Imaging Observation Of PMNA In Percutaneous Kyphoplasty

[Objective] Osteoporotic vertebral fractures is divided into Osteoporoticvertebral compression fracture(OVCF) and Osteoporotic vertebral burstfracture(OVBF) according to imaging observation.By the retrospectiveobservation of the PMMA site and main way of the two groups ofpatients in Percutaneous kyphoplasty(PKP),to discuss the feasibility andsafety of treatment of kyphoplasty osteoporotic burst frac-ture.[Methods]Four hundred fifty cases of patients with osteoporoticvertebral fractures were treated using PKP in spinal surgery department ofthe Affiliated Hospital of Luzhou Medical College from October2005toMay2012.According to the postoperative complete image datas,thepatients were divided into OVBF and OVCF groups.32OVBF patientswith32vertebraes who satisfied the inclusion criteria were taken as thestudy group,and289vertebrates of269OVCF patients were taken as thecontrol group.The PMMA of the two groups of the patients was dividedinto:spinal canal,intervertebral disc,vertebral side,vertebral anterior,theparavertebral venous and needle tract.After the operation,the degrees oflow back pain relief of two groups of patients were observed according toVisual Analogue Scale (VAS).According to the imaging datas,the mainway in which PMMA was leaked in spinal canal was observed.Dis-placement of bone block of the posterior wall of vertebral body and changes of spinal stenosis rate of the OVBF group postoperation weremeasured with the David method.The recovery of the height of vertebralbody and the change of angle of Cobb in the two groups pre-andpost-operation were also observed.[Results]The operations of two groupswho are301patients with330vertebras were accomplished successfully.PMMA occurred in a total of144patients with161vertebras.PMMA ratewas50%in the OVBF group with16vertebras.PMMA rate was48.7%inthe OVCF group with145vertebras,There were no significant differences(P>0.05).To the leakage rate of spinal canal:OVBF was6.3%.OVCF was12.4%,There were no significant differences (P>0.05).Outside the spinalcanal leakage rate:Disc leakage rate of OVBF was15.6%,OVCF was4.0%,There were significant differences(P<0.05);To the leakage rate ofother parts(vertebral body anterior、 the vertebral body side、paravertebralvenous and needle tract),there were no significantdifferences (P>0.05) in the two groups.In the process of pushing bonecement injection,there is one patient with blood pressure dropping andone with cerebrospinal fluid leakage.The morbidity of postoperativecomplication:pneumonia in2cases,urinary tract infection in1case andlower limbs deep venous thrombosis in2cases,no incision infection andpulmonary embolism.Two groups of patients were followed up for3months to8years(1.5years on average).During the follow-up,4casesdied of myocardial infarction,3cases of hypertension cerebral hemorrhage,2cases of unknown reasons,1case of lung cancer;Refracturehappened to1case in OVBF group,3cases in OVCF group postoper-ation.The age,gender,disease duration,degree of osteoporosis and theamount of PMMA were no significant differences (P>0.05)betweenOVBF and OVCF.The two groups of patients were injected PMMA3-6ml,and with the increase of the amount of PMMA,Leakage rateincreases.Two groups of patients were injected the same amount ofPMMA,There were no significant differences in leakage rate.Spinal canalencroachment rate (%) was no significant differences (P>0.05) in OVBFgroup pre-and post-operation.In OVBF group,vertebral body heightrecovered19.1%and17.5%,Cobb recovered8.2°and7.6°after theoperation and in the last follow-up compared with the preoperation,Therewere significant differences(P<0.05).In OVCF group vertebral bodyheight recovered18.1%and17.4%,Cobb recovered7°and6.3°,afterthe operation and in the last followup compared with thepreoperation,There were significant differences(P<0.05). of the twogroups of patients were obviously relieved post-operation and in the lastfollow-up.The VAS of the OVBF group and the OVCF group arerespectively8.7±1.2and8.6±1.6pre-operation.They were respectively3.0±0.9and3.1±0.9post-operation,There were significant differences(P<0.05),There were no significant differences (P>0.05) postoperativeand follow-up.The VAS of the two groups of patients between whom PMMA were leaked in spinal canal are respectively8.1±0.6and8.0±0.8pre-operation,They were respectively2.3±0.4and3.1±0.5post-operation.There were significant differences(P<0.05).The VAS of thetwo groups of patients between whom bone cement were leaked inintervertebral disc are respectively8.0±1.6and8.1±2.0pre-operation,they are respectively3.1±0.1and2.9±0.8post-operation,VAS were nosignificant differences.There were no significant differences for the VASof two groups of patients whether PMMA was leaked between them ornot in postoperation and follow-up.To the cement leakage group,therewere also no significant differences for the VAS of two groups of patientsboth in spinal canal and disc in postoperation and follow-up.[Conclusions]1.Occurrence rate of the spinal canal leakage was similarbetween OVBF and OVCF in PKP.The main way of PMMA leakingspinal canal was basivertebral veins or basivertebral foramen instead ofposterior wall of vertebral body where fracture occurred2.The rate ofPMMA to Disc in the patients of OVBF was higher than those ofOVCF,which was possibly related to the damage of upper and lowerendplate when the fracture happened to vertebrae.3.vertebral body heightwas obviously increased to the patients of OVBF post-operation ofPKP.The kyphotic deformity is obviously improved.There was nodisplacement of bone block of posterior wall of vertebral body and nochanges of spinal stenosis rate of burst fractures postoperation.4.Low back pain of patients was obviously relieved using PKP whether it isOVBF or OVCF.Low back pain of the patients was relievedpost-operation of PKP whether it is PMMA leakage in spinal canal、Intervertbral disc or other parts of the vertebra.