关键词: 脊柱骨折, 骨质疏松, 经皮椎体成形术, 复位

Abstract:

BACKGROUND: Objective To investigate the effect and preponderance of the method of manual reduction combined with Percutaneous vertebroplasty (PVP) through unipedicular approach under general anesthesia in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods  A  retrospectively compared study of 53 cases  with a single vertebral OVCF were performed from July 2012 to December 2014. The group A (32 cases) were treated by manual reduction combined with PVP  through unipedicular approach to inject bone cement in the vertebral bodies of OVCF under general anesthesia. The group B (21 cases ) were treated with conventional PVP . Results  There was an average of 6 months follow-up time (3-14 months).（1） In group A ：VAS score descend from (8.3±0.7) points preoperatively to (2.1±0.6) postoperatively, to (1.9 ± 0.6) in the final follow-up; Vertebral compression ratio descend from (34.2 ±7.3) % preoperatively back to (4.3±2.4) % postoperatively, to (5.0 ±2.7) % in the final follow-up; Cobb's Angle descend from (21.9±3.8) degrees preoperatively back to (8.6±1.7) postoperatively, (9.0±1.8) in the final follow-up. There was  significant difference between preoperative and postoperative time point (P < 0.01).（2） In group B：VAS score descend from (8.1±0.8) points preoperatively to (2.6±0.5) postoperatively, to (2.1±0.5) in the final follow-up; Vertebral compression ratio descend from (35.0±7.6) % preoperatively back to( 24.3±6.7) % postoperatively, to (25.2±6.8) % in the final follow-up; Cobb's Angle descend from (22.0±3.9) degrees preoperatively back to (18.8±3.6) postoperatively, (19.3±3.7) in the final follow-up. There was  significant difference between preoperative and postoperative time point (P < 0.01). （3） There was no significant difference in VAS score between two group (P > 0.05). There was  significant difference in postoperative Vertebral compression ratio and Cobb's Angle between two groups (P < 0.01).（4） Group A (15.6%) compared with group B (28.6%), bone cement leakage rate significantly reduced. Conclusion  (1)Under  general anesthesia, because of relief of pain of patient and relaxation of waist and back muscle, manual reduction is  easier, the recovery of height and Cobb's angle of vertebral body is more satisfactory after manual reduction. (2)A gap was formed in the vertebral bodies with OVCF after manual reduction. We doesn't need to increase the  angle of puncture through unipedicular approach when the bone boipsy needle  pierce through the gap, and the security is higher in the process of puncture. (3)The pressure of bone cement injected is not large when bone cement was injected into the gap . The bone cement is not easy to leak, and can diffuse to opposite side. The  distribution of bone cement is more ideal with  PVP  through unipedicular approach .