fluoroscopy times(group A: 23.47±2.73 times vs.group B: 25.94±2.85 times),while the bone cement leakage rate in group B was lower [group A: 32.73%(18 /55)vs.group B: 14.71%(10/68)],the difference was statistically significant(P<0.05).There was no significant difference in the amount of bone cement injected between the two groups(group A:3.82±1.06 ml vs.group B: 4.16±0.94ml)and hospital stay(group A: 1.31±0.60 days vs.group B: 1.29±0.59 days)(P>0.05).There was no significant change in BMD at the last follow-up compared with preoperative BMD in the two groups(P>0.05),and there was no significant difference in BMD at each time point between the groups(P>0.05).The incidence of re-fractures at the last follow-up in the two groups was significantly higher than that of re-fractures at 3 months after surgery(P<0.05),and there was no significant difference in the incidence of re-fractures between the groups at 3 months after surgery(P>0.05),but The incidence of re-fracture at the last follow-up was higher in group A than group B [group A: 25.45%(14/55)vs.group B: 11.76%(8/68)],the difference was statistically significant(P<0.05).The percentage of anterior edge height,sagittal kyphosis cobb angle,VAS score,and ODI index at the first day after surgery and the last follow-up in the two groups were significantly improved compared with those before surgery(P<0.05).There were no significant differences in the percentage of the anterior edge height of the injured vertebrae,the sagittal kyphotic cobb angle,the VAS score,and the ODI index between the groups before and 1 day after the operation(P>0.05).However,compared with group B at the last follow-up,the percentage of the anterior edge height of the injured vertebrae in group A was lower(group A:80.45±8.59% vs.group B: 83.71±7.68%),the sagittal kyphosis cobb angle was larger(group A: 10.09± 2.34° vs.group B: 9.32±2.43°),the VAS score was higher(group A:1.58±0.99 points vs.group B: 1.22±0.97 points),and the ODI index was higher(group A: 13.37±5.82% vs.group B: 11.34±5.47%),the differences were statistically significant(P<0.05).Conclusion: PVP and PKP have similar clinical effects in the early treatment of OTCF involving the upper third of the vertebral body in the acute phase.Both can effectively stabilize the fractured vertebral body in a timely manner,relieve pain,avoid the patient’s long-term bedridden complications,and improve the patient’s quality of life.However,compared with PKP,PVP has shorter operation time,less intraoperative blood loss,and fewer times of fluoroscopy;and PKP has a lower bone cement leakage rate than PVP.In addition,in the long-term prognosis,PKP has a lower incidence of re-fractures than PVP,and has more advantages in maintaining the height of the injured vertebrae and relieving pain.In summary,it is safer and more effective to choose PKP therapy for patients with OTCF involving the upper 1/3 of the vertebral body in the acute phase. |
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