基于Mimics软件分析椎体成形术后骨水泥形态和弥散程度的临床意义
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摘要
背景:有研究发现,骨水泥分布形态及弥散程度是影响椎体成形术临床疗效的主要因素。目的:探讨Mimics软件分析骨水泥形态和弥散程度的可行性,以及骨水泥形态和弥散程度与临床疗效的关系。方法:纳入2017年1月至2018年3月自贡市第四人民医院收治的骨质疏松性椎体压缩骨折患者170例,其中男41例,女129例,年龄60-97岁,均进行骨水泥椎体成形术治疗。术后2d进行X射线与CT检查,依据X射线中骨水泥分布分为4组,分别为Ⅰ型(大部分骨水泥连续、均匀分布在椎体内)、Ⅱ型(大部分骨水泥分布在椎体中央区)、Ⅲ型(大部分骨水泥分布在椎体两侧)、Ⅳ型(大部分骨水泥分布在椎体一侧及中央)、Ⅴ型(大部分骨水泥分布在椎体一侧)型;依据CT影像资料创建Mimics项目文件,计算骨水泥体积与弥散体积;术后随访6个月,对比各组目测类比评分、Oswestry功能障碍指数与Cobb角,分析骨水泥分布形态、骨水泥弥散体积、骨水泥弥散体积比与临床疗效之间的关系。结果与结论:(1)术后2 d、6个月,5种形态骨水泥组目测类比评分、Oswestry功能障碍指数均较术前明显改善(P <0.05),Ⅰ型组Cobb角较术前明显改善(P <0.05),Ⅱ-Ⅴ型组Cobb角与术前比较无差异(P> 0.05);(2)骨水泥弥散体积为(6.69±1.19) mL,骨水泥弥散体积比为(20.93±3.13)%;骨水泥注入量与术后2 d、术后6个月的目测类比评分、Oswestry功能障碍指数、Cobb角间不存在关联性,骨水泥弥散体积与术后6个月的目测类比评分、术后2 d和术后6个月的Oswestry功能障碍指数评分间存在负相关(P <0.05),但关联性弱;骨水泥弥散体积比与术后2d、术后6个月的目测类比评分、Oswestry功能障碍指数评分间存在负相关(P<0.05),关联性强;(3)结果表明,基于Mimics软件的三维重建功能,能准确计算骨水泥弥散体积及弥散体积比,如骨水泥分布形态均匀良好,更能缓解局部后凸角;骨水泥弥散体积比与临床疗效呈正相关,较骨水泥体积更有临床价值。
BACKGROUND: It has been found that the distribution and diffusion degree of bone cement are the main factors influencing the clinical effect of percutaneous vertebroplasty. OBJECTIVE: To explore the feasibility of analyzing bone cement distribution form and diffusion degree based on Mimics software, and to evaluate the relationship of clinical efficacy with bone cement distribution form and diffusion degree. METHODS: A total of 170 cases of osteoporotic vertebral compression fracture admitted to Zigong No. 4 People's Hospital from January 2017 to March 2018 were included, including 41 cases of males and 129 cases of females aged 60-97 years. All of them were treated with percutaneous vertebroplasty. X-ray and CT examination were done at postoperative 2 days, and the bone cement distribution was classified into five types based on the distribution of bone cement in X-ray images, including type Ⅰ (most cement continuously and evenly distributed in the vertebral body), type Ⅱ (most cement distributed in the central vertebral bodies), type Ⅲ (most cement distributed on both sides of vertebral body), type Ⅳ (most cement distribution at the side of the vertebral bodies and the central), type Ⅴ (most cement distribution at the side of the vertebral body). Mimics project files were created based on CT image data to calculate bone cement volume and diffusion volume. After 6 months of follow-up, visual analogue scale score, Oswestry disability index and Cobb angle were compared among groups to analyze the relationship between bone cement distribution, bone cement diffusion volume, bone cement diffusion volume ratio and clinical efficacy. RESULTS AND CONCLUSION:(1) The visual analogue scale score and Oswestry disability index of the five types of bone cements were significantly improved at 2 days and 6 months after surgery compared with preoperative data (P < 0.05), the Cobb angle of the type Ⅰ group was significantly improved compared with preoperative data(P < 0.05), and the Cobb angles of the type Ⅱ-Ⅴ groups showed no difference from the preoperative data (P > 0.05).(2) The diffusion volume of bone cement was (6.69±1.19) mL, and the diffusion volume ratio of bone cement was(20.93±3.13)%. There was no correlation between the volume of bone cement injection and the visual analogue scale score, Oswestry disability index and Cobb angle at 2 days and 6 months after surgery. There was a negative correlation between the bone cement dispersion volume and the visual analogue scale score at 6 months after surgery, and the Oswestry disability index score at 2 days and 6 months after surgery (P < 0.05), but the correlation was weak. The diffusion volume ratio of bone cement was negatively correlated with the visual analogue scale score and Oswestry disability index score at 2 days and 6 months after surgery (P < 0.05), showing a strong correlation. These findings show that, based on the three-dimensional reconstruction function of Mimics software, the diffusion volume and diffusion volume ratio of bone cement can be accurately calculated. The bone cement evenly distributed can alleviate the local kyphosis. The diffusion volume ratio of bone cement is positively correlated with clinical efficacy, which is more valuable than the volume of bone cement.
BACKGROUND: It has been found that the distribution and diffusion degree of bone cement are the main factors influencing the clinical effect of percutaneous vertebroplasty. OBJECTIVE: To explore the feasibility of analyzing bone cement distribution form and diffusion degree based on Mimics software, and to evaluate the relationship of clinical efficacy with bone cement distribution form and diffusion degree. METHODS: A total of 170 cases of osteoporotic vertebral compression fracture admitted to Zigong No. 4 People's Hospital from January 2017 to March 2018 were included, including 41 cases of males and 129 cases of females aged 60-97 years. All of them were treated with percutaneous vertebroplasty. X-ray and CT examination were done at postoperative 2 days, and the bone cement distribution was classified into five types based on the distribution of bone cement in X-ray images, including type Ⅰ (most cement continuously and evenly distributed in the vertebral body), type Ⅱ (most cement distributed in the central vertebral bodies), type Ⅲ (most cement distributed on both sides of vertebral body), type Ⅳ (most cement distribution at the side of the vertebral bodies and the central), type Ⅴ (most cement distribution at the side of the vertebral body). Mimics project files were created based on CT image data to calculate bone cement volume and diffusion volume. After 6 months of follow-up, visual analogue scale score, Oswestry disability index and Cobb angle were compared among groups to analyze the relationship between bone cement distribution, bone cement diffusion volume, bone cement diffusion volume ratio and clinical efficacy. RESULTS AND CONCLUSION:(1) The visual analogue scale score and Oswestry disability index of the five types of bone cements were significantly improved at 2 days and 6 months after surgery compared with preoperative data (P < 0.05), the Cobb angle of the type Ⅰ group was significantly improved compared with preoperative data(P < 0.05), and the Cobb angles of the type Ⅱ-Ⅴ groups showed no difference from the preoperative data (P > 0.05).(2) The diffusion volume of bone cement was (6.69±1.19) mL, and the diffusion volume ratio of bone cement was(20.93±3.13)%. There was no correlation between the volume of bone cement injection and the visual analogue scale score, Oswestry disability index and Cobb angle at 2 days and 6 months after surgery. There was a negative correlation between the bone cement dispersion volume and the visual analogue scale score at 6 months after surgery, and the Oswestry disability index score at 2 days and 6 months after surgery (P < 0.05), but the correlation was weak. The diffusion volume ratio of bone cement was negatively correlated with the visual analogue scale score and Oswestry disability index score at 2 days and 6 months after surgery (P < 0.05), showing a strong correlation. These findings show that, based on the three-dimensional reconstruction function of Mimics software, the diffusion volume and diffusion volume ratio of bone cement can be accurately calculated. The bone cement evenly distributed can alleviate the local kyphosis. The diffusion volume ratio of bone cement is positively correlated with clinical efficacy, which is more valuable than the volume of bone cement.
引文
[1]王志宝,孙铁山,李国平.近20年来中国人口老龄化的区域差异及其演化[J].人口研究,2013,37(1):66-77.
[2]Alpantaki K,Dohm M,Korovessis P,et al.Surgical options for osteoporotic vertebral compression fractures complicated with spinal deformity and neurologic deficit.Injury.2018;49(2):261-271.
[3]Schupfner R,Stoevelaar H,Blattert T,et al.Treatment of osteoporotic vertebral compression fractures:Applicability of appropriateness criteria in clinical practice.Pain Physician.2016;19(1):113-120.
[4]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南[J].中华骨与关节外科杂志,2015,8(5):371-375.
[5]Luthman S,Widén J,Borgstr?m F.Appropriateness criteria for treatment of osteoporotic vertebral compression fractures.Osteoporos Int.2017;29(4):793-804.
[6]Wang B,Guo H,Yuan L,et al.A prospective randomized controlled study comparing the pain relief in patients with osteoporotic vertebral compression fractures with the use of vertebroplasty or facet blocking.Eur Spine J.2016;25(11):3486-3494.
[7]Li YX,Guo DQ,Zhang SC,et al.Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty(pvp)or percutaneous kyphoplasty(pkp).Int Orthop.2018;42(9):2131-2139.
[8]江晓兵,莫凌,梁德,等.骨水泥在椎体骨折线内弥散情况对椎体成形术治疗效果的影响[J].中国脊柱脊髓杂志,2014,24(2):144-149.
[9]贺宝荣,许正伟,郝定均,等.骨水泥在骨质疏松性骨折椎体内分布状态与生物力学性能的关系[J].中华骨科杂志,2012,32(8):768-773.
[10]黄文东.骨水泥弥散体积在椎体成形术中概念的建立和初步应用[D].广州:广州医科大学,2010.
[11]江晓兵,黄伟权,庞智晖,等.基于Mimics软件计算椎体强化术后椎体内骨水泥体积及骨水泥/椎体体积比的新方法[J].中国脊柱脊髓杂志,2013,23(3):238-243.
[12]Song BK,Eun JP,Oh YM.Clinical and radiological comparison of unipedicular versus bipedicular balloon kyphoplasty for the treatment of vertebral compression fractures.Osteoporos Int.2009;20(10):1717-1723.
[13]张大鹏,毛克亚,强晓军,等.椎体增强术后骨水泥分布形态分型及其临床意义[J].中华创伤杂志,2018,34(2):130-137.
[14]Yang EZ,Xu JG,Huang GZ,et al.Percutaneous vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures.Spine(Phila Pa 1976).2016;41(8):653-660.
[15]Zhang L,Liu Z,Wang J,et al.Unipedicular versus bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures:a prospective randomized study.BMC Musculoskelet Disord.2015;16:145.
[16]Zhang Y,Shi L,Tang P,et al.Comparison of the efficacy between two micro-operative therapies of old patients with osteoporotic vertebral compression fracture:A network meta-analysis.J Cell Biochem.2017;118(10):3205-3212.
[17]Chang X,Lv Y-F,Chen B,et al.Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture:A meta-analysis of prospective comparative studies.Int Orthop.2014;39(3):491-500.
[18]Blasco J,Martinez-Ferrer A,Macho J,et al.Effect of vertebroplasty on pain relief,quality of life,and the incidence of new vertebral fractures:A 12-month randomized follow-up,controlled trial.J Bone Miner Res.2012;27(5):1159-1166.
[19]Clark W,Bird P,Gonski P,et al.Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures(vapour):A multicentre,randomised,double-blind,placebo-controlled trial.Lancet.2016;388:1408-1416.
[20]Lin JH,Chien LN,Tsai WL,et al.Early vertebroplasty associated with a lower risk of mortality and respiratory failure in aged patients with painful vertebral compression fractures:A population-based cohort study in taiwan.Spine J.2017;17(9):1310-1318.
[21]Palmer S,Barnett S,Cramp M,et al.Effects of postural taping on pain,function and quality of life following osteoporotic vertebral fractures-a feasibility trial.Musculoskeletal Care.2018;16(3):345-352.
[22]Schiller J,Korallus C,Bethge M,et al.Effects of acupuncture on quality of life and pain in patients with osteoporosis-a pilot randomized controlled trial.Arch Osteoporos.2016;11(1):34.
[23]Hou Y,Yao Q,Zhang G,et al.Polymethylmethacrylate distribution is associated with recompression after vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures:A retrospective study.PLoS One.2018;13(6):e0198407.
[24]Chen Q,Liu L,Liang G.Distribution characteristics of bone cement used for unilateral puncture percutaneous vertebroplasty in multiple planes.Orthopade.2018;47(7):585-589.
[25]Sun HB,Jing XS,Liu YZ,et al.The optimal volume fraction in percutaneous vertebroplasty evaluated by pain relief,cement dispersion,and cement leakage:A prospective cohort study of 130patients with painful osteoporotic vertebral compression fracture in the thoracolumbar vertebra.World Neurosurg.2018;114:677-688.
[26]Zhang L,Wang Q,Wang L,et al.Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures.Clin Interv Aging.2017;12:431-436.
[27]林上进,林伟龙,杨丰建,等.Pvp术骨水泥形态类型与术后伤椎高度丢失的关系研究[J].老年医学与保健,2017,23(4):309-313.
[28]Garg B,Mehta N.Current status of 3d printing in spine surgery.JClin Orthop Trauma.2018;9(3):218-225.
[29]Hsu MR,Haleem MS,Hsu W.3D Printing Applications in Minimally Invasive Spine Surgery.Minim Invasive Surg.2018;2018:4760769.
[30]Khan U,Yasin A,Abid M,et al.A Methodological Review of 3DReconstruction Techniques in Tomographic Imaging.J Med Syst.2018;42(10):190.
[31]Li J,Lin J,Xu J,et al.A novel approach for percutaneous vertebroplasty based on preoperative computed tomography-based three-dimensional model design.World Neurosurg.2017;105:20-26.
[32]Li J,Lin J,Yang Y,et al.3-dimensional printing guide template assisted percutaneous vertebroplasty:Technical note.J Clin Neurosci.2018;52:159-164.
[33]Yu W,Liang D,Yao Z,et al.Risk factors for recollapse of the augmented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral fractures with intravertebral vacuum cleft.Medicine(Baltimore).2017;96(2):e5675.
[34]付兆宗,陈忠羡,秦英,等.骨水泥分布指数对椎体成形术后症状性邻近节段骨折的影响[J].南方医科大学学报,2017,37(7):947-951.
[35]Li H,Yang D,Ma L,et al.Risk factors associated with adjacent vertebral compression fracture following percutaneous vertebroplasty after menopause:A retrospective study.Med Sci Monit.2017;23:5271-5276.
[36]Ye L,Liang,Jiang X,et al.Risk factors for the occurrence of insufficient cement distribution in the fractured area after percutaneous vertebroplasty in osteoporotic vertebral compression fractures.Pain Physician.2018;21(1):33-42.
[37]王拴池,王芳芳,陶晓冰.数字骨科分析PVP术后骨水泥弥散程度及其与临床疗效的关联性[J].实用骨科杂志,2018,24(2):104-107.
[38]Wang S,Wang H,Niu L.Clinical efficacy of pvp and pkp in the treatment of ovcfs after bilateral resection of ovarian cancer.Oncol Lett.2018;16(1):151-156.
[39]Wang H,Sribastav S,Ye F,et al.Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures:A meta-analysis of the literature.Pain Physician.2015;18(3):209-222.
[40]Zhou T,Lin H,Wang H,et al.Comparative study on the biomechanics between improved pvp and traditional pkp in the treatment of vertebral peripheral wall damage-type ovcf.Exp Ther Med.2017;14(1):575-580.
[41]Guo Z,Wang W,Gao W,et al.Comparison the clinical outcomes and complications of high-viscosity versus low-viscosity in osteoporotic vertebral compression fractures.Medicine(Baltimore).2017;96(48):e8936.
[2]Alpantaki K,Dohm M,Korovessis P,et al.Surgical options for osteoporotic vertebral compression fractures complicated with spinal deformity and neurologic deficit.Injury.2018;49(2):261-271.
[3]Schupfner R,Stoevelaar H,Blattert T,et al.Treatment of osteoporotic vertebral compression fractures:Applicability of appropriateness criteria in clinical practice.Pain Physician.2016;19(1):113-120.
[4]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南[J].中华骨与关节外科杂志,2015,8(5):371-375.
[5]Luthman S,Widén J,Borgstr?m F.Appropriateness criteria for treatment of osteoporotic vertebral compression fractures.Osteoporos Int.2017;29(4):793-804.
[6]Wang B,Guo H,Yuan L,et al.A prospective randomized controlled study comparing the pain relief in patients with osteoporotic vertebral compression fractures with the use of vertebroplasty or facet blocking.Eur Spine J.2016;25(11):3486-3494.
[7]Li YX,Guo DQ,Zhang SC,et al.Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty(pvp)or percutaneous kyphoplasty(pkp).Int Orthop.2018;42(9):2131-2139.
[8]江晓兵,莫凌,梁德,等.骨水泥在椎体骨折线内弥散情况对椎体成形术治疗效果的影响[J].中国脊柱脊髓杂志,2014,24(2):144-149.
[9]贺宝荣,许正伟,郝定均,等.骨水泥在骨质疏松性骨折椎体内分布状态与生物力学性能的关系[J].中华骨科杂志,2012,32(8):768-773.
[10]黄文东.骨水泥弥散体积在椎体成形术中概念的建立和初步应用[D].广州:广州医科大学,2010.
[11]江晓兵,黄伟权,庞智晖,等.基于Mimics软件计算椎体强化术后椎体内骨水泥体积及骨水泥/椎体体积比的新方法[J].中国脊柱脊髓杂志,2013,23(3):238-243.
[12]Song BK,Eun JP,Oh YM.Clinical and radiological comparison of unipedicular versus bipedicular balloon kyphoplasty for the treatment of vertebral compression fractures.Osteoporos Int.2009;20(10):1717-1723.
[13]张大鹏,毛克亚,强晓军,等.椎体增强术后骨水泥分布形态分型及其临床意义[J].中华创伤杂志,2018,34(2):130-137.
[14]Yang EZ,Xu JG,Huang GZ,et al.Percutaneous vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures.Spine(Phila Pa 1976).2016;41(8):653-660.
[15]Zhang L,Liu Z,Wang J,et al.Unipedicular versus bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures:a prospective randomized study.BMC Musculoskelet Disord.2015;16:145.
[16]Zhang Y,Shi L,Tang P,et al.Comparison of the efficacy between two micro-operative therapies of old patients with osteoporotic vertebral compression fracture:A network meta-analysis.J Cell Biochem.2017;118(10):3205-3212.
[17]Chang X,Lv Y-F,Chen B,et al.Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture:A meta-analysis of prospective comparative studies.Int Orthop.2014;39(3):491-500.
[18]Blasco J,Martinez-Ferrer A,Macho J,et al.Effect of vertebroplasty on pain relief,quality of life,and the incidence of new vertebral fractures:A 12-month randomized follow-up,controlled trial.J Bone Miner Res.2012;27(5):1159-1166.
[19]Clark W,Bird P,Gonski P,et al.Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures(vapour):A multicentre,randomised,double-blind,placebo-controlled trial.Lancet.2016;388:1408-1416.
[20]Lin JH,Chien LN,Tsai WL,et al.Early vertebroplasty associated with a lower risk of mortality and respiratory failure in aged patients with painful vertebral compression fractures:A population-based cohort study in taiwan.Spine J.2017;17(9):1310-1318.
[21]Palmer S,Barnett S,Cramp M,et al.Effects of postural taping on pain,function and quality of life following osteoporotic vertebral fractures-a feasibility trial.Musculoskeletal Care.2018;16(3):345-352.
[22]Schiller J,Korallus C,Bethge M,et al.Effects of acupuncture on quality of life and pain in patients with osteoporosis-a pilot randomized controlled trial.Arch Osteoporos.2016;11(1):34.
[23]Hou Y,Yao Q,Zhang G,et al.Polymethylmethacrylate distribution is associated with recompression after vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures:A retrospective study.PLoS One.2018;13(6):e0198407.
[24]Chen Q,Liu L,Liang G.Distribution characteristics of bone cement used for unilateral puncture percutaneous vertebroplasty in multiple planes.Orthopade.2018;47(7):585-589.
[25]Sun HB,Jing XS,Liu YZ,et al.The optimal volume fraction in percutaneous vertebroplasty evaluated by pain relief,cement dispersion,and cement leakage:A prospective cohort study of 130patients with painful osteoporotic vertebral compression fracture in the thoracolumbar vertebra.World Neurosurg.2018;114:677-688.
[26]Zhang L,Wang Q,Wang L,et al.Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures.Clin Interv Aging.2017;12:431-436.
[27]林上进,林伟龙,杨丰建,等.Pvp术骨水泥形态类型与术后伤椎高度丢失的关系研究[J].老年医学与保健,2017,23(4):309-313.
[28]Garg B,Mehta N.Current status of 3d printing in spine surgery.JClin Orthop Trauma.2018;9(3):218-225.
[29]Hsu MR,Haleem MS,Hsu W.3D Printing Applications in Minimally Invasive Spine Surgery.Minim Invasive Surg.2018;2018:4760769.
[30]Khan U,Yasin A,Abid M,et al.A Methodological Review of 3DReconstruction Techniques in Tomographic Imaging.J Med Syst.2018;42(10):190.
[31]Li J,Lin J,Xu J,et al.A novel approach for percutaneous vertebroplasty based on preoperative computed tomography-based three-dimensional model design.World Neurosurg.2017;105:20-26.
[32]Li J,Lin J,Yang Y,et al.3-dimensional printing guide template assisted percutaneous vertebroplasty:Technical note.J Clin Neurosci.2018;52:159-164.
[33]Yu W,Liang D,Yao Z,et al.Risk factors for recollapse of the augmented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral fractures with intravertebral vacuum cleft.Medicine(Baltimore).2017;96(2):e5675.
[34]付兆宗,陈忠羡,秦英,等.骨水泥分布指数对椎体成形术后症状性邻近节段骨折的影响[J].南方医科大学学报,2017,37(7):947-951.
[35]Li H,Yang D,Ma L,et al.Risk factors associated with adjacent vertebral compression fracture following percutaneous vertebroplasty after menopause:A retrospective study.Med Sci Monit.2017;23:5271-5276.
[36]Ye L,Liang,Jiang X,et al.Risk factors for the occurrence of insufficient cement distribution in the fractured area after percutaneous vertebroplasty in osteoporotic vertebral compression fractures.Pain Physician.2018;21(1):33-42.
[37]王拴池,王芳芳,陶晓冰.数字骨科分析PVP术后骨水泥弥散程度及其与临床疗效的关联性[J].实用骨科杂志,2018,24(2):104-107.
[38]Wang S,Wang H,Niu L.Clinical efficacy of pvp and pkp in the treatment of ovcfs after bilateral resection of ovarian cancer.Oncol Lett.2018;16(1):151-156.
[39]Wang H,Sribastav S,Ye F,et al.Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures:A meta-analysis of the literature.Pain Physician.2015;18(3):209-222.
[40]Zhou T,Lin H,Wang H,et al.Comparative study on the biomechanics between improved pvp and traditional pkp in the treatment of vertebral peripheral wall damage-type ovcf.Exp Ther Med.2017;14(1):575-580.
[41]Guo Z,Wang W,Gao W,et al.Comparison the clinical outcomes and complications of high-viscosity versus low-viscosity in osteoporotic vertebral compression fractures.Medicine(Baltimore).2017;96(48):e8936.