Clinical Observation Of Manipulative Reduction Combined With Staged Bone Cement Injection Percutaneous Vertebroplasty In The Treatment Of Osteoporotic Vertebral Compression Fractures

ObjectiveTo observe the clinical efficacy,practicability and safety of manipulative reduction combined with staged bone cement injection Percutaneous Vertebroplasty(PVP)in the treatment of osteoporotic vertebral compression fracture(OVCF).MethodFrom February 2019 to August 2019,a total of 60 patients with OVCF who met the inclusion criteria and exclusion criteria in spine surgery of our hospital were selected.According to the random number table method,30 patients were assigned to the control group and 30 patients to the experimental group according to the sequence of operation time.The experimental group was treated by manipulative reduction combined with PVP injection in stages,while the control group was treated by manipulative reduction combined with PVP.The patients were followed up for 6 months.Before treatment and on the first day,three months and six months after operation,visual analogue scales(VAS)were used to evaluate the patients' back pain and Oswestry disability index(ODI)score was used to evaluate the improvement of the patients' quality of life.The reduction of vertebral body was evaluated by Cobb angle,anterior and middle height of vertebral body,compression rate and reduction rate.The scores of the above scoring scales were collected and recorded through outpatient and inpatient follow-up.ResultsIn this study,60 patients were included,the follow-up time was 6 months,all patients completed the follow-up.There were 13 males and 17 females in the experimental group,with an average age of 68.97 ± 7.53 years old.There were 10 males and 20 females in the control group,with an average age of 66.93 ± 7.20 years old;In terms of hospitalization days,the average hospitalization time of the experimental group was 3.57 ± 2.25 days,and that of the control group was 3.40 ± 2.49 days.A total of 60 injured vertebrae were included,including 4thoracic vertebrae and 26 lumbar vertebrae in the experimental group,including 1,3,14,8and 4 T11,T12,L1,L2 and L3 respectively;5 thoracic vertebrae and 25 lumbar vertebrae in the control group,including 2,3,12,8,3 and 2 T11,T12,L1,L2,L3 and L4 respectively.The VAS and ODI scores of each follow-up point in the two groups were significantly lower than those before operation(P<0.01),and the improvement degree on the first day after the operation was significantly lower than that at the follow-up time point(P<0.05).VAS scores in the final follow-up group were lower than those in the control group(P<0.05).There was no difference between the two groups in the comparison of the anterior edge,middle height,compression rate and kyphosis Angle of the injured vertebra before surgery.The front height of the injured vertebrae was significantly increased in both groups on the first day after operation(P<0.01),and the experimental group was significantly higher than the control group(P<0.01).During the follow-up period,there were different degrees of front edge height loss in the two groups,and the loss rate in the control group was significantly higher than that in the experimental group(P<0.01).The kyphotic deformity was significantly improved in both groups on the first day after surgery,and the kyphotic Angle in the experimental group was significantly higher than that in the control group(P<0.01).The kyphotic Angle in theexperimental group was lower than that in the control group at the last follow-up(P<0.05).There was no significant improvement in the intermediate height and compression rate of the injured vertebra between the two groups,and there was no statistically significant difference between the two groups at the last follow-up(P>0.05).The difference of operation duration between the two groups was statistically significant(P<0.05).There were 18 cases of bone cement exudation,and the exudation rate was 30%.Among them,there were 5 cases in the experimental group,and type B,C,S and D were 1,1,1 and 2 cases,respectively.There were13 cases in the control group,and there were 1,7,2 and 3 cases in type B,type C,type S and type D,respectively(P<0.05).There were 2 cases of adjacent vertebral refracture,all of which occurred in the control group(P>0.05).ConclusionManipulative reduction combined with phased bone cement injection of PVP has a good analgesic and functional improvement effect,which can partially restore the height of the anterior edge of the vertebral body and the posterior convex angle.At the last follow-up,the VAS score was lower and the anterior height of vertebral body was better maintained.It has a long-term clinical significance in preventing the loss of anterior height,the aggravation of kyphosis and the leakage of bone cement,with a good clinical application value.