| Background: Percutaneous Vertebroplasty(PVP)in the treatment of Acute Osteoporotic Vertebral Compression Fractures(AOVCF)can early stablize fractures,restore vertebral biomechanical stability,relieve pain,improve patient quality of life.However,there is still little research on whether there is a certain relationship between different distribution sites of AOVCF with PVP bone cement involving in the upper 1/3 of the vertebral body with fracture line and the postoperative efficacy.Objective: To explore and analyze the relationship between different bone cement distribution sites and postoperative clinical efficacy of AOVCF in PVP treatment of fracture line involving in the upper 1/3 of vertebral body.Furthermore,standardized PVP bone cement strengthening scheme can be provided for clinicians,so as to obtain better clinical efficacy,relieve patients’ pain and reduce related surgical complications.Methods: The clinical data of patients who received PVP treatment in the Affiliated Red Cross Hospital of Xi ’an Jiaotong University and whose fracture line involved in the upper1/3 of AOVCF in the vertebral body were retrospectively analyzed from January 2017 to December 2018.After strict screening of inclusion and exclusion criteria,a total of 206 patients were included,including 71 males and 135 females,aged 60-90 years[(70.14±6.44)years].According to the different distribution sites of bone cement,they were divided into two groups: group A with bone cement distribution covering the fracture injury area(143 cases)and group B with bone cement distribution not covering the fracture injury area(63 cases).General data of patients were collected,such as age,sex,Body Mass Index(BMI),Bone Mineral Density(BMD),fracture segment,duration of surgery,length of hospital stay,duration from injury to surgery,intraoperative blood loss,and dose of bone cement.Visual Analog Scale(VAS)and Oswestry Disability Index(ODI)were recorded before surgery,1 day after surgery,3 months after surgery and at the last follow-up.The height of the anterior edge of the injured vertebra and the Cobb Angle of the injured vertebra were measured on X-ray film.Preoperative general data,VAS score,ODI index,anterior edge height of injured vertebra and Cobb Angle of injured vertebra at preoperative,1 day after surgery,3 months after surgery and the last follow-up of patients in the two groups were statistically analyzed and compared,and the incidence of related complications was recorded.Results: All the 206 patients successfully completed the operation,and no serious complications occurred during the operation and postoperative follow-up.All patients were followed up for 24-39 months [(29.67±4.71)months].There were no significant differences in gender,age,BMI,BMD,fracture site,operation time,hospitalization time,injury to operation time,intraoperative blood loss and bone cement dose between group A and B(P > 0.05).VAS score,ODI index,anterior edge height of injured vertebrae and Cobb Angle of injured vertebrae were significantly improved in both groups compared with those before surgery at 1 day,3 months and the last follow-up(P < 0.05).The improvement of VAS score and ODI index in group B at 1 postoperative day was not as significant as that in group A(P < 0.05).There were no statistical differences in VAS score and ODI index between the two groups before surgery,3 months after surgery and at the last follow-up(P > 0.05).The height of the anterior edge of the injured vertebra and the Cobb Angle of the injured vertebra in the last follow-up of group B were significantly different from that 1 day and 3 months after surgery(P < 0.05),while the Cobb Angle of the injured vertebra in the last follow-up of group A was not significantly different from that 1 day and 3 months after surgery(P > 0.05).At the last follow-up,there were significant differences between the two groups in the height of the anterior edge of the injured vertebra and the Cobb Angle of the injured vertebra(P < 0.05).There were no significant differences in the anterior edge height and Cobb Angle of the injured vertebra between the two groups before,1 day after and 3 months after surgery.Intraoperative bone cement leakage occurred in 19 cases of group A and 8 cases of group B.No obvious clinical symptoms were caused and no special treatment was given.During the last follow-up,14 refractures occurred in group A and 7 in group B.There was no statistical difference in the rate of bone cement leakage and vertebral refracture between the two groups.Conclusion: The different distribution of bone cement is the influencing factor of the early curative effect after PVP,and is also the risk factor of the gradual occurrence of kyphosis in the long-term injured vertebra after PVP.When the bone cement distribution covered the fracture injury area,the early curative effect was the best,and the anterior edge height of the long-term injured vertebra and the loss of Cobb Angle of the injured vertebra were less.However,the different distribution of bone cement has little influence on the occurrence of bone cement leakage and postoperative vertebral refracture. |
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