BACKGROUND: In the treatment of osteoporotic vertebral compression fractures with percutaneous kyphoplasty, the choice of filling material has become an important factor for the surgical outcome.
OBJECTIVE: To investigate the effects of polymethyl methacrylate (PMMA), calcium phosphate cement (CPC) and CPC with recombinant human bone morphogenetic protein-2 (rhBMP-2/CPC) in the treatment of osteoporotic vertebral compression fractures.
METHODS: One hundred and twenty patients with osteoporotic thoracolumbar compression fractures undergoing percutaneous kyphoplasty were included, and were randomly divided into three groups, PMMA, CPC and rhBMP-2/CPC groups (n=40 per group). After 7 days of treatment, the clinical efficacy of each group was evaluated. The use of analgesics was evaluated before and 3 months after treatment. Bone mineral density was assessed before treatment and 3 and 6 months after treatment. At 1 year after treatment, the incidence of new fractures was counted.
RESULTS AND CONCLUSION: The total effective rate of the three groups was 97.5%, and there was no significant difference in the clinical efficacy among groups (
P > 0.05). The visual analogue scale scores in each group after 7-day treatment were all improved compared with the baseline (
P < 0.05). The improvement in the CPC and rhBMP-2/CPC groups was significantly better than that in the PMMA group (
P < 0.05). There was no difference in the improvement between CPC and rhBMP-2/CPC groups (
P > 0.05).The recovery of motor function in the three groups at 7 days after treatment was significantly better than the baseline (
P < 0.05). The improvement degree in the CPC and rhBMP-2/CPC groups was significantly better than that in the PMMA group (
P < 0.05). The height of the injured anterior and middle vertebral column and the Cobb angle of kyphosis in each group at 7 days after treatment were significantly improved compared with the baseline (
P < 0.05).There was no significant difference in the degree of improvement among groups (
P > 0.05). At 3 months after treatment, the patients in all groups were separated from the analgesic drugs. At 6 months after treatment, the bone mineral density in the PMMA and CPC groups showed no significant difference compared with the baseline (
P > 0.05). The bone mineral density in the rhBMP-2/CPC group was significantly increased compared with the baseline (
P < 0.05). After 1 year of treatment, the incidence of new fractures in the CPC and rhBMP-2/CPC groups was significantly lower than that in the PMMA group (
P < 0.05), and there was no difference between CPC and rhBMP-2/CPC groups (
P >0.05). These results suggest that the clinical efficacy of PMMA, CPC and rhBMP-2/CPC in the treatment of osteoporotic vertebral compression fractures is satisfactory. CPC and rhBMP-2/CPC can accelerate pain relief and hold long-term support effect, reduce the incidence of new fractures, and meanwhile, rhBMP-2/CPC can increase the vertebral mineral density.