Effects Of Different Surgical Approach And Bone Cement Dose On Coagulation Functions During Percutaneous Vertebral Augmentation In Elderly Patients

ObjectiveTo evaluate the effects of different surgical approach and bone cement (i.e. polymethylmethacrylate, PMMA) dose on coagulation functions during percutaneous vertebral augmentation in old patients with osteoporotic veterbral compression fractures (OVCF) and it’s clinical significance.MethodsTwenty-eight patients who were diagnosed OVCF, with32vertebrae underwent percutaneous vertebral augmentation in our section betweent the October2010to March2012. Under the guidance of C-arm f luoroscogy, PMMA was injected into the fractured vertebrae percutaneously via transpedicular. Activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), D-Dimer concentration (D-D-Dmier) were measured lOmin before and5min,30min, lh after bone cement implantation. The bone cement does in one operation was also recorded afer operarion. The change on coagulation functions before and after bone cement implantation was analyzed, and the differences between group of PKP and group of PVP, group of small dose (thoracical vertebrae^3ml, lumber vertebrae^5ml) and group of large does (thoracical vertebrae>3ml, lumber vertebrae>5ml)were also assessed.Results1. The mean D-Dmier of all patients was a little higher than normal scale and rose gradually after bone cement implantation. There were significant differences among the various moments before and after bone cement implantation (P<0.05), excluding the compartion between the moment of30min and lh after bone cement implantation (P>0.05). Other magnitudes were normal, and there were not statistic differences among them (P>0.05).2.In PKP and PVP, The mean D-Dmier of both groups were a little higher than normal scale and rose gradually after bone cement implantation. The mean D-Dmier of PVP groups was a little lower in the moment Ih afer bone cement implantation than30min afer, but both were higher than normal scale. There were statistic differences between the moment of l0min before bone cement implantation and each moment after in both groups (P<0.05), such as the moment of30min after bone cement implantation and the moment of5min and lh after in PKP group (P<0.05), but not in PVP group (P>0.05). Other magnitudes were normal.In PKP group, APTT demonstrated significant differences between the moment of30min after bone cement implantation and the moment l0min before and5min after (P>0.05).3. The mean D-Dmier of small dose group and large dose group were both a little higher than normal scale and rose gradually after bone cement implantation. In small dose group, There were no significant differences among the various moments before and after bone cement implantation (P>0.05), excluding the compartion between the moment of30min and Ih after bone cement implantation (P<0.05). But in large dose group, it was opposite. There were significant differences among the various moments before and after bone cement implantation (P<0.05), excluding the compartion between the moment of30min and lh after bone cement implantation (P>0.05). Other magnitudes were normal.ConclusionsIt can cause hypercoagulabale state in lh after PMMA implantation in percutaneous vertebral augmentation in elderly patients. We propose taking treatment like prevention of thrombosis, improvement of microcirculation, and traditional Chinese medicine after operation. PKP and PVP can both impact on coagulabale function in patients, but it showed no significant different between PKP and PVP, thus we shoukd select the appropriate procedure in accordance with the specific circumstances of the patients. Injecting PMMA too much in one operation may be the risk factors to cause hypercoagu1able state and we should be appropriate on the basis of ensuring the efficacy of surgery to reduce the PMMA injection...