Influence Of Vertebral Intraosseous Pressure On Pain In Patients With OVCF And Clinical Significance

Objective:To reduce the intraosseous pressure in patients with OVCF and t o study the signifycance of the change of intraosseous pressure in patients.Methods:Twenty-two patients with OVCFs who underwent PKP From March 2022 to March 2023,22 patients(mean age 67.66±9.37 years)who underwent PKP for OVCFs(agreed with our data collection)were selected.The peak blood pressure,terminal blood pressure,bone mineral density,VAS,ODI,initial intraosseous pressure,peak intraosseous pressure,terminal intraosseous pressure,initial intraosseous pressure,peak intraosseous pressure and terminal intraosseous pressure of injured vertebrae were compared.During the operation,the changes of blood pressure of the patients were closely monitored and the intraosseous pressure of the responsible vertebral body and the adjacent normal vertebral body was continuously;after the pressure of the monitor was zero,a hollow needle with a sensor was inserted into the backboned through the pedicle of the C-arm X-ray machine,and the intraosseous pressure was continuously monitored,and the static intraosseous pressure was used as the initial intraosseous pressure.The contralateral channel was used as a way to inject bone cement,and a hollow puncture needle was also inserted into the anterior 2/3 of the vertebral body through the pedicle approach under the fluoroscopy of C-arm X-ray machine.The initial intraosseous pressure of responsible vertebral body,the value of terminal intraosseous pressure 15 minutes after cement injection were recorded,and the research indexes of patients before and after operation were evaluated.Results:Demographic and clinical distribution characteristics of patients with OVCF:among the 22 patients were 6 males(27.3%)and 16 females(72.7%).The age scope was 51 to 81 years old,with an average of(67.66±9.37)in 22 cases of fractured vertebrae.There were 1 case of thoracic 10 vertebral fracture,accounting for 4.5%,and 6 cases of thoracic 11 vertebral fracture.accounting for 27.3%,6 cases of thoracic 12 vertebral body fracture,accounting for 27.3%,5 cases of lumbar 1 vertebral body fracture,accounting for 22.7%,2 cases of lumbar 2 vertebral body fracture,accounting for 9.1%,2 cases of lumbar 3 vertebral body fracture,17 cases were mainly concentrated in the thoracolumbar segment,accounting for 77.3%.The after operation systolic blood pressurediastolic blood pressure,,VAS、ODI score,terminal intraosseous pressure of injured vertebrae and terminal intraosseous pressure of normal vertebrae were lower than those before and during operation.The changes of preoperative and postoperative systolic blood pressure,diastolic blood pressure,initial intraosseous pressure,terminal intraosseous pressure,initial intraosseous pressure and terminal intraosseous pressure of normal vertebral body were analyzed.the results showed that there was significant difference between preoperative systolic blood pressure(146.4±18.2)and postoperative systolic blood pressure(138.1±15.8)P<0.001.There was difference between preoperative DBP and postoperative diastolic blood pressure DBP(P<0.001).There was significant difference between the initial and final intraosseous pressure of injured vertebrae(P<0.001),and between the initial and final intraosseous pressure of normal vertebrae(P<0.001).That is,the preoperative systolic blood pressure is higher than the postoperative systolic blood pressure,the preoperative diastolic blood pressure is higher than the postoperative diastolic blood pressure,the initial intraosseous pressure of the injured vertebra is higher than the terminal intraosseous pressure of the injured vertebra,and the initial intraosseous pressure of the normal vertebral body is higher than that of the normal vertebral body.The correlation between systolic blood pressure,diastolic blood pressure,preoperative and postoperative VAS,ODI and initial,peak and terminal intraosseous pressure was analyzed.The results showed that there was a small correlation between initial intraosseous pressure and preoperative systolic blood pressure.There was also a small correlation between the peak intraosseous pressure of the injured vertebrae and the peak systolic blood pressure during the operation,and there was no significant difference,but there was a partial correlation between VAS and ODI score and intraosseous pressure before operation,3 days after operation and 1 week after operation,but P>0.05.Therefore,there was no positive correlation.The analysis of variance of repeated measurements before and after operation showed that there was significant difference in VAS before operation,VAS at 3 days after operation and VAS score at 1 week which after the operation(F=554.051,P<0.001).There was significant difference between ODI before operation,VAS at 3 days after operation and VAS score at 1 week after operation(F=446.705,P<0.001).The results of the line chart of VAS and DOI showed that the effect of pain relief after operation was significantly better than that before operation.The BMD(-2.7±0.2)was negatively correlated with the initial intraosseous pressure of injured vertebrae(48.2±13.7,P>0.05),and also negatively correlated with the initial intraosseous pressure of normal vertebrae(21.9±5.6,P>0.005).Conclusion:The intraosseous pressure of OVCF was higher than that of normal vertebral body.The increase of initial intraosseous pressure of injured vertebrae is partially related to pain and has a non-linear relationship.There was a negative correlation between BMD and intraosseous pressure.There was a partial correlation between the initial blood pressure and initial intraosseous pressure of the fractured vertebral body.