| Objectives:(1)To evaluate the clinical efficacy of percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)in the treatment of nonunion of osteoporotic thoracolumbar fractures by imaging,VAS score and ODI dysfunction index.(2)To explore the relationship between the height recovery of injured vertebrae,the improvement of kyphosis angle and clinical efficacy.(3)To evaluate the efficacy of Chinese herbal fumgation combined with functional exercise on residual pain after operationMethods:Fifty patients with nonunion of osteoporotic vertebral fracture were selected and followed up for 6 months.The patients came from the Dept of Orthopaedic and Traumatology of WuXi Hospital Affiliated to NanJing University of Chinese Medicine from September 2016 to September 2018 were selected.A total of 50 vertebral bodies(excluding fresh fractures)were followed up for 6 months.Patients admitted to hospital enjoin absolute bed rest,improve bone mineral density(lumbar spine and hip),CT scan reconstruction and thin and MRI.Active treatment of hypertension,diabetes and other diseases in order to satisfy the operation needs.VAS pain score and ODI index were recorded before operation,1 day after operation,1 week after operation and the last follow-up.The anterior height(mm)and sagittal Cobb angle(degree)of the injured vertebrae were measured before operation,1 day after operation and the last follow-up.The recovery rate of injured vertebral height and the improvement rate of Cobb angle were calculated.Fifty patients were randomly divided into control group(functional exercise)and experimental group(functional exercise+herbal fumigation).One week after operation,VAS score and ODI index were compared.Statistical methods were used to compare the VAS score,ODI index and image measurement before and after surgery to evaluate the effect of PVP/PKP in the treatment of osteoporotic thoracolumbar fracture nonunion.The recovery rate of the body and the improvement rate of Cobb angle were calculated.The relationship between judgment and postoperative pain score was compared.The VAS score and ODI index were compared 1 day and 1 week after operation.The effect of Chinese medicine smoker combined with functional exercise on postoperative pain was evaluated.Results:All patients were treated with PVP or PKP.The operation was successful.No complications such as pulmonary infection and hemorrhoids occurred during hospitalization,and there were no cases of shedding.There were 6 cases of cement leakage,4 cases of intervertebral space leakage,2 cases of vertebral body leading edge leakage,and 6 patients had no symptoms of nerve inj ury.After treatment,the VAS score decreased from 3.040±0.754 to 3.700±0.735 at 1 day after surgery,and the pain VAS score was 3.640±0.802 at the last follow-up.The ODI index decreased to 43.920±7.599 from 85.540±5.775 before surgery.The pain ODI index of the last follow-up was 41.46±6.713;the height of the injured anterior border was improved from 15.744±4.831 at the time of surgery to 22.598±5.202,and the height of the leading edge of the injured vertebra was 20.397±5.029 at the last follow-up;the Cobb angle of the injured vertebra was 16.960 before surgery 16.960±6.147 improved to 9.440±4.708 on the 1st postoperative day,and the Cobb angle was 11.240±4.909 at the last follow-up.The VAS score,ODI index,height of the injured anterior border and sagittal sagittal shape were obtained at 1 day and at the last follow-up.There was a statistically significant difference between the Cobb angle and the preoperative(P<0.001).There was no significant difference in VAS score and ODI index between 1 day after operation and the last follow-up data(P>0.05).There was significant difference in the height of the anterior edge of the injured vertebra and the Cobb angle of the sagittal vertebra between 1 day after operation and the last follow-up data(P<0.001).Correlation analysis was used to analyze the relationship between the height recovery rate of the injured vertebrae,the improvement rate of Cobb angle and the change rate of VAS score and ODI index.It was found that there was no correlation between the height recovery rate of the injured vertebrae and the improvement rate of Cobb angle and the change rate of VAS score and ODI index(P>0.05).The VAS scores of the control group and the experimental group were 3.72±0.737 and 3.68±0.748,respectively.The ODI index of the control group and the experimental group were 44.360±6.689 and 43.480±8.530,respectively.There was no significant difference in days(P>0.05).The VAS scores of the control group and the experimental group were 2.96±0.455 and 1.76±0.597,respectively.The ODI index of the control group and the experimental group were 30.920±3.872 and 24.280±5.920,respectively.There was a statistical difference(P<0.05).Conclusion:PVP or PKP is effective in treating non-healing of osteoporotic thoracolumbar fractures.If the height of the vertebral body is restored to a satisfactory PVP in the overextended position,the bone cement leakage can be reduced by using high-viscosity PMMA cement,reducing the mixing time,and sub-step time gradient injection of bone cement;Vertebral height recovery is not satisfactory for feasible PKP.There was no significant correlation between the height recovery of the injured vertebrae and the improvement of the kyphosis angle and the improvement rate of VAS and ODI.At the last follow-up,further compression of the vertebral body was observed,and there was no significant correlation between the analysis and the VAS score at the last follow-up.Traditional Chinese medicine smoked combined with functional exercise can alleviate postoperative residual pain,which can highlight the advantages of PVP/PKP minimally invasive treatment for non-union of osteoporotic thoracolumbar fractures,and improve the quality of life of patients. |
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