| Objective:1. To evaluate the risk factors of refracture in cemented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients.2. To evaluate the therapeutic effects of conservative treatment of refracture in cemented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients.Methods:1. Between January, 2012 and August, 2014, a total of 324 elderly patients(381vertebrae) received percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Of these patients, 12 patients(14 vertebrae) complained of recurrence of back pain and were confirmed to have refracture in the cemented vertebrae by imaging examination. Patients were divided into the normal group and the fracture group. The normal group contained the patients without refracture in cemented vertebrae and the patients with refracture in cemented vertebrae were divided into the fracture group. age, sex, body mass index(BIM), lumbar spine bone mineral density, treated vertebral level, dosage of cement, cement distribution, time of refracture, vertebral height restoration, angle of vertebral end-plate restoration were assessed.2. Seven of these 12 patients(9 vertebrae) received conservative treatments with analgesics, osteoporosis medication, bracing and physical therapy, and their visual analogue scale(VAS) scores and Oswestry disability index(ODI) at 7 days and 1, 3 and 12 months after the treatment were measured.Results:1. There were 324 patients(381vertebrae) received percutaneous vertebroplasty for osteoporotic vertebral compression fractures, included 12 patients(14 vertebrae) with refracture in cemented vertebrae after percutaneous vertebroplasty for following up for 21.3±11.2months(average 13~29 months). The average age and BMI was(71.5±7.6) years old and(21.3±3.3) in the normal group, and(70.8±6.4) years old and(21.7±3.0) in the fracture group. The average interval time of refracture in cement vertebrae was(8.4±6.6) weeks. Age, Sex and BMI did not reached statistical significant differences between the normal group and the fracture group(P>0.05). The average lumbar vertebrae BMD in the normal group and the fracture group were(-3.0±0.5) and(-3.6±0.5), and showed significant differences(P<0.05). Cement distribution showed the same statistical result. The average percent of the height restoration of cement vertebrae in the normal group was(15.1±7.4), and(15.1±7.4) in the fracture group. They showed significant differences(P<0.05). The average angle of vertebral end-plate restoration in the normal group and the fracture group were(6.6°±3.3°) and(8.8°±2.7°), and show significant differences(P<0.05).2. The 7 patients were followed up for 21.3±11.2months(average 13~29 months) after conservative treatments. Their VAS score and ODI decreased significantly over time after treatment(P<0.05) and showed significant differences between the measurements at 7 days, 1 and 3 months(P<0.05) but not between 3 and 12months(P>0.05).The average VAS score and ODI before treatments were 8.3±0.8 and(88.3±3.2)%, 3.1±1.2 and(56.3±7.7) % at 1 month, and 0.8±0.7 and(5.9±2.8) % at 3 months during the follow-up, respectively. No such complications as phlebothrombosis of leg, decubitus, or hypostatic pneumonia occurred in these cases.Conclusions:1. Incidence rate of cement vertebrae after percutaneous vertebroplasty is low. The risk factors of refracture in cement vertebrae included lower BIM, lack of bone cement, dissymmetry distribution of bone cement, higher restoration of cement vertebrae, more restoration the angle of vertebral end-plate.2. Refracture in the cemented vertebrae is one of the important causes of recurrence of back pain following percutaneous vertebroplasty. Conservative treatment is effective in relieving pain and improving the spine function in such cases without obvious complications. |
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