Objective To evaluate the effectiveness of Confidence high viscosity bone cement system and postural reduction in treating acute severe osteoporotic vertebral compression fracture (OVCF). Methods Between June 2004 and June2009, 34 patients with acute severe OVCF were treated with Confidence high viscosity bone cement system and postural reduction. There were 14 males and 20 females with an average age of 72.6 years (range, 62-88 years). All patients had single thoracolumbar fracture, including 4 cases of T11, 10 of T12, 15 of L1, 4 of L2, and 1 of L3. The bone density measurement showed that T value was less than —2.5. The time from injury to admission was 2-72 hours. All cases were treated with postural reduction preoperatively. The time of reduction in over-extending position was 7-14 days. All patients were injected unilaterally. The injected volume of high viscosity bone cement was 2-6 mL (mean, 3.2 mL). Results Cement leakage was found in 3 cases (8.8%) during operation, including leakage into intervertebral space in 2 cases and into adjacent paravertebral soft tissue in 1 case. No cl inical symptom was observed and no treatment was pearformed. No pulmonary embolism, infection, nerve injury, or other complications occurred in all patients. All patients were followed up 12-38 months (mean, 18.5 months). Postoperatively, complete pain rel ief was achievedin 31 cases and partial pain refief in 3 cases; no re-fracture or loosening at the interface occurred. At 3 days after operation and last follow-up, the anterior and middle vertebral column height, Cobb angle, and visual analogue scale (VAS) score were improved significantly when compared with those before operation (P lt; 0.05)；and there was no significant difference between 3 days and last follow-up (P gt; 0.05). Conclusion Confidence high viscosity bone cement system and postural reduction can be employed safely in treating acute severe OVCF, which has many merits of high viscosity, long time for injection, and easy-to-control directionally.
ObjectiveTo discuss the effectiveness of high viscosity bone cement in unilateral puncture percutaneous vertebroplasty (PVP) for the treatment of osteoporotic fresh vertebral fracture and operation skills of the bone cement leakage prevention. MethodsBetween November 2005 and October 2013, 82 elderly patients with fresh thoracolumbar vertebral fracture were first treated with hyperextension postural reduction and then with high viscosity bone cement in unilateral pedicle puncture PVP. Of 82 cases, 25 were male and 57 were female with an average age of 72.3 years (range, 61-90 years). The causes included falling injury in 28 cases, sprain injury in 11 cases, car shock injury in 4 cases, fracture by cough or sneeze in 6 cases, and no obvious reason in 33 cases. The time from injury to operation was 3-15 days (mean, 7.6 days). Single segment was involved in 74 cases, and double segments in 8 cases. The operation time, fluoroscopy time, intraoperative blood loss, and hospitalization time were recorded, bone cement leakage was observed;pain visual analogue scale (VAS) was used to evaluate pain relief effect;X-ray films were taken for measurement of the Cobb angle and anterior vertebral body height compression ratio to evaluate the correction effect. ResultsThe average operation time was 16 minutes;the average fluoroscopy time was 48 seconds;the average hospitalization time was 3 days. All cases were followed up from 6 to 18 months (mean, 6.8 months). Leakage of bone cement occurred in 6 cases (7.3%), including 3 cases of paravertebral soft tissue leakage, 1 case of intervertebral disc leakage, and 2 cases of venous leakage. There was no nerve damage or paralysis. At last follow-up, VAS score was significantly decreased to 1.3±0.9 from preoperative 8.8±1.2 (t=73.891, P=0.000);Cobb angle was significantly reduced to (25.06±6.18)° from preoperative (34.79±7.18)° (t=18.878, P=0.000);and the anterior vertebral body height compression ratio was significantly increased to 67.8%±5.7% from preoperative 41.3%±9.8% (t=36.880, P=0.000). ConclusionApplication of high viscosity bone cement in unilateral puncture PVP can shorten operation time, reduce bone cement leakage rate, and achieve satisfactory effectiveness.