ABSTRACT
Objective:
To compare the clinical efficacies of precision targeted and traditional percutaneous
vertebroplasty (PVP) in the
treatment of refracture of injured
vertebra after operation for Kümmell
disease.
Methods:
A retrospective
cohort study was conducted to analyze the clinical data of 23 Kümmell
disease patients suffering from refracture of injured
vertebra after PVP in Zhengzhou Orthopedic
Hospital from October 2014 to October 2018. The
patients included 7
males and 16
females,
aged 53-89 years [(69.3±3.5)years]. There were 11
patients of stage I Kümmell
disease and 12
patients of stage II Kümmell
disease. The vertebral distribution of fracture was T 11 (3
patients), T 12 (9
patients), L 1 (8
patients) and L 2 (3
patients). Eleven
patients received traditional PVP
treatment (traditional PVP group) and 12
patients received precision targeted PVP
treatment (targeted PVP group). The operation
time, amount of
bone cement injection and filling of
bone cement in the fracture space were compared between the two groups. The visual analogue score (VAS) and Oswestry disability index (ODI) were also compared before operation, at 2 days, 1 month, 3 months, 6 months after operation, and at the last follow-up. The rates of
bone cement leakage and re-collapse of injured
vertebra were observed in the two groups.
Results:
The
patients were followed up for 12-36 months [(24.2±2.6)months]. There were no significant differences in the operation
time or amount of
bone cement injection between the two groups (all P>0.05). All the fracture spaces in the targeted PVP group were fully filled with
bone cement, while 4
patients in the traditional PVP group showed inadequate filling of the fracture area ( P<0.05). The VAS values in the targeted PVP group were (8.9±0.5)points, (1.6±0.2)points, (1.7±0.1)points, (1.8±0.1)points, (1.9±0.3)points, and (1.8±0.4)points before operation, at 2 days, 1 month, 3 months, 6 months after operation and at the last follow-up; and those in the traditional PVP group were (9.1±0.9)points, (1.8±0.4)points, (1.8±0.2)points, (2.0±0.4)points, (2.1±0.2)points, and (2.4±0.3)points, respectively. The VAS values of both groups were significantly decreased at 2 days, 1 month, 3 months, 6 months after operation, and at the last follow-up compared with those before operation (all P<0.05), but there was no significant difference between different
time points after operation (all P>0.05). No significant differences were found in the VAS values between the two groups before operation and at 2 days, 1 month, 3 months and 6 months after operation (all P>0.05). However, the VAS value in the targeted PVP group was significantly lower than that in the traditional PVP group at the last follow-up ( P<0.05). The ODI values in the targeted PVP group were 38.5±4.3, 7.2±2.3, 7.3±2.0, 7.2±1.8, 7.3±2.4, and 7.4±2.5 before operation and at 2 days, 1 month, 3 months, 6 months after operation, and at last follow-up; and those in the traditional PVP group were 37.8±4.1, 7.5±2.5, 7.7±1.9, 7.9±2.4, 8.1±2.6, and 9.6±2.4, respectively. The ODI values of both groups were significantly decreased at 2 days, 1 month, 3 months, 6 months after operation and at the last follow-up compared with those before operation (all P<0.05), but there were no significant differences between different
time points after operation (all P>0.05). The ODI values were not significantly different between the two groups before operation and at 2 days, 1 month, 3 months, 6 months after operation (all P>0.05), but the ODI value in the targeted PVP group was significantly lower than that in the traditional PVP group at the last follow-up ( P<0.05). There were no significant differences in the rates of
bone cement leakage or re-collapse of injured
vertebra between the two groups (all P>0.05).
Conclusion:
Compared with traditional PVP
treatment for refracture of injured
vertebra after operation for Kümmell
disease, targeted PVP can make
bone cement injection fully dispersed, greatly reduce
pain and promote functional recovery.