| Objective:Percutaneous vertebroplasty（PVP）is currently one of the most successful and effective surgical method for the treatment of osteoporotic vertebral compression fractures（OVCF）.However,the effect of bone cement filling surgery is often not good,resulting in poor postoperative pain improvement in some patients,re-fracture of the vertebral body after surgery or even adjacent vertebral body fractures.This study explored the therapeutic effect and advantages of applying percutaneous multi-point puncture technique to inject bone cement in patients with insufficient cement distribution（ICD）during vertebroplasty.Provides a safe and effective remedy in the event of insufficient cement distribution.Methods:Since September 2020,percutaneous multipoint vertebroplasty has been widely used in patients with insufficient cement distribution in our hospital.Percutaneous multipoint vertebroplasty was performed in 40 OVCF patients with insufficient cement distribution from September 2020 to September 2021.At the same time,40 OVCF patients with insufficient cement distribution but without multipoint vertebroplasty before September 2020 were selected and analyzed.Create a corresponding case inclusion and exclusion criteria based on the data related to 80 OVCF patients admitted to the Northern Jiangsu People’s Hospital.Case inclusion criteria:① Patients diagnosed as primary osteoporosis by bone mineral density measurement;② Patients diagnosed as fresh vertebral compression fracture by magnetic resonance imaging（MRI）;③Patients with typical low back pain and vertebral body percussion pain during physical examination;④Patients diagnosed as single segmental vertebral fracture without spinal cord nerve injury;⑤The follow-up of the whole process was completed.Case exclusion criteria:① Patients with nerve and spinal cord compression;②Patients with vertebral compression fractures caused by secondary diseases such as vertebral tumors;③Patients with stale vertebral fracture;④Patients who cannot tolerate surgery and anesthesia due to physical reasons;⑤ Patients with multi-segmental vertebral compressionfracture.Based on the difference of operation,the patients were divided into two groups.Observation group:40 patients underwent percutaneous multipoint vertebroplasty.Control group:40 patients without percutaneous multipoint vertebroplasty.The operation time,penetrating frequency,bone cement dosage,preoperative and postoperative pain visual analog scale（VAS）,sagittal Cobb angle of injured vertebra X-ray,anterior height ratio of injured vertebrae and bone vertebrae,and the distribution and leakage rate of cement in the fractured vertebral body were compared between the two groups.Data analysis was performed using SPSS 22.0 computer application software.The analysis of variance of repeated measurement was used to compare the two groups at different time points before and after operation,normally distributed measurement data were expressed as mean±standard deviation,independent samples t-test was carried out for comparison between groups,and count data were subjected to chi-square test.When P<0.05,the data difference was statistically significant.Results:1.In terms of intraoperative conditions:Compared with the control group,the operation time,inter-operative fluoroscopy times,and bone cement consumption in the observation group were significantly higher than those in the control group（P<0.05）.2.In terms of VAS score:The VAS scores of patients in each group at 1 day and 6 months after operation were significantly lower than those before operation in each group（P<0.05）;There was no significant difference in the VAS scores before surgery and 1 day after surgery between the two groups（P>0.05）.However,the VAS score of the observation group was lower than that of the control group at 6 months after surgery（P=0.001）.3.In terms of the sagittal Cobb angle of X-ray of injured vertebra:Compared with the control group,the Cobb angle of the observation group decreased more significantly than the control group at 1 day and 6 months after operation（P<0.05）.4.In terms of the height ratio of the anterior edge of the injured vertebra:Compared with the control group,the height ratio of the anterior edge of the injured vertebra in the observation group was also significantly higher than that in the control group（P<0.05）.5.In terms of bone cement distribution and leakage:The distribution of bone cement in the observation group was significantly better than that in the control group（P=0.000）.There was no significant difference in the leakage rate of bone cement between the two groups（P=0.077）.6.In terms of perioperative complications:A few patients in each group had postoperative adverse reactions such as nausea and vomiting,dizziness,urinary retention,constipation and delirium,but there was no significant difference between the two groups（P>0.05）.All groups successfully carried out a 180-day follow-up work,and there were no adverse conditions such as spinal cord nerve injury,fracture recurrence and peripheral vertebral fracture.Conclusion:The application of multi-point puncture technique in PVP can improve the distribution of cement,better restore and maintain the height of injured vertebrae,and more effectively reduce the long-term pain of patients.It does not,meanwhile,increase the leakage rate of cement.It is a safe and effective remedy for the insufficient cement distribution in the first puncture. |
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