| Objective: To investigate and compare the therapeutic effect, technical safety and cost-effectiveness in the treatment of painful osteoporotic vertebral compression fractures(OVCFs)with percutaneous vertebroplasty(PVP) and kyphoplasty(PKP).Materials and Methods: Since 2002-2007, 72 patients (96 vertebrae) with painful OVCFs were treated by PVP (n=34) or PKP (n=38) under the guidance of C-arm fluoroscopy. After the transpedicular placement of bone biopsy needle into the affected vertebral body,polymethylmethacrylate was straightforwardly injected through the needle with a 1-mL Luer-Lok syringe in PVP, while polymethylmethacrylate was inserted followed by inflating to create cavities in the vertebral body in PKP. Operation time, duration of hospitalization, total amount of bone cemet injected and therapeutic cost were recorded respectively. The score of visual analogue scale point(VAS, 10-point scale)was analyzed at different time points, including pre-operative vertebroplasty/kyphoplasty,24 hours, one week and one month after vertebroplasty/kyphoplasty. Result of pain relief and complications were observed. The Cobb's angle and anterior and middle height of vertebral bodies were measured pre-and post-operatively.Results: The procedure was technically successful in all patients, with 1 to 34 months of the follow-up time(mean time, 8.9 m). (1)Mean operation time per vertebra in PVP was 35.1±10.6 min, which was significant shorter than that (89.5±33.0 min) in PKP(t=10.5,P<0.01). (2)The mean duration of hospitalization and therapeutic cost of PVP for each patient was 7.9±2.9 d and 8485.7±3054.5 yuan, respectively, which were strikingly lower than those (10.8±4.2d, 53731.2±8804.6 yuan) of PKP (t=3.4, P<0.01; t=28.5, P<0.01). (3)There was no significant difference (t=1.7,P>0.05)between average cement volumes of PVP (4.9±1.1 ml) and PKP(5.4±1.7 ml). (4)Among patients treated with PVP and PKP, the overall rate of pain relief was 94.4%(68/72). the scores of VAS at different time points were as the following: pre-operation(8.3±0.4 vs 7.9±0.8), post-operative 24 h (2.9±0.9 vs 2.8±1.2), 1 w (2.6±0.9 vs 2.6±1.1), and 1 m(2.6±0.9 vs 2.5±1.3) in PVP and PKP, respectively. There was significant difference between pre- and post-operative time points(P<0.05). However, there was no striking difference between the corresponding scores in PVP and PKP(F=0.9,P>0.05). (5)The Cobb's angle, anterior and middle height of vertebral bodies were corrected in both PVP and PKP. In PVP, the preoperative Cobb's angle, anterior and middle height of vertebral bodies were 23.2±3.8°,19.1±1.4mm, 25.2±1.0 mm, respectively, which was significant different (P<0.05) from the corresponding post-operative index(19.4±3.9°, 21.0±1.5mm, 27.0±1.2mm, respectively). In PKP,there was significant different (P<0.05) between the above pre-and post-operative index (25.1±5.0°vs 10.7±2.8°, 19.5±1.5mm vs 24.3±1.9mm, 25.4±1.1mm vs 29.7±1.3mm, respectively). As to the above index, the overall correcting effect in PKP was much better than that in PVP(F=33.0,P<0.05). (6)In 9 cases of PVP and 3 cases of PKP, cement leakage occurred (χ~2=4.7,P<0.05), resulting in no clinical symptoms. (7)There were no major complications during the two procedures.Conclusion: (1)As a minimal invasive intervention, PVP and PKP can provide good improvement in pain relief and functional treatment of painful OVCFs. (2)PVP has more reasonable costeffectiveness than PKP, adapting to wide application. (3)These conclusions need to be updated on the basis of the findings of future randomized controlled trials.
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