| ObjectiveThis study is to investigate the incidence and the risk factors of non-surgical vertebral fractures after percutaneous vertibroplasty(PVP)and percutaneous kyphoplasty (PKP);to further analyze its related factors, to find the differences and similarities between the adjacent and the remote vertebrae;to improve the understanding of non-surgical vertebral fractures after PVP and PKP, so as to take more effective measures to prevent it. Meanwhile, the author try to find the effect of nourishing kidney and activating blood recipe on preventing new vertebral fractures, to provide reference of clinical medicine.MethodsThis study mainly enployed retrospective Clinical trials research methods, and made use of the information of the patients who were diagnosed with thoracolumbar vertebral body compression fractures, and accepted single level PVP/PKP during Jan.2009 to Dec.2013 of the second affiliated hospitals of Guangzhou University of Chinese Medicine. The patients are divided into two groups depending on whether there are non-surgical vertebral fractures, while the fracture group is divided into two groups according to the new fracture was happened on adjacent or distant vertebral. The possible correlative factors included the patients’sex, age, surgical approach(PVP or PKP), bone cement injection volume, operation vertebral segments, correction of vertebral bodies’ local sagittal Cobb’s angle, bone cement extravasation, use of antiosteoporotic medications and nourishing kidney and activating blood recipe during perioperative.x2-Test was applied to enumeration data, Independent-Samples T-Test was applied to measurement data, SPSS 19.0 statistical software was applied to number data, and with the standard that the study is statistical significant in the case of P<0.05, and is obviously statistical significant in the case of P<0.01.ResultsIn this study,452 patients were treated with single level PVP/PKP, including 359 females and 93 males, aging from 49 to 93, with an average age of 74.98±8.42.211 patients accepted PVP, while the other 241 pantients accepted PKP.116 patients had bone cement extravasation with the incidence of 25.7%. Bone cement injection volume was from 1.2 to 7.2ml, with an average volume of 3.56±0.95ml. Before the surgery, the local sagittal Cobb’s angle was from-31.70°～48.73°, with an average of 11.08°±11.73°, while it came to be from -30.86°～40.53° with an average of 6.11°±11.31° after the surgery. The local sagittal Cobb’s angles were corrected from-3.08° 14.85°,with an average of 4.97°±2.35°。397 patients accepted antiosteoporotic therapy with the rate of 87.8%, while 333 patients accepted nourishing kidney and activating blood recipe with the rate of 73.7% during perioperative period.Among the 452 patients,64 patients had non-surgical vertebral fractures after the surgery with the incidence of 25.7%, including 52 females and 12 males. time of second fracture was from 1 to 53 months, with an average of 14.56 ±11.46 months,Fracture group and non-fracture group had no statistical difference in sex,age,follow-up time,surgical approach(PVP or PKP),bone cement injection volume, operation vertebral segments,preoperative vertebral bodies’local sagittal Cobb’s angle(P>0.05).The incidence of bone cement extravasation in fracture group was higher than that in non-fracture group (P<0.01).The use of antiosteoporotic medications and nourishing kidney and activating blood recipe during perioperative period and the amount of correction of vertebral bodies’local sagittal Cobb’s angle in fracture group was more than that in non-fracture group. Multiple-factors logistic regression analysis showed that bone cement extravasation, correction of vertebral bodies’local sagittal Cobb’s angle, absence of antiosteoporotic medications and nourishing kidney and activating blood recipe during perioperative period were the predominant correlative factors associated with the non-surgical vertebral fracture after PVP/PKP. In fracture group, the incidence of fracture in distant vertebral is slightly higher than that in adjacent vertebral but with no statistical difference(P>0.05). Adjacent vertebral group and distant vertebral group had no statistical difference in sex, age, time of second fracture, surgical approach(PVP or PKP),bone cement injection volume, operation vertebral segments, preoperative vertebral bodies’local sagittal Cobb’s angle, bone cement extravasation, correction of vertebral bodies’local sagittal Cobb’s angle, use of antiosteoporotic medications and nourishing kidney and activating blood recipe during perioperative period(P>0.05). The amount of correction of vertebral bodies’ local sagittal Cobb’s angle in adjacent vertebral group was more than that in distant vertebral group(P<0.05). Patients accepted PKP had higher correction of vertebral bodies’local sagittal Cobb’s angle than those accepted PVP(P<0.01). However, there was no statistical difference between the two surgical approachs in bone cement extravasation and time of second fracture.ConclusionThe reasons that may cause non-surgical vertebral fractures after PVP or PKP varied.This study show us that bone cement extravasation, excessive correction of the vertebral bodies’local sagittal Cobb’s angle, and absence of antiosteoporotic medications during perioperative period can significantly increase the incidence of new fractures. At the same time, accepting nourishing kidney and activating blood recipe during perioperative period may help preventing new vertebral fractures. To avoid new fractures after PVP/PKP, Doctors should grasp ite possible correlative factors, and need precise operation during the surgery. Avoiding bone cement extravasation and excessive correction of the vertebral bodies’local sagittal Cobb’s angle are important measures. We should also attach importance to the use of antiosteoporotic medications during perioperative period. We can also use nourishing kidney and activating blood recipe to help preventing new vertebral fractures, so that the quality of medical care can be improved. |
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