Comparison Of Three Filling Materials In Thoracolumbar Vertebral Osteoporotic Fractures

Objective: To investigate the effects of polymethylmethacrylate(PMMA),calcium phosphate cement(CPC)and calcium phosphate cement(rh BMP-2/CPC)on osteoporosis of thoracolumbar spine during percutaneous kyphoplasty(PKP).The effect of osteoporotic vertebral compression fractures(OVCF)In order to find better filling materials for osteogenesis or improve clinical efficacy.Methods: 120 patients with osteoporotic compression fractures were randomly divided into three groups.All of them were filled with bone cement by PKP.PMMA was used as the filling material of bone cement in 40 cases of control group.The remaining 40 patients in the observation group used rh BMP-2/CPC as bone cement material.PMMA control group: 13 male patients,27 female patients;age55-85 years old,average age(67.31 + 5.54)years;Location of injured vertebrae: 1case of T6 vertebral body,1 case of T7 vertebral body,2 cases of T8 vertebral body,3cases of T9 vertebral body,3 cases of T10 vertebral body,6 cases of T11 vertebral body,9 cases of T12 vertebral body,10 cases of L1 vertebral body,3 cases of L2 vertebral body,1 case of L3 vertebral body and 1 case of L5 vertebral body.CPC observation group: 15 male patients and 25 female patients;aged 58-81 years,with an average age of(68.33 + 5.35)years;injured vertebral position: 1 case of T7 vertebral body,2 cases of T8 vertebral body,2 cases of T9 vertebral body,4 cases of T10 vertebral body,5 cases of T11 vertebral body,8 cases of T12 vertebral body,12 cases of L1 vertebral body,4 cases of L2 vertebral body,1 case of L3 vertebral body and 1case of L5 vertebral body.The rh BMP-2/CPC observation group included 16 male patients and 24 female patients,aged 56-82 years,with an average age of 66.89(+5.12)years.The location of injured vertebrae was T6 vertebral body in 1 case,T8 vertebral body in 1 case,T9 vertebral body in 2 cases,T10 vertebral body in 3 cases,T11 vertebral body in 6 cases,T12 vertebral body in 7 cases,L1 vertebral body in 12 cases,L2 vertebral body in 5 cases,L3 vertebral body in 2 cases and L5 vertebral body in 1 case.After 7 days,the clinical efficacy,function recovery [the European Spine Osteoporosis Study(European spinal osteoporosis study,EVOS)score,the Oswestry dysfunction index questionnaire(Oswestry Disability Index questionnaire,ODI)score],pain intensity [visual analogue pain score(visual)],injury vertebra morphology(injury)Vertebral height and kyphosis Cobb angle of the anterior central column of the vertebral column were compared,the bone mineral density and the use of painkillers were followed up for 3 months.Bone mineral density of 6 months follow-up and the incidence of new fractures in 1 years were analyzedResults: There was no significant difference in sex composition,age and type of injured vertebra among the three groups(P>0.05).The total effective rate was 97.5% 7days after operation in the three groups.There was no significant difference in clinical efficacy among the three groups(P>0.05).Compared with that before operation,ECOS-16 score,height of injured anterior and middle vertebral column and angle of kyphosis Cobb were significantly improved after operation in the three groups(P<0.05),but there was no significant difference between the three groups(P>0.05).Before operation,there was no significant difference in VAS and ODI scores between the 3 groups(P>0.05),CPC observation group.After operation,the 7d VAS score and ODI score of rh BMP-2/CPC observation group were better than those of PMMA control group(P<0.05).The total incidence of new fracture within one year in PMMA group was higher than that in CPC group and rh BMP-2/CPC group(P<0.05).There was no significant difference between CPC observation and rh BMP-2/CPC observation group in the overall incidence of new fractures within one year(P>0.05).There was no significant difference between the 3 groups in the incidence of new fractures near the vertebral body(P>0.05).After 3 months of follow-up,there was no significant difference in vertebral bone density between the 3groups(P>0.05).Six months after operation,the bone mineral density of injured vertebrae in rh BMP-2/CPC observation group was better than that in PMMA control group and CPC observation group(P< 0.05).Conclusion:PMMA,CPC and rhBMP-2/CPC have better clinical efficacy in the treatment of OVCF.CPC and rh BMP-2/CPC can improve the pain rate and long-term support effect better.At the same time,rh BMP-2/CPC can increase vertebral bone density and effectively inhibit the recurrence of fractures.Therefore,rh BMP-2/CPC filling material has better biological properties and can increase vertebral bone mineral density under the same conditions,so it has a broader application prospect.