Therapeutic effects of percutaneous vertebroplasty and
kyphoplasty on osteoporotic vertebral compression fracture

doi:10.3969/j.issn.2095-4344.2233

Abstract

Abstract:

BACKGROUND: Percutaneous vertebral body stenting system (VBS) can alleviate patient's pain, recover the height of vertebral body, and correct local kyphosis, but there is no definite clinical study to show that it has obvious advantages over percutaneous kyphoplasty (PKP).

OBJECTIVE: To compare the short-term effect of VBS versus PKP in the treatment of osteoporotic vertebral compression fracture.

METHODS: Forty patients with osteoporotic vertebral compression fracture who received VBS or PKP between January 2017 and December 2018 in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were included in this study. They were divided into a VBS group (n=15) and a PKP group (n=25) according to surgery method. According to whether fluoroscopic operation was performed in retroextension position, two subgroups were designated: VBS retroextension group (n=7) and PKP retroextension group (n=14).

RESULTS AND CONCLUSION: Compared with the PKP group, the amount of bone cement injected into the vertebra was greater in the VBS group (P < 0.05). There were no significant differences in operation time, intraoperative blood loss, and leakage rate of cement between PKP and VBS groups (P > 0.05). Compared with preoperative situations, Visual Analogue Scale score was significantly decreased after surgery in both VBS and PKP groups, and further decreased at the last follow-up (P < 0.05). The height of anterior edge of the injured vertebra, the height of middle part of the injured vertebra and the ratio of the height of the anterior edge of injured vertebra to adjacent vertebra were significantly increased after surgery in both VBS and PKP groups (P < 0.05). In both VBS and PKP groups, the Cobb angle of vertebral compression was significantly decreased after surgery compared with before surgery (P < 0.05). After surgery, the Cobb angle of vertebral compression in the VBS group was smaller than that in the PKP group (P < 0.05). In the VBS group, local Cobb angle after surgery was significantly decreased compared with that before surgery (P < 0.05). There were no significant differences in operation time, intraoperative blood loss, amount of bone cement, bone cement leakage, clinical efficacy (VAS score), imaging evaluation (height of anterior edge of injured vertebra, height of middle part of injured vertebra, height ratio of anterior edge of injured vertebra to adjacent vertebra, Cobb angle of vertebral compression and local Cobb angle between VBS retroextension and PKP retroextension groups (P > 0.05). These results suggest that VBS and PKP are effective in the treatment of osteoporotic vertebral compression fractures. VBS can better correct compression kyphosis deformity when more bone cement is injected. The difference of therapeutic efficacy between two surgical approaches can be reduced with proper surgical position, keeping the surgical segment in the retroextension position.

Key words: osteoporosis, vertebral compression fracture, vertebral body stenting system, kyphoplasty, clinical observation, imaging evaluation, bone tissue engineering

CLC Number:

Ma Yanhuai, Zhang Shuncong, Yuan Kai, Zhou Tengpeng, Luo Peijie, Mo Guoye, Guo Huizhi, Tang Yongchao, Guo Danqing, Wen Guangwei, Xu Yuerong. Therapeutic effects of percutaneous vertebroplasty and kyphoplasty on osteoporotic vertebral compression fracture[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(14): 2170-2176.

Figures/Tables 4

40例患者均顺利完成手术，平均手术时间(38.63± 7.57) min，术中出血量(2.18±1.63) mL，骨水泥量(5.99± 1.80) mL，共有10例患者出现术中骨水泥渗漏(VBS组4例，PKP组6例)，所有患者均未出现骨水泥渗漏相关并发症(如神经根性疼痛、截瘫及肺栓塞等)。与PKP组相比，VBS组术中注入骨水泥量较多(P=0.011)，两组在手术时间、术中出血量及渗漏率等方面均无显著差异(P > 0.05)；在VBS后伸位组与PKP后伸位组的比较中，两组在手术情况方面无显著差异(P > 0.05)。 2.4 各组临床疗效比较与手术前相比，VBS组和PKP组的目测类比评分均明显下降，VBS组从(8.07±0.80)分下降至(1.73±0.70)分(P=0.000)，并在随访时降低至(0.73±0.59)分(P=0.000)，PKP组从术前8.04±0.74下降至(1.64±0.64) (P=0.000)，在随访时降低至(0.84±0.69)分(P=0.000)；但组间对比差异无显著性意义(P > 0.05)；VBS后伸位组与PKP后伸位组在疼痛缓解方面无显著差异(P > 0.05)，见表2。 2.5 各组影像学评估比较 VBS组伤椎前缘高度(P=0.000)、伤椎中部高度(P=0.001)及伤椎前缘高度比(P=0.000)较术前明显增加，PKP组伤椎前缘高度(P=0.003)、伤椎中部高度(P=0.000)及伤椎前缘高度比(P=0.001)较术前增加。两组末次随访与术后比较均无显著差异(P > 0.05)，两组对比组间差异无显著性意义(P > 0.05)；VBS组与PKP组压缩Cobb角较术前均显著降低(P < 0.05)，随访与术后对比无显著差异(P > 0.05)，在组间对比中，VBS手术后及末次随访压缩Cobb角均低于PKP组 (P < 0.05)；VBS组局部Cobb角较术前明显降低(P < 0.05)，PKP组术前后局部Cobb角无显著差异(P > 0.05)，组间对比差异无显著性意义(P > 0.05)；在VBS后伸位组与PKP后伸位组的比较中，两组在影像学评估方面无显著差异(P > 0.05)。见表3。 "

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