| ObjectiveWith the global population aging, the incidence of osteoporosis increased year by year, As the new technology in the field of minimally invasive spine surgery, Percutaneous Vertebroplasty (PVP) have achieved significant clinical efficacy of treatment in osteoporotic vertebral compression fractures (Osteoporotic Vertebral compress fractures, OVCF). However, the reports on the follow-up of PVP postoperative have found adjacent vertebral fracture (AVF) incidence was increasing year by year. According to reports from current literature, there was existing differences for whether PVP postoperative fracture will increase the possibility of adjacent vertebrae. Many scholars concluded that the distribution and morphology of bone cement led to the AVF of the risk factors by various studies ,including the finite element model, body model of bio-mechanics, review and other non-randomized clinical. However, whether different distribution of bone cement will produce different clinical effects, including clinical analgesic effect, and Imaging improvement and the secondary vertebral fractures occurred adjacent in follow-up situation and so on , has not been reported in domestic . With the retrospective study method of clinical case, in accordance with distribution of the different bone cement of patients after PVP treatment of paosteoporotic vertebral compression fractures to conduct the clinical efficacy research and analysis group by group, and make further follow-up study for each group . Here is the objectives of this study :①: Comparison for the clinical efficacy of bulky and spongy two bone cement distribution patterns. then further discuss and analysis the differences between the two clinical efficacy .②: analysis for the relationship between new occurred AVF and two bone cement distribution patterns of bulk and spongy-like , and then further explore the related risk factors for new occurred AVF after PVP Provided reference for further study the cause and prevention of AVF after PVP in the future.Methods1.From January, 2007 to August ,2010, PVP was performed on 98 patients with single osteoporotic vertebral compression fracture. All the patients were examined physical examination, imaging studies , pain scale , imaging studies, image changes before surgery, including VAS, the height of anterior part,middle,posterior part of the vertebrates on the lateral position X-ray film, angle of kyphotic deformity. After surgery, according to the performance on CT or X-ray of distribution of bone cement. and according to the different ratio bettwen the diffusion volume and injected volumes of cement of vertebral body to group the patients .98 patients will be divided into two group : bulk group (group A) and sponge-like group (group B).Compared the injection of bone cement , postoperative improvement rate in patients with pain, radiographic results. Comparison of statistical analysis was used in order to evaluate the relationship between the clinical efficacy and the distribution patterns of the two bone cements . Data was statistical analysis by using SPSS 17.0 software.2. From January, 2007 to August, 2010, PVP was performed on 98 patients with osteoporotic single vertebral compression fracture, with a total of 98 vertebral bodies. With postoperative X ray or CT image data, based on postoperative CT or X ray bone cement distribution patterns in the vertebral body, 92 patients will be divided into two group : bulk group (group A) and sponge-like (group B).Data was statistical analysis by using SPSS 17.0 software .Through each follow-up time point, by using imaging methods such as the thoracic and lumbar X ray or CT and so on, to observe postoperative changes in adjacent vertebral bodies. Comparison for the incidence of secondary vertebral compression fractures and the time of the postoperative new vertebral compression fractures. Data was statistical analysis by using SPSS 17.0 software.Results1.The differences between two VAS scores of before and after surgery was existing statistically significant (P<0.05); The average improve rate of VAS score between two groups was not statistically significant.(P> 0.05).2. The differences between the height of anterior part and central vertebral body of two groups before and after operation was existing statistically significant (P<0.05) ;But the height of the posterior part between preoperative and postoperative was not statistically significant (P>0.05) ;The kyphotic angle of two groups between preoperative and postoperative both are existing differences (P<0.05); The differences of average improvement rate of the height of anterior part between the two groups was not statistically significant (P>0.05) ; The differences of average recovery rate of the height of middle part between the two groups was existing statistically significant (P<0.05) ; The differences of average recovery rate of the height of the posterior part between the two groups was not statistically significant (P>0.05) ;The differences of average improvement rate of vertebral kyphotic angle between the two groups after operation was not statistically significant (P> 0.05).3. For the block group ( group A), bone cement injected volume was correlated positively with the height change(postoperative and preoperative) of the anterior part and middle part , kyphotic angle of the vertebrates(P<0.05). There is no correlation between bone cement injected volume and the height of the posterior part (postoperative and preoperative). (P>0.05). For Sponge-like group ( group B ), there is no correlation between bone cement injected volume(in a certain range) and the height change(postoperative and preoperative) of the anterior part and middle part , posterior part, kyphotic angle of the vertebrates (P>0.05).4. In the follow-up study, excluding 5 cases were failure, and the remaining 93 cases be counted into the final statistical analysis. 10 patients (22.2%) with new fracture in group A of 45 patients, which occurred in the adjacent vertebral bodies of 7 patients (15.6%).8 patients (15%) with new fracture in group B of 40 patients , which occurred in the adjacent vertebral bodies of 4 patients (10%). Two new adjacent vertebral fracture rate show evident differences (p<0.05).Group A : new fracture were found in the average time 90±49.98 days after PVP, which the adjacent vertebral fractures occur in the average time 78.75±49.23 days. Group B: new fracture were found in the average time 176.25±65.24 days after PVP, which the adjacent vertebral fractures occur in the average time 195±106.06 days. The average time of two new fracture occurred shows a significant difference (p<0.05).The average time of the adjacent vertebral fractures occurred shows a significant difference (p<0.05).Conclusion1. PVP in the form of block and two sponge distribution pattern of bone cement can effectively relieve pain,and enhance the mechanical properties of vertebral body to restore vertebral body stability.2. In a certain range of cement injected volume (1.5-5ml), both the two types of block and Sponge-like distribution pattern of bone cement can partially restore vertebral body compression in the height of anterior part and middle part and improve kyphosis. Distribution pattern of block located in the height of middle vertebral body for restoration surgery will be better than Sponge-like distribution pattern.3. The secondary vertebral fracture rate of block distribution is higher than sponge-like distribution, especially for the adjacent vertebral fractures. Secondary fractures of bulky distribution patterns is faster than the sponge-like distribution pattern. |
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