Efficacy comparison between simulated optimization methods combined with percutaneous vertebroplasty and percutaneous kyphoplasty for osteoporotic thoracolumbar fracture / 中华创伤杂志

ABSTRACT

Objective@#To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF).@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015. There were 54 males and 82 females, aged 55 to 83 years old, with an average age of 68.3 years. All the enrolled patients had single segment vertebral compression fractures, whose compression degree was ≥1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies. Among them, 59 patients were treated with simulated optimal reduction combined with PVP (PVP group), and 77 patients were treated with PKP (PKP group). The operation time, intraoperative fluoroscopy time, incidence of bone cement leakage, hospitalization cost and length of stay were compared between the two groups. Postoperative X-ray and CT examination were performed to observe bone cement diffusion. Before surgery and after surgery (1 day, 1 week, 1 month, 6 months, 1 year, 2 years and 3 years), Visual analogue scale (VAS) score, Oswestry disability index (ODI) scores, Cobb's angle, ratio of anterior and middle height of the affected vertebrae, and the incidence of vertebral refractures within 3 years were compared between the two groups.@*Results@#All the patients were followed up for 29-43 months, averaging 36 months. One patient in the PVP group was lost to follow-up after one year. In the PKP group, two patients were lost to follow-up after one year and one patient was lost to follow-up after two years. In the PVP group, single vertebral body operation time [(28.9±5.7)seconds] and intraoperative fluoroscopy time [(54.0±13.4)seconds] were significantly less than those in the PKP group, with statistically significant differences (P<0.01). The incidence of bone cement leakage in the two groups was 8.5% and 7.8%, respectively, with no significant difference (P>0.05). The hospitalization cost in the PVP group [(9.7±3.2)thousand yuan] was lower than that in the PKP group [(22.35±16.2)thousand yuan](P<0.01). The diffusion coefficient in PVP group (2.40±0.27) was higher than that in the PKP group (2.29±0.19) (P<0.01). In both groups, the fractured vertebral anterior height ratio, fractured vertebral middle height ratio and Cobb's angle were significantly improved after operation (P<0.01), while there were no significant differences between the two groups (P>0.05). In both groups, the VAS and ODI were significant decreased after operation (P<0.01). Better results were obtained in PVP group than the PKP group concerning the VAS [(2.5±0.8)points vs. (2.6±0.9)points, (2.7±0.3) points vs. (2.8±0.5)points, (2.8±0.6) points vs. (2.9±0.7)points] and ODI [(25.3±4.0 vs. 25.5±3.9, 25.8±4.1 vs. 27.5±4.0, 26.0±2.9 vs. 28.6±3.9)] at postoperative 1, 2 and 3 years, and there were no significant difference between the two groups at postoperative 1 day, 1 week, 1 month and 6 months (P>0.05). The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in the PKP group (0 vs. 1.3%)(P<0.01).@*Conclusion@#For OVCF, the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP, but the recovery of height of diseased vertebra and correction of kyphosis are better, with lower re-fracture rate of adjacent vertebra in the later stage.