| Purpose:A retrospective analysis of percutaneous kyphoplasty,cutaneous kyphoplasty,Two surgical methods,PKP and traditional pedicle screw fixation,were used to treat patients with different degrees of kyphotic vertebral column compression fracture(OVCF).The clinical and imaging data of preoperative and postoperative follow-up were integrated.To analyze the clinical efficacy and safety of PKP technique or traditional pedicle-screw internal fixation in the treatment of patients with different degrees of local kyphosis(Cobb Angle),and to provide a certain reference for the selection of surgical methods for thoracolumbar OVCF patients with different degrees of kyphosis.Method:A total of 96 patients with osteoporotic fractures of thoracollumbar vertebrae combined with kyphosis admitted to the Spinal Surgery Department of Ganzhou People’s Hospital from January 2018 to December 2021 were selected as the research objects.All the injured vertebrae in all cases were single-level compression fractures of T11-L2,and all met the inclusion criteria.They were divided into PKP group(group A)and traditional pedicle screw internal fixation group(group B)according to the surgical method.Patients in each group were divided into A1 group /B1 group(Cobb < 20°)and A2 group /B2 group(Cobb≥20°)according to whether the preoperative local Cobb Angle was greater than 20°.There were 29 cases in group A1,including 12 males and 17 females,with an average age of 69.86±8.65 years.There were 23 cases in group A2,including 8 males and 15 females,with an average age of70.61±9.14 years.There were 18 cases in group B1,including 7 males and 11 females,with an average age of 69.89±6.45 years.There were 26 cases in B2 group,including10 males and 16 females,with an average age of 69.77±6.59 years.All patients received standard anti-osteoporosis treatment after surgery.X-ray examinations were performed before surgery,1 week after surgery,3 months after surgery,and 1 year after surgery.The vertebral shape recovery rate was evaluated by comparing the local Cobb Angle and Beck index of the anterior edge of the vertebral body during the preoperative and postoperative follow-up.VAS)and Oswestry disability index(ODI)were used to evaluate the rate of symptom improvement in OVCF patients with different degrees of local Cobb Angle before surgery.Result:(1)There were no significant differences in gender,age,bone density,injured vertebral segment,clinical symptoms and signs among all patients(P > 0.05);(2)All patients in the four groups successfully completed the operation and received complete follow-up.The operation duration,hospital stay and intraoperative blood loss in the PKP group(group A)were significantly less than those in the traditional pedicle screw fixation group(group B)(P < 0.05),and there was no statistical difference among the same operation groups(P > 0.05).(3)There were no significant differences in VAS and ODI scores among the four groups before surgery(P > 0.05),and they were improved at each time point 1 week,3 months and 1 year after surgery(P < 0.05).The VAS scores of group A1 week and3 months after surgery were significantly lower than those of group B.One year after surgery,there was no statistical difference between group A1 and group B,and the VAS scores of group A2 were higher than those of the other three groups(P < 0.05).The ODI score of group A1 week after surgery was significantly lower than that of group B,3 months after surgery and 1 year after surgery,the ODI scoreof group A1 was lower than that of group A2(P < 0.05),there was no significant difference between group A1 and BI(P > 0.05),and the ODI score of group B2 was significantly lower than that of group A2 1 year after surgery(P < 0.05).(4)There were no significant differences in Cobb Angle and Beck index between groups A1 and B1,A2 and B2 before surgery(P > 0.05).Groups A and B were improved at each time point 1 week,3 months and 1 year after surgery(P < 0.05),and group A was significantly lower than group B at each follow-up time point after surgery(P > 0.05).(5)There were 7 cases of bone cement leakage in group A during the operation,among which 3 cases in group A1 and 4 cases in group A2 had no statistical difference(P > 0.05),no serious spinal cord or nerve injury,no bone cement allergy was observed.During the follow-up period,9 cases of recurrent or new fractures occurred in group A,including 3 cases in group A1 and 6 cases in group A2.Although the total incidence was not statistically significant(P > 0.05),it could be seen that there were significantly more recurrent or new fractures in group A1 than in group A2.In group B,there were 3 cases of adjacent vertebral fracture or refracture of injured vertebral body,1 case of deep venous thrombosis of lower limb,1 case of operative oral infection,1 case of urinary tract infection,1 case of pulmonary infection,and 1 case of internal fixation loosening during postoperative follow-up.There was no statistical difference in the total incidence among subgroups(P > 0.05),while the total incidence in group A2 was significantly higher than that in group B2(P < 0.05).All of the above were cured by conservative treatment.During the follow-up period,the symptoms of adjacent vertebral fractures were improved after conservative or surgical treatment according to the severity,and the pain was improved after removal of internal fixation looseness.Conclusion:(1)PKP and traditional pedicle screw fixation in the treatment of single level thoracolumbar osteophobic fracture with kyphosis have satisfactory efficacy and high safety.(2)For patients with Cobb Angle < 20°,both PKP and conventional pedicle screw fixation improved pain,function,kyphosis,and anterior edge height of the injured vertebra.The effect of PKP on the correction of kyphosis and the maintenance of the anterior edge height was worse than that of conventional pedicle screw fixation,but there was no significant difference in pain and function.In addition,PKP was superior to conventional pedicle screw fixation in terms of hospital stay,operation duration,blood loss and short-term pain improvement.(3)For patients with Cobb Angle ≥20°,PKP was significantly worse than traditional pedicle screw fixation in the correction of kyphosis and the recovery of anterior vertebral edge height,and PKP was less effective than pedicle screw fixation in the improvement of pain and function over 1 year long-term follow-up.In addition,the incidence of refracture and adjacent vertebral fracture with PKP is significantly higher than that with conventional pedicle screw fixation,requiring re-hospitalization.(4)Among subgroups,PKP was significantly better than Cobb≥20° in terms of efficacy,kyphotic deformity correction and long-term recurrence fracture incidence in patients with Cobb < 20°;Traditional pedicle screw fixation can effectively improve symptoms,correct kyphosis,and maintain the stability of the injured vertebra in patients with Cobb < 20° and Cobb≥20°.However,for patients with Cobb < 20°,PKP can be given priority in terms of surgical trauma,surgical cost,and patient tolerance.(5)The loss of the injured vertebral front height during postoperative follow-up may be related to the degree of recovery of the injured vertebral height.Excessive reduction should be avoided for elderly patients with severe osteoporosis during the reduction of the injured vertebral height. |
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