A Comparative Clinical Study Of PVP In The Treatment Of OVCFs With Or Without Intravertebral Vacuum Cleft

Objective:To study and research the difference about the clinical efficacies,complications and prognosis between the Osteoporotic Vertebral Compression Fractures with or without Intravertebral Vacuum Cleft which are treated by the operation of Percutaneous Vertebroplasty. Methods:To analyze the clinical datas of Osteoporotic Vertebral Compression Fractures in the Department of Orthopedics of Shanxi Medical University subordinate People's Hospital from March 2012 to April 2014 retrospectively and select 32 cases of the single Osteoporotic Vertebral Compression Fractures accompanied with Intravertebral Vacuum Cleft to be the IVC group, according to the IVC patients' gender, age, fracture of vertebral body to match the NOT IVC group's cases which are osteoporotic oertebral compression fractures and without Intravertebral Vacuum Cleft. According to the degree of pain relief, imaging data, follow-up information of the two groups' patients on preoperative and postoperative. Then summarize and evaluate the difference about the clinical efficacies,complications and prognosis between the two groups which are treated by the operation of Percutaneous Vertebroplasty combined with literatures. Results:Intravertebral Vacuum Cleft are mainly occurred in the thoracolumbar body of spine. All the surgeries were completed successfully. The IVC is a risk factor of bone cement leakage as well as the re-fracture of adjacent vertebral bodies. The relative risk or odds ratio were 1.67 and 1.5(ORleakage =1.67, ORre-fracture =1.5); all the patients with postoperative pain symptoms, anterior vertebral compression rate, vertebral kyphosis angle were improved significantly, the differences were significant statistically(P < 0.05), after operation compared with those before. But the IVC group are better than the NOT IVC group on compression and kyphosis correction, t1=6.06; t2=6.19,(1is compression correction; 2 is kyphosis correction), the differences had statistical significant statistically(P < 0.05). Similarly, the long-term follow-up found that the re-compression and re-convex degree of IVC group is higher than NOT IVC group, tre-compression=6.72, tre-convex=5.59, the differences had statistical significant statistically(P < 0.05). Conclusion:Percutaneous Vertebroplasty is an effective means of treatment for Osteoporotic Vertebral Compression Fractures with or without Intravertebral Vacuum Cleft, it can relieve patients' pain, correct vertebral bodies' compression and kyphosis effectively; IVC is a risk factor of bone cement leakage in PVP and re-fracture of adjacent vertebral bodies after PVP. The phenomenon is conductive to vertebral height recovery and kyphosis correction during PVP, meanwhile, is a risk factor for re-compression and re-convex postoperative slowly. So controlling the injection of bone cement is the key step in the surgery, less injection of bone cement for reducing the leakage rate will resulting in poor pain relief, and more injection in order to more vertebral height recovery will increase the risk of re-fracture, so both of them are not desirable. In the operation, if the operators can hold the bone cement fill up the whole fracture and diffuse like a cloud is the best.