The Effect Of Bone Cement Distribution On Clinical Efficacy After PKP For OVCFS

Objective:Osteoporotic vertebral compression fractures?OVCFs?has become a common disease of the elderly.Because of poor conservative treatment effect and long-term risk for patients with pain symptoms,the mainly treatment method is minimally invasive surgery at present.Percutaneous kyphoplasty?PKP?generally available because of its advantages of minimally invasive,good curative effect and lesscomplications.Previous studies have revealed that both the volume and filling pattern of bone cement correlate with the clinical outcomes afterPKP procedure.However,the role of bone cement distribution remains to be illustrated.Therefore,this study mainly investigated the clinicalrelationship between bone cement distribution and efficacy of PKP in the treatment of OVCFs.Materials and methods:This study enrolled 100 elderly patients?male 21,female 79?with primary osteoporotic vertebral compression fractures,and underwent PKP in our hospital from January 2018 to January 2019.Observers using Image J to calculate injury vertebral bone cement within the area and vertebral body area on spinal postoperative X-rayposteroanterior?PA?and lateral?LAT?,calculating the ratio of area of bone cement and injured vertebral area on PA and LAT(R_PA,R_LAT).The patients were divided into three groups by distribution:the mass group,the mixed group and the dispersion group.The mass group-bone cement dispersion?25%,R_PA?50%,R_LAT?50%;mixed group-bone cement dispersion 25%?50%,R_PA?50%,R_LAT>50%or R_PA>50%,R_LAT?50%;dispersion group-bone cement dispersion>50%,R_PA>50%,R_LAT>50%.Visual analoguescales?VAS?,Oswestry dysfunction index questionnaire?ODI?andKyphosis Cobb Angle on PA and LAT spinal X-ray were compared for each group preoperative,3 days postoperative and 6 months postoperative.Recovery rate of injured vertebral height,bone cement leakage,adjacentvertebral fracture and occurrence of refracture of injured vertebral in 3 days postoperative and 6 months postoperative were evaluated.All data wereprocessed by SPSS 22.0.The measurement data were expressed as"mean±standard deviation",and tested by one-way analysis of variance.Thecounting data is represented by"%",and tested by chi-square test.Results:All patients were followed for 6-12 months,with an average of?8.09±1.52?months.Intraoperative injection volume of bone cement was3-8ml,with an average of?4.81±1.09?ml.There were no statistically significant differences in gender,age,fracture segment,fracture compression degree,operation time and bone cement injection amount among the three groups?P>0.05?.There was no significant difference in VAS score and ODI score among the three groups preoperative?P>0.05?.VAS score and ODI score 3 days and 6 months postoperative of the three groups were significantly different from those in preoperative?P<0.05?.In3 day postoperative,VAS score and ODI score of the mixed group and the diffuse group were significantly lower than those in the lumpy group,with statistically significant difference?P<0.05?,but there was no statistically significant difference between the mixed group and the diffusion group?P>0.05?.There was no statistically significant difference in VAS score and ODI evaluation between the three groups 6 months postoperative,?P>0.05?.There was no significant difference in Cobb Angle between the three groups preoperative?P>0.05?.3 days and 6 months postoperative,Cobb Angle of the three groups was significantly lower than that in preoperative?P<0.05?,and Cobb Angle of the diffuse group was significantly lower than that of the mass group and the mixed group?P<0.05?.The recovery rate of injured vertebra height in 3 day and 6 months postoperative was significantly higher in the dispersion group than in the mass group and the mixed group?P<0.05?.There was no significant difference in postoperative complications among the three groups?P>0.05?.The incidence of bone cement leakage was 14%?14/100?,including 6 cases of transcortical type and 8 cases of transvertebral segmental vein type.The incidence of refracture of adjacent vertebral body was 4%?4/100?,including 1 case of T12 and 3 cases of L1 fracture.Conclusion:Pain relief and functional recovery were significantlyimproved in OVCFs patients after PKP.The distribution of bone cement in vertebral body is one of the factors influencing the effect of PKP.