Clinical Effects Of Thoracolumbar Osteoporotic Vertebral Compression Fractrues Using Different Treatment Modalities

Objective: To compare clinical effect for treating thoracolumbar osteoporotic vertebral compression fractrues using different treatment modalities.Method: A total of 113 cases with thoracolumbar osteoporotic vertebral compression fractrues were treated using different modalities including conservative treatment,percutaneous vertebral plasty and combining conservation and PKP between september 2015 to september 2016 in Affiliated hospital of Qingdao University and the Han Ting people's hospital of Weifang.Among them,106 cases were followed up for more than 6 months.X ray,Dural Energy X ray,CT and MRI were used to evaluate patients.Three groups were divided according to the treatment: the anti-osteoporosis drugs group(A group)included 32 patients(including 5 male and 27 femal,60-86 years old and average 66.28±5.84 years old)with 40 centrums(one of T8;two of T7,T9,L3 and L4;three of T10,L3;four of T11;ten of L1;eleven of T12).And there were 25 of cases single vertebral body,6 cases of two vertebrae and 1 cases of three vertebrae.The percutaneous kyphoplasty group(B group)included 35 patients(including 6 male and 29 femal,61-86 years old and average 66.40±5.52 years old)with 49 centrums(two of T8,T9 and L3;four of T10;five of L2;nine of T11;eleven of L1;fourteen of T12).And there were 22 of cases single vertebral body,12 cases of two vertebrae and 1 cases of three vertebrae.The percutaneous kyphoplasty combined with anti-osteoporosis drugs group(C group)included 39 patients(including 7 male and 32 femal,61-88 years old and average 66.51±6.15 years old)with 54 centrums(three of T8,L3;four of T9,L2;five of T10;eight of T11;fourteen of T12;thirteen of L1).And there were 26 of cases single vertebral body,11 cases of two vertebrae and 2 cases of three vertebrae.The patients in A group were treated with hard bed,the cushion was put behind the affected centrum and took exercise.The patients were treated with 1200mg/d calcium carbonate and 150mg/d diclofenac sodium sustained release tablets,as well as the 5mg zoledronic acid via intravenous injection for 15-30 minutes or 70 mg alendronic acid via oral.The patients could take out-of-bed activity after 1-3month.The patients in B group were operated with percutaneous kyphoplasty under local anesthesia.The patients were treated with 1200mg/d calcium carbonate and 150mg/d diclofenac sodium sustained release tablets after the operation,and took out-of-bed activity in the second day.The patients in the C group were treated with 5mg zoledronic acid via intravenous injection for 15-30 minutes or 70 mg alendronic acid via oral than the B group and took out-of-bed activity in the second day.The date collected by the patients in the three group and handle with SPSS19.0.Visual analogue scale(VAS)of the early stage and the long-term stage patients,the change of Cobb angle in sagittal,and the anterior vertebral height in sagittal,bone density,dysfunction index,intervertebral disc degeneration rate and re-fracture rate close to the affected centrum and the sagittal index of the affected centrum were compared in three groups.Results: The 106 of 113 cases were followed up for 6-18 months,averaged 12.3 ± 3.8 months.The gender,age,body index,VAS,bone density and the sagittal index of the affected centrum of the patients in the three groups before treatment were no significant statistically difference by F test,x2 test.The percutaneous kyphoplasty operation could release the painful of the patients in B and C group,and the difference was statistically significant.And the pain between A and B group was no statistically difference.The change of Cobb angle in sagittal of the three groups was similar to the VAS results,and the two results had correlation.The compared of the anterior vertebral height in sagittal of the affected centrum,ODI and the sagittal index of the affected centrum before and after treatment were no significant difference.However,there was no difference between the A group and the B group.The C group was better than the A and B group and had significant statistically difference.The compared of the bone density in the B group before and after treatment were significant difference and the bone density was decreased after surgery.The bone density of A and C group were increased after the treatment and the difference between before and after treatment was statistically significant.While the difference between the A and C group was no significant difference.And the difference between the B and A,C was statistically significant.The intervertebral disc degeneration rate close to the affected centrum by MRI was 42.0%(60/143),the A group was 32.5%(13/40),the B group was 55.1%(27/49)and the C group was 37.0%(20/54).The difference between the B group and the A,C group was statistically significant(P<0.05).While the difference between the A group and the C group was no statistically significant(P>0.05).The re-fracture rate close to the affected centrum collected by MRI were 28 cases and the re-fracture rate was 19.6%(28/143)in totally.The A group was 17.5%(7/40),the B group was 22.4%(11/49)and the C group was 18.5%(10/54).The difference between the A group and the C group was no statistically significant(P>0.05),and the difference between the B group and the A,C group was statistically significant(P<0.05).Conclusion: The anti-osteoporosis drugs,the percutaneous kyphoplasty surgery and the percutaneous kyphoplasty surgery combined with anti-osteoporosis drugs were three methods in treatment of lumbar osteoporotic vertebral compressive fracture.The surgery could release the pain of the osteoporotic vertebral compressive fracture and the patient could take out-of-bed activity,however,the surgery could increased the degree of osteoprosis,the intervertebral disc degeneration rate and re-fracture rate close to the affected centrum.The anti-osteoporosis drugs and the percutaneous kyphoplasty surgery combined with anti-osteoporosis drugs could increased the degree of osteoprosis,the intervertebral disc degeneration rate and re-fracture rate close to the affected centrum.The percutaneous kyphoplasty surgery combined with anti-osteoporosis drugs could decrease the intervertebral disc degeneration rate and re-fracture rate close to the affected centrum,increase the anterior vertebral height in sagittal,bone density and he sagittal index of the affected centrum.The percutaneous kyphoplasty combined with anti-osteoporosis drugs in treatment of lumbar osteoporotic vertebral compressive fracture could make up the deficient of the anti-osteoporosis drugs or the percutaneous kyphoplasty only,and which is a efficient method.