Clinical Study of Treating of Osteoporotic Vertebral Compression Fractures by Kyphoplasty
|Keywords||percutaneous kyphoplasty (PKP) osteoporotic vertebral compression fracture (OVCF) the volume of bone cement injected the effects unilateral and bilateral pedicle injection of bone cement|
Objective:To evaluate the efficacy of percutaneous kyphoplasty (PKP) with balloon system for the treatment of osteoporotic vertebral compression fracture (OVCF), and to assess the clinical result of the volume of bone cement injected and the effects of unilateral and bilateral pedicle injection of bone cement, and the prevention of bone cement leakage.Methods:From February 2007 to February 2009, PKP treatment was applied on 43 vertebral bodies in 33 cases of OVCF. Preoperative CT scan showed that all posterior vertebral walls were intact. PKP treatment was performed under X-ray perspective. Clinical outcomes were assessed using a visual analogue scale (VAS) for pain rating, index of physical activity levels, analgesic use score, Japanese Orthopaedic Association (JOA) score for low back pain (full score is 29 points), Cobb’s angle measurement, operation time of single vertebral body, volume of cement injected,and complications. The cases were divided into four grades according to the ratio of bone cement injected to volume of vertebral body lesions. Pain relief was assessed by WHO criteria.Results:The operation was successful on 33 cases,43 vertebral bodies in total. There were no neurological damage, pulmonary embolism and other serious complications. Patients in all groups achieved marked pain relief. Leakage of the bone cement occurred in 4 cases without significant clinical symptoms. All patients were followed postoperatively for9 to 12 months (mean 10.7 months). The VAS scores were 7.86±1.12 points at preoperation,2.26±0.89 points at 24h postoperation and 2.62±1.01 points at last follow-up. The JOA scores werel3.56±4.32 points at preoperation, 24.77±2.26 points at 24h postoperation and 21.58±3.55 points at last follow-up. There were statistically significant differences when compared with before operation (P＜0.05).20 patients were complete remission (CR), and 13 patients were partial remission (PR). The efficacy of clinical treatment (CR+PR) was 100%. There were also significant improvement from preoperation to postoperation in the mean values for Cobb’s angle (25.1±5.0°to 12.7±2.8°; P＜0.05), index of physical activity levels (from 3.24±0.3 to 1.34±0.2; P＜0.05), and analgesic use score (3.15±0.2 to 1.68±0.2; P＜0.05). While there were no significant difference among groups of grade 1,2 and 3, neither were between unilateral and bilateral pedicle injection of bone cement (P＞0.05).Conclusions:1、Kyphoplasty is an effective treatment with less trauma and shorter operative time, less blood loss and other minimally invasive advantages.2、Kyphoplasty effectively alleviates pain caused by senile osteoporotic vertebral compression fractures, and well corrects kyphosis.3、There is no demonstrable correlation between volume of bone cement injected and the clinical efficacy. Considering the safety of treatment, volume of bone cement injected should be appropriately limited during surgery.4、There is no provable correlation between unilateral and bilateral pedicle injection of bone cement and the clinical efficacy. The unilateral pedicle approach has relatively larger risk but with less operation time.