A Comparison Study Of Percutaneous Kyphoplasty With Injection Of Polymethylmethacrylate And Calcium Sulfate Cement In The Treatment Of Thoracolumbar Fractures

【Objective】To provide the guidance for clinical application by compare the short-term clinical results of percutaneous kyphoplasty with polymethylme -thacrylate(PMMA) and calcium sulfate cement(CSC) in treatment of thoracolumbar fractures【Methods】Twenty-four cases(male9,female 15) of thoracolumbar fractures were divided into 2 groups:PMMA(13 cases),CSC(11 cases).The changes of height of vertebral bodies,the VAS,the score of activity,the using of analgesic,the complication and recurrence rate,the degradation of cement were investigated.【Results】The VAS and the score of activity were decreased from 8.1±0.8 and 3.5±0.3 pre -oper ation to 2.1±1.1and 1.6±0.5 24h of post-operation,1.3±1.0 and 1.3±0.8 one week of postoperation, 0.9±1.1 and 1.3±0.5 six mouths of post-operation in PMMA group(p＜0.05),while the VAS and the score of activity were decreased from 8.0±0.8 and 3.0±0.5 pre-oper ation to 4.1±0.6and 2.1±0.8 24h of post-operation,3.3±0.8 and 2.1±0.6 one week of post-operation, 1.1±0.7 and 1.3±0.6 six mouths of post-operation in CSC group(p＜0.05).There were significant diferences in both groups(p＜0.01),and diference between PMMA group and CSC group(p＜0.05).There were significant changes in height of the vertebral bodies ofpre-operation and post-operation.The mean height of the anterior,media and posterior vertebral bodies was 2.1±0.6cm,1.8±0.5cm,2.4±0.5cm preoperatively and 2.5±0.8cm,2.4±0.7cm,2.9±0.5cm postoperatively in PMMA group(p＜0.05),while 2.1±0.3cm,1.6±0.8cm,2.7±0.6cm preoperatively and 2.4±0.8cm,2.3±0.8cm,2.9±0.6cm postoperatively in CSC group (p＜0.05).There were no significant diferences in both groups(p＞0.05).There were 2 paravertebral intravenous leaks but no any clinical symptom.1 cases of CSC leak into the spinal canal and form a placeholder,but did not cause nerve injury,follow-up review of CT scan in 1 month after post-operation founded the CSC began to degradated,the patient has no neurological symptoms.The follow up period was 3～6months,CSC began to degradation in 5 week and decreased obviously in8 week.,3case have further vertebral compression occurred in 5 patients at the 3months follow up in CSC group,the others were lost.no major complications occurred in this series.There was no analgesic used in lmonth of post-operation,There was no case with collapse continuing in last folow-up.【Conclusion】PMMA compares to CSC have:(1) good operability,there is sufficient time to operate during operation and better monitoring,higher security.(2) reliable analgesic effect,the better activity.CSC can be degrade but the rate is too fast,may cause to further vertebral compression occurred.PMMA cann't degrade,There was no case with collapse continuing in follow-up. PKP is a safe,effective and few complication technique treatment for thoracolumbar fractures.But the injectability time of CSC currently products is too short,cann't relief pain quickly,degraded fastily and so on still not to suitable for applies in the PKP. CSC has the following advantages:(1) no poly thermal reaction;(2) biodegradability;(3) security,its non-thermal effects and biodegradability even if happen intraoperative leakage will no cause the spinal cord nerve damage.Its shortcomings are obvious:(1)non-enough strength after solidification,analgesicless effect,postoperative pain symptoms improvement worse than the PMMA group,but without the use of painkillers;(2) too fast degradation,CSC began to degradation in 5 week and decreased obviously in8 week.,follow-up found that CSC entirely degradation lead to vertebral collapse and a high loss of complications;(3) poor-operationing,The Solidification time is only 1 min;(4) less effective intraoperative imaging is due to poor intraoperative monitoring.