Comparative Study On The Treatment Of Bone-setting Manipulative Reduction Combined With Percutaneous Kyphoplasty And Percutaneous Kyphoplasty On Osteoporotic Vertebral Compression Fractures

Objective: To evaluate and compare the curative effect and application prospects ofmanipulative reduction of vertebral body combined with percutaneous kyphoplasty(PKP) and percutaneous kyphoplasty for treatment of osteoporotic vertebralcompression fractures (OVCF)Materials and Methods: This study retrospectively analyzed27patients (34vertebrae)of osteoporotic vertebral compression fractures between September2011and December2013treated spine surgery at the first Affiliated Hospital of Dalian Medical University.6male and21female patients with an average age of72.3years (51-80years). Twogroups were randomly divided according to different surgical methods: Group Aincluded12cases (14vertebrae) treated with hyperextension manipulative reductioncombined with percutaneous kyphoplasty,&Group B included15cases (20vertebrae)treated with percutaneous Kyphoplasty alone. Both underwent bilateral pedicle punctureand bilateral expansion kyphoplasty. The two groups were compared using VAS painscore, Oswestry Disability Index, pre and post-operative vertebral height and Cobbangle, operative time, intraoperative amount of bone cement, bone cement leakagesituation. Results:1. The visual analog scale (VAS)Manipulative reduction combined with percutaneous kyphoplasty group:1day beforesurgery VAS score was (8.4±1.4) points,1day after surgery VAS score was (2.5±0.8)points, VAS scores was significant differences between pre-operative and postoperative(P <0.01).Kyphoplasty alone group:1day before surgery VAS score was (8.3±0.9) points,1dayafter surgery VAS score was (2.9±0.8) points, VAS scores was significant differencesbetween pre-operative and postoperative (P <0.01).Pre-operative and postoperative VAS scores showed no significant difference (P>0.05).There were no significant differences between2groups in relieve pain symptoms.2. Oswestry disability indexManipulative reduction combined with percutaneous kyphoplasty group: preoperativeOswestry score was (73.2±10.9),1day after surgery Oswestry score was (21.4±6.3),preoperative and postoperative Oswestry score was statistically significant (P <0.01).Kyphoplasty alone group: preoperative Oswestry score was (75.1±12.8),1dayaftersurgery Oswestry score was (22.0±5.1), preoperative and postoperative Oswestryscore was statistically significant (P <0.01).Oswestry Disability Index showed no significant difference between the two groups (P>0.05).Both groups effectively restored spinal function, there was no significant differencebetween the two groups.3. anterior vertebral height, central heightManipulative reduction combined with percutaneous kyphoplasty group: preoperativeanterior and central heights were16.4±2.3(mm)、18.6±2.2(mm)respectively;intraoperative anterior and central heights were22.4±3.7(mm)、25.1±2.4(mm)respectively;1day postoperative anterior and central heights were20.2±3.3(mm)、23.6±2.8(mm) respectively; compared to preoperative, intraoperative vertebral heightrecovered significantly (P <0.01), compared to preoperative, postoperative vertebralheight restored significantly (P <0.01), postoperative vertebral height loss compared with intraoperative height was statically significant (P <0.05).Kyphoplasty alone group: preoperative anterior and central heights were16.3±2.1(mm)、18.2±2.7(mm)respectively; intraoperative anterior and central heights were17.6±2.8(mm)、19.4±3.3(mm) respectively;1day postoperative anterior and centralheights were19.6±2.0(mm)、22.7±2.5(mm)respectively. Surgery had significantrestoration of vertebral height (P <0.05), comparison of with vertebral height restorationbefore and after surgery was significant (P <0.01), comparison of with vertebral heightduring and after surgery was highly significant (P <0.01).Preoperative and postoperative vertebral body height comparison between the twogroups has no statistical significance (P>0.05), intraoperative vertebral body heightwas significant difference (P <0.01)Both groups were effectively restored vertebral height, Preoperative and postoperativevertebral body height comparison between the two groups has no statistical significance。In the two groups of intraoperative recovery vertebral body height have significantdifferences.4. Vertebral kyphosis correctionManipulative reduction combined with percutaneous kyphoplasty group: Pre, intra andpostoperative Cobb angles vertebrae were（16.5±3.7°）、（8.3±3.3°）and（9.1±4.2°）;comparison between pre and postoperative Cobb angles were statistically significant (P<0.01). Pre and intraoperative Cobb angles were statistically significant (P <0.01), Intraand postoperative Cobb angles were statistically significant (P <0.05).Kyphoplasty alone group: Pre, intra and postoperative Cobb angles vertebrae were（16.8±5.1°）、（13.5±4.7°）and（8.7±3.0°）Cobb angles of the two groups before andafter surgery were statistically significant (P <0.01). Pre and intraoperative Cobb angleswere statistically significant (P <0.05)。 Intra and postoperative Cobb angles werestatistically significant (P <0.01).The difference between the two groups was statistically not significant (P>0.05), Twogroups of intraoperative cobb Angle difference was statistically significantBoth groups effectively corrected vertebral kyphosis, Two groups of preoperative and postoperative correction vertebral kyphosis has no obvious difference, intraoperativeManipulative reduction group for the vertebral kyphosis correction better than PKP onlygroup is obviously, there are significant differences.5. Operation timeAverage operative time for Manipulative reduction combined with percutaneouskyphoplasty group was53.9±6.7min; average operative time for kyphoplasty onlygroup was51.8±6.1min. No significant difference between the two groups operatingtime.(P>0.05)6. Bone cement consumptionManipulative reduction combined with percutaneous kyphoplasty group of bonecement dosage was5.7±0.9ml; kyphoplasty only group bone cement dosage was5.4±0.6ml. There was no significant difference between the two groups of bone cementconsumption.(P>0.05)7. Bone cement leakageIn Manipulative reduction combined with percutaneous kyphoplasty group of12patients (14vertebrae), leakage occurred in two cases (2vertebrae), the occurrence ratewas14.3%; in kyphoplasty only group of15patients (20vertebrae) cement leakageoccurred in three case (3vertebrae), the occurrence rate was15.0%. Leakage of bonecement groups was no statistically significant (P＞0.05).Conclusion: The combination of manual reduction with PKP and PKP only treatmentfor osteoporotic vertebral compression fractures have a good analgesic effect,effectively correct vertebral kyphosis and restore vertebral height. Two surgical methodsfor OVCF have no significant difference in relieving pain, restoring vertebral height,restoring spinal function, operation time, amount of bone cement and bone cementleakage rate. Manual reduction combined with PKP group restore the vertebral bodyheight intraoperation is better than PKP only group，But after surgery is lost，May beassociated with the position of the balloon placed，Believe that with the improvementsof this will further improve the clinical curative effect，But still need more clinical observation.