Application Study Of Curved Vertebroplasty In The Treatment Of Osteoporotic Vertebral Compression Fracture

Objective(1)To investigate the value of Angle bending vertebroplasty in the correction of local kyphosis of vertebral compression fracture.(2)To studythe distribution of bone cement in the treatment of osteoporotic vertebral compression fractures with Angle vertebroplasty and its effect on recurrent fractures.(3)A multi-center clinical study was conducted to explore the clinical effect of Angle vertebroplasty.Methods(1)72 elderly patients with osteoporotic thoracolumbar vertebral compression fractures admitted to our department from September 2016 to December 2017 were selected and divided into three groups according to the surgical method:unilateral PVP treatment group,CVP treatment group and Hyperextension reduction combined with CVP treatment group.The perioperative data of the three groups were compared,and the differences in preoperative and postoperative vertebral compression rate and postoperative vertebral reduction rate,as well as the differences in preoperative and postoperative VAS score and ODI score of lumbago and backache were compared,so as to evaluate the effect of Angle vertebroplasty in the correction of posterior lordosis.(2)157 elderly patients with thoracolumbar vertebral compression fractures due to osteoporosis admitted to our department from January 2015 to December 2017 were selected and divided into three groups according to the surgical method:unilateral PVP treatment group,bilateral PVP treatment group and CVP treatment group.The perioperative data,postoperative bone cement distribution patterns and the incidence of secondary fractures in different bone cement distribution patterns of the three groups were compared to evaluate the value of Angle vertebroplasty in bone cement distribution and prevention of secondary fractures.(3)346 elderly patients with osteoporotic thoracolumbar compression fractures of three hospitals in different areas from 2014 to 2018 were selected,and divided into two groups according to the operation method,bilateral PVP treatment and CVP treatment group,to compare the differences between two groups of perioperative data,postoperative bonecement leakage rate and the preoperative and postoperative lumbar back pain VAS scores and ODI score,evaluate the clinical effect of CVP on OVCF.Results(1)Compared with with the CVP treatment group and the unilateral PVP treatment group,the operative time of the CVP group was longer(P<0.05),which may be related to the intraoperative postural reduction(10-20min).Compared with the unilateral PVP treatment group,the postoperative vertebral compression rate of the CVP combined group was significantly reduced(P<0.05),and the vertebral reduction rate was significantly increased(P<0.05),while there was no statistically difference in the postoperative vertebral compression rate and vertebral reduction rate between the CVP treatment group and the unilateral PVP treatment group(P>0.05).The reduction rate of vertebral body was related to the operation mode,but had no linear correlation with the amount of bone cement.(2)In terms of hospitalization cost,operation cost and operation time,bilateral PVP treatment group was significantly higher than unilateral PVP treatment and CVP treatment group(P<0.05).Compared with the unilateral PVP treatment group,the amount of bone cement was significantly increased in the bilateral PVP treatment group(P<0.05),while the amount of bone cement was not significantly increased in the CVP treatment group(P>0.05).The incidence of secondary fracture in the CVP group was 3.2%,significantly lower than the 15%in the unilateral PVP group(P<0.05).Secondary fracture mainly occurred within 1 year after surgery,and the incidence was higher from 3 months to 1 year.Thoracolumbar segment(t11-12)is a high incidence area of spinal compression fractures,and the vertebral bodies of postoperative secondary fractures are mainly distributed in the thoracolumbar segment(55.6%),followed by the lower lumbar segment(13-15,38.8%).CVP after treatment of bone cement distributed ? type(95.3%)and bone cement after bilateral PVP treatment mainly is ? type(64.9%)and ?distribution type(32.4%),unilateral PVP treatment of bone cement is mainly a ? type(71.7%)and V type(28.3%)of the distribution;Bone cement distribution types are independent risk factors of postoperative secondary fracture,bone cement were ? type and V type distribution of the incidence of secondary fracture distribution is significantly higher than other types(P<0.05),bone cement were I and III distribution canobviously reduce the incidence of secondary fracture.(3)Intraoperative blood loss,operation time and bone cement usage in the CVP treatment group were significantly lower than those in the bilateral PVP treatment group(P<0.05).The overall leakage rate of postoperative bone cement was 34.1%in the bilateral PVP treatment group,significantly higher than the 25.8%in the CVP treatment group(P<0.05).Preoperative degree of vertebral compression have an effect on bone cement leakage rate,degree of ? group of bone cement leakage rate was 38.8%,37.6%,? degrees group were higher than ?degrees group 23.1%(P<0.05).The incidence of vertebral bone cement with cleft sign before operation was 57.4%,which was significantly higher than that of the vertebral body without cleft sign before operation(8.2%,P<0.05).In terms of improving patients' pain and social function,there was no statistically significant difference in short-term postoperative efficacy between the two treatment measures(P>0.05).Conclusion(1)Compared with PVP,CVP has no obvious advantages in local kyphosis correction,while combined with hyperextension position reduction can significantly improve the kyphosis correction effect.(2)OVCF are more likely to happen at Thoracolumbar segment(T11-L2),which is also a zone more of postoperative secondary fracture.Postoperative secondary fractures tend to occur in postoperative 3 months to 1 year period.(3)Distribution of bone cement are independent risk factors for secondary fracture,CVP techniques can complete bilateral bone cement injection through unilateral puncture,can optimize the distribution of bone cement in the vertebral body,strengthen the vertebral body,better improve the spinal stability and at the same time reduce the secondary fracture risk.(4)Preoperative vertebral body accompanied by fissure sign,preoperative vertebral body weight degree compression,and intraoperative bone cement injection in large quantity and bilateral puncture can increase the risk of bone cement leakage.CVP technology can achieve targeted bone cement injection,reduce bone cement usage and reduce the incidence of bone cement.(5)CVP technology can obtain the same clinical effect with the traditional technique of PVP,patients can obtain satisfactory postoperative pain relief and functional improvement.