Analysis Of The Curative Effect Of Two Surgical Methods In The Treatment Of Elderly Osteoporotic Thoracolumbar Compression Fractures

Objectives Compare the clinical efficacy and safety of two different surgical methods percutaneous kyphoplasty（PKP）and posterior long segment fixation combined with vertebroplasty（LSF-VP）for the treatment of severe bone in the elderly with loose thoracolumbar compression fractures with kyphosis.Methods To review and analyze a total of 54 patients collected in our hospital with percutaneous kyphoplasty（PKP,n=30,control group）and long-segment fixation via posterior approach combined vertebroplasty treatment of patients（LSF-VP,n=24,the experimental group）from June 2015 to June 2020 as the research object.Patients in two groups were treated with the anterior vertebral body compression exceeded 50%and/or the kyphotic deformity cobb angle exceeded 40°,and were severe osteoporotic thoracolumbar compression fractures with no neurological symptoms and signs.The injured vertebrae of all selected cases were T₁₁～L₂ single-segment compression fractures.We collected and compared the general information of the two groups patients,such as age,sex,course of disease,involved segments,bone mineral density T value,and related symptoms and signs（whether they are combined with nerve compression symptoms）,and compared the general operation conditions of the two groups patients（operation time-consuming,bone cement injection usage,intraoperative blood loss,length of stay in hospital）.Visual analogue scale（VAS）was used to assess the degree of back pain at different time points（before surgery,day of discharge,12 months after surgery）,and at different time points（Before the operation,the day of discharge,and the 12th month after the operation）.The height of the anterior and posterior edge of the vertebral body,the compression ratio of the vertebral body,and the changes in the thoracolumbar cobb angle of the two groups were measured and compared at different time points（before surgery,the day of discharge and the 12th month after the operation）.The oswestry dysfunction index（ODI）was used to evaluate the recovery of motor function of the two groups patients,and the dual-energy X-ray bone densitometer was used to detect the improvement of the lumbar spine bone density,and the postoperative complications of the two groups were recorded.Results There was no statistically significant difference in general information between the two groups patients in terms of age,gender,course of disease,involved segments,bone mineral density T value,and related symptoms and signs（p>0.05）.Both groups of patients successfully completed the operation and received complete follow-up.The operation time of the experimental group was significantly longer than the control group（p<0.05）and the amount of bone cement injection used was more than the control group（p<0.05）.Also the amount of intraoperative blood loss was more than that of the control group.Control group（p<0.05）.There was no significant difference in the VAS scores between the two groups before operation（p>0.05）.The VAS scores of the two groups on the day of discharge and the 12th month after the operation were significantly lower than those before the operation（p<0.05）,and there was no difference in the VAS scores of the two groups on the day of discharge.The VAS score of the experimental group was significantly lower than that of the control group at the 12th month after surgery（p<0.05）.There was no significant difference in the height of the anterior and posterior edge of the vertebral body,the compression ratio of the vertebral body,and the cobb angle of the thoracolumbar between the two groups before operation（p>0.05）.The height of the anterior and posterior edges of the vertebrae of the two groups on the day of discharge and the 12th month after the operation The vertebral compression ratio and the cobb angle of thoracolumbar were lower than those before the operation（p<0.05）.The height of the anterior edge of the vertebral body of the experimental group on the day of discharge and the 12th month after the operation was significantly higher than that of the control group（p<0.05）,while the vertebral compression ratio and the thoracolumbar Cobb angle were significantly lower than the control group（p<0.05）.There was no significant difference in the height of the posterior edge of the vertebral body between the two groups on the day of discharge（p>0.05）.There was no significant difference in the preoperative ODI scores between the two groups（p>0.05）.ODI scores on the day of discharge and the 12th month after the operation of the two groups were significantly lower than those before the operation（p<0.05）.The ODI score of the experimental group at the 12th month after operation was significantly lower than the control group（p<0.05）.There was no significant difference between the two groups on the day of discharge and the bone mineral density on the day of discharge and the 12th month after the operation（p>0.05）.Both groups had postoperative complications such as pressure ulcers and bone cement leakage,but the difference in incidence was not statistically significant（p>0.05）.During the follow-up period,the experimental group did not have internal fixation failure,re-fracture or adjacent vertebral fractures.In the control group,there was one case of recurrence of low back pain at 14 months postoperatively,which was accepted due to poor maintenance of the vertebral body height and Cobb angle>40°as second surgical treatment（LSF-VP）.Another case received a second operation due to the decrease in cone height,compression fracture of adjacent segment and kyphosis in the 18th month after operation.There was no re-fracture or adjacent vertebral fracture in this group.Conclusions Percutaneous kyphoplasty and posterior long-segment fixation combined with vertebroplasty for the treatment of severe osteoporotic thoracolumbar compression fractures and kyphotic deformities in the elderly both can achieve relatively ideal therapeutic effects and comparatively good safety.Percutaneous kyphoplasty treatment of the disease has certain advantages in reducing the amount of bone cement injection and intraoperative blood loss,shortening the operation time and hospitalization time.But the using of long-segment fixation combined with vertebral body posteriorly in the treatment of this disease is better than percutaneous kyphoplasty in alleviating back pain,correcting deformities,maintaining the height of the vertebral body and promoting the recovery of motor function.Figure9,Table9,Reference176...