Discussion On The Correlation Between Posterior Vertebral Fracture And Intervertebral Disc Degeneration In Patients With PVP Based On The Paying Equal Attention To Sinew And Bone

ObjectiveFrom the view of intervertebral disc,based on the traditional medical concept "paying equal attention to sinew and bone,strengthening the bones and sinew",to explore the relationship between "sinew injury" and "bone disease",and to show wheather there is correlation between subsequent near vertebral fracture and intervertebral disc degeneration after percutaneous vertebro-plasty in osteoporotic vertebral compression fractures.And to further expl-ore whether intervertebral disc degeneration can be used as a risk predictor for subsequent near vertebral fractures.To provide a new diagnosis and treatment idea,objective image support for prevention adjacent vertebral fractures after percutaneous vertebroplasty,and to optimize the operation efficacy.MethodsUsing the case cohort study method,according to the selection and exclusion criteria included 199 patients who due to osteoporotic vertebral compression fractures treated with PVP in the Second Traditional Chinese of Guangdong Province and Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital between January 2013-December 2015 were retrpspec-tively reviewed.According to the age of patients stratified random sampling,to establish sub-cohort(including vertebral fractures and lost patients)53 cases.All patients were followed up for at least one year and mean follow-up(27.36±10.49)months.Recording patients general situation(Gender,age,BMI(kg/m2),BMD(T-score),injury time,fracture vertebral body,bone cement volume,intervertebral leakage and the creep index?local kyphosis Cobb Angle of Surgical vertebrae),past history,initial fracture adjacent to the disc degeneration level(according to Pfirrmann grading[61]system).Disc 1-3 degenerated into non-exposure factors,4?5 degenerated into exposure factors.According to the last video data,divided into case group and control group.The distribution of exposure factors in the two groups is compared by chi-square test to estimate the OR value of disc degeneration.Using Cox regression analysis methods to analyze subsequent adjacent vertebral fracture after veterbroplasty,Calculate the relative risk HR of intervertebral disc degeneration.ResultsDuring the follow-up period,70 patients developed fractures,of which 21 cases of fractures occurred in non-adjacent vertebral body,no analysis;the remaining 49 patients occurred near the vertebral fracture as a case group.Removed 2 patients who fall-off and 11 patients with subsequent vertebral fractures,leaving 40 cases as control group.In case group which involved 26 cases of adjacent vertebral body,7 males and 21 females,(13.23±5.58)months,average age was(74.96 ±9.23)years,BMD(T-score)averaged(-3.15±0.78)SD,BMI average(21.56±3.95)(kg/m2),the last partial convex Cobb angle(14.16 ±7.37)degrees,the final wedge index(71.46 ± 6.16)%,the average cement injection volume(5.40±1.77)ml,including bone cement disc leakage in 6 cases;Jumping vertebrae 23 cases,5 males and 18 females with an average age of(73.74±9.41)years,subsequent fractures time were averaged(17.78 ±6.22)months,BMD(T-score)average(-3.26 ±0.72)SD,BMI average(19.60±3.94)(kg/m2),The last partial convex Cobb angle(12.45±7.88)degrees,the final wedge index(68.64 ± 8.72)%,bone cement injection volume on average(4.55±1.47)ml,of which 7 cases of bone cement disc leakage.Control group 40 cases,6 males and 34 females,follow-up time was(26.68±7.22)months,average age was(72.43 ± 8.14)years,BMD(T-score)averaged(-2.89±0.67)SD,BMI average(20.90±3.03)(kg/m2),the last partial convex Cobb angle(11.84±6.12)degrees,the final wedge index(69.79±7.30)%,the average cement injection volume was(5.37 ± 1.39)ml,including bone cement disc leakage in 9 cases.Case group and control group Intervertebral disc exposure 0R=2.638,95%CI(1.096,6.351),Indicating that disc degeneration may increase the risk of postoperative vertebral fracture.The results were statistically significant(P<0.05).Multiple-factors Cox regression analysis showed that HR was 1.811,95%CI(1.030,3.184),the results were statistically significant(P<0.05).ConclusionBased on the theory of "paying equal attention to sinew and bone",confirmed that there was a positive correlation between intervertebral disc degeneration and subsequent near fractures after percutaneus vertebroplasty;and the 4?5 grade intervertebral disc degeneration of the subsequent near vetebral compression fractures rate is slightly degenerated 1.811 times,intervertebral disc degeneration is an independent risk factor for subsequent near vetebral compression fractures after PVP.Thereby demonstrating the pathologic features of "sinew injury" accompanied by "bone disease","sinew injury" can induce the development of bone injury.It can be used as a risk predictor of subsequent fractures.In clinical treatment,should pay more attention to the OVCF patients with intervertebral,concerned about the adjacent intervertebral disc functional of patients,and strengthen the functional guidance training of PVP patients with intervertebral disc degeneration.In order to better prevent the occurrence of vertebral fractures and optimize postoperative efficacy.