| Since Galibert and Deramond described PVP (Percutameous vertebroplasty, PVP) technique in 1987, PVP have been performed for nearly 30 years, and is increasingly being recognized as the standard of care for managing painful osteoporotic vertebral compression fractures (VCFs). Although PVP has been shown to achieve effective pain relief and has a low reported complication rate, leakage of cement after PVP has been reported in between 38% and 72.5% of cases, and fat embolism has been reported as a potential complications during PVP.PKP(Percutaneous Kyphopalsty, PKP), which was developed from PVP. PKP aimed to eliminate the leakage of cement injected has also been introduced for about 7 years. There have been many aspects of the technique been recommended in order to prevent these potential complications, such as:suitable liquid of the cement, low pressure of injection, suitable volume of the cement injected, et al. Clinical studies showed that cement leak via the basivertebral vein, via the segmental vein and via a cortical defect. Althoud PVP and PKP had been performed widely, there are many proplems:(1) How to selecte PVP or PKP for the treatement of VCFs. (2) the management of the treatment of upper and mid-thoracic vertebral compression fractures. (3) Percutaneous vertebroplasty (PVP) have become established methods for the treatment of uncomplicated osteoporotic vertebral fractures, however, it's not available for the treatment of fractures with neurological deficits. How to treat VCFs patients with neurological deficits. (4) Results of percutaneous vertebroplasty and kyphonoplasty for the treatment of osteoporotic Kummell's disease, et al.Objective1. To evaluate the Results of Percutaneous Vertebroplasty and Kyphonoplasty for the Treatment of Osteoporotic Vertebral Compression Fractures.2. To explore percutaneous bone puncturing track on dry spinal vertebrae (T3-T10); To evaluate the characteristics and effects of unilateral extrapedicular vertebroplasty and kyphoplasty in the treatment of high and mid-thoracic vertebral fractures.3. PVP have become established methods for the treatment of uncomplicated osteoporotic vertebral fractures, however, it's not available for the treatment of fractures with neurological deficits. PVP/PKP combined with microsurgical interlaminary decompression were developed to allow spinal decompression as well as vertebral augmentation.4. To evaluate the results of percutaneous vertebroplasty and kyphonoplasty for the treatment of osteoporotic vertebral Kummell's diseaseMatierals and Methods1. Thirty-seven patients (60 vertebral f ractures) were treated with percutaneous vertebroplasty (18 patients,25 vertebral fractures) or percutaneous kyphoplasty (19 patients,35 vertebral fractures). All patients were observed VAS scales and patients satisfactory degrees at 1 day before operation,1 day,1 week,4 weeks,8 weeks,12 weeks and 24 weeks after operations. The restorations of kyphosis was determined and cement leakage was observed.2. Anatomical research on dry spinal vertebrae:evaluate the length of the bone puncturing track on dry spinal vertebraes (T3-T10); Clinical research:retrospective analysis of 39 vertebrae in 26 patients (M:F =8:18) who underwent unilateral extrapedicular vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures at high and mid-thoracic vertebra between November 2004 and March 2010 in our hospital.The fracture vertebras is T3 1, T43, T54, T6 4, T7 6, T8 10, T9 6, T10 5. The mean age was 71.3±1.3 years.The average time of fracture was 3.5 weeks.One level was 17 cases, two levels were 5 cases and three levels were 4 cases.Clinical outcomes were evaluated using VAS. The rate of loss anterior and middle heights of the vertebral body, the rate of cement leakage and the rate of suitable puncture before and after operation were evaluated.3. Before PVP were preformed, interlaminary decompression were performed to reduction the fragmentation of the posterior wall in 21 patients,9 men,12 femalls.65-87 years old (averenged 73.5 years). T9 2 cases, T10 1 cases, T11 1 case, T12 8 cases, L1 7 cases, L3 2 cases patients with osteoporotic fractures involving neural compression. Clinical outcomes were evaluated using VAS4.63 patients suffered 65 vertebral Kummell's disease were treated with PVP or PKP. PVP group:33 patients,35 verthereas,3 men and 29 women aged 46～81 years (mean 69.2±6.3years); PKP group:30 patients, 30 verthebreas 3 men and 27 women aged 52-79 years (mean,68.7±6.5 years).Results1. Postoperative VAS scales of all patients reduced obviously after operation (P＜0.01), and there was no statistic difference between two groups (P＞0.05). The restoration rates of kyphosis were (65.50±3.15)% and (67.83±4.24)% in two groups, with no statistic difference between two groups (P＞0.05). All patients were satisfied with these treatments, but no statistic difference between two groups (P＞0.05) in 1 day,1 week and 4 weeks after operation. The rate of cement leakage was significant higher in the percutaneous vertebroplasty group (44.00%) than that in the percutaneous kyphoplasty group (14.29%) (P＜0.01) 2. The length of the bone puncturing track on dry spinal vertebraes are (26.0±1.2)mm to(30.1±2.3)mm on T3-T10; Clinical research showed that twenty-seven levels were treated in 15 cases with PVP,and twelve levels were treated in 11 cases with PKP.The rate of cement leakage was 10.25%.All patients were followed up over 1 year.The VAS scores were 9.8±0.3 preoperatively and 5.7±0.4 of 1 day and 3.3±0.4 of final follow up postoperatively (P＜0.05). The anterior and middle vertebral height restoration were (63.1±18.6)% and (68.5±25.3)% respectively (P＜0.05).3. It costed about 60-80 minuts to perform the PVP and interlaminary decompression. There were no complications. The fragmentation of the posterior wall was easy pushed award. No cement leakage was found. These patients could walk freely and these neurological deficits were completely improved at 4 weeks postoperasionly.4. Postoprative VAS scales (1day, 1week,4weeks,8 weeks,24 weeks 1 year) of all patients reduced obviously with a significant difference (P＜0.01), the changes of VAS had no significant difference between tow groups (P＞0.05). The restorations of kyphosis were observed in both groups, but no significant difference between tow groups (P＞0.05). All patients were satisfied with these treatments, but no significant difference between tow groups (P＞0.05). The rates of cement leakage had no significant difference beteen the PVP group and the PKP group (P＞0.05). Conclusion1. Both percutaneous vertebroplasty and kyphoplasty can effectively relieve the back pain. Percutaneous vertebroplasty is superior to percutaneous kyphoplasty in the prevention of cement leakage.2. Unilateral extrapedicular vertebroplasty and kyphoplasty were safety in the treatment of upper and mid-thoracic vertebral compression fractures. The osteous track should be measured on three-dimensional CT images before PVP and PKP.3. The present interlaminary approach for verteoplasty eanables treatment of severe osteoporotic fractures involving fragmentation of the posterior wall and neural compromise. Decomprepressive surgery is possible and the risk of epidural cement leakage is controlled intraoperatively.4. Both percutaneous vertebroplasty and kyphoplasty can effectively relieve the back pain. PVP should be preforred to PKP for the treatment of Kummell's disease.
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