| Objective1、Based on the follow-up data of large cases and finite element study,designed the“Anchor Injection Method”,the clinical efficacy and mechanism for two complex types of osteoporotic vertebral compression fractures:ruptured OVCFs and Kümmell’ disease were observed under theory of the traditional Chinese medicine“stability differentiation”,in order to restore vertebral stability.2、Based on the theory of the traditional Chinese medicine“tendon-bone stability syndrome differentiation”,investigate the clinical efficacy of massage combined with moxibustion in the treatment of postoperative pain after PVP,in order to enrich the theory of“stability syndrome differentiation”in Chinese orthopedics.Methods1.Part Ⅰ:The clinical data of patients who underwent bilateral PVP treatment with front-opening annulas in the Liuzhou Traditional Chinese Medical Hospital(Liuzhou Traditional Chinese Zhuang Medical Hospital)from August 1.2017 to December 31,2019 due to osteoporotic vertebral compression fractures were retrospectively analyzed.According to the inclusion criteria and exclusion criteria,225 patients were included and divided into postoperative new adjacent vertebral fracture group(group A,42 patients)and postoperative non-fracture group(group B,183 patients)during 24 months follow-up period.Observation factors of the 2 groups include:patient gender,age,bone density,the severity of the fractured vertebral body,the history of the fractured vertebrae,the segments of PVP,the average amount of cement injection,types of bone cement distribution,the leakage of bone cement,contact of bone cement with fractured endplate、the injury of the upper and lower discs of the vertebrae.2.Part Ⅱ:We selected a female patient with osteoporotic vertebral compression fracture and obtained CT data of the thoracolumbar region.Some softwares such as Mimics 19.0、Geomagic Studio 2015、3D Slicer 5.0.2、Solid Works 2021 and Hypermesh 2019 were used to construct a T12 fracture model,the material properties of cancellous units in the vertebral body were replaced by 2 cylindrical PMMA unites,each one is 2mL typically.the finite elements of T12 vertebral functional unit compression fracture and 4 types of bone cement dispersion were established.The stress distribution of the thoracolumar model under different pressures and loads was observed.3.Part Ⅲ:The clinical data of patients in the Liuzhou Traditional Chinese Medical Hospital(Liuzhou Traditional Chinese Zhuang Medical Hospital)from January 1,2019 to December 31,2020 due to OVCFs of cortical defect were retrospectively analyzed.According to the inclusion criteria and exclusion criteria.91 patients were included.All patients received bilateral PVP treatment with anchor injection method.Side-opening cannulas were used in 30 cases,side-opening and front-opening cannulas were used in 30 cases,front-opening cannulas were used in 31 cases.patient gender,age,bone density,the segments of PVP,the severity of the fractured vertebral body,the amount of cement injection,the leakage of bone cement,the distribution of inhomogeneous cement,the Cobb angle of the affected vertebra,the recovery of the leading edge height of the affected vertebra,VAS scores,ODI scores,incidence of new adjacent vertebral fractures after surgery were observed.4.Part Ⅳ:This study was a prospective study.The clinical data of patients in the Liuzhou Traditional Chinese Medical Hospital(Liuzhou Traditional Chinese Zhuang Medical Hospital)from November 24.2021 to January 31,2023 due to Kümmell’s disease were analyzed.According to the inclusion criteria and exclusion criteria,76 patients were included and divided into Huayu Bushen PVP group(extracting liquid from IVC,Huayu Bushen decoction was given after operation,38 patients)and normal PVP group(receiving PVP only,38 patients)during 6 months follow-up period.patient gender,age,bone density,anterior vertebral height compression rate,anterior vertebral height before operation,the amount of cement injection,the leakage of bone cement,severe inhomogeneous cement distribution,new adjacent fracture,the loosening of bone cement,VAS scores,ODI scores,the Cobb angle of the affected vertebra,the leading edge height of the affected vertebra,were observed.5.Part Ⅴ:The clinical data of patients in the Liuzhou Traditional Chinese Medical Hospital(Liuzhou Traditional Chinese Zhuang Medical Hospital)from January 1,2017 to June 30,2022 due to postoperative pain after percutaneous vertebroplasty were retrospectively analyzed.According to the inclusion criteria and exclusion criteria,70 patients were included.All patients were divided into 2 groups,the treatment group(massage and moxibustion group,35 cases)and the control group(oral NSAIDs drugs group,35 cases).The treat-ment group was treated with massage、moxibustion and oral NSAIDs drugs,once a day.The control group was only given NSAIDs drugs once a day.The treatment course of both groups was 5 days.the VAS scores.ODI scores,effective rate,were observed.Results1.Part Ⅰ Statistical analysis showed that age,sex,bone mineral density,bone cement injection volume,bone cement leakage,the severity of the fractured vertebral bodysymmetrical cement distribution were not the variables associated with new adjacent vertebral fracture after PVP(P>0.05).Statistical analysis indicated that severe inhomogeneous cement distribution,unsatisfactory endplate cement augmentation,and the number of hospitalization for multiple fractures were significantly associated with new adjacent vertebral fracture after PVP(P<0.05).2.Part Ⅱ:For the 4 finite element models,maximum von Mises stress and maximum displacement were increased significantly after PVP in uneven cement filling model,similar changes could be seen in the compressive load and displacement curve of bone cement.Uneven cement filling could influence the stability of fractured vertebral body.3.Part Ⅲ:The front-opening cannulas group incurred significantly less bone cement voluble injection and higher incidence of new adjacent vertebral fractures after surgery,than the other groups(P<0.05).There were no significant differences between the 3 groups in vertebral height restoration,kyphosis correction,cement leakage,VAS scores and ODI scores(P>0.05).4.Part Ⅳ:The VAS scores of the Huayu Bushen PVP group were significantly improved on the second day、2 weeks、4 weeks and 3 months after surgery compared with the normal PVP group(P<0.05).The ODI scores of the Huayu Bushen PVP group were significantly improved on the 2 weeks、4 weeks and 3 months after surgery compared with the normal PVP group(P<0.05).The Cobb angle in the Huayu Bushen PVP group were more stable than the normal PVP group on 6 months after surgery(P<0.05).5.Part Ⅴ:After one course of treatment,the ODI scores in the treatment group were significantly improved compared with the control group,and the difference was statistically significant(P<0.05).Conclusion1.Part Ⅰ:Severe inhomogeneous cement distribution,unsatisfactory endplate cement augmentation and the number of hospitalization for multiple fractures are among the risk factors for new adjacent vertebral fractures after PVP.2.Part Ⅱ:Three-dimensional finite element study suggests that inhomogeneous distribution of bone cement has a certain effect on the stability of fractured vertebrae.3.Part Ⅲ:PVP based on“Anchor Injection Method”is an effective method in the treatment of OVCFs with cortical defect.Both the side-opening and side-opening+front-opening annulas approachs of PVP can achieve more satisfactory cement injection than front-opening cannulas approach,and have a lower incidence of new adjacent vertebral fractures after surgery.4.Part Ⅳ:Huayu Bushen PVP group can significantly alleviate the pain of patients with KD and obtain better clinical efficacy,compared with the normal PVP group.5.Part Ⅴ:The combined application of moxibustion and massage therapy according to the theory of stability syndrome differentiation in Chinese Orthopedics can achieve a better clinical efficacy. |
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