| Objective:The purpose of this study was to investigate the clinical efficacy of percutaneous vertebroplasty based on various improved methods in the treatment of senile osteoporotic thoracolumbar burst fractures.Methods:Forty-six elderly patients with osteoporotic thoracolumbar burst fractures（OTBF）treated in the spine surgery department of our hospital from January 2017 to January 2021 were selected as the research objects.All of them were treated with percutaneous vertebroplasty,combined with various improved methods such as postural reduction,manual reduction,sealing fracture gap with gelatin sponge,high viscosity bone cement,fractional injection of bone cement and so on.All patients were followed up regularly after operation,and guided to carry out standardized anti osteoporosis treatment.The general data of patients were recorded,including gender,age,bone mineral density,injury factors and postoperative hospital stay;Operation related indexes include operation segment,operation time,amount of bone cement injection and postoperative complications;The clinical evaluation indexes included VAS score,ODI index and Asia neurological function grade before operation,the first day after operation,3 months after operation and the last follow-up;The imaging evaluation indexes included the anterior,middle and posterior vertebral height,Cobb angle and bone cement leakage of the injured vertebrae in the lateral films of thoracolumbar spine before operation,on the first day after operation and at the last follow-up.All evaluations are completed by two researchers independently,and the average value is taken to ensure the accuracy of the evaluation.When there are different views on the qualitative evaluation,the researchers with higher professional titles are invited to make the final judgment.Statistical methods were used to compare the data before operation,the first day after operation,3 months after operation and the last follow-up.Results:All 46 patients completed the operation successfully,and the follow-up data were complete.The follow-up time was 12-26 months,with an average follow-up time of（16.38.3 ± 3.66）months.The follow-up results showed that the VAS scores（2.68 ± 0.62）,（1.18 ± 0.59）and（1.07 ± 0.68）at the first day,three months and the last follow-up were significantly lower than those before operation（7.43 ± 1.22）（P<0.05）.The VAS scores at the third month after operation were further lower than those on the first day after operation（P<0.05）.There was no significant change at the last follow-up（P>0.05）.The ODI scores（37.32%±4.34%,23.36%±5.42%,22.97%±5.38%）on the first day after operation,three months after operation and the last follow-up were significantly lower than those before operation（73.57%±3.74%）（P<0.05）.The ODI scores at the third month after operation were further lower than those on the first day after operation（P<0.05）.There was no significant change at the last follow-up（P>0.05）.The Asia neurological function classification of all patients at each follow-up time point before and after operation was grade E.The height of anterior edge of vertebral body relative to vertebral body before operation,on the first day after operation and at the last follow-up were 65.91%±8.79%,91.90%±4.88%and 90.50%±5.45%respectively;The relative vertebral height in the middle of vertebral body was 64.27%±6.25%,90.32%±5.16%and 89.78%±4.65%respectively before operation,on the first day after operation and at the last follow-up;The relative height of vertebral posterior margin before operation,the first day after operation and the last follow-up were 64.71%±6.35%,90.49%±4.46%and 89.77%±4.10%respectively.On the first day after operation,the relative vertebral height of each part（anterior,middle and posterior edge）was significantly higher than that before operation（P<0.05）;Although the height of the last follow-up was slightly lost,it was still significantly improved than that before operation（P<0.05）,and there was no significant difference compared with the first day after operation（P>0.05）.The Cobb angle（6.71°±1.17°,6.90°±11.30°）was significantly improved on the first day after operation and at the last follow-up compared with that before operation（16.22°±12.05°）,and the difference was statistically significant（P<0.05）;There was no significant difference between the last follow-up and the first day after operation（P>0.05）.Eight patients（17.39%）had bone cement leakage,and there were no serious complications such as bone cement embolism and neurological symptoms caused by bone cement leakage.Conclusion:Combined with a variety of improved methods,percutaneous vertebroplasty is used to treat senile osteoporotic thoracolumbar burst fractures.It has reliable curative effect,relatively safe and obvious economic benefits,which is conducive to improving the quality of life of patients. |
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