| Objective: To analysis the causes of recurrent vertebralfractures after percutaneous kyphoplasty in the treatment of osteoporoticvertebral compression fracture, and to explore its treatment. Methods: Atotal of453vertebras in238patients were treatment by PKP for the firsttime from March2012to April2014. There were no further vertebralfractures among364vertebras in185patients (the first group),and35vertebras in21patients which were found re-fractures were treated withPKP again (re-fractures group).54vertebras in32patients were lostfollow-up. The clinical data, imaging characteristics and follow-up resultsof the first group and re-fracture group were analysed respectively.Result: The first group have217cases,185cases were followed upranged from3months to21months with an average of12±1.61months,and32cases were lost follow up.57cases in the first group were over80years old, accounting for30.81%,145cases were no obvious causes,accounting for78.38%,21cases were with a clear life injury, accountingfor11.35%,and15patients were with chronic cough, accounting for8.11%.61cases were involved in single segment, accounting for32.97%, 64cases were in two segments, accounting for34.59%,41cases were inthree segments, accounting for22.16%, and19cases were in four ormore segments, accounted for10.27%.141cases involved in thethoracolumbar spine, accounting for76.22%,28cases were found aboveT10, accounting for15.14%, and16cases occurred below L2, accountingfor8.65%. Intraoperative bone cement injection volume was3.52±1.55mlper segment in patients without fracture and symptomatic. Thepreoperative bone mineral density was-3.16±1.55SD in patientswithout fracture and symptomatic. There was no intraoperative spinalcord and nerve injuries, pulmonary embolism and puncture tractinfections. One case was subjected to nerve root compression because ofintraoperative bone cement leakage,it was subjected to decompressiontherapy postoperative. SF-12score (The MOS12-item Short-FormHealth Survey,SF-12) was27.02±6.37preoperatively, was30.23±2.06at2weeks postoperatively, was37.56±5.33at3months postoperatively,was43.11±4.32at6months postoperatively, and was52.22±4.04at thelast follow up. VAS score (Visual analogue scale) was7.52±1.22preoperatively, was5.15±1.56at2weeks postoperatively, was4.24±1.35at3months postoperatively, was3.43±2.49at6monthspostoperatively, and was2.33±1.45at the last follow up. ODI score(Oswestry disability index version, ODI) was30.31±4.21preoperatively,was20.27±3.68at2weeks postoperatively, was13.74±2.66at3months postoperatively, was10.06±3.14at6months postoperatively, and was9.65±1.48at the last follow up. Among the re-fractures21cases.16cases were found in the adjacent vertebral segment, accounting for76.19%, and5cases were found in non-contiguous vertebral, accountingfor23.81%.7cases were over80years old, accounting for33.33%,14cases were no obvious causes, accounting for66.67%,4cases were witha clear life injury, accounting for19.05%, and3patients were withchronic cough, accounting for14.29%.13cases were involved in singlesegment, accounting for61.90%,6cases were in two segments,accounting for28.57%, one case were in three segments, accounting for4.76%, and one case were in four or more segments, accounted for4.76%.12cases involved in the thoracolumbar, accounting for57.14%,2caseswere found above T10, accounting for9.52%, and7cases occurred belowL2, accounting for33.33%.Intraoperative bone cement injection volumewas4.08±2.12ml per segment. The preoperative bone mineral densitywas-3.89±0.68SD. There were no interoperative spinal cord and nerveinjuries, pulmonary embolism and puncture tract infections. SF-12score:was26.39±5.48preoperatively, was28.45±5.23at2weekspostoperatively, was31.33±6.39at3months postoperatively, was37.56±4.43at6months postoperatively, and was45.34±5.63at the lastfollow up. VAS score was7.43±1.89preoperatively, was5.01±1.73at2weeks postoperatively, was4.53±1.29at3months postoperatively, was 5.01±1.73at6months postoperatively, and was6.62±1.87at the lastfollow up. ODI score was30.48±1.79preoperatively, was18.36±2.24at2weeks postoperatively, was18.07±1.96at3months postoperatively,was16.08±2.30at6months postoperatively, and was15.39±1.95at thelast follow up. Conclusion: OVCF often occurs in the thoracolumbar,PKP is a safe and effective treatment method for it. It can relieve painquickly with minimal invasion and few complications. Recurrentvertebral fractures after percutaneous kyphoplasty occurred mainly theadjacent vertebral bodies and the degree of osteoporosis is the main causeof re-fracture vertebras after PKP. Patient’s age, a large degree ofactivity, trauma and chronic cough may contribute to a new fracture. Itwas suggested that PKP is a safe, effective and beneficial treatmentmethod for the re-fracture vertebras. |
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