Effect Of Percutaneous With High-viscosity Bone Cement In Treatment Of Severe Osteoporotic Vertebral Compression Fracture

Background and objective:In recent years,the fast development of minimally invasive surgery,new technology,new methods,new equipment,new ideas emerge.As a new technology in the field of minimally invasive spine surgery,vertebral plasty(Vertebroplasty,VP)has received the widespread attention.In 1984,the French scholar Galibert etc.Based on the experience of surgical filling bone cement,adopted for the first time after percutaneous puncture vertebral body bone cement injection in the treatment of vertebral body invasive cavernous hemangioma,has obtained the good effect of analgesia,thus created the vertebral plasty.In 1997 the United States for the first time the percutaneous vertebral plasty(Pereutaneous Vertebroplasty,PVP)used in the traditional treatment ineffective treatment of osteoporotic vertebral compression fractures,with satisfactory results.In 2000 China report will keratoplasty for the treatment of osteoporotic vertebral bodies protrusion deformity after treatment,the curative effect is satisfied.Since then,vertebral plasty as an effective means of minimally invasive treatment of osteoporotic vertebral compression fractures,have been applied in clinic gradually and effectively solve th e fracture cause of pain and deformity,for the treatment of osteoporotic vertebral compression fractures has brought great changes.Percutaneous vertebral plasty(percutaneous vertebroplasty,PVP)in the treatment of elderly(osteoporotic vertebral compression will fracture,OVCF)caused by the pain has a small surgical trauma,high safety,simple operation,quick effect,in the clinical application of rapid promotion,has been widely used in the treatment of vertebral hemangioma,myeloma,vertebral body of primary and metastatic malignant tumor,especially the osteoporosis vertebral compression fractures patients with intractable pain,has obtained the good curative effect [1].But for the heavy OVCF(serious collapse of vertebral height,vertebral height less than 1/3 of the original height)of the treatment,the operation is difficult,high risk of leakage of bone cement,it is controversial,many scholars regard it as PVP treatment of relatively contraindicated [2].Clinical reports PVP in the treatment of severe OVCF literature are relatively rare.In this study,we through changing the traditional puncture pattern,to establish the puncture needle is a perspective,both inside and outside needle position,location,side established will puncture sleeve accurately placed on the center of the severe osteoporosis vertebral compression fractures,and at the same time by using high viscosity injection of bone cement to take first slow,quick way,minimize the occurrence of leakage of bone cement.Methods:Collected in January 2013-January 2015 the application of PVP treatment of 176 patients with severe thoracolumbar OVCF,among which 61 were male,female 115 cases,58 ~ 78 years old;An average of 67.7 years old.Sprain falls 94 cases,31 cases,51 cases have no obvious cause.Involving 204 vertebral bodies,of which 23 vertebral T10,22 vertebral T11,T12 49 vertebral,L1 vertebral 43,L2 vertebral 29,vertebral body wall damage after 38 job,highly compressed vertebral bodies were greater than 2/3.After comparing before and after surgery were injured vertebral body height,convex Cobb Angle,visual analogue scale(VAS)and Oswestry disability index(ODI),the changes of bone cement perfusion,leakage and other complications.Inclusion criteria:(1)all patients M RI tips for fresh fractures,bone mineral density measurement T value or less 2.5 SD,diagnosed with primary or secondary osteoporosis.(2)patients with prior to admission are significantly lower back pain and restricted movement;(3)preoperative X-ray showed > 2/3 injured vertebral compression degree and the diagnosis of severe OVCF.Ex clusion criteria: MRI revealed stenosis,tube placeholder,or neurological damage.Results:With application of PVP treatment of 176 patients with severe thoracolumbar compression fractures,among which 61 were male,female 115 cases;Age 58 to 78 years old,average 67.7 years old.Sprain causes: fall 94 cases,31 cases,51 cases have no obvious cause.Involving 204 vertebral bodies,of which 23 vertebral T10,22 vertebral T11,T 12 49 vertebral,L1 vertebral 43,L2 vertebral 29,vertebral body wall after 38 vertebral destruction.64 cases of patients with bone cement leakage,leakage rate is 36.4%,among them 7 cases by the vertebral venous leakage,leakage of intervertebral disc 38 cases,vertebral soft tissue before 19 cases of leakage.Part 5 cases of lower back pain relief,4 cases of 5 minutes after injection of bone cement in a burning sensation in the lower extremities,10 minutes later,all no obvious adverse reaction occurred,including the spinal cord compression or damage symptoms and signs,epidural hematoma,pulmonary infection,pulmonary embolism,bedsore,etc.,centerless cerebrovascular accident.Patients with postoperative ODI [(31.73-7.98)] and VAS] [(2.33 + 0.91)points are better than preoperative [(75.40 + 8.17)points,(7.23-0.88)](p < 0.05).Postoperative(3 d and postoperative 1 year)after fanterior flange height,height of vertebral body center line,after convex Cobb Angle,VAS score and ODI compared with preoperative,differences were statistically significant(p < 0.05).But after 1 year and 3 d postoperative fanterior flange height,height of vertebral body center line,protruding after Cobb Angle,VAS pain score,ODI spine score difference has no statistical significance(p > 0.05).Conclusion:PVP severe OVCF treatment with bone cement with high viscosity,can significantly relieve pain and improve movement function,is a safe and effective method.