| BackgroundOsteoporosis is the frequent disease of old ages, expecially occurs in the post-menopause old females, and the vertebral compression fracture is the most common complication of osteoporosis. Along with the aging frequency of the social populacation, the amount of osteoporosis patient increased gradually, and the thoracic and lumbar compression fracture increased accordingly. With regard to the old age osteoporosis compression fracture, the conservative treatment was the common method formerly. But the body constitution of the old ages are not good commonly, they often have many complications, the rate of complications is high. However, the surgery method has more trauma and more risk. The tolerance of the surgery and anesthesia of the old ages is not good, many patient can not tolerant or accept the traditionary open surgery method. So, how to take a more minimal injury and more effective treatment become an important topic of the therapy of thoracic and lumbar compression fracture.The French neuroradiologist adopted the percutaneous vertebroplasty to treat the cervical vertebral angeioma first and achieved big success. Afterward, the percutaneous vertebroplasty was adopted to treat the vertebral compression fracture and vertebral tumor gradually. Later, with the basis of the percutaneous vertebroplasyty, the percutaneous kyphoplasty and Sky kyphoplasty were designed and applicated. Also, some scholar adopted the manipulative reduction unioned percutaneous verteoplasty to treat the vertebral fracture and accepted good effect too. But, many question involved the percutaneous vertebroplasty was not certain. For example, the questions of which vertebroplasty style is better, one side and two side approach which is better, more or less bone cement infusing in is better, the therapeutic efficacy of the bone cement dispersing style remains many controversy. Through analyzing and studying the recent year therapeutic data of our hospital, we proposed our opinion and the choice rules about the percutaneous vertebroplasty.Objective1To observe the therapeutic efficacity and the radiological exposure of different percutaneous vertebroplasty style.2To observe the therapeutic efficacity and bone cement leak rate of different bone cement disperse style.3To observe the therapeutic efficacity of single or doule side vertebral approach style.4To observe the therapeutic efficacity and bone cement leak rate of different bone cement infusing quantity.5Through the observation of all sorts of indicatrix, evaluate and guide the choice of different vertevroplasty style.Method1The clinical application comparison of PVP, PKP and manipulative reduction PVPReview the case of osteoporosis first lumbar vertebral fracture between Sep.2010to Sep.2012accepted double-side approach PVP, PKP and manipulative reduction PVP in our orthopaedics department, observe the VAS score, the Cobb’s angle improvement rate,the JOA score,the bone cement disperse style,the bone cement leak rate, the radiological exposure, the operation time and the tolerant competence of the patient, then analyse the data statistically. 2The effect of different bone cement disperse style to therapeutic efficacityReview the osteoporosis thoracic and lumbar vertebral compression fracture cases which accepted the single-side approach PVP and taken the anteroposterior position and lateral position DR picture. Calculate the area of the disperse district and the bolus district with the Auto CAD2007graphic processing soft and calculate the ratios of the two district and classify the cases to3type according to the ratios. Observe the VAS Score, the vertebral height compression rate, the JOA score and the cement leak rate, then analyse the data statistically.3The clinical application comparison of double-side and single-side vertevral approach PVPReview the cases of twelfth thoracic vertevral and first lumbar vertebral compression fracture which accepted the double-side or single-side approach PVP, Observe the VAS score, vertebral height compression rate, JOA score, the radiological exposure, the operation time and tolerant competence of the patient, analyse the data statistically.4The clinical application comparison of different bone cement quantityReview the cases of first lumbar vertebral compression fracture which accepted the double-side approach PVP with small bone cement quantity or large quantity, Observe the VAS score, vertebral height compression rate, JOA score,the bone cement leak rate and the blood pressure descending,analyse the data statistically.Result1The clinical application comparison of PVP, PKP and manipulative reduction PVP The VAS score shows the significant different inside any group compared with the preoperative and postoperative score (=2.712, P<0.05; t2=2.608, P<0.05; t3=2.679, P<0.05). But there is no significant different among3groups preoperatively and postoperatively (F,=2.326, P>0.05; F2=2.075,P>0.05)the Cobb’s angle measurement shows the significant different inside any group compared with the preoperative and postoperative value (t1=2.698,P<0.05;t2=2.953, P<0.05; t3=3.107, P<0.05). And there is no significant different among3groups preoperatively (F,=2.373, P>0.05), But there is significant different of the Cobb’s angle improvement rate among3groups postoperatively (F2=2.865, P<0.05) Compared with each other, there is significant different between PVP and manipulative PVP group or PVP and PKP group, no significant different between PKP and manipulative groups.The JOA score shows the significant different inside any group compared with the preoperative and postoperative score (t1=3.118, P<0.05; t2=2.976, P<0.05; t3=2.853,P<0.05). But there is no significant different among3groups preoperatively and postoperatively (F,=2.413, P>0.05; F2=2.652, P>0.05)。The fineness rate among3groups has no significant different (X2=1.853, P>0.05)The bone cement disperse style composition among3groups is significant different (X2=17.631, P<0.05). the bone cement leak rate shows no significant different among3groups (X2=2.633, P>0.05) The radiological exposure shows significant different among3groups (F,=12.751, P<0.05). Compared with each other, there is significant different between each2groups, the PVP group shows the least exposure, the PKP group shows the most exposure.the operation time shows significant different among3groups (F=11.652, P<0.05). Compared with each other, there is significant different between each2groups, the PVP group shows the least operation time, the PKP group shows the most operation time. The tolerant competence of the patient shows significant different among3groups (X2=7.623, P<0.05), the PVP group shows the best tolerance.2The effect of different bone cement disperse style to therapeutic efficacityThe VAS score shows the significant different inside any group compared with the preoperative and postoperative score (t1=2.724, P<0.05; t2=3.159, P<0.05;t3=3.263,p<0.05). But there is no significant different among3groups preoperatively and postoperatively (F,=2.357, P>0.05; F2=2.289, P>0.05)the vertebral compression rate shows the significant different inside any group compared with the preoperative and postoperative value (t,=2.963, p<0.05; t2=3.027, p<0.05; t3=2.726, p<0.05). And there is no significant different among3groups preoperatively (F1=2.238, P>0.05), there is significant different among3groups postoperatively (F2=6.351, p<0.05).Compared with each other, there is significant different between PVP and manipulative PVP group or PVP and PKP group, no significant different between PKP and manipulative groups.The JOA score shows the significant different inside any group compared with the preoperative and postoperative score (t1=2.983, p<0.05; t2=3.125, P<0.05; t3=3.257, P<0.05). But there is no significant different among3groups preoperatively and postoperatively (F1=1.867, P>0.05; F2=2.113, P>0.05). The fineness rate among3groups has no significant different (X2=0.846, P>0.05)The bone cement leak rate shows no significant different among3groups (X2=1.536, P>0.05)3The clinical application comparison of double-side and single-side vertevral approach PVPThe VAS score shows the significant different inside any group compared with the preoperative and postoperative score (t1=3.231, P<0.05; t2=3.352, P<0.05). But there is no significant different between2groups preoperatively and postoperatively(t1=3.231, P<0.05; t2=3.352, P<0.05)The vertebral compression rate shows the significant different inside any group compared with the preoperative and postoperative value (t1=3.389,P<0.05;t2=3.265, P<0.05).And there is no significant different between2groups preoperatively and preoperatively (t1=1.574, P>0.05; t2=1.692, P>0.05)The JOA score shows the significant different inside any group compared with the preoperative and postoperative score (t1=3.236, P<0.05; t2=3.186, P<0.05). But there is no significant different between2groups preoperatively and postoperatively(t1=1.358, P>0.05; t2=1.524, P>0.05). The fineness rate between2groups has no significant different (u=1.156, P>0.05)The radiological exposure time and dose area product show significant different between2groups (t1=3.164, P<0.05; t2=3.235, P<0.05), the single-side approach PVP group shows the less radiological exposure. The operation time shows significant different between2groups (t=4.635, P<0.05), the single-side approach PVP group shows the less operation time. The tolerant competence of the patient shows significant different between2groups (X2=4.157, P<0.05),the PVP group shows the better tolerance.4The clinical application comparison of different bone cement quantityThe VAS score shows the significant different inside any group compared with the preoperative and postoperative score(t1=3.168, P<0.05;t2=3.563, P<0.05). But there is no significant different between2groups preoperatively and postoperatively(t1=1.231,P<0.05; t2=1.352,P<0.05)The vertebral compression rate shows the significant different inside any group compared with the preoperative and postoperative value (t1=2.653,P<0.05; t2=3.117,P<0.05).And there is no significant different between2groups preoperatively and preoperatively (t1=1.365, P>0.05; t2=1.286, P>0.05)The JOA score shows the significant different inside any group compared with the preoperative and postoperative score (t1=3.974, P<0.05; t2=3.821,P<0.05). But there is no significant different between2groups preoperatively and postoperatively(t1=1.532, P>0.05; t2=1.163, P>0.05).The fineness rate between2groups has no significant different (u=0.956, P>0.05)The bone cement leak rate shows significant different between2groups (X2=4.936, P<0.05), infusing more bone cement quantity can increase the leak rate.The blood pressure of some patients descended slightly during the operation, but no serious blood pressure descending to shock in any case.Conclusion1The clinical therapeutic efficacity is similar among the PVP, PKP and manipulative PVP, but the PVP method shows better operation tolerance, less operation time and radiological exposure. The PKP method is some better in kyphosis correcting.2The bone cement disperse style makes no different effect to therapeutic efficacity in early term.3The single-side approach shows the equivalent efficacity as the double-side approach, but the single-side approach shows the better operation tolerance and less operation time, less radiological exposure.4More or less bone cement infusion quantity during the operation may creat the similar therapeutic effect, but the more quantity makes higher bone cement leak rate.5The simple PVP can be used in treating the osteoporosis vertebral compression fracture and get satisfied therapeutic efficacity. It can increase the operationg tolerance and decrease the radiological exposure, much applicable to old ages.6The choice of operation style depends on the specific patient and specific circumstance. If the operation index is approciated, the technique is skilled, the operation procedure is monitored well, the therapeutic outcome will be good. |
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