The Imaging Characteristics Of Osteoporotic Vertebral Compression Fractures Nonhealing And The Choice Of Surgical Treatment

Object To investigate the clinical features of vertebral compression fractures caused by osteoporosis and the guiding of imaging staging on surgical treatment.Methods In this study,53 patients with osteoporotic vertebral compression fractures were enrolled from January 2009 to December 2015 in the Affiliated Hospital of Qingdao University,including 5 males and 48 females aged from 50 to 86 years(mean 70.2 years old).All patients had detailed and completed clinical and imaging data.Analyzing the clinical and imaging data of all patients and the imaging features of osteoporotic vertebral compression fractures were summarized.All patients were staged according to different imaging characteristics.Acorrding to the stage different surgical procedures were determined.The changes of vertebral anteroposterior height,vertebral wedge degree and VAS score were measured and analyzed before and after operation to evaluating the effect of operation.Result In this study,a total of 53 Fractures of the vertebral body did not heal,the fracture is mainly concentrated in the T12,L1 level(a total of 39 vertebrae,accounting for 73.6%).The vacuum cleft were seen in the vertebral body of 21 cases(39.6%),liquid signals of 26 cases(49.1%),6 cases(11.3%)without vacuum clft and fluid sign but with visible fracture sclerosis,8 cases(15.1%)could see the opening phenomenon.Vertebral compression fracture nonunion involving the upper endplate were 37 cases,involving the upper and lower endplate of 12 cases,involving the lower endplate of 4 cases.There were 14 cases of vacuum in the intervertebral disc adjacent to the vertebral body,of which olny 1 case of intervertebral disc vacuum interlinked the fractured vertebral body.According to Li on the compression of the vertebral compression of the classification of all the lesions were staged,including 11 cases of stage ?,16 cases of stage ?,26 cases of stage ?.All patients with stage ? and stage ? were treated with PVP or PKP.Among them,14 cases were treated with PVP and 13 cases underwent PKP operation.The patients with stage ? were involved in the posterior of the spine and the spine was unstable.All patients had a smooth operation and no neurological symptoms were observed.5 cases of PVP and PKP patients with bone cement leakage,of which PVP group 2 cases,PKP group 3 cases,3 cases leaked in front of vertebral body,2 cases leaked intervertebral space,in the last follow-up there was no bone cement shifting.All patients with PVP,PKP and open surgery,Preoperative VAS score,vertebral anterior height,vertebral wedge angle and Cobb angle were statistically different from three days after peration.There was no significant difference between the vertebral posterior height before and three days after peration,no statistically significant difference between the last three days and the last follow up,no significant difference between the VAS score of the patients treated with PVP and PKP.The operation time was longer than that of PVP and PKP group.Conclusion The osteoporotic vertebral compression fractures was mainly ocurred in the thoracolumbar junction(T12?L1),the imaging of vacuum cleft?fluid signs and hardened fracture line has a good guiding significance for the diagnosis of vertebral compression fracture nonhealing.The vertebral compression fracture nonunion typing by Li has a good clinical guidance on the choice of surgical procedures,for? and ? patients PVP or PKP surgery can achieve satisfactory results,but the existence of bone cement leakage requires attention in clinical practice.? patients often have spine instability and neurological damage symptoms,most of need for fixing fusion.