Comparative Study Of PVP/PKP Clinical Effects For Treating Osteoporotic Vertebral Compression Fractures

ObjectiveRecently, a large number of clinical researches reported that percutaneous vertibroplasty (PVP) and percutaneous kyphoplasty (PKP) are effective operation methods for treating osteoporotic vertebral compression fractures. But as the minimally invasive technique of PVP/PKP spreading in the clinic, bone cement leakage is still a severe complication of the PVP/PKP. Meanwhile, no large sample size patients are applied to comparative study of the PVP/PKP clinical effects. In this study, we made researches of the comparative study of PVP/PKP clinical effects and the related risk factors of bone cement leakage. Moreover, the clinical effects of nourishing kidney and activating blood recipe were also studied for perioperative patients and bone cement leakage, which may be a guidance for clinical medication. Our study is expected to provide reliable reference for clinical practice.MethodsThis study mainly enployed retrospective methods and collected basic information of the 550 cases patients who were diagnosed with thoracolumbar vertebral body compression fractures and underwent single level PVP/PKP surgical treatment for recent six years in the second affiliated hospitals of Guangzhou University of Chinese Medicine. Based on the surgical methods, the patients are divided into PVP and PKP groups. While the patients are grouped into bone cement leakage and non-bone cement leakage groups depending on whether there are bone cement leakage. The collected data were recorded to consist of the statistics database for the data analysis. The measurement data included the following-up time, the patients’age, bone cement injection volume, preoperative vertebral bodies’local sagittal Cobb’s angle, postoperative vertebral bodies’local sagittal Cobb’s angle and correction of vertebral bodies’local sagittal Cobb’s angle employed Independent-Samples T-Test, while the enumeration data included the patients’sex, operative vertebral segments, surgical approach (PVPorPKP), whether the bone cement leakage or not, whether having anti-osteoporotic medications in the perioperative period or not and whether having nourishing kidney and activating blood recipe in the perioperative period or not adopted x2-Test. We put the statistical data into the multivariate Logistic regression analysis and obtained the risks for the bone cement leakage. The data were analyzed by SPSS 17.0 statistical software, based on which, there was statistical difference on the condition of P<0.05 and significant statistical difference in the case of p＜0.01.ResultsIn this study,550 patients were treated with single level PVP/PKP and the average following-up time was 37.87±13.83 months including 440 females and 110 males with the patients’age from 49 to 93 years old and average age of 75±8.70 years old.300 patients were underwent PVP surgery and 250 patients were treated with PKP surgery. The distribution of operative vertebral segments was 3 T5,2 T6,10 T7,11 T8,8 T9,16 T10,43 Til,125 T12,181 L1, 90 L2,41 L3 and 20 L4.143 patients had underwent bone cement leakage with the incidence of 26.0%. Bone cement injection volume was from 1.2 to 7.5ml with an average volume of 3.56±0.98ml. Preoperative vertebral bodies’local sagittal Cobb’s angle was from-31.70° to 48.73° with an average angle of 11.57°±11.50°. Postoperative vertebral bodies’local sagittal Cobb’s angle was from-30.86° to 40.53° with an average angle of 5.70°±11.03°. Correction of vertebral bodies’local sagittal Cobb’s angle was from-2.41 ° to 23.67° with an average angle of 4.87°±2.78°. The patients of anti-osteoporotic medications during perioperative period were 475 cases with the rate of 86.4%. And 367 patients accepted nourishing kidney and activating blood recipe with the rate of 73.7%during perioperative period.Among the 550 patients,300 patients had PVP operation including 243 females and 57 males with bone cement injection volume from 1.2 to 7.5ml with an average volume of 3.72±1.07ml, while 250 patients had PKP operation including 197 females and 53 males with bone cement injection volume from 1.2 to 6.0ml with an average volume of 3.39±0.83ml. There are no statistical differences in following-up time, the patients’sex, the patients’age, the bone cement leakage, preoperative vertebral bodies’local sagittal Cobb’s angle, postoperative vertebral bodies’local sagittal Cobb’s angle, having anti-osteoporotic medications in the perioperative period, having nourishing kidney and activating blood recipe in the perioperative period and operative vertebral segments between PVP group and PKP group (P>0.05). While there are significantly statistical differences in bone cement injection volume and correction of vertebral bodies’local sagittal Cobb’s angle between PVP group and PKP group (P<0.01). In PVP group, there are 83 patients who have bone cement leakage with incidence rate of 27.7%. However, in PKP group, there are 60 patients who have bone cement leakage with incidence rate of 24.0%. In spite of no statistical difference, there is still clinical significance in terms of bone cement leakage. Among the 550 patients,143 patients underwent bone cement leakage including 111 females and 32 males, while 407 patients had no bone cement leakage including 329 females and 78 males. There are no statistical differences in the patients’sex, the patients’age, having nourishing kidney and activating blood recipe in the perioperative period and operative vertebral segments between bone cement leakage group and non-bone cement leakage group (P>0.05). While there are significantly statistical differences in the following-up time, preoperative vertebral bodies’local sagittal Cobb’s angle and having anti-osteoporotic medications in the perioperative period between bone cement leakage group and non-bone cement leakage group (p＜0.01). And there are statistical differences in the bone cement injection volume, postoperative vertebral bodies’local sagittal Cobb’s angle and correction of vertebral bodies’local sagittal Cobb’s angle between bone cement leakage group and non-bone cement leakage group (P<0.05). The bone cement leakage group have larger following-up time, bone cement injection volume, preoperative vertebral bodies’local sagittal Cobb’s angle, postoperative vertebral bodies’local sagittal Cobb’s angle and correction of vertebral bodies’local sagittal Cobb’s angle than non-bone cement leakage group. The patients of having anti-osteoporotic medications in the bone cement leakage group accounts for 78.3%, which is smaller than those in non-bone cement leakage group(89.2%). The non-bone cement leakage group has advantage over the bone cement leakage group in anti-osteoporotic treatment. We put the statistical data into the multivariate Logistic regression analysis and obtained the risks for the bone cement leakage. And the results showed that the testing coefficients of having anti-osteoporotic medications, correction of vertebral bodies’local sagittal Cobb’s angle and bone cement injection volume, follow-up period were less than 0.05, and there is statistically significant. The patients who had anti-osteoporotic medications were not tend to suffering the bone cement leakage, which was negatively correlated. While the patients who had lager correction of vertebral bodies’local sagittal Cobb’s angle, lager bone cement injection volume, long follow-up period were tend to suffering the bone cement leakage, which was positively correlated.ConclusionBoth PVP and PKP have advantage in correcting vertebral bodies’local sagittal Cobb’s angle and kyphosis to promote living quality of the patient. However, compared with PVP, PKP can obviously correct vertebral bodies’local sagittal Cobb’s angle. PVP is tend to leading to bone cement leakage possiblely caused by large bone cement injection volume. There are many risk factors, which lead to postoperative bone cement leakage of PVP and PKP. Large bone cement injection volume, correction of vertebral bodies’local sagittal Cobb’s angle and no anti-osteoporotic treatment during the perioperative period may enhance the incidence rate of bone cement leakage. Additionally, anti-osteoporotic treatment during the perioperative period may reduce the risk of bone cement leakage. In order to choose appropriate surgical methods and prevent bone cement leakage of fracture vertebral body, the surgeons should be familiar with operation skills and explore the patient case data and imaging information in detail in preoperation. In the operation, the condition of bone cement leakage in the patients should be prevent to the greatest extent. Moreover, correction of vertebral bodies’local sagittal Cobb’s angle should not be overwhelming emphasized and anti-osteoporotic treatment during the perioperative period should be implemented. Additionally, traditional Chinese medicine (nourishing kidney and activating blood recipe) should be emphasized during the perioperative period for enhancing the patients’ physical condition. We should combine traditional Chinese and western medicine treatment in order to improve medical quality.