[Clinical research of traditional bone-setting and target puncture techniques in percutaneous vertebroplasty for osteoporotic vertebral compression fractures].

Abstract

Objective: To compare the bone cement diffusion and clinical effects between conventional percutaneous vertebroplasty(PVP) and the application of positioning reduction and targeted puncture techniques in the treatment of elderly patients with osteoporotic vertebral compression fractures.

Methods: A retrospective comparative study was conducted, analyzing the clinical data of 268 elderly patients with single-level vertebral fractures admitted between January 2021 and March 2023. The patients were divided into two groups:the conventional PVP group (138 cases) and the targeted PVP group (130 cases). Among them, 138 patients in the conventional group were treated by traditional PVP with bilateral approach including 26 males and 112 females, with a mean age of (72.9±4.0) years old. Another 130 patients in the targeted PVP group included 23 males and 107 females, with a mean age of (72.2±7.0) years old;vertebral reduction was first achieved using prone traction and compression reduction technique based on preoperative imaging examination, the operating bed was used to maintain spinal hyper-extension of the spine and puncture the fracture space target to inject bone cement. The adequacy of bone cement filling in the fracture gap was evaluated based on imaging examination. The operation time, the rate of bone cement leakage and the type of leakage, bone cement filling in the fracture area, the amount of cement injection, the thoracolumbar back pain visual analogue scale(VAS), Oswestry disability index(ODI), and the local kyphosis Cobb angle of the fractured vertebra were compared between two groups.

Results: The operation time (43.9±5.7) min, bone cement filling (5.3±1.5) ml in the conventional PVP group were higher than the target group (39.3±3.6) min, (4.1±1.7) ml(P<0.05). There were no statistically significant differences in bone cement leakage rate or type(P>0.05). The targeted PVP group achieved sufficient bone cement filling in the fracture area, while the conventional PVP group had 34 cases (25.0%) with insufficient filling in the fracture area(P<0.01). There was no significant difference in VAS, ODI, and local Cobb angle of the fractured vertebra before operation between two groups(P>0.05). The VAS of 3.64±0.94 and ODI of 11.50±0.38 at 3 day after operation in the target group were better than those of the conventional group 4.69±0.78 and 15.06±1.66 (P<0.05). The local Cobb angle (7.51±5.37)° was less than that of the conventional group (11.68±3.98)°(P<0.05).

Conclusion: The application of positioning reduction and targeted puncture techniques in percutaneous vertebroplasty for elderly patients with osteoporotic vertebral compression fractures can restore vertebral height using positioning reduction technique to avoid excessive tension on the intervertebral soft tissue. Targeted puncture technique effectively stabilizes vertebral fractures and achieves adequate bone cement filling, thereby improving surgical outcomes. This technique is safe and effective, representing a new treatment modality.