| Objective:To predict and analyze the effects of different types of bone cement dispersion distribution on the early curative effect of bilateral percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures.Methods:The Patients with single vertebral osteoporotic vertebral compression fracture treated in the Department of Orthopaedics of our hospital from January 2018 to December 2019 were analyzed retrospectively.According to the inclusion and exclusion criteria,155 patients with osteoporotic vertebral compression fractures underwent percutaneous vertebroplasty were selected and followed up for 1-24 months.The distribution of bone cement was determined by X-ray,and divided into two groups: bone cement separation group(n = 77,22 cases of thoracic vertebra fracture and 55 cases of lumbar vertebra fracture)and bone cement fusion group(n =78,39 cases of thoracic vertebra fracture and 39 cases of lumbar vertebra fracture).According to the location of the fracture,the patients were divided into two groups:thoracic fracture group(n=22),bone cement fusion group(n=39)and lumbar fracture group(n=94,of which 55 cases were bone cement separation and distribution,39 cases were bone cement fusion distribution).Distribution statistics of each group of patients’ age,sex,bone mineral density T value,bone cement leakage,bone cement injection volume,operation time,visual analogy score,Oswestry dysfunction index score,vertebral height recovery and local kyphosis Cobb angle change.At 2 days after operation and the last follow-up,the differences of the above indexes between the bone cement separation group and the bone cement fusion group were compared.At the same time,the differences of the above indexes between thoracic and lumbar fractures and the distribution of different bone cement in the same site of osteoporotic vertebral compression fracture were compared between the two groups.Results:(1)There was no significant difference in sex,age,bone mineral density T value,bone cement leakage and bone cement injection between the bone cement separation group and the bone cement fusion group(P>0.05).The operation time in the bone cement separation group was less than that in the bone cement fusion group(P < 0.05).The visual analogue scale score and Oswestry dysfunction index of the bone cement separation group and the bone cement fusion group were lower after surgery than those before surgery(P<0.05).The visual analogue scale score of the bone cement separation group was lower than that of the bone cement fusion group during final follow-up(P<0.05).The relative height of anterior edge and midline of the injured vertebra was higher after surgery than that before surgery(P<0.05),and the local kyphotic Cobb angle was lower than that before surgery(P<0.05).There was no significant difference between the two groups in the changes of anterior and midline relative height and local kyphosis Cobb angle(P > 0.05).(2)Under the separation and distribution type of bone cement,the visual analogy score,Oswestry dysfunction index score,relative height of anterior edge and midline of injured vertebrae and local kyphosis Cobb angle in thoracic fracture group and lumbar fracture group were improved compared with those before operation(P<0.05).The height recovery of anterior edge of injured vertebra in thoracic fracture group was lower than that in lumbar fracture group on 2 days after operation(P<0.05)and the visual analogy score on 2 days after operation was lower than that in lumbar fracture group(P<0.05),but there was no significant difference in relative height of injured vertebrae and local kyphosis Cobb angle between the two groups(P>0.05).(3)Under the distribution type of bone cement fusion,the visual analogy score,Oswestry dysfunction index score,relative height of anterior edge and midline of injured vertebrae and local kyphosis Cobb angle of thoracic and lumbar fractures were improved on the 2nd day and last follow-up after operation(P < 0.05).The visual analogy score of the last follow-up in the thoracic fracture group was higher than that in the lumbar fracture group(P < 0.05).There was no significant difference in the relative height between the anterior edge of the injured vertebra and the midline and the change of Cobb angle of local kyphosis between the two groups(P>0.05).(4)In the thoracic vertebra fracture group,the visual analogy score,the Oswestry dysfunction index score,the relative height of the anterior edge and midline of the injured vertebra and the local kyphosis Cobb angle in the cement separation group and bone cement fusion group were improved as compared with those before operation(P<0.05).The visual analogy score of the last follow-up in the bone cement separation group was lower than that in the bone cement fusion group(P<0.05).There was no significant difference in the relative height recovery of the anterior edge and midline of the injured vertebrae and the change of local kyphosis Cobb angle between the two groups on the 2nd day and the last follow-up(P>0.05).(5)In lumbar fracture group,bone cement separation group and bone cement fusion group,the visual analogy score,Oswestry dysfunction index score,relative height of anterior edge and midline of injured vertebrae and local kyphosis Cobb angle in bone cement separation group and bone cement fusion group were improved as compared with those before operation(P< 0.05).There was no significant difference in visual analogy score,Oswestry dysfunction index score,relative height of anterior margin and midline of injured vertebrae,Cobb angle of local kyphosis,recovery of relative height of anterior margin and midline of injured vertebrae and variation of Cobb angle of local kyphosis between the two groups at each time point(P>0.05).Conclusion:(1)Both distribution of bone cement can obtain satisfactory short-term curative effect,but separation of bone cement distribution has better long-term curative effect.(2)Under the same type of bone cement distribution,percutaneous vertebroplasty and bone cement injection can achieve satisfactory results in the treatment of osteoporotic vertebral compression fractures in different parts.(3)In the same site of osteoporotic vertebral compression fracture,satisfactory results can be obtained by two kinds of diffusion distribution of bone cement.(4)The diffusion distribution of bone cement is not a risk factor of bone cement leakage,but high cement injection is one of the risk factors of bone cement leakage. |
PDF Full Text Request