A Comparative Study Of The Effect Of PKP For Very Severe Osteoporotic Vertebral Compression Fractures Of Thoracolumbar At Different Courses Of Disease

Objective:Compare the surgical effectiveness of percutaneous kyphoplasty(PKP)for very severe osteoporotic vertebral compression fractures(vsOVCFs)of thoracolumbar at different courses of disease.Methods:A total of 104 patients with thoracolumbar vsOVCF who met the selection criteria and underwent treatment in our hospital from January 2015 to July 2017 were included into this retrospectively study.They were grouped according to the courses of the disease,Group A:the course of disease is within 1 week(26 cases),Group B:the course of disease is 2-3 weeks(27 cases),Group C:the course of disease is 3-6weeks(25 cases),Group D:the course of disease is more than 6 weeks(26cases).Observe and record the pain visual analogue score(VAS),Oswestry dysfunction index(ODI),local kyphosis(LKA)before and after surgery,cement volume during operation,cement leakage,postoperative vertebral recollapse and adjacent vertebral fractures(AVF)after surgery.The last follow-up was over 2 years.These indicators were used to assess pain,functional improvement and complications.Results:There were no significant differences in preoperative clinical data of age,gender,body mass index,bone mineral density and intravertebral vacuum cleft between the four groups(P>0.05).The postoperative VAS scores and ODI in each group were significantly improved(P<0.05),the improvement in pain was continuous;But the VAS and ODI in Group A(2.7±0.5 and 36.9%±4.1%,respectively)and Group B(2.8±0.4 and 37.8%±3.2%,respectively)were significantly lower than those in Group C(3.2±0.8 and 43.4%±3.4%,respectively)and Group D(3.3±0.4 and 44.7%±4.6%,respectively)at the last follow-up,P<0.05;The LKA and vertebral height of each group were significantly corrected immediately after surgery,but at the last follow-up,LKA was significantly larger in the Group C and D than those in the Group A and B(P<0.05),the height of the injured vertebral in the Group C and D(14.4mm±1.6mm and14.6mm±1.8mm,respectively)was significantly lower than those in the Group A and B(16.3mm±0.9mm and 16.5mm±0.9mm,respectively)(F=9.839,P=0.000);The leakage rate of bone cement was lower in Group B(25.9%),which was significantly different from the other groups(?~2=8.506,P=0.037);The recollapse ratio in Group A and B(7.7%and 11.1%,respectively)was significantly lower than that in Group C and D(40.0%and 46.2%,respectively),and the difference was statistically significant(?~2=16.633,P=0.001).The incidence of AVF in Group A and B(7.7%and 7.4%,respectively)was significantly lower than that in Group C and D(28.0%and 26.9%,respectively),and the difference was statistically significant(?~2=7.534,P=0.057).Conclusion:PKP for vsOVCFs is safe and effective at all stages.Within 3 weeks of fracture,PKP has achieved relatively better and sustained results.After 3 weeks of fracture,PKP surgery may increase the risk of bone cement leakage,vertebra re-collapses and fracture of adjacent vertebra.