The Study Of Clinical Classification And Recommendation Of Surgeries Of Osteoporotic Vertebral Compression Fractures Based On Extent CT Scans

Objective1. To compare the clinical effects of PVA treating OVCFs including PVA vs consevative treatment and PVP vs PKP through meta-analysis.2. To analyze the correlative factors of the height reduction of index vertebra of patients suffering OVCFs by extent CT scans and to introduce the new classification of OVCFs and suggestion of treatment elections.BackgroundFormer Classifications of OVCFs are based on the natural progress, not on treatment suggestion. Although the clinical effects of PVA are widely accepted, there are still some arguments:1.What are the best indications for PVP and PKP;2. Whether or not the morphology of the index vertebra affect vertebrae reduction;3. What are the correlative factors of reduction potentials of the index vertebra, and whether reduction potentials are related to TCM syndromes. This study is planned to solve the arguments by a meta-ananlysis and a clinical study so as to improve decision makings in OVCFs treatment.Methods1. Article Reviews (meta-analysis)13prospective articles were collected by searching in Pubmed database and references of reviews and system analysis, which were related to12clinical trials. There were7articles referred to PVA vs conservative therapies and6refrred to PVP vs PKP. The compared items of the meta-analysis included pains (VAS), functional disability(mRDQ), quality of life(EQ-5D), incidence of adjacent vertebral fractures, cement leakage, local Cobb angel of index vertebra, postop index vertebra heights(IVH). The quality of the articles were assessed by two independent researchers.2. Clinical Study149patients of OVCFs at T12or LI were retrospectively enrolled. All patients accepted extent CT scans preoperatively and were treated with PVP or PKP. Fractures were divided into2types according to severity of compression. Type A:improvement of IVH in extent position was no less than30%of original height, and type B:improvement of IVH was less than30%of original height. Patients were divided into2groups according to fracture types. Patients in each groups were divided into2subgroups by difference of surgeries. Finally, there were4groups:Group Vr, type A and PVP; Group Vi, type B and PVP; Group Kr, type A and PKP; Group Ki, type B and PKP. VAS, ODI scores, IVH preop and postop, fracture morphology, cement leakage, rvertebral refracture and TCM syndromes. The correlations of fracture reduction and fracture morphology were analyzed. The classification of OVCFs based on extent CT scans was discussed.Results1. Articles Review(meta-analysis)1) PVA vs conservative therapies7articles containing879patients were included. Compared with conservative therapies, those who accepted PVA got significant less pains[MD=0.68,95%CI (0.14,1.23)] and better QoL[MD=0.03,95%CI (0.01,0.05)], while no statistical differences in functional disability [MD=0.0395%CI(0.01,0.05)] and adjacent fracture[OR=0.87,95%CI (0.40,1.87)].2) PVP vs PKP6articles containing587patients were enrolled, which were all non-randomized prospective clinical trials. Compared with PVP, PKP had a lower risk of cement leakage[OR=0.48,95%CI(0.30,0.76)], while no significant differences in postop IVH[MD=-0.30,95%CI (-2.32,1.71)] and local Cobb angel[MD=-1.79,95%CI(-3.88,0.30)] of index vertebra and risk of adjacent fracure[0R=1.38,95%CI (0.72,2.62)].2. Clinical StudyAll196patients were separated into4groups:52in PVP with type B (Vi),50in PVP with type A (Vr),24in PKP with type B and23in PKP with type A. The baseline of patients in4groups were familiar. Preop standing IVH were statistically lower than that in preop extent and postop standing position in groups of Vi, Vr and Kr(P<0.05). In Ki group, preop standing and extent IVH were statistically lower than that in postop. standing position(P<0.05). More improvement of IVH in PKP group was found than that in PVP group(P<0.05), while there was no significant difference in improvement of IVH between group Vr and Kr(P>0.05). In Ki group,10patients got satisfied reduction of IVH by PKP, while14didn’t. The former patients had younger age, more severe compression of IVH, higher bone density than the latter. The protection factor of satisfied reduction in extent position was disease duration<14d(OR:=0.06); and the risk factors were bone density≥-3.5(OR=3.0) and separated fracture(OR=3.0). The risk factors of impact fracture were:unsatisfied reduction in extent position(OR=4.3), disease duration<14d(OR=6.1) and low ODI scores(30-65)(OR=4.3), and protection factor was bone density≥-3.5(OR=0.3).Conclusion1. Articles Review(Meta-Analysis)Compared with conservative therapies, PVA is better in pain reduction and QoL improvement, while no vital differences in function disability improvement and adjacent fractures. The clinical effects of PVA are better than conservative therapies. PKP and PVP are similar in vertebra reduction and adjacent fracture. Cement leakage of PKP is significant lower than PVP.2. clinical study1) Based on extent CT scans, OVCFs could be divided into3types:Type A:patients with satisfied extent reduction(heights improvement^30%original heights), PVP is suggested.Type Bl:patients with bad extent reduction(height improvements<30%original heights), older in age, light compression and moderate osteoporosis are less possible to achieve satisfied reduction through ballon tamp. PVP is suggested.Type B2:patients with bad extent reduction(height improvements<30%original heights), younger in age, severe compression and severe osteoporosis could achieve reduction through ballon tamp. PKP is suggested.2) Risk factors of satisfied extent reduction are:disease duration≥14d, severe osteoporosis(BMD≥-3.5) and separated fracture of index vertebra.