Clinical Observation Of Manual Reduction Combined With Different Doses Of Bone Cement PVP In The Treatment Of Osteoporotic Vertebral Compression Fractures

Objective:To explore the reliable and effective amount of bone cement perfusion during percutaneous vertebroplasty?PVP?by observing the clinical efficacy and complications of manual reduction combined with different doses of bone cement injection in the operation for treatment of osteoporatic vertebral compression fractures.Methods:60 patients with osteoporatic vertebral compression fractures met the inclusion criteria who were treated in the Spinal surgery of the Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine during January 2019 to December 2019 were selected as research objects,the patients'ages range from 65 to 83,and the range of involved vertebral bodies was T₁₁-L₂.Patients were divided into group A?n=30?and group B?n=30?according to the random number table method.Patients in the group A were injected 2.0?3.5 m L of bone cement during the operation?low dose group?after manual reduction and patients in the group B were injected 3.6?5.0ml of bone cement during the operation?high dose group?after manual reduction.The patients in both groups received anti-osteoporosis and routine basic treatment after operation.The VAS score and ODI index,the angle Cobb kyphosis of vertebral body,the sagittal surface index of injured vertebral body were observed and analyzed before and after operation.The bone cement leakage and other postoperative complications were also observed and analyzed.The clinical curative effect was judged by modified Mac Nab criteria.Results:All 60 patients had successful operation without related complications,the patients'pain was significantly relieved,10 patients occurred bone cement leakage without any symptoms like spinal cord and nerve compression,etc.One of the patients in group A was lost in postoperative follow-up,and two of the patients in group B did not reach the set minimum dose of 3.6 ml,and the above three patients were not included in the final result analysis to evaluate the efficacy.The VAS scores in the point of 1 day,1 week and 3 months after operation,the ODI index,the angle of local kyphosis Cobb and the sagittal surface index of injured vertebral body in the point of 1 day and 3 months after operation,which were all improved?P<0.05?.It indicated that manual reduction combined with different doses of bone cement PVP cure osteoporatic vertebral compression fracture,which had good short-term and medium-term curative effect.There was no statistical difference between the two groups?P>0.05?in terms of VAS score,ODI index,angle of Cobb,sagittal surface index and excellent rate of treatment in each observed time point,it incated that there was no difference on curative effect.In terms of bone cement leakage,the total leakage rate was 6.8%?2/29?in group A,which was significantly lower than 28.5%?8/28?in group B?P<0.05?.Conclusion:1.Traditional Chinese Medicine manual reduction combined with different doses of bone cement PVP cure osteoporatic vertebral compression fracture,which can significantly relieve pain and effectively restore the stiffness and strength of the injured vertebral and the height of the front edge,correction of some kyphosis.2.Low-dose bone cement can reduce the leakage rate of bone cement,Chinese medicine manipulation can be used to repair the injured vertebral body before PVP cure osteoporotic vertebral compression fracture,when the compression degree of injured vertebral body?50%,it is appropriate to inject about 3 ml of bone cement during PVP,so it is not necessary to pursue too much bone cement perfusion.