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The Correlation Research on the Distribution Pattern of Bone Cement and Clinical Efficacy of Percutaneous Vertebroplasty

Author: LinXueYang
Tutor: GaoLiangBin
School: Guangzhou Medical College
Course: Orthopedics
Keywords: Osteoporotic vertebral compression fractures After percutaneous vertebroplasty Bone cement distribution Vertebral height Kyphotic Cobb angle Adjacent vertebral fractures
CLC: R687.3
Type: Master's thesis
Year: 2011
Downloads: 58
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Abstract

Research purposes with the aging of the global population, the incidence of osteoporosis is increasing year by year, PVP as a new technology for the field of minimally invasive spinal surgery, in the treatment of osteoporotic vertebral compression fractures (Osteoporotic vertebral compress fractures, OVCF) achieved significant clinical efficacy. But in results of PVP postoperative follow-up found adjacent vertebral fracture incidence reported increasing year by year. According to the currently reported in the literature for PVP postoperative increases the possibility of adjacent vertebral fractures also have differences. But many scholars through finite element biomechanical cadaver model biomechanics, non-randomized clinical review of research that the distribution and morphology of the bone cement is the risk of adjacent vertebral fractures (Adjacent vertebral body fracture, AVF) a. Produce different clinical efficacy for bone cement distribution itself whether surgery vertebral, including clinical analgesic effect, iconographic, and even affect the adjacent vertebral secondary fracture occurrence, the country has not been reported. In this study, a retrospective study of clinical cases grouping of patients with osteoporotic vertebral compression fractures after PVP treatment of vertebral bone cement distribution analysis of clinical efficacy, and further cases of patients with the queue follow-up studies. By this study for the following purposes: 1, the clinical efficacy of postoperative lumpy and two spongy bone cement distribution patterns and differences exist between further discussion and analysis. 2, analysis lumpy after two spongy bone cement distribution patterns and new hair AVF, and to further explore the risk factors of PVP of postoperative new hair AVF. To provide a reference for future research on the study of the etiology and prevention of the PVP postoperative AVF. Materials and Methods 1, select the hospital bone surgery from January 2007 to August 2010 using percutaneous vertebroplasty (PVP) treatment of the single vertebral osteoporotic vertebral compression fractures in 98 patients. The preoperative line physical examination, imaging studies, record the patient's level of pain, radiographic changes (including VAS score, anterior vertebral lateral X-ray, the middle of the height of the trailing edge of the vertebral kyphosis Cobb angle). Postoperative each vertebral bone cement distribution in the CT performance, in accordance with the the dispersion volume injection of bone cement volume ratio of the 98 patients were divided into lumpy group (A) and diffusion-like group (B) record the amount of cement injected two groups, postoperative pain improvement rate imaging change. Results using statistical methods to analyze, evaluate two bone cement distribution patterns and the relationship between the clinical efficacy. Data using SPSS 17.0 software for statistical analysis. 2, select the hospital of Orthopaedic Surgery from January 2007 to August 2010 using percutaneous vertebroplasty (PVP) in the treatment of a single vertebral osteoporotic vertebral compression fractures in 98 patients with a follow-up study. Postoperative CT or X-ray bone cement in the vertebral body distribution patterns of the 98 patients were divided into the agglomerate group (A group) and sponge-like group (B). Through the postoperative follow-up time point review of the thoracolumbar spine X-ray or CT imaging methods were observed postoperative changes in adjacent vertebral bodies. Record two groups occur secondary to fracture location, the number of fractures and vertebral secondary time interval. Compare two groups of patients with secondary vertebral compression fracture incidence and secondary fracture interval. Data using SPSS 17.0 software for statistical analysis. Third, the results of the two groups preoperative and postoperative VAS score difference of statistical significance (P lt; 0.05); differences between the two groups VAS score average improvement rate was no statistical significance (P gt; 0.05). . Preoperative, postoperative anterior vertebral and central height difference was statistically significant (P lt; 0.05), and the posterior edge height of preoperative and postoperative differences were not statistically (P gt; 0.05), preoperative and postoperative vertebral kyphosis Cobb angle difference (P lt; 0.05); between the two groups vertebral height average improvement rate difference was not statistically significance (P gt; 0.05), two groups mid-height between vertebral average recovery rate difference was statistically (P lt; 0.05). The average recovery rate between the two groups the posterior margin height difference was not statistically significance (P gt; 0.05). The average improvement rate differences between the two groups vertebral kyphosis Cobb angle postoperative statistical significance (P gt; 0.05). 3. Lumpy group (A) injected cement volume and postoperative anterior vertebral height, vertebral height changes in Central and vertebral kyphosis Cobb angle change (after preoperative difference) into a positive correlation (P lt ; 0.05), while the with the postoperative trailing edge height changes (difference after preoperative) was not related to sex (P gt; 0.05). Sponge-like group (B) in a certain range of injected cement volume and postoperative anterior vertebral height, middle height, the height of the trailing edge and vertebral kyphosis Cobb angle (after preoperative difference) were not correlated (P gt; 0.05), 4. follow-up study, exclude the five cases were followed up fails, the remaining 93 cases included in the final statistical analysis. A group of 43 patients, 10 (23.3%) patients with secondary vertebral fractures, including eight patients (18.6%) occurred in the adjacent vertebral bodies. Group B, 50 patients in 4 (8%) patients with new fractures, two patients (4%) occurred in the adjacent vertebral. The two sets of secondary vertebral fracture incidence significantly different (p lt; 0.05), two sets of secondary adjacent vertebral fracture incidence there are significant differences (p lt; 0.05). A group was found that new fractures, the average time was 90 ± 49.98 days, the average time of the adjacent vertebral fractures was 78.75 ± 49.23 days. In group B, found that the average time for new fractures 176.25 ± 65.24 days, the average time of the adjacent vertebral fractures was 195 ± 106.06 days. The two groups were significantly different (p lt; 0.05) the average time of new fractures, two sets of adjacent vertebral fractures average time a significant difference (p lt; 0.05). Fourth, the conclusion after percutaneous vertebroplasty in Mission massive and two spongy bone cement distribution patterns can effectively relieve pain, enhance the performance of the vertebral body mechanics to restore vertebral stability; 2. Cement injected in a certain range amount (1.5-5ml), lumpish and dispersion like two bone cement distribution patterns can partially restore the compressed vertebral Central height and improve kyphosis. The lumpy distribution model restoration surgery vertebral Central height better than the sponge-like distribution pattern. Lumpy distribution pattern of postoperative secondary vertebral fracture incidence higher than the distribution pattern of the cavernous especially adjacent vertebral fractures. Lumpy distribution pattern of the occurrence of secondary fractures faster than the sponge-like distribution pattern.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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