A Comparative Study On The Clinical Outcomes Between Vertebral Body Forming And Non-Surgical Treatment In Elderly Patients With Osteoporotic Thoracolumbar Vertebral Compression Fractures

BackgroundIn recent years, due to the increasing degree of aging, the incidence of osteoporosis is increasing year by year. The clinical symptom of thoracolumbar vertebral compression fracture is more obvious, the patient can be limited by pain. Extent of severe fractures, spinal nerve by oppression may cause double lower limb sensory motor disorder, limbs pain radiation, retrosternal pain, intercostal neuralgia. If the spinal cord and spinal cord compression can affect the function of rectum and bladder, the quality of life is affected seriously. The treatment of thoracolumbar vertebral compression fractures can be roughly divided into surgical treatment and non-surgical treatment, but the advantages and disadvantages of these two treatments, as well as short, medium-term efficacy have not been well documented. For clinicians, how to choose a reasonable and effective treatment for elderly patients with osteoporotic thoracolumbar vertebral compression fractures is still challenging. In this study, the clinical efficacy of percutaneous vertebral body forming and non-surgical treatment was compared in the elderly patients with osteoporotic thoracolumbar vertebral compression fractures in our hospital, in order to provide the relevant reference for the clinical treatment options.ObjectiveTo compare the clinical efficacy of vertebroplasty (Percutaneous Vertebra Plasty, PVP) with non-surgical therapy in the treatment of osteoporotic vertebral compression fractures (Nonsurgical Treatment, NST). adding a theoretical basis for treating bone fractures.MethodsSelect from March 2010 to June 2013, the Third Affiliated Hospital of Xinxiang Medical College of Orthopaedic Surgery treated osteoporotic thoracolumbar vertebral compression fracture patients for the study, based on the different treatment options, will be divided into two groups, one receiving vertebra body angioplasty treatment, follow-up for more than one year 54 cases of PVP group, receiving non-surgical therapy, follow-up of more than one year were 52 cases of NST group. Two groups of patients showed no significant difference (P>0.05) in terms of gender, age, duration, degree of fracture, comparable. VAS, Analog Cobb and ADL were caculated before treatment, followed up for 12 months. VAS score and ADL score were evaluated in 1th day,1th week,1th Month,3th Month and 12th Month after treatment, respectively X ray also was taken at each time point. Statistical analysis of different time points in patients was done with vertebral body height and Cobb angle changes, and the complications occurred were recorded and compared.Results1. All patients completed treatment and follow-up, no patients dead or lost to follow. VAS and ADL score:Before treatment, VAS scores and ADL scores between two groups of patients were not significantly different (P>0.05). After treatment, within the group:after PVP treatment group at each time point VAS score and ADL scores were better than before treatment, the difference was statistically significant (P<0.05); after treatment NST group 1th week,1th Month,3th Month and 12th Month VAS scores were better than the previous month treatment, the difference was statistically significant(P<0.05), after treatment in 1th Month,3th Month and 12th Month ADL scores were better than before treatment, the difference was statistically significant (P<0.05). Group comparison:the VAS scores in the PVP group were significantly higher than those in the ADL group(P<0.01). But after treatment the VAS score and ADL score in 2 groups of patients were not statistical significant in 3th Month and 12th Month(P>0.05).2. Cobb angle and anterior height of vertebral body:In the PVP group, the Cobb angles were(13.80°±3.08°)、(13.42°±2.50°)、(13.08°±2.64°)and (13.48°±3.12°), respectively, before and after treatment. The front height of the vertebral body was (19.48±4.35)mm、 (20.86±4.56)mm、(20.84±3.42)mm and (20.63±3.56)mm. In the NST group, the Cobb angles were (13.78°±3.12°)、(12.28°±3.08°)、(11.66°±4.12°)and (12.06°±3.42°) respectively, before and after treatment. The front height of the vertebral body was (19.52±4.62)mm、(22.52±3.58)mm、(23.24±3.62)mm and (22.78±4.22)mm. There was no significant difference between the 2 groups of patients treated with Cobb angle and anterior vertebral body height (P>0.05). But at the first month, the 3rd month, the 12th month after treatment, the Cobb angle of NST group and the front height of vertebral body were high to PVP group, the difference was statistically significant (P<0.05).3. Complications occurred:During the treatment and follow-up,1 cases of bone cement leakage occurred in the PVP group(the paraspinal soft tissue leakage, did not cause obvious clinical symptoms), and 1 cases with vertebral fractures. The overall incidence rate was 3.7%(2/54). There were 1 case of re-fracture,3 cases of bedsore,2 case of urinary tract infection and 2 case of pulmonary infection in NST group. The overall incidence rate was 15.4%(8/52). Incidence rate of was significantly lower in PVP than in NST group (P <0.05). Conclusions 1. PVP treatment can quickly and effectively relieve the pain caused by vertebral compression fractures, significantly improving life quality of patients. However, there was no significant difference in the long-term effect and NST treatment. 2. In the improvement of Cobb angle and the recovery of vertebral body height, the effect of PVP has less effect than that of NST. 3. Complication in the PVP group was lower than that of NST.