{"paper_id":"0046286c-256c-4e65-be82-01557d56062d","body_text":"Clinical Observation of Two Bone Cement Distribution Modes After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Observation of Two Bone Cement Distribution Modes After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures Qiujiang Li, Xingxia Long, Yinbin Wang, Tao Guan, Xiaomin Fang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-468772/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Current findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs).The present retrospective study aimed to investigate the differences in clinical efficacy and related complications between the two bone cement distribution modes. Methods: We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty.Patients were divided into blocky and spongy group according to the type of postoperative bone cement distribution. Clinical efficacy and related complications was compared between the two bone cement distribution modes on 24h after the operation and last follow-up. RESULTS: The mean follow-up time was 17.54 months. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24h postoperatively, and at the last follow-up. There were 42 cases (12.8%) of adjacent vertebral fractures, 26 cases (19.8%) in the blocky group and 16 cases (8.1%) in the spongy group. There were 57 cases (17.3%) of bone cement leakage, 18 cases (13.7%) in blocky group and 39 cases (19.7%) in the spongy group. At 24 hour postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. Loss of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up. Conclusions: Compared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions. Orthopedics osteoporotic vertebral compression fractures OVCFs percutaneous vertebralplasty PVP bone cement distribution adjacent vertebral fracture vertebral body height Figures Figure 1 Figure 2 Figure 3 Introduction With the aging of the social population,incidence of osteoporosis is constantly increasing，seriously affecting life quality of elderly patients[1]. Osteoporotic Vertebral Compression Fractures (OVCFs), one of the most common complications of osteoporosis, often occur in low energy damage or the absence of a clear trauma history,which primarily results in persistent back pain,local vertebral kyphosis,a reduced quality of life as well as increased mortality[2, 3]. The prevalence increases with age, with an estimated 140 000 new vertebral fractures per year in the United States[4, 5]. Percutaneous vertebroplasty can provide instant pain relief and stabilize the fractured vertebral body through the minimally invasive injection of polymethylmethacrylate(PMMA) bone cement, which has been widely used in OVCFs treatment[6, 7]. However, the risks related with vertebroplasty are not uncommon such as kyphosis, loss of height and adjacent segment fracture,and may be related to the type of bone cement distribution[6-9]. However, few studies have reported the relationship between bone cement distribution and imaging changes and clinical outcomes following PVP. Therefore, the present study aimed to investigate the differences in vertebral height correction, local vertebral kyphosis correction，pain relief, functional recovery, etc between the two bone cement distribution modes. Methods General data The clinical data of patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty from April 2016 to April 2019 were retrospectively reviewed. The inclusion criterias are as follows: 1.the patient had obvious thoracolumbar and back pain, and limited physical activity, especially in cases of turning over or getting up. 2.T score ≤−2.5 at spine/hip at Dual energy X-ray absorptiometry (DXA). 3.The signal change of the lumbar fracture by lumbar magnetic resonance imaging(MRI) suggesting a hyperintense T2 signal and a hypointense T1 signal,or a whole-body bone scan performed a active bone metabolism. Exclusion criterias are as follows: 1.Patients with OVCFs caused by tumor, infection, or tuberculosis. 2.Patients had coagulation dysfunction,combined systemic disease,and inability to tolerate the procedure. 3. Systemic or local infection. 4. Spinal cord compression and obvious neural symptoms such as numbness and/or muscle weakness. 5. Incomplete follow-up data. We eventually recruited 392 patients, including 60 males and 269 females, mean age 68.21±10.48 years, and mean follow-up time 17.54 months. The present study was approved by the medical ethics committee of the Peoples Hospital of Ningxia Hui Autonomous Region.All included patients signed an informed consent. Surgical method The patient was placed in the prone position, the abdomen was vacated, and the fractured vertebrae were located under C-arm fluoroscopic guidance. The puncture needle was inserted into the vertebral body via bilateral arch pathways. The tip of the puncture needle was located in the anterior middle third of the vertebral body on the lateral view, and the anterior-posterior view was located between the inner edge of the ipsilateral pedicle and the vertebral body midline. The working channel is established and the high-viscosity cement is slowly injected under C-arm fluoroscopy until the bone cement approaches the posterior wall of the vertebral body where leakage may occur, and the working channel is slowly withdrawn after the cement has hardened. The whole procedure was done with the assistance of C-arm fluoroscopy. All patients were given oral calcium and vitamin D postoperatively and an intravenous infusion of Zoledronic acid (Aclasta, 100ml/5mg) once a year thereafter for 3 years. Patients were reviewed on the postoperative 24h for anteroposterior and lateral radiographs and discharged 2 to 3 days after surgery.X-ray films of injured vertebra were reviewed periodically after surgery. Grouping method Anteroposterior and lateral radiographs were taken 24 hours after surgery and divided into blocky group(Figure 1) and spongy groups(Figure 2) according to the difference in the distribution of bone cement in the vertebral body on the X-ray images after PVP treatment. Evaluation method Gender, nationality, age, diabetes history, hypertension history, fracture history, body mass index (BMI), Bone mineral density(BMD), fracture segment, follow up time, bone cement volume, operation duration, blood loss, adjacent vertebral fracture and bone cement leakage were documented. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) were recorded to assess the clinical outcomes before surgery, 24h after surgery and at the last follow-up. The anterior vertebral height (AVH) and local kyphotic angle (LKA, Cobb’s method) of the fractured vertebral body were measured before surgery, 24h after surgery and at the last follow-up. AVH change was defined as postoperative AVH - preoperative AVH. The anterior vertebral height ratio(AVHR) was defined as the height of the anterior wall of the compressed vertebral body / (the height of the anterior wall of the upper vertebral body + the height of the anterior wall of the lower vertebral body)×2(Figure 3). The anterior vertebral height recovery ratio(AVHRR) was defined as postoperative AVHR - preoperative AVHR. The anterior vertebral height loss ratio(AVHLR) was defined as postoperative AVHR-last follow-up AVHR. Cobb angle was defined as the angle formed by the upper and lower endplates of the fractured vertebral body(Figure 3). Local kyphotic angle change was defined as last follow-up Cobb angle – postoperative Cobb angle . Statistical analysis The data were statistically analyzed using SPSS 22.0 software (SPSS, Inc., USA). Categorical variables were expressed as rates, and the chi-square test was used for comparison between groups. Continuous variables were expressed as mean + standard deviation, and independent samples t-test or analysis of variance (ANOVA) was used for comparison between groups. Differences were defined as statistically significant at P<0.05. Results All patients received PVP treatment for single level OVCF and finished mean 17.54 months of follow-up (range from 11 to 36 months). There was no significant difference in gender, nationality, age, comorbidities(diabetes history, hypertension history, fracture history), BMI, BMD, fracture segment, follow up time, bone cement volume, operation duration and blood loss, as depicted in Table 1. There were no statistically significant differences in the VAS and ODI between the two groups before the operation,but a significant reduction in pain was reported in the blocky and spongy group after surgery(Table 2).The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24h postoperatively, and at the last follow-up(Table 2). There were 42 cases (12.8%) of adjacent vertebral fractures, 26 cases (19.8%) in blocky group and 16 cases (8.1%) in spongy group. The incidence of postoperative adjacent vertebral fractures in spongy group was significantly lower than that in blocky group, and the difference was statistically significant(Table 2). There were 57 cases (17.3%) of bone cement leakage, 18 cases (13.7%) in blocky group and 39 cases (19.7%) in spongy group(Table 2). There were no clinical symptoms between two groups, and the difference was not statistically significant. Local kyphotic angle change was significant smaller in spongy group(Table 2). AVHHR in spongy group is higher than that in blocky group, it was significant difference in AVHRR between the two groups(Table 2). At the last follow-up, AVHLR in spongy group was significantly lower than that in group A.AVH and AVHR were all significantly restored at 24h and last follow-up after surgery, compared with the preoperative data in groups(Table 2). Similarly, Cobb angle improved significantly after surgery for both groups(Table 2). At the 24h and last follow-up, AVH, AVHR,AVH change in spongy group were significantly higher than that in blocky group, while Cobb angle was significantly lower(Table 2). Discussion In 1987, Galibert first used vertebroplasty to treat C2 vertebral hemangioma. Studies have been reported on PVP for OVCFs in 1988 and 1994, respectively. Since then, the technique has been developed and refined, and it has gradually become the main methods for treating OVCFs due to its simplicity and efficacy. PVP strengthens the vertebral body by injecting bone cement into the fractured vertebral body to restore the height, strength, and stiffness of the vertebral body, while correct the local kyphosis and produce a thermal effect on the nociceptive nerves around the vertebral body to rapidly relieve pain symptoms. However, this method is affected by many factors, such as BMD, the amount, distribution, and leakage of bone cement, etc. A biomechanical study of 120 vertebrae from 10 osteoporotic female cadavers found, on average 16.2% and 29.8% of the vertebral cement filling is required to restore strength and stiffness, respectively, and it was no correlation between the recovery of vertebral strength and stiffness and the percentage volume of bone cement filling[18]. Liebschner [19] et al. performed a single lumbar PVP finite element analysis study, which found that only a small amount of bone cement (14% volume) was required to restore the stiffness of the fractured vertebrae to pre-injury levels, and that a larger volume of bone cement did not provide greater benefit, as the increase in vertebral strength with bone cement resulted in asymmetric distribution of bone cement and strength imbalance on both sides of the vertebral body. Related studies also confirm the above-mentioned view [20, 21]. In addition, the correlation between bone cement volume and surgical outcome is small, and an increase in cement volume may increase the risk of cement leakage [22]. Bone cement injection volume is a one-sided indicator of the benefit of bone cement and does not reflect the distribution of bone cement within the vertebral body. Therefore, it is important to study the distribution of bone cement and the clinical outcome and prognosis of PVP. However, few studies have reported the effect of bone cement distribution on radiographic and functional recovery after PVP treatment. Compared to PVP, PKP results in poorer cement distribution and a greater likelihood of postoperative vertebral height loss [23]. The main reason is that the expansion of the balloon compresses the more lax cancellous bone in the cone, thus creating a \"cavity\" at the balloon site, and the injected bone cement tends to be distributed in this low-pressure cavity without dispersing into the surrounding bone, making it difficult to bind tightly to the cancellous bone. Therefore, this blocky distribution of bone cement has been shown to be an important factor in vertebral body height loss. The subjects selected in this study were all post-PVP patients, excluding the influence of the surgical approach on the results. A study by Chen [24] et al. reported that the symmetric distribution of bone cement is closely related to the stiffness of the vertebral body, and in unilateral vertebroplasty, the bone cement is often confined to the ipsilateral side of the vertebral body and cannot effectively diffuse across the midline; therefore, the end result can be a significant reduction in the stiffness of the vertebral body on the unreinforced side of the bone cement compared to the reinforced side. The biomechanical imbalance can exacerbate the pressure load on the spine, resulting in effects that are difficult to reverse, such as loss of height of the fractured vertebral body, disc degeneration in adjacent segments, and even fracture of the vertebral body in adjacent segments [25, 26]. Therefore, all subjects included in this study received bilateral arch root PVP surgery, further reducing the detrimental effects of asymmetric distribution of bone cement in the coronal plane. The majority of females in this study indicated that postmenopausal women are more likely to have osteoporosis in patients. Spinal imaging changes such as vertebral body height and Cobb angle are often used as indicators to assess the efficacy of PVP[27]. Yan[28] et al. reported that PVP was able to restore vertebral body height and correct kyphosis. The results of the present study showed that PVP was able to significantly restore anterior vertebral body height and reduce the Cobb angle without considering the cement distribution, and if the cement was spongy in the vertebral body, it could better maintain the height of the vertebral body and reduce the risk of postoperative vertebral body height loss as well as local kyphosis. There are numerous factors that contribute to enhanced postoperative vertebral body height loss and increased kyphosis that do not require exposure to a traumatic event and may be related to the severity of osteoporosis, daily activity level, and cement distribution[25]. However, bone cement distribution is an important factor contributing to vertebral height loss[9]. He[23] et al. reported that the incidence of vertebral height loss was higher in the uninterlocked solid pattern of bone cement distribution than in the interlocked solid pattern. Furthermore, Yu[8] et al. also confirmed that the comparatively diffused pattern of bone cement distribution has better medium and long-term clinical outcomes, compared to the solid lump distribution pattern. The spongy bone cement distribution allows cancellous bone and bone cement to more fully interlock and increases vertebral strength and stiffness with greater homogenization, thus reducing the risk of vertebral height loss after PVP[29]. Our study also found a loss of vertebral body height and local kyphosis over time in the blocky and spongy group postoperatively, which is consistent with previous findings[30, 31]. In contrast, the blocky group showed more pronounced changes on imaging than the spongy group, which was related to the distribution of bone cement. Our study is consistent with previous studies reporting[32, 33] that PVP significantly relieves short-term pain and restores function, regardless of the bone cement distribution pattern. In long-term follow-up, it was also found that VAS and ODI scores were significantly lower in the spongy group than in the blocky group, suggesting that spongy bone cement distribution has better analgesic and functional recovery effects. The cause of persistent lower back pain is mainly related to insufficient filling of the bone cement[34]. The bone cement does not bind effectively to the fractured vertebrae, and the low strength and stiffness of the vertebrae are not sufficient to provide effective support, resulting in a continuous loss of height[35, 36]. Therefore, we speculate that the spongy distribution of the bone cement allows greater contact with the cancellous bone within the vertebral body, which can adequately immobilize the fractured fragment, increasing spinal stability and reducing micromovement of the trabeculae, thus reducing pain and achieving functional recovery[34, 37]. Liebschner[19] et al. reported that the recovery of vertebral body strength was closely related to the distribution of bone cement. The strength and stiffness of the vertebral body after bone cement strengthening are significantly higher than the adjacent vertebrae, and the inhomogeneous distribution of bone cement makes the strength and stiffness of the vertebral body asymmetrical in all areas, and all of these factors tend to increase the risk of fracture of the adjacent vertebral body after PVP[24, 38, 39]. Therefore, numerous studies have confirmed that homogeneous distribution of bone cement within cancellous bone can reduce stress concentration and thus reduce the risk of fracture in adjacent vertebrae[29, 40]. The spongy group has a spongy and homogeneous distribution of bone cement, which can fill the cancellous bone better and reduce the concentrated stress between adjacent vertebrae. Our results confirmed that the incidence of adjacent vertebral fractures was significantly lower in the blocky group than spongy. Therefore, achieving good distribution of bone cement within cancellous bone is crucial in reducing the risk of adjacent vertebral fractures. There is an association between the distribution of bone cement and cement leakage[29]. The overall bone cement leakage rate in our findings was consistent with the results reported in previous studies[41], and most patients were clinically asymptomatic. The rate of bone cement leakage was lower in the blocky group than spongy, but the difference was not statistically significant. This may be due to the diffuse distribution of the spongy cement, which is more widely distributed than the blocky group and more likely to leak through the broken bone cortex or endplate to the intervertebral disc or paravertebral area[40]. Therefore, the surgeon should carefully analyze the imaging data preoperatively and should suspend the procedure in case of intraoperative cement leakage. Limitations: This study currently has some limitations. First, our study is a retrospective study with a relatively small sample size, which may result in some bias. Second, the grouping method in our study differs from previous studies, in which it may lead to subjective bias in the results. Therefore, multicenter, prospective studies with larger samples are needed to further elucidate the relationship between intravertebral bone cement distribution and clinical outcomes of PVP. Conclusion Both groups of bone cement distribution have good immediate analgesic effect. However, compared with the blocky group, the spongy group could better maintain the height of the vertebral body, correct local kyphotic, improve function, reduce the risk of postoperative adjacent vertebral fractures, and it was more effective. Abbreviations OVCFs=Osteoporotic Vertebral Compression Fractures; PVP=Percutaneous vertebroplasty; PMMA=Polymethylmethacrylate; DXA=Dual energy X-ray absorptiometry; MRI=Magnetic resonance imaging; BMD=Bone mineral density; BMI=body mass index; ODI=Oswestry Disability Index; VAS=Visual Analog Scale; AVH=anterior vertebral heigh; LKA=local kyphotic angle; AVHR=anterior vertebral height ratio; AVHRR=anterior vertebral height recovery ratio; AVHLR=anterior vertebral height loss ratio Declarations Ethics approval and consent to participate This study was approved by the institutional review boards/Ethics Committees of People's Hospital of Ningxia Hui Autonomous Region, and was conducted in compliance with the ethical principles of the Helsinki Declaration of 1975. Written informed consent was obtained from the patients or their family members. Consent for publication Not applicable. Availability of data and materials Please contact the corresponding author for data requests. Competing interests No potential conflict of interest relevant to this article was reported. Funding This study was funded by Ningxia Hui Autonomous Region Science and Technology Benefiting People Special Project(2018KJHM00) . Authors ’ contributions All authors made substantive intellectual contributions in this study to qualify as authors. L QJ, L XX and C LJ designed this study. L QJ, L XX, W YB, F XM, G T,H XH and Jiang Xiaocheng participated in collecting and analyzing raw materials. An initial draft of the manuscript was written by L QJ and L XX. G DG, L JH, and C LJ re-drafted parts of the manuscript and provided helpful advice on the final revision. All authors were involved in writing the manuscript. All authors read and approved the final manuscript. Acknowledgements We wish to thank radiology department, other orthopedic medical staff and rehabilitation nurse, for her help and cooperation during the study. 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Tan L, Wen B, Guo Z, Chen Z: The effect of bone cement distribution on the outcome of percutaneous Vertebroplasty: a case cohort study. BMC Musculoskelet Disord 2020, 21(1):541. Ye LQ, Liang, Jiang XB, Yao ZS, Lu H, Qiu T, Yu WB, Mo L, Zhang SC, Jin DX: 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):E33-E42. Niu J, Zhou H, Meng Q, Shi J, Meng B, Yang H: Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty: a retrospective analysis. ACTA RADIOL 2015, 56(11):1380–1387. Kim YY, Rhyu KW: Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture. EUR SPINE J 2010, 19(11):1907–1912. Steinmann J, Tingey CT, Cruz G, Dai Q: Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976) 2005, 30(2):201–205. Furtado N, Oakland RJ, Wilcox RK, Hall RM: A biomechanical investigation of vertebroplasty in osteoporotic compression fractures and in prophylactic vertebral reinforcement. Spine (Phila Pa 1976) 2007, 32(17):E480-E487. Chevalier Y, Pahr D, Charlebois M, Heini P, Schneider E, Zysset P: Cement distribution, volume, and compliance in vertebroplasty: some answers from an anatomy-based nonlinear finite element study. Spine (Phila Pa 1976) 2008, 33(16):1722–1730. Chen JB, Xiao YP, Chen D, Chang JZ, Li T: Clinical observation of two bone cement distribution modes of percutaneous vertebroplasty in the treatment of thoracolumbar Kummell's disease. J ORTHOP SURG RES 2020, 15(1):250. Xiang GH, Tong MJ, Lou C, Zhu SP, Guo WJ, Ke CR: The Role of Unilateral Balloon Kyphoplasty for the Treatment of Patients with OVCFS: A Systematic Review and Meta-Analysis. PAIN PHYSICIAN 2018, 21(3):209–218. Tables Table 1. Comparison of baseline characteristics of patients between two groups. Blocky group Spongy group t/χ 2 -value P-value Gender 0.304 0.581 Male 22（16.8%） 38（19.2%） Female 109（83.2%） 160（80.8%） Nationality 0.117 0.732 Han 118（90.1%） 176（88.9%） Hui 13（9.9%） 22（11.1%） Age(years) 3.968 0.265 <60 4（3.1%） 12（6.1%） 60~70 47（35.9%） 71（35.9%） 70~80 54（41.2%） 89（44.9%） >80 26（19.8%） 26（13.1%） Diabetes history(%) 9.2% 8.6% 0.032 0.857 No(cases) 119 181 Yes(cases) 1 17 Hypertension history(%) 48.9% 44.9% 0.483 0.487 No(cases) 67 109 Yes(cases) 64 89 Fracture history(%) 16.8% 15.7% 0.075 0.784 No(cases) 109 167 Yes(cases) 22 31 BMI(kg/m 2 ) 24.25±3.61 23.65±3.42 1.537 0.125 Bone mineral density (T score) -3.23±0.85 -3.26±0.90 0.260 0.795 Fracture segment 3.544 0.170 Thoracic (T1~9) 10（7.6%） 20（10.1%） Thoracolumbar (T10~L2) 78（59.5%） 97（49.0%） Lumbar (L3~5) 43（32.8%） 81（40.9%） Follow up time(months) 17.83±7.33 17.35±6.54 0.618 0.537 Bone cement volume(mL) 4.15±1.16 4.11±1.11 0.264 0.792 Operation duration(mins) 42.6±12.04 41.73±11.12 0.67 0.503 Blood loss(mL) 11.17±3.66 11.07±3.58 0.239 0.811 Table 2 Analysis of outcome between two groups Blocky group Spongy group T-value P-value VAS pre-op 6.29±0.90 6.28±1.05 0.060 0.948 24h post-op 2.54±0.91 2.12±0.79 4.355 <0.001 last follow-up 2.13±0.738 1.81±0.67 4.090 <0.001 ODI pre-op 63.63±11.94 61.02±11.79 1.958 0.051 24h post-op 35.88±6.72 33.84±6.38 2.773 0.006 last follow-up 26.78±5.53 23.2±7.59 4.941 <0.001 AVH(mm) pre-op 14.60±2.96 15.22±3.16 -1.785 0.075 24h post-op 16.72±3.12 17.62±3.19 -2.505 0.013 last follow-up 16.23±3.13 17.14±3.25 -2.545 0.011 Cobb(%) pre-op 26.71±6.91 27.08±7.55 -0.465 0.642 24h post-op 17.94±3.51 15.85±4.03 4.847 <0.001 last follow-up 24.31±4.92 21.04±4.59 6.142 <0.001 AVHR(%) 24h post-op 54.95±10.61 58.17±10.55 -2.703 0.007 last follow-up 46.58±10.96 50.55±10.84 -3.237 0.001 AVH change(mm) 24h post-op 2.13±0.73 2.40±0.69 -3.427 0.001 last follow-up 1.63±1.078 1.93±1.08 -2.466 0.014 AVHLR(%) 8.37±2.97 7.62±2.96 2.245 0.025 AVHRR(%) 6.99±2.42 7.94±2.35 -3.544 <0.001 Local kyphotic angle change( ° ) 6.37±4.27 5.20±3.81 2.553 0.011 Adjacent vertebral fractures(%) 19.8% 8.1% 9.802 0.002 No(cases) 105 182 Yes(cases) 26 16 Bone cement leakage (%) 13.7% 19.7% 1.953 0.162 No(cases) 113 151 Yes(cases) 18 39 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 17 May, 2021 Reviews received at journal 14 May, 2021 Reviewers agreed at journal 13 May, 2021 Reviews received at journal 11 May, 2021 Reviewers agreed at journal 04 May, 2021 Reviewers invited by journal 04 May, 2021 Editor assigned by journal 03 May, 2021 Editor invited by journal 30 Apr, 2021 Submission checks completed at journal 30 Apr, 2021 First submitted to journal 27 Apr, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-468772\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":24149879,\"identity\":\"60e8ea9c-4c36-46fd-a14b-c71f18c4b8b2\",\"order_by\":0,\"name\":\"Qiujiang Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Graduate School of Ningxia Medical 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15:14:11\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-468772/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-468772/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":8995637,\"identity\":\"1c759018-8d48-4da7-a625-a894eb1f884b\",\"added_by\":\"auto\",\"created_at\":\"2021-05-10 13:22:28\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":710879,\"visible\":true,\"origin\":\"\",\"legend\":\"Distribution characteristics of blocky bone cement. A Anteroposterior X-ray film of local solid distribution pattern in the blocky group. B Lateral X-ray film of local solid distribution pattern in the blocky group.\",\"description\":\"\",\"filename\":\"figure1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-468772/v1/58941eb2a674d7305e082ac4.png\"},{\"id\":8995635,\"identity\":\"940e12b6-3558-4a75-b9d7-4082bc2a34cc\",\"added_by\":\"auto\",\"created_at\":\"2021-05-10 13:22:28\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":102847,\"visible\":true,\"origin\":\"\",\"legend\":\"Distribution characteristics of spongy bone cement. A Anteroposterior X-ray film of diffuse distribution pattern in the spongy group. B Lateral X-ray film of diffuse distribution pattern in the spongy group.\",\"description\":\"\",\"filename\":\"figure2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-468772/v1/f567ae7a8ba365e199fc7dc6.png\"},{\"id\":8995809,\"identity\":\"bc2a5b74-2387-46d5-bdf5-4c78358a949b\",\"added_by\":\"auto\",\"created_at\":\"2021-05-10 13:25:28\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":875571,\"visible\":true,\"origin\":\"\",\"legend\":\"Radiographic evaluation of compressed vertebrae. A The anterior vertebral height ratio(AVHR) was defined as the height of the anterior wall of the compressed vertebral body(b) / (the height of the anterior wall of the upper vertebral body(a) + the height of the anterior wall of the lower vertebral body(c))×2. B Cobb angle was defined as the angle formed by the upper endplates(Line a) and lower endplates(Line b) of the fractured vertebral body.\",\"description\":\"\",\"filename\":\"figure3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-468772/v1/cd139e7b595db7cd1fce27c1.png\"},{\"id\":13691416,\"identity\":\"f6f64a3a-87d7-4a5a-a18c-c29c67c70a6d\",\"added_by\":\"auto\",\"created_at\":\"2021-09-17 12:38:38\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1994116,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-468772/v1/f13b8373-bdd5-432f-8f79-87d934e05182.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eClinical Observation of Two Bone Cement Distribution Modes After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eWith\\u0026nbsp;the\\u0026nbsp;aging\\u0026nbsp;of\\u0026nbsp;the\\u0026nbsp;social population,incidence\\u0026nbsp;of\\u0026nbsp;osteoporosis\\u0026nbsp;is constantly increasing，seriously affecting\\u0026nbsp;life\\u0026nbsp;quality\\u0026nbsp;of\\u0026nbsp;elderly patients[1]. Osteoporotic Vertebral Compression Fractures (OVCFs), one of the most common complications of osteoporosis, often occur\\u0026nbsp;in low\\u0026nbsp;energy\\u0026nbsp;damage or the absence\\u0026nbsp;of a clear\\u0026nbsp;trauma\\u0026nbsp;history,which primarily results in persistent back\\u0026nbsp;pain,local vertebral kyphosis,a reduced\\u0026nbsp;quality\\u0026nbsp;of\\u0026nbsp;life as well as\\u0026nbsp;increased\\u0026nbsp;\\u0026nbsp;mortality[2, 3]. The prevalence increases with age, with an estimated 140 000 new vertebral fractures per year in the United States[4, 5]. Percutaneous vertebroplasty can provide instant\\u0026nbsp;pain\\u0026nbsp;relief\\u0026nbsp;and stabilize\\u0026nbsp;the fractured vertebral body through the minimally invasive injection of polymethylmethacrylate(PMMA) bone cement, which has\\u0026nbsp;been\\u0026nbsp;widely\\u0026nbsp;used\\u0026nbsp;in\\u0026nbsp;OVCFs\\u0026nbsp;treatment[6, 7]. However, the risks related with vertebroplasty\\u0026nbsp;are\\u0026nbsp;not uncommon\\u0026nbsp;such\\u0026nbsp;as kyphosis,\\u0026nbsp;loss\\u0026nbsp;of\\u0026nbsp;height\\u0026nbsp;and adjacent segment fracture,and may be related to the type of bone cement distribution[6-9]. However, few studies have reported the relationship between bone cement distribution and imaging changes and clinical outcomes following PVP. Therefore, the present\\u0026nbsp;study\\u0026nbsp;aimed\\u0026nbsp;to\\u0026nbsp;investigate the differences in vertebral height correction, local vertebral kyphosis correction，pain relief, functional recovery, etc between the two bone cement distribution modes.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eGeneral data\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe clinical data of patients with\\u0026nbsp;single-segment\\u0026nbsp;OVCFs who underwent bilateral percutaneous vertebroplasty from April 2016 to April 2019 were retrospectively reviewed. The inclusion criterias are as follows: 1.the\\u0026nbsp;patient had\\u0026nbsp;obvious thoracolumbar and back\\u0026nbsp;\\u0026nbsp;pain, and\\u0026nbsp;limited\\u0026nbsp;physical activity,\\u0026nbsp;especially\\u0026nbsp;in cases of turning\\u0026nbsp;over or getting\\u0026nbsp;up. 2.T\\u0026nbsp;score \\u0026le;\\u0026minus;2.5 at spine/hip at\\u0026nbsp;Dual energy X-ray absorptiometry (DXA). 3.The signal change of the lumbar fracture by lumbar magnetic resonance imaging(MRI) suggesting a hyperintense T2\\u0026nbsp;signal\\u0026nbsp;and a hypointense T1\\u0026nbsp;signal,or a whole-body\\u0026nbsp;bone\\u0026nbsp;scan performed a active bone metabolism. Exclusion criterias are as follows: 1.Patients with OVCFs\\u0026nbsp;caused\\u0026nbsp;by tumor, infection, or\\u0026nbsp;tuberculosis. 2.Patients\\u0026nbsp;had\\u0026nbsp;coagulation\\u0026nbsp;dysfunction,combined\\u0026nbsp;systemic\\u0026nbsp;disease,and inability to\\u0026nbsp;tolerate\\u0026nbsp;the procedure. 3. Systemic or local infection. 4. Spinal cord compression and obvious neural symptoms such as numbness and/or muscle weakness. 5. Incomplete follow-up data. We eventually recruited 392 patients, including 60 males and 269 females, mean age 68.21\\u0026plusmn;10.48 years, and mean follow-up time 17.54 months. The\\u0026nbsp;present\\u0026nbsp;study\\u0026nbsp;was\\u0026nbsp;approved\\u0026nbsp;by the medical\\u0026nbsp;ethics\\u0026nbsp;committee\\u0026nbsp;of\\u0026nbsp;the\\u0026nbsp;Peoples\\u0026nbsp;Hospital\\u0026nbsp;of\\u0026nbsp;Ningxia\\u0026nbsp;Hui\\u0026nbsp;Autonomous\\u0026nbsp;Region.All included patients signed an informed consent.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSurgical method\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe patient was placed in the prone position, the abdomen was vacated, and the fractured vertebrae were located under C-arm fluoroscopic guidance. The puncture needle was inserted into the vertebral body via bilateral arch pathways. The tip of the puncture needle was located in the anterior middle third of the vertebral body on the lateral view, and the anterior-posterior view was located between the inner edge of the ipsilateral pedicle and the vertebral body midline. The working channel is established and the high-viscosity cement is slowly injected under C-arm fluoroscopy until the bone cement approaches the posterior wall of the vertebral body where leakage may occur, and the working channel is slowly withdrawn after the cement has hardened. The whole procedure was done with the assistance of C-arm fluoroscopy. All patients were given oral calcium and vitamin D postoperatively and an intravenous infusion of\\u0026nbsp; Zoledronic acid (Aclasta, 100ml/5mg) once a year thereafter for 3 years. Patients were reviewed on the postoperative 24h for anteroposterior and lateral radiographs and discharged 2 to 3 days after surgery.X-ray films of injured vertebra were reviewed periodically after surgery.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eGrouping method\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAnteroposterior and lateral radiographs were taken 24 hours after surgery and divided into blocky group(Figure 1) and spongy groups(Figure 2) according to the difference in the distribution of bone cement in the vertebral body on the X-ray images after PVP treatment.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEvaluation method\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eGender, nationality, age, diabetes history, hypertension history, fracture history, body mass index (BMI), Bone mineral density(BMD), fracture segment, follow up time, bone cement volume, operation duration, blood loss, adjacent vertebral fracture and bone cement leakage were documented. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) were recorded to assess the clinical outcomes before surgery, 24h after surgery and at the last follow-up. The anterior vertebral height (AVH) and local kyphotic angle (LKA, Cobb\\u0026rsquo;s method) of the fractured vertebral body were measured before surgery, 24h after surgery and at the last follow-up. AVH change was defined as postoperative AVH - preoperative AVH. The anterior vertebral height ratio(AVHR) was defined as the height of the anterior wall of the compressed vertebral body / (the height of the anterior wall of the upper vertebral body + the height of the anterior wall of the lower vertebral body)\\u0026times;2(Figure 3). The anterior vertebral height recovery ratio(AVHRR) was defined as postoperative AVHR - preoperative AVHR. The anterior vertebral height loss ratio(AVHLR) was defined as postoperative AVHR-last follow-up AVHR. Cobb angle was defined as the\\u0026nbsp;angle\\u0026nbsp;formed by the\\u0026nbsp;upper\\u0026nbsp;and\\u0026nbsp;lower\\u0026nbsp;endplates\\u0026nbsp;of\\u0026nbsp;the fractured vertebral body(Figure 3). Local kyphotic angle change was defined as last follow-up Cobb angle \\u0026ndash; postoperative Cobb angle .\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data were statistically analyzed using SPSS 22.0 software (SPSS, Inc., USA). Categorical variables were expressed as rates, and the chi-square test was used for comparison between groups. Continuous variables were expressed as mean + standard deviation, and independent samples t-test or analysis of variance (ANOVA) was used for comparison between groups. Differences were defined as statistically significant at P\\u0026lt;0.05.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eAll patients received PVP treatment for single level OVCF and finished mean 17.54 months of follow-up (range from 11 to 36 months). There was no significant difference in gender, nationality, age, comorbidities(diabetes history, hypertension history, fracture history), BMI, BMD, fracture segment, follow up time, bone cement volume, operation duration and blood loss, as depicted in Table 1.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThere were no statistically significant differences in the VAS and ODI between the two groups before the operation,but a significant reduction in pain was reported in the blocky and spongy group after surgery(Table 2).The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24h postoperatively, and at the last follow-up(Table 2).\\u003c/p\\u003e\\n\\u003cp\\u003eThere were 42 cases (12.8%) of adjacent vertebral fractures, 26 cases (19.8%) in blocky group and 16 cases (8.1%) in spongy group. The incidence of postoperative adjacent vertebral fractures in spongy group was significantly lower than that in blocky group, and the difference was statistically significant(Table 2). There were 57 cases (17.3%) of bone cement leakage, 18 cases (13.7%) in blocky group and 39 cases (19.7%) in spongy group(Table 2). There were no clinical symptoms between two groups, and the difference was not statistically significant.\\u003c/p\\u003e\\n\\u003cp\\u003eLocal kyphotic angle change was significant smaller in spongy group(Table 2). AVHHR in spongy group is higher than that in blocky group, it was significant difference in AVHRR between the two groups(Table 2). At the last follow-up, AVHLR in spongy group was significantly lower than that in group A.AVH and AVHR were all significantly restored at 24h and last follow-up after surgery, compared with the preoperative data in groups(Table 2). Similarly, Cobb angle improved significantly after surgery for both groups(Table 2). At the 24h and last follow-up, AVH, AVHR,AVH change in spongy group were significantly higher than that in blocky group, while Cobb angle was significantly lower(Table 2).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn 1987, Galibert first used vertebroplasty to treat C2 vertebral hemangioma. Studies have been reported on PVP for OVCFs in 1988 and 1994, respectively. Since then, the technique has been developed and refined, and it has gradually become the main methods for treating OVCFs due to its simplicity and efficacy. PVP strengthens the vertebral body by injecting bone cement into the fractured vertebral body to restore the height, strength, and stiffness of the vertebral body, while correct the local kyphosis and produce a thermal effect on the nociceptive nerves around the vertebral body to rapidly relieve pain symptoms. However, this method is affected by many factors, such as BMD, the amount, distribution, and leakage of bone cement, etc.\\u003c/p\\u003e\\n\\u003cp\\u003eA biomechanical study of 120 vertebrae from 10 osteoporotic female cadavers found, on average 16.2% and 29.8% of the vertebral cement filling is required to restore strength and stiffness, respectively, and it was no correlation between the recovery of vertebral strength and stiffness and the percentage volume of bone cement filling[18]. Liebschner [19] et al. performed a single lumbar PVP finite element analysis study, which found that only a small amount of bone cement (14% volume) was required to restore the stiffness of the fractured vertebrae to pre-injury levels, and that a larger volume of bone cement did not provide greater benefit, as the increase in vertebral strength with bone cement resulted in asymmetric distribution of bone cement and strength imbalance on both sides of the vertebral body. Related studies also confirm the above-mentioned view [20, 21]. In addition, the correlation between bone cement volume and surgical outcome is small, and an increase in cement volume may increase the risk of cement leakage [22]. Bone cement injection volume is a one-sided indicator of the benefit of bone cement and does not reflect the distribution of bone cement within the vertebral body. Therefore, it is important to study the distribution of bone cement and the clinical outcome and prognosis of PVP. However, few studies have reported the effect of bone cement distribution on radiographic and functional recovery after PVP treatment.\\u003c/p\\u003e\\n\\u003cp\\u003eCompared to PVP, PKP results in poorer cement distribution and a greater likelihood of postoperative vertebral height loss [23]. The main reason is that the expansion of the balloon compresses the more lax cancellous bone in the cone, thus creating a \\\"cavity\\\" at the balloon site, and the injected bone cement tends to be distributed in this low-pressure cavity without dispersing into the surrounding bone, making it difficult to bind tightly to the cancellous bone. Therefore, this blocky distribution of bone cement has been shown to be an important factor in vertebral body height loss. The subjects selected in this study were all post-PVP patients, excluding the influence of the surgical approach on the results.\\u003c/p\\u003e\\n\\u003cp\\u003eA study by Chen [24] et al. reported that the symmetric distribution of bone cement is closely related to the stiffness of the vertebral body, and in unilateral vertebroplasty, the bone cement is often confined to the ipsilateral side of the vertebral body and cannot effectively diffuse across the midline; therefore, the end result can be a significant reduction in the stiffness of the vertebral body on the unreinforced side of the bone cement compared to the reinforced side. The biomechanical imbalance can exacerbate the pressure load on the spine, resulting in effects that are difficult to reverse, such as loss of height of the fractured vertebral body, disc degeneration in adjacent segments, and even fracture of the vertebral body in adjacent segments [25, 26]. Therefore, all subjects included in this study received bilateral arch root PVP surgery, further reducing the detrimental effects of asymmetric distribution of bone cement in the coronal plane. The majority of females in this study indicated that postmenopausal women are more likely to have osteoporosis in patients.\\u003c/p\\u003e\\n\\u003cp\\u003eSpinal imaging changes such as vertebral body height and Cobb angle are often used as indicators to assess the efficacy of PVP[27]. Yan[28] et al. reported that PVP was able to restore vertebral body height and correct kyphosis. The results of the present study showed that PVP was able to significantly restore anterior vertebral body height and reduce the Cobb angle without considering the cement distribution, and if the cement was spongy in the vertebral body, it could better maintain the height of the vertebral body and reduce the risk of postoperative vertebral body height loss as well as local kyphosis. There are numerous factors that contribute to enhanced postoperative vertebral body height loss and increased kyphosis that do not require exposure to a traumatic event and may be related to the severity of osteoporosis, daily activity level, and cement distribution[25]. However, bone cement distribution is an important factor contributing to vertebral height loss[9]. He[23] et al. reported that the incidence of vertebral height loss was higher in the uninterlocked solid pattern of bone cement distribution than in the interlocked solid pattern. Furthermore, Yu[8] et al. also confirmed that the comparatively diffused pattern of bone cement distribution has better medium and long-term clinical outcomes, compared to the solid lump distribution pattern. The spongy bone cement distribution allows cancellous bone and bone cement to more fully interlock and increases vertebral strength and stiffness with greater homogenization, thus reducing the risk of vertebral height loss after PVP[29]. Our study also found a loss of vertebral body height and local kyphosis over time in the blocky and spongy group postoperatively, which is consistent with previous findings[30, 31]. In contrast, the blocky group showed more pronounced changes on imaging than the spongy group, which was related to the distribution of bone cement.\\u003c/p\\u003e\\n\\u003cp\\u003eOur study is consistent with previous studies reporting[32, 33] that PVP significantly relieves short-term pain and restores function, regardless of the bone cement distribution pattern. In long-term follow-up, it was also found that VAS and ODI scores were significantly lower in the spongy group than in the blocky group, suggesting that spongy bone cement distribution has better analgesic and functional recovery effects. The cause of persistent lower back pain is mainly related to insufficient filling of the bone cement[34]. The bone cement does not bind effectively to the fractured vertebrae, and the low strength and stiffness of the vertebrae are not sufficient to provide effective support, resulting in a continuous loss of height[35, 36]. Therefore, we speculate that the spongy distribution of the bone cement allows greater contact with the cancellous bone within the vertebral body, which can adequately immobilize the fractured fragment, increasing spinal stability and reducing micromovement of the trabeculae, thus reducing pain and achieving functional recovery[34, 37].\\u003c/p\\u003e\\n\\u003cp\\u003eLiebschner[19] et al. reported that the recovery of vertebral body strength was closely related to the distribution of bone cement. The strength and stiffness of the vertebral body after bone cement strengthening are significantly higher than the adjacent vertebrae, and the inhomogeneous distribution of bone cement makes the strength and stiffness of the vertebral body asymmetrical in all areas, and all of these factors tend to increase the risk of fracture of the adjacent vertebral body after PVP[24, 38, 39]. Therefore, numerous studies have confirmed that homogeneous distribution of bone cement within cancellous bone can reduce stress concentration and thus reduce the risk of fracture in adjacent vertebrae[29, 40]. The spongy group has a spongy and homogeneous distribution of bone cement, which can fill the cancellous bone better and reduce the concentrated stress between adjacent vertebrae. Our results confirmed that the incidence of adjacent vertebral fractures was significantly lower in the blocky group than spongy. Therefore, achieving good distribution of bone cement within cancellous bone is crucial in reducing the risk of adjacent vertebral fractures.\\u003c/p\\u003e\\n\\u003cp\\u003eThere is an association between the distribution of bone cement and cement leakage[29]. The overall bone cement leakage rate in our findings was consistent with the results reported in previous studies[41], and most patients were clinically asymptomatic. The rate of bone cement leakage was lower in the blocky group than spongy, but the difference was not statistically significant. This may be due to the diffuse distribution of the spongy cement, which is more widely distributed than the blocky group and more likely to leak through the broken bone cortex or endplate to the intervertebral disc or paravertebral area[40]. Therefore, the surgeon should carefully analyze the imaging data preoperatively and should suspend the procedure in case of intraoperative cement leakage.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLimitations:\\u003c/strong\\u003e This study currently has some limitations. First, our study is a retrospective study with a relatively small sample size, which may result in some bias. Second, the grouping method in our study differs from previous studies, in which it may lead to subjective bias in the results. Therefore, multicenter, prospective studies with larger samples are needed to further elucidate the relationship between intravertebral bone cement distribution and clinical outcomes of PVP.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eBoth groups of bone cement distribution have good immediate analgesic effect. However, compared with the blocky group, the spongy group could better maintain the height of the vertebral body, correct local kyphotic, improve function, reduce the risk of postoperative adjacent vertebral fractures, and it was more effective.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eOVCFs=Osteoporotic Vertebral Compression Fractures; PVP=Percutaneous vertebroplasty; PMMA=Polymethylmethacrylate; DXA=Dual energy X-ray absorptiometry; MRI=Magnetic resonance imaging; BMD=Bone mineral density; BMI=body mass index; ODI=Oswestry Disability Index; VAS=Visual Analog Scale;\\u003c/p\\u003e\\n\\u003cp\\u003eAVH=anterior vertebral heigh; LKA=local kyphotic angle; AVHR=anterior vertebral height ratio; AVHRR=anterior vertebral height recovery ratio; AVHLR=anterior vertebral height loss ratio\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was approved by the institutional review boards/Ethics Committees of People's Hospital of Ningxia Hui Autonomous Region, and was conducted in compliance with the ethical principles of the Helsinki Declaration of 1975. Written informed consent was obtained from the patients or their family members.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication \\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials \\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePlease contact the corresponding author for data requests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNo potential conflict of interest relevant to this article was reported.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding \\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was funded by Ningxia Hui Autonomous Region Science and Technology Benefiting People Special Project(2018KJHM00) .\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026rsquo;\\u003c/strong\\u003e\\u003cstrong\\u003econtributions \\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors made substantive intellectual contributions in this study to qualify as authors. L QJ, L XX and C LJ designed this study. L QJ, L XX, W YB, F XM, G T,H XH and Jiang Xiaocheng participated in collecting and analyzing raw materials. An initial draft of the manuscript was written by L QJ and L XX. G DG, L JH, and C LJ re-drafted parts of the manuscript and provided helpful advice on the final revision. All authors were involved in writing the manuscript. All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements \\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe wish to thank radiology department, other orthopedic medical staff and rehabilitation nurse, for her help and cooperation during the study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eA\\u003c/strong\\u003e\\u003cstrong\\u003euthors\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026rsquo;\\u003c/strong\\u003e\\u003cstrong\\u003einformation \\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e1\\u003c/sup\\u003eGraduate School of Ningxia Medical University, Yinchuan, Ningxia, China.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e2\\u003c/sup\\u003eDepartment of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e3\\u003c/sup\\u003eWest China Hospital, Sichuan University,Sichuan,China\\u003c/p\\u003e\\n\\u003cp\\u003e*Correspondence: Lijun Cai, No. 56, Zhengyuan Street, Yinchuan, Ningxia, 750002, China.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eCompston JE, McClung MR, Leslie WD: Osteoporosis. 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Osteoporos Int 2001, 12(6):429\\u0026ndash;437.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTan L, Wen B, Guo Z, Chen Z: The effect of bone cement distribution on the outcome of percutaneous Vertebroplasty: a case cohort study. BMC Musculoskelet Disord 2020, 21(1):541.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYe LQ, Liang, Jiang XB, Yao ZS, Lu H, Qiu T, Yu WB, Mo L, Zhang SC, Jin DX: 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):E33-E42.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNiu J, Zhou H, Meng Q, Shi J, Meng B, Yang H: Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty: a retrospective analysis. ACTA RADIOL 2015, 56(11):1380\\u0026ndash;1387.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKim YY, Rhyu KW: Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture. EUR SPINE J 2010, 19(11):1907\\u0026ndash;1912.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSteinmann J, Tingey CT, Cruz G, Dai Q: Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976) 2005, 30(2):201\\u0026ndash;205.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFurtado N, Oakland RJ, Wilcox RK, Hall RM: A biomechanical investigation of vertebroplasty in osteoporotic compression fractures and in prophylactic vertebral reinforcement. Spine (Phila Pa 1976) 2007, 32(17):E480-E487.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChevalier Y, Pahr D, Charlebois M, Heini P, Schneider E, Zysset P: Cement distribution, volume, and compliance in vertebroplasty: some answers from an anatomy-based nonlinear finite element study. Spine (Phila Pa 1976) 2008, 33(16):1722\\u0026ndash;1730.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChen JB, Xiao YP, Chen D, Chang JZ, Li T: Clinical observation of two bone cement distribution modes of percutaneous vertebroplasty in the treatment of thoracolumbar Kummell's disease. J ORTHOP SURG RES 2020, 15(1):250.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eXiang GH, Tong MJ, Lou C, Zhu SP, Guo WJ, Ke CR: The Role of Unilateral Balloon Kyphoplasty for the Treatment of Patients with OVCFS: A Systematic Review and Meta-Analysis. PAIN PHYSICIAN 2018, 21(3):209\\u0026ndash;218.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1. Comparison of baseline characteristics of patients between two groups.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\"\\u003e\\n\\u003ctbody\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBlocky group\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSpongy group\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003et/\\u0026chi;\\u003csup\\u003e2\\u003c/sup\\u003e-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eGender\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.304\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.581\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Male\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e22（16.8%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e38（19.2%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Female\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e109（83.2%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e160（80.8%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eNationality\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.117\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.732\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Han\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e118（90.1%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e176（88.9%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Hui\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e13（9.9%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e22（11.1%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAge(years)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e3.968\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.265\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026lt;60\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e4（3.1%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e12（6.1%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp; 60~70\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e47（35.9%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e71（35.9%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e70~80\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e54（41.2%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e89（44.9%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026gt;80\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e26（19.8%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e26（13.1%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDiabetes history(%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e9.2%\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e8.6%\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.032\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.857\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003eNo(cases)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e119\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e181\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003eYes(cases)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e1\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e17\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eHypertension history(%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e48.9%\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e44.9%\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.483\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.487\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003eNo(cases)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e67\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e109\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003eYes(cases)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e64\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e89\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFracture history(%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e16.8%\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e15.7%\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.075\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.784\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003eNo(cases)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e109\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e167\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003eYes(cases)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e22\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e31\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBMI(kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e24.25\\u0026plusmn;3.61\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e23.65\\u0026plusmn;3.42\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e1.537\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.125\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBone mineral density (T score)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e-3.23\\u0026plusmn;0.85\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e-3.26\\u0026plusmn;0.90\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.260\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.795\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFracture segment\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e3.544\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.170\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp; Thoracic (T1~9)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e10（7.6%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e20（10.1%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003eThoracolumbar (T10~L2)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e78（59.5%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e97（49.0%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp; Lumbar (L3~5)\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e43（32.8%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e81（40.9%）\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFollow up time(months)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e17.83\\u0026plusmn;7.33\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e17.35\\u0026plusmn;6.54\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.618\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.537\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBone cement volume(mL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e4.15\\u0026plusmn;1.16\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e4.11\\u0026plusmn;1.11\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.264\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.792\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eOperation duration(mins)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e42.6\\u0026plusmn;12.04\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e41.73\\u0026plusmn;11.12\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.67\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.503\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"33%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBlood loss(mL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"21%\\\"\\u003e\\n\\u003cp\\u003e11.17\\u0026plusmn;3.66\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"20%\\\"\\u003e\\n\\u003cp\\u003e11.07\\u0026plusmn;3.58\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"13%\\\"\\u003e\\n\\u003cp\\u003e0.239\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.811\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2 Analysis of outcome between two groups\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\"\\u003e\\n\\u003ctbody\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBlocky group\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSpongy group\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eT-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eVAS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003epre-op\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e6.29\\u0026plusmn;0.90\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e6.28\\u0026plusmn;1.05\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e0.060\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e0.948\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003e24h post-op\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e2.54\\u0026plusmn;0.91\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e2.12\\u0026plusmn;0.79\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e4.355\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003elast follow-up\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e2.13\\u0026plusmn;0.738\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e1.81\\u0026plusmn;0.67\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e4.090\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eODI\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003epre-op\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e63.63\\u0026plusmn;11.94\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e61.02\\u0026plusmn;11.79\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e1.958\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e0.051\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003e24h post-op\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e35.88\\u0026plusmn;6.72\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e33.84\\u0026plusmn;6.38\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e2.773\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e0.006\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003elast follow-up\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e26.78\\u0026plusmn;5.53\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e23.2\\u0026plusmn;7.59\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e4.941\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAVH(mm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003epre-op\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e14.60\\u0026plusmn;2.96\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e15.22\\u0026plusmn;3.16\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e-1.785\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e0.075\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003e24h post-op\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e16.72\\u0026plusmn;3.12\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e17.62\\u0026plusmn;3.19\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e-2.505\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e0.013\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003elast follow-up\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd 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width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e26\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e16\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003ctr\\u003e\\n\\u003ctd width=\\\"38%\\\"\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eBone cement leakage (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"19%\\\"\\u003e\\n\\u003cp\\u003e13.7%\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"18%\\\"\\u003e\\n\\u003cp\\u003e19.7%\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e1.953\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd 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width=\\\"11%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003ctd width=\\\"12%\\\"\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/td\\u003e\\n\\u003c/tr\\u003e\\n\\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-musculoskeletal-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bmsd\",\"sideBox\":\"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://author-welcome.nature.com/12891\",\"title\":\"BMC Musculoskeletal Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"osteoporotic vertebral compression fractures, OVCFs, percutaneous vertebralplasty, PVP, bone cement distribution, adjacent vertebral fracture, vertebral body height\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-468772/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-468772/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003eCurrent\\u0026nbsp;findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs).The present\\u0026nbsp;retrospective\\u0026nbsp;study\\u0026nbsp;aimed\\u0026nbsp;to\\u0026nbsp;investigate the differences in clinical\\u0026nbsp;efficacy\\u0026nbsp;and\\u0026nbsp;related\\u0026nbsp;complications\\u0026nbsp;between the two bone cement distribution modes. \\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003eWe retrospectively reviewed the medical records of the patients with\\u0026nbsp;single-segment\\u0026nbsp;OVCFs who underwent bilateral percutaneous vertebroplasty.Patients were\\u0026nbsp;divided\\u0026nbsp;into blocky and spongy group according to the type of postoperative\\u0026nbsp;bone\\u0026nbsp;cement\\u0026nbsp;distribution. Clinical\\u0026nbsp;efficacy\\u0026nbsp;and\\u0026nbsp;related\\u0026nbsp;complications\\u0026nbsp;was compared between the two bone cement distribution modes on 24h after the operation and last follow-up.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eRESULTS: \\u003c/strong\\u003eThe mean follow-up time was 17.54 months. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24h postoperatively, and at the last follow-up. There were 42 cases (12.8%) of adjacent vertebral fractures, 26 cases (19.8%) in the blocky group and 16 cases (8.1%) in the spongy group. There were 57 cases (17.3%) of bone cement leakage, 18 cases (13.7%) in blocky group and 39 cases (19.7%) in the spongy group. At 24 hour postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. Loss of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eConclusions: \\u003c/strong\\u003eCompared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Clinical Observation of Two Bone Cement Distribution Modes After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2021-05-10 13:22:26\",\"doi\":\"10.21203/rs.3.rs-468772/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Major revision\",\"date\":\"2021-05-17T06:29:09+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2021-05-14T06:24:58+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"0e47995f-d248-472f-8198-03e33668f296\",\"date\":\"2021-05-14T00:39:40+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2021-05-11T15:47:03+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"aee49096-58f1-407b-9b74-bc1eda21e015\",\"date\":\"2021-05-04T17:11:04+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2021-05-04T13:32:25+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2021-05-03T09:11:32+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2021-04-30T05:58:15+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2021-04-30T05:47:59+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Musculoskeletal Disorders\",\"date\":\"2021-04-27T15:04:56+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-musculoskeletal-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bmsd\",\"sideBox\":\"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://author-welcome.nature.com/12891\",\"title\":\"BMC Musculoskeletal Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"9b9064ec-372a-410a-a84a-04bbb915eef0\",\"owner\":[],\"postedDate\":\"May 10th, 2021\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[{\"id\":4211255,\"name\":\"Orthopedics\"}],\"tags\":[],\"updatedAt\":\"2021-06-14T05:59:11+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2021-05-10 13:22:26\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-468772\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-468772\",\"identity\":\"rs-468772\",\"version\":[\"v1\"]},\"buildId\":\"7rjqhiLT3MXkJMwkYKINL\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}