Efficacy of enhancement treatment on osteoporotic vertebral compression fracture and its complications in the elderly / 中华老年医学杂志

ABSTRACT

Objective To investigate the efficacy of the enhancement treatment on osteoporotic vertebral compression fracture and its complications in the elderly.Methods From September 2007 to February 2012,183 patients with osteoporotic vertebral compression fracture underwent percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) in our department.157 of them were completely followed up (PKP group,n=96; PVP group,n=61) and totally 182 vertebral bodies were fractured (PKP group,n=107; PVP group,n=75).Visual analogue scale (VAS) score and Oswestry disability index (ODI) score were evaluated before and 3 days and 3 months after the surgery.Plain film radiography was taken to evaluate the vertebral body height.ODI score was evaluated at the end of the follow-up.The leakage of polymethylmethacrylate (PMMA) during the operation and the refracture were recorded.Results The mean height of the vertebral body before operation had no difference between PVP and PKP group [(1.31±0.18) cm vs.(1.32±0.16) cm,t =0.72,P＞0.05].After the operation,the mean height of the vertebral body was lower in PVP group than in PKP group [(1.50±0.20) cm vs.(1.66±0.17) cm,t=2.28,P＜0.05].The mean amount of the PMMA injected into the vertebral bodies was less in PVP group than in PKP group [(2.93±0.34) ml vs.(3.34±0.49) ml,t=2.39,P＜0.05].In the PVP group,the VAS scores were (7.5±0.79),(3.0±0.6) and (1.9±0.9) before,3 days and 3 months after operation respectively,and there was a significant difference in VAS score before versus 3 days after operation (t =15.59,P＜0.05).In thePKPgroup,the VAS scores were (7.3±1.0),(3.0±0.8) and (2.2± 0.9)before,3 days and 3 months after operation respectively,and there was a significant difference in VAS score before versus 3 days after operation (t=10.69,P＜0.05).In the PVP group,the ODI scores were (78.9±7.3),(30.0±3.7) and (25.5±3.5) before and 3 months after operation and at the end of follow-up respectively,and there were significant differences in ODI score before operation versus 3 months after operation (t=20.83,P＜0.01) and 3 months after operation versus at the end of follow-up (t=4.03,P＜0.05).In the PKP group,the ODI scores were (78.8±6.8),(29.8±4.43) and (23.8 ± 2.7) before operation,3 months after operation and at the end of follow-up respectively,and there were significant differences in ODI score before operation versus 3 months after operation (t=21.52,P＜0.01) and 3 months after operation versus at the end of follow-up (t=3.14,P＜0.05).There were no significant differences in VAS and ODI scores between the two groups before versus after operation (t=0.34,P＞0.05).The incidence of refracture was 8.2％ in PVP group and 9.4％ in PKP group,which had no statistical difference between the two groups(x2 =0.06,P＞0.05).All the leakage was asymptomatic.The incidence of PMMA leakage was 20.0％ (15 cases) in PVP group and 9.3％ (10 cases) in PKP group,which had a statistical difference between the two groups (x2 =4.22,P ＜ 0.05).Conclusions Enhancement treatment for osteoporotic vertebral compression fracture can quickly relieve the pain and improve the quality of life.PKP and PVP show no differences in the effect of analgesia and the improvement of life quality,but PKP has the advantages in recovering vertebral height and reducing PMMA leakage.