| PartⅠ: Vertebroplasty Versus Conservative Treatment for Painful Osteoportic Vertebral Compression Fractures, Which One Is Better? --- A Meta-analysis【Objective】To perform a Meta-analysis to compare the clinical outcomes and complications of vertebroplasty versus conservative treatment for painful osteoportic vertebral compression fractures(OVCF).【Methods】MEDLINE, EMBASE databases and other databases were searched for all the relevant original articles published from January 1987 to March 2011 comparing vertebroplasty with conservative treatment For painful osteoportic vertebral compression fractures. Only randomized controlled trail (RCT), quasi-RCT, Prospective cohort studies are qualified to be enrolled in this meta-analysis. The following outcomes were mainly evaluated: Visual Analog Scale (VAS), vertebral height, deformity index, new vertebral fractures, complications and mortality.【Results】15 articles fulfilled all inclusion criteria. The baseline characteristics including sex, age, number of prevalent fractures, etc were comparable for both groups (P>0.05).VAS score for the vertebroplasty group was significantly low than the conservative treatment group at 1-3 days, 1 month, 3 months, 6 months and 1 year after surgery (P<0.05). At 2 years after surgery, there was no significant differences (P>0.05) for the VAS score. Vertebral height for the vertebroplasty group was significantly higher than the conservative treatment group at 1 week, 3months, 6months after surgery (P<0.05). Deformity index for vertebroplasty group was comparable with conservative treatment group at 6 months after surgery (P>0.05), but was signficantly lower at 1 year after surgery. There was no significant difference in the occurrence of new fractures of vertebral bodies and complication between them at 1-3 days, 1 month, 3 months, 6 months, 1 year and 2 years after surgery (P>0.05). The mortality for both group was comparable at 6 months, 1 year, 2 years after surgery (P>0.05), but the fracture-related death for the vertebroplasty group was significantly lower than the conservative treatment group (P<0.05).【Conclusions】Percutaneous vertebroplasty is eff ective and safe in the treatment of painful OVCF. Pain relief after vertebroplasty is immediate and sustained for at least a year.Part II: Kyphoplasty Versus Vertebroplasty for Painful Osteoportic Vertebral Compression Fractures, Which One Is Better? --- A Meta-analysis【Objective】To perform a Meta-analysis to compare the clinical outcomes and complications of kyphoplasty versus vertebroplasty for painful osteoportic vertebral compression fractures (OVCF).【Methods】MEDLINE, EMBASE databases and other databases were searched for all the relevant original articles published from January 1987 to March 2011 comparing kyphoplasty with vertebroplasty for painful osteoportic vertebral compression fractures. randomized controlled trail (RCT), quasi-RCT, prospective or retrospective cohort studies are qualified to be enrolled in this meta-analysis. The following outcome were mainly evaluated: visual analog scale (VAS), vertebral height, kyphosis angle, new vertebral fractures, cement leakage【Results】15 articles fulfilled all inclusion criteria. The baseline characteristics including sex, age, number of prevalent fractures, etc were comparable for both groups (P>0.05).VAS score for the kyphoplasty group was comparable with the vertebroplasty group at 1-3 days, 3 months, 6 months, 1 year and 2 years after surgery (P<0.05). Vertebral height for the kyphoplasty group was significantly higher than the Vertebroplasty group at 3 months, 6 months and 2 years (P<0.05). Kyphosis angle for kyphoplasty group was signficantly lower at 3 months, 6 months and 2 years (P<0.05). The occurrence of new vertebral fractures for kyphoplasty group had no significant difference with the Vertebroplasty group at 3 months, 6 months and 2 years (P>0.05). The occurrence of cement leakage was significanty lower than the Vertebroplasty group (P<0.05).【Conclusions】Percutaneous kyphoplasty is better than vertebroplasty in the treatment of painful OVCF. Kyphoplasty had better improvement at vas score, vertebral height and kyphosis angle with lower occurrence of cement leakage.Part III: Experimental Research about The Injection Technique of Cement in Kyhoplasty【Objective】To do a systematic and comprehensive experimental research using human specimens to find the best injection technique of cement in kyphoplasty.【Method】Using NXS-11A to test cement viscosity at 0°, 20°and 37°and get the rule of cement viscosity changing with time. Using human specimens as experimental subjects to test the volume of cement injected at different time points of injection and different rate of injection when cement leakage found. We also test the cement distribution in the vertebral body and studied changes of injection pressure during all the injection processes. We compared the volume of cement injected when cement leakage found using‘staged modulation staged injection technique’, using‘single modulation low-temperature staged injection technique’and‘single modulation single injection technique’.【Result】At 0°, 20°and 37°, bone cement viscosity were all increasing over time, and have a period of upheaval. However, low temperature significantly slowed the increase in viscosity bone cement process, significantly extending the dramatic changes period of cement viscosity. At 20°room temperature, with the increase of injection time point, the injected volume of bone cement had also continued to increase. Within the first 6min, volume of cement injected slowly increased, while, after 7min it significantly increased until the cement can not be injected due to high viscosity. 7min is the time when the volume of cement can dramatically increase. And with increasing over time, the distribution of cement in vertebral body became better with more regular shape. Injection pressure increased with time at the same injection rate. When the cement injection rate increased, the injection pressure also gradually increased, and the volume of cement continued to decline. The volume of cement injected was 5.11±0.47ml for the group using‘staged modulation staged injection technique’. It had no significantly different with 5.17±0.50ml for the group using‘single modulation low-temperature staged injection technique. They were both more than 4.35±0.46ml‘single modulation single injection technique’.【Conclusion】‘Proper time, Low Pressure, Slowly, Staged cement Injection Technique’should be used in kyphoplasty, which can greatly reduce the incidence of cement leakage.Part IV : Clinical Research about The Injection Technique of Cement in Kyhoplasty.【Objective】To prospectively compare kyphoplasty using‘Proper time, Low Pressure, Slowly, Staged cement Injection Technique’(‘Stage injection group’) with kyphoplasty using traditional injection technique(‘Traditional injection group’) for the treatment of osteoporotic vertebral compression fractures.【Methods】The study population included 129 patients (160 vertebral fractures) in the‘Stage injection group’and 105 patients(128 vertebral fractures) in the‘Traditional injection group’. The mean follow-up period was 25.3 months and 24.7 months respectively. The baseline characteristics including sex, age, number of prevalent fractures, etc were comparable for both groups. Outcomes were measured pre- and postoperatively using VAS, ODI, the anterior vertebral height, the kyphosis angle, the occurrence of new vertebral fractures and cement leakage .【Results】In the‘Stage injection group’, VAS improved from 7.8±1.3 preoperatively to 2.1±1.9 at last follow-up (P <.05). Preoperatively, the ODI was 77.3±5.9, which improved to 39.7±9.7 (P <.05). The anterior vertebral height improved from (61.5±5.7)% preoperatively to (84.6±2.9)% at last follow-up(P <.05). The kyphosis angle improved from 17.9~0±7.8~0 to 0.5~0±7.5~0 at last followu-up(P < .05). In‘Traditional injection group’, VAS improved from 7.5±1.6 to 2.3±2.5 at last follow-up (P <.001). Preoperatively, the ODI was 75.3±7.2, which improved to 38.7±10.9 (P <.05). The anterior vertebral height improved from (63.9±6.5)% preoperatively to (83.1±6.2)% at last follow-up (P <.05). The kyphosis angle improved from 18.3~0±8.5~0 to 8.7~0±6.5~0 (P < .05). There was no significant difference in VAS, ODI, the anterior vertebral height and the kyphosis angle between the two groups both preoperatively and postoperatively (P >0.05). There was no significant difference in the occurrence of new fractures of vertebral bodies of the‘Stage injection group’(7.8%) versus the‘Traditional injection group’(7.6%). There were only 3 patients having cement leakage (2.3%) in‘Stage injection group’, which was significantly less than‘Traditional injection group’(8 patients, 7.6%) (P <.05).【Conclusions】Both kyphoplasty using‘Proper time, Low Pressure, Slowly, Staged cement Injection Technique’and kyphoplasty using traditional injection technique are effective at improving pain, functional disability, vertebral height and kyphosis angle; however, kyphoplasty using‘Proper time, Low Pressure, Slowly, Staged cement Injection Technique’has significantly less cement leakage. |
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