Correlation Between Vertebral CT Values And Vertebral Compression Fractures And Clinical Study After Jintiange Interventio

Objective:1.By measuring the CT value of vertebral body in patients with osteoporotic vertebral compression fracture,analyze and compare the consistency between vertebral CT value and MRI to identify fresh or old fractures,and explore the feasibility of vertebral CT value to diagnose fresh OVCF.2.The CT values of fractured vertebrae and non-fractured vertebral bodies(L1 vertebrae)were measured in patients with osteoporotic vertebral compression fracture in subregions to explore the distribution pattern of regional vertebral CT values in different conditions.OVCF patients were injected with high CT areas(cement injection in high CT area)and low CT areas(cement injection in low CT area)to observe the diffusion of bone cement after percutaneous vertebroplasty to guide the selection of cement injection area for percutaneous vertebroplasty.3.Based on meta-analysis,to explore the effect of Jintiange Capsule assisted percutaneous vertebral augmentation on postoperative relief of lumbar and back pain and improvement of functional activities in patients with osteoporotic vertebral compression fracture.4.The anti-osteoporosis efficacy of Jintiange capsule-assisted PVP was evaluated by vertebral CT value,clinical score scale(VAS score for low back pain,lumbar dysfunction index ODI,lumbar JOA score),and traditional Chinese medicine symptoms.Methods:1.In a retrospective study,40 patients were treated for OVCF fractures in our department.Among them,10 were male and 30 were female,aged 55-89 years(74.63±9.71),involving 10 vertebrae in the thoracic spine and 45 vertebrae in the lumbar spine.All patients completed preoperative and postoperative thoracolumbar CT examinations and measured their vertebral CT values to study their consistency with MRI diagnosis of fresh or old osteoporotic vertebral compression fractures.2.Regional vertebral CT values of fractured and non-fractured vertebrae(L1 vertebrae)in OVCF patients were observed and investigated for their distribution characteristics.According to the distribution pattern of regional CT values,patients who met the inclusion criteria were divided into high CT areas(bone cement injection in high CT area)and low CT areas)(bone cement injection in low CT area)to observe the dispersion of bone cement after percutaneous vertebroplasty at different injection points.3.Based on Meta analysis,domestic and foreign databases were searched with the keywords "jintiange capsule","jintian ge capsule","jintiange jiaonang",""jin tian ge jiaonang",and the search time was from database establishment to June 1,2022,and 12 articles were finally included in a meta-analysis of Jintiger Capsule assisted vertebroplasty(PVA)therapy for OVCF,focusing on clinical efficacy and drug safety.4.Forty-two patients with OVCF and parallel percutaneous vertebroplasty in our hospital were grouped by random number chart method.Control group 21 patients received routine anti-osteoporosis treatment after surgery:oral alendronate sodium tablets(70 mg/tablet,taken in the morning,1 tablet each time,once a week)plus calcium carbonate D3 tablets(specification:each tablet containing calcium 600 mg/vitamin D3 125 international units,taken orally,1 tablet each time,1-2 times a day).In the observation group,21 patients were given oral gold day capsules(0.4g/pill,3 times per day)on the basis of conventional treatment.Compare and analyze the changes in vertebral CT value,VAS score of low back pain,lumbar spine dysfunction index(ODI),lumbar JOA score and TCM syndrome before and after treatment,and evaluate the anti-osteoporosis effect of Jintiange capsule on osteoporosis in patients after PVP.Results:1.A total of 40 patients with 55 vertebrae in the study of identifying fresh or old fractures from MRI were included in this study,MRI diagnosed 42 fresh fractured vertebrae and 13 old vertebral fractures.Among 42 vertebrae with fresh fracture diagnosed by MRI,CT values of 41 vertebrae(139.99 ± 49.69 HU)were significantly higher(24.59-233.18 HU,x:84.75,p<0.01)than those of adjacent vertebrae(60.44±34.74 HU)with normal morphology and were diagnosed as fresh fracture.One vertebra and 13 obsolete vertebrae diagnosed by MRI had CT values(55.65 ±31.31 HU)similar to or slightly lower(1.09-14.51 HU,x=7.16,p>0.05)than those of adjacent vertebrae(55.07±29.47 HU)and were diagnosed as obsolete fractured vertebrae,14 in total.Wilcoxon Rank sum test analyzed MRI and vertebral CT values in identifying fresh and old OVCF fractures(Kappa value=0.951).2.A total of 46 vertebrae from 42 patients measuring regional CT values were included in this study,among which 46 fractured vertebrae occurred and 35 osteoporosis non-fractured vertebrae(L1 vertebrae)occurred.In the vertebral body of the fracture group:the upper 1/3 of the vertebral body was 183.57 ± 34.49 HU,the middle 1/3 was 142.50 ± 23.91 HU and the lower 1/3 was 146.32 ± 29.31 HU.CT mean of anterior and posterior partition,the anterior half of the vertebral body was 144.76 ± 29.67 HU and the second half was 169.92 ± 32.82 HU.The left half 1/2 was 151.51± 31.18 HU and the right half 1/2 was 153.12±30.89 HU.In osteoporosis non-fractured vertebrae(L1 vertebrae):the upper 1/3 of the vertebral body was 59.52 ±11.17 HU,the middle 1/3 was 85.67±13.84 HU,and the lower 1/3 was 74.26 ±13.59 HU.CT mean of anterior and posterior vertebral body:the first half was 59.58 ± 10.12 HU and the second half was 81.88±14.06 HU.CT mean of left and right vertebral divisions,the left half 1/2 was 70.32 ± 10.88 HU and the right half 1/2 was 73.85±10.53 HU.Regional trend of upper,middle and lower CT values of the fractured vertebrae,the upper CT value is the highest,followed by the middle and lower parts.The CT value of the first half is lower than the second half of the second half,there is no significant difference in the left and right half CT values.Osteoporotic vertebral body without fracture(L1 vertebral body)CT partitioning trend:the highest in the middle and the lowest in the upper part,the CT value of the first half is lower than the second half,the left and right half is not significant.In the study of correlation between vertebral CT values and cement distribution after PVP:all 21 patients in the high CT value area injection group had disseminated postoperative bone cement distribution.In the 21 patients injected in the low CT value area,3 patients had diffusion distribution and 18 patients had non-diffusion distribution.The Spearman correlation coefficient was 0.886,indicating a significant positive correlation between bone cement distribution type and vertebral CT values after PVP.3.In the study based on Meta-analysis,a total of 12 Chinese and English literature were included.The statistical analysis concluded that Jintiange capsule can reduce the pain after PVA in OVCF patients,improve postoperative low back function,and improve postoperative vertebral BMD and serum BGP,which is expected to become an optional treatment for anti-osteoporosis treatment after PVA.4.In the study of improving bone mineral density in patients after PVP:the CT value of the observation group was 69.85 ± 9.87 HU and 93.63 ± 14.16 HU after treatment.The CT value was significantly higher than before treatment,greater than the CT value of the control group(p<0.05),suggesting that the capsule could improve the bone mineral density of patients after OVCF.In the observation group,the scores of chest pain,lumbar spine tingling,lumbar and knee tenderness,lower limb impotence,difficult walking,tinnitus and TCM symptoms were lower than that of the control group(p<0.05),and the clinical symptoms of patients with Jintiange capsule assisted PVP were significant.In the functional score,the VAS score and lumbar spine dysfunction index decreased after treatment compared with before treatment,and the JO A score increased after treatment than before treatment,and the observation group was more obvious compared with the control group.This indicates that the regular anti-osteoporosis treatment after PVP is effective in improving the lumbar spine function and relieving lumbar and back pain,and the observation group has obvious advantages over the control group.Conclusions:1.The vertebral CT value has high consistency with MRI in the diagnosis of fresh and old fractures of OVCF,and can accurately distinguish between fresh and old fractures by comparing the CT values of the target vertebra and the neighbors.2.①The regional CT values of the fractured and non-fractured vertebra(L1 vertebra)in OVCF patients showed an obvious distribution pattern:the upper part of the non-fractured vertebra(L1 vertebra)had the lowest CT value,and the middle part had the highest CT value.The CT value of the first half was lower than that of the second half.The upper part of the fractured vertebra had the highest CT value.The first half is lower than the second half.②There was a significant positive correlation between bone cement dispersion and vertebral CT value after vertebra plasty(r=0.886,p<0.05),and bone cement dispersion was more uniform in patients with high CT value after PVP injection.3.Based on Meta-analysis,it believe that Jintiange capsule can effectively reduce the pain after PVA in OVCF patients,improve postoperative low back function,and improve postoperative vertebral BMD and serum BGP.4.Jintiange capsule can improve bone density,improve clinical symptoms and low back function after PVP,and is an effective method for regular anti-osteoporosis treatment after OVCF and PVP.