Clinical observation on minimally invasive percutaneous pedicle screw combined with bone cement injection in the treatment of senile osteoporotic vertebral fracture

Abstract

Objective To investigate the clinical effect of percutaneous kyphoplasty (PKP), minimally invasive percutaneous pedicle screw fixation combined with bone cement injection in the treatment of senile osteoporotic vertebral fracture. Methods Sixty-four patients who underwent operation with osteoporotic vertebral compression fractures due to osteoporosis were randomly divided into control group and observation group, with 32 cases in each group. The control group underwent PKP, the observation group underwent percutaneous pedicle screw fixation combined with bone cement injection. Operation time, intraoperative blood loss and hospital stay after operation were compared between two groups. VAS score and bone cement leakage were observed and recorded before operation, on 1 d, in 1 week, 1, 2, 3, 6 months after operation and at the last follow-up. Correction rate, recovery rate, vertebral compression rate, Cobb angle and kyphosis correction rate in different periods were compared. Results The average follow-up period was 17.7 months, and the first case of bone cement leakage were found in control group. There was no leakage of bone cement in observation group. The operation time, blood loss and postoperative hospital stay in observation group were more than those in control groups, the difference was significant (P<0.01). VAS score of control group and observation group decreased from 9.4±3.1, 9.4±2.0 before operation to 2.0±1.3, 2.3±1.1, 1 d after operation respectively (P<0.05); Oswestry score of control group and observation group decreased from 37.2±10.1, 36.8±9.7 before operation to 11.0±9.1, 10.7±10.1 after operation respectively (P<0.01). Vertebral compression rate and Cobb angle significantly decreased in both groups after operation (P all<0.01). The VAS scores of control groups increased 1 week after operation, and had transient decrease 2 months after operation and then tended to be stable; in control group, vertebral height compression rate and Cobb angle increased continuously after operation, recovery rate of injured vertebral height and kyphosis correction rate after operation reduced and then tended to be stable 3 months after operation. The indexes of observation groups had no significant change with the time going after operation, and there were significant differences in the indexes at each point between the two groups (P<0.05). Conclusions Minimally invasive percutaneous pedicle screws combined with the bone cement injection, compared with PKP, has significant effect on senile osteoporotic vertebral fractures and can prevent further vertebral collapse so as to maintain the curative effect. Key words: Osteoporotic vertebral compression fractures; Percutaneous kyphoplasty; Percutaneous pedicle screw fixation; Clinical curative effect