A Study Of Percutaneous Kyphoplasty With Calcium Phosphate Cement In Traumatic Thoracolumbar Vertebral Fractures

Background: The percutaneous kyphoplasty(PKP) has been widely used in the treatment of vertebral compression fractures. The characteristic of calcium phosphate cement(CPC) were excellent biocompatibility, osteoin‐duction, suitable bio-mechanical strength, non-toxic and biodegradability.It is increasingly concerned due to those characteristics superior than polymethylmethacrylate(PMMA) by orthopedist. PKP with CPC in treatment of traumatic vertebral fractures has been partially recognized.However, this view is always controversial about efficacy and deformity correction. The relationship between the vertebral bone defect of postoperative and the loss of corrective angle and height remains unclear.Objective: To investigate the efficacy and radiological results of PKP with CPC in treatment young traumatic thoracolumbar vertebral fractures patients without neurological symptoms.Method: A retrospective study of clinical and radiological data of 11 young traumatic thoracolumbar vertebral fractures cases without neurological symptoms, all patients received PKP with CPC. The visual analogue scale(VAS) and Oswestry disability index(ODI) were used to evaluate efficacy. Mimics software was used to measure cement volume(CV) and hollow volume(HV) through CT data. Filling rate(FR),ossification volume(OV),ossification rate(OR)and vertebral hollow rate(VHR)were used to evaluate osteoinductive and surgical effect.Image-pro plus software was used to measure and calculate anterior vertebral height(AVH),percentage of anterior vertebral height(AVH%),posterior vertebral height(PVH),percentage of posterior vertebral height(PVH%),beck index(BI),vertebral kyphosis angle(VKA) and segmental kyphosis angle(SKA) by X-ray.Result:⑴The VAS and ODI decreased from preoperative 8.9(8.2-9.2)and 84.00(75.56-88.00) to the last follow-up 1.5(1.2-1.7)and 15.56(11.11-26.67),respectively.⑵ The CV from postoperative 4.03(2.98-5.89)cm3decreased to the last 3.32(1.97-5.11)cm3(p<0.05),the OV of CPC was0.83(0.62-1.02)cm3,OR was 19.11%(11.71%-33.89%) and the FR was9.52%(7.83%-12.11%).⑶The AVH from preoperative 2.08(1.89-2.88)cm increased to the last 2.61(2.09-3.10)cm(p<0.05), The AVH improved0.37(0.20-0.57)cm. AVH% from preoperative 0.75(0.65-0.86) increased to the last 0.85(0.72-0.97)(p<0.05); The PVH and the PVH% no significant improvement(p>0.05, p>0.05); BI from preoperative0.67(0.63-0.84) increased to the last 0.80(0.68-0.91)(p<0.05).⑷The VKA improved by 2.12(0.76-8.26)° from preoperative 16.65(5.06-23.75)°to the last 10.76(7.98-20.40)°(p<0.05), and SKA decreased 1.30(0.46-6.10)°from preoperative 18.12(1.52-24.27)° to the last 16.29(2.13-21.43)°(p<0.05). The VHR of four cases were 4.82%,8.80%,10.37% and11.60%, respectively. The VHR related to the loss of correction of AVH and VKA(p<0.05, p<0.05), unrelated to the loss of correction of PVH and SKA(p>0.05,p>0.05).Conclusion: ⑴ We recognized excellent efficacy of PKP with CPC in treatment no neurological symptoms young traumatic vertebral fractures patients. ⑵ CPC had certain osteoinductive ability. ⑶ PKP can restore a part of anterior height of fracture vertebral and correct fracture vertebral deformity.⑷The hollow was possible lead to the loss of correction AVH and VKA.