OBJECTIVE: To observe the postoperative quality of life in patients with osteoporotic vertebral compression fractures treated with percutaneous vertebroplasty (PVP). METHODS: Percutaneous vertebroplasty was used to treat 47 cases of osteoporotic spinal compression fractures. The SF-36 health questionnaire, visual analog scale (VAS), analgesic medication score, and mobility score were used to quantify and compare the patients’ preoperative and postoperative quality of life. RESULTS: All 47 patients were followed up from 15 to 36 months, with a mean of 28.6 months. The postoperative SF-36 scores, mobility, and pain improvement were better than the preoperative status, which was statistically significant (P < 0.01). Conclusion: The implementation of percutaneous vertebroplasty for osteoporotic vertebral compression fractures improves the quality of life (QOL) of patients with osteoporotic vertebral compression fractures. Since 1984, when percutaneous vertebroplasty (PVP) was first used in France by Galibert to treat cervical vertebral hemangiomas, and since 1990, when it was used to treat osteoporotic vertebral compression fractures, the technique has been continuously improved and developed. Due to the obvious pain relief effect, PVP has become rapidly popular worldwide in recent years. From 2003 to 2006, a total of 47 cases of osteoporotic vertebral compression fractures were treated with PVP in our department, which achieved satisfactory results and significantly improved the quality of life of patients, and the follow-up results are reported as follows. 1. Data and methods 1.1 General data This group of cases was diagnosed as elderly osteoporotic spinal vertebral compression fractures in our orthopedic department from 2003 to 2006, a total of 47 cases, including 11 men and 36 women, aged 50 to 87 years old, with an average of 71.9 years old. There were 1 T4, 2 T5, T63, 8 T7, 4 T8, 11 T9, 14 T10, 16 T11, 28 T12, 32 L1, 20 L2, 13 L3, 12 L4, 9 L5 vertebrae involved in the fracture, with an average cement infusion of 5.07 ML. 12 cases (25.5%) had single vertebral fractures. Double vertebral fractures were found in 12 cases (25.5%). All 47 patients were followed up from 15 months to 36 months, with a mean of 28.6 months. Preoperative X-ray frontal and lateral radiographs and CT examinations were performed to clarify the diagnosis and exclude nerve compression. Bone scans were performed to exclude tumors if tumors were suspected before surgery. Postoperatively, X-ray frontal and lateral radiographs and/or CT examinations were performed. Preoperative SF-36 [2, 3] score [including physical component summary (PCS) and mental component summary (MCS)]: PCS score 38-80, mean 53.4; MCS score 28-58, mean 42.7. Preoperative pain visualization grading VAS [4] scores ranged from 5.5 to 10, with a mean of 7.67. Preoperative analgesic medication use score and mobility score [5]: analgesic medication use score 0 to 4, mean 1.72; mobility score 1 to 4, mean 2.66. 1.2 Surgical method Prone position with local infiltration anesthesia for single vertebrae and general anesthesia for multiple vertebrae. The C-arm X-ray machine was used to locate the entry point of the arch root on one side. The middle thoracic vertebra was accessed through the lateral arch, and the thoracolumbar segment below was accessed through the arch. A small incision of 3 mm was made in the skin centered on the entry point, and an 11-13 G bone penetrating needle was used under fluoroscopy to puncture the anterior 1/3 of the vertebral body and inject the contrast agent Omnipaque 5 Ml. Polymethylmethacrylate (PMMA) bone cement was prepared as powder (g): liquid (ml) = 3:2, and the bone cement was pushed in with a 1 ml syringe under the surveillance of the C-arm X-ray machine. The injection process is closely monitored by the lateral C-arm X-ray machine, and the injection is stopped as soon as the leakage of bone cement is detected. After the injection, the bone cement was allowed to set, the cannula was withdrawn and the surgical wound was sutured. After awakening, the patient was observed for respiration, blood pressure, heart rate, sensation and movement of both lower limbs. The operation was finished after the vital signs were stable and there was no sensory-motor impairment of both lower limbs. 1.3 Follow-up Follow-up was performed 1 to 3 years after surgery, and the follow-up was a combination of telephone, letter and outpatient review. The follow-up included general condition and complications. The health questionnaire SF-36 and the VAS scoring system were used for quantitative assessment. The analgesic use and mobility scores [5] were as follows: analgesic use score (0 - no use of drugs; 1 - use of non-steroidal anti-inflammatory drugs; 2 - irregular oral narcotic analgesics; 3 - regular oral narcotic analgesics; 4 - intravenous or intramuscular narcotic sedative drugs) mobility score (1 - no significant difficulty in movement; 2 - difficulty in walking; 3 - need to use a wheelchair or can only sit and stand; 4 - forced to bed). ; 4 ~ forced to bed) Visual analogue scoring method (VAS [4]) for pain level: 0: no pain; 1 to 3: mild pain; 4 to 6: moderate pain; 7 to 10, severe pain. 1.4 Statistical treatment Statistical treatment was performed using SPSS for windows 11.5 package. p<0.01 was considered statistically significant. < p=""> 2. Results 2.1 General conditions of the study subjects PVP was successful in all 35 cases, with bone cement injected via one side of the arch, and the bone cement diffused through the vertebral body midline. 12 cases had bone cement that failed to diffuse through the vertebral body midline, and then bone cement was injected via contralateral arch puncture. In one case, the bone cement leaked to the lateral side of the vertebral body and in one case, the bone cement leaked into the intervertebral space, but there were no clinical symptoms in any of the cases. No complications such as nerve injury, spinal cord compression, pulmonary embolism and infection were observed in all cases, and no fracture of adjacent vertebrae occurred. Postoperatively, symptoms resolved rapidly after symptomatic supportive treatment and bed rest. He was discharged from the hospital 5-8 days after surgery. Anti-osteoporosis treatment such as calcium, diphosphonates, active vitamin D, and calcitonin were routinely applied postoperatively to prevent the occurrence of re-fracture. 2.2 Comparison of patients’ preoperative and postoperative quality of life By the time of discharge, 32 patients (68.1%) had complete pain relief and 15 patients (31.9%) had significant pain relief. When patients were followed up from 15 months to 36 months after surgery, the postoperative SF-36 (including PCS and MCS) scores were higher than those before surgery, which was statistically significant (see Table 1 for details). The VAS score, analgesic drug score, and mobility score were all lower than those before surgery, which were statistically significant (see Table 2 for details). Table 1 Comparison of patients’ preoperative and 1-year postoperative SF-36 scores Patients (n=47) Total score Physical health (PCS) Mental health (MCS) Preoperative 96.7±19.5 53.4±15.9 42.7±19.5 1-year postoperative 126.5±27.3 66.5±12.5 60.4±17.9P ＜0.01 ＜ 0.01 ＜0.01 Physical health status (physical component summary,PCS) Mental health (mental component summary,MCS) Table 2 Comparison of patients’ preoperative and 1-year postoperative VAS scores, analgesic medication scores, and mobility scores Patients (n=47) VAS Analgesic medication scores Mobility Ability score Preoperative 7.67±2.26 1.72±1.5 2.66±0.41 1 year postoperative 2.67±1.81 1.47±0.82 1.30±0.93P ＜0.01 ＜0.01 ＜0.01 ＜0.01 Pain visual analog scale (VAS) 3. Discussion of osteoporosis vertebral compression fractures ( osteoporosis vertebral compression fracture (OVCF) is a common disease endangering the health of middle-aged and elderly people, and it occurs in postmenopausal women. For osteoporosis vertebral compression fracture, the traditional treatment is mainly conservative, including rest, medication for pain relief, and external fixation with braces, which may lead to further bone loss and aggravate osteoporosis, thus forming a vicious circle; open surgery often leads to internal fixation failure due to the patient’s poor general condition and insufficient strength of screw fixation. The pain relief rate of PVP for osteoporotic vertebral compression fractures is reported to be over 90% in the literature, and its pain relief mechanism has not been fully elucidated. The pain relief mechanism of vertebroplasty may be related to the following factors: the stabilizing and supporting effect of bone cement, which is injected into the vertebral body and solidifies into a hard mass, preventing the decrease of vertebral body support caused by calcium deficiency or osteolytic damage, and also making multiple microscopic vertebral fractures The temperature generated during the polymerization reaction of the bone cement ranges from 52 to 93°C. The high temperature causes necrosis of the tissues around the bone cement and destroys the nociceptive nerve endings in the tissues, resulting in the disappearance or relief of pain; biomechanical experiments have confirmed that PMMA injection can effectively restore the strength and stiffness of the compressed vertebral body, thereby increasing the stability of microfractures in the vertebral body. Biomechanical experiments confirmed that PMMA injection could effectively restore the strength and stiffness of the compressed vertebral body, thus increasing the stability of microfractures in the vertebral body. This may be one of the main mechanisms of pain relief. Vertebroplasty provides rapid pain relief and allows for early postoperative functional exercise of the low back muscles and weight-bearing walking with lumbar girth protection. This greatly reduces the complications and morbidity and mortality associated with prolonged bed rest. Exercise stimulates bone formation, strengthens bone, increases bone density and thus improves the internal environment of bone, while effectively preventing further bone loss and greatly improving the patient’s quality of life. The rapid relief of bodily pain (BP) and the improvement of physical functioning (PF) enable patients to perform various activities of daily life independently and gradually remove the role limitations due to physical health (RP). health (RP). The patient’s confidence in overcoming the illness is increased, and the general health perceptions (GH) are gradually enhanced. As a result, the patient’s physical component summary (PCS) (PCS includes PF, RP, BP, GH) increases. Role limitations due to emotional problems (RE) are gradually lifted, depression and anxiety are relieved, mental health (MH) is promoted, and finally mental health (mental component summary, MCS) is achieved (MCS includes PCS and MCS represent the quality of life of the patients. The postoperative PCS and MCS of our patients were higher than the preoperative ones, which was statistically significant, indicating that the patients’ quality of life was significantly improved. Osteoporotic vertebral compression fractures can be classified as (a) acute/subacute single-segment fractures. (b) Unstable fractures (c) (Multiple) fractures with progressive or slow collapse of the vertebral body. (a) Acute/subacute single-segment fractures. Although most simple single-segment osteoporotic vertebral compression fractures (VBCFs) can heal for days to weeks with non-surgical treatment (rest, pain relief, bracing) and pain relief, approximately 1 in 6 patients will still require hospital admission [15]. In addition, there will be a significant percentage of patients who will experience progressive vertebral collapse and eventual spinal deformity for an indeterminate period of time. For such patients, vertebroplasty may be a treatment option. A number of clinical studies have demonstrated its effectiveness [16, 17]. In fresh fractures, pain relief is achieved in 93% of patients [18]. In old fractures, it is effective in 80% [19, 20]. In more than 500 cases treated, 87% of patients experienced pain relief [17] and VAS scores decreased from 7.8 to 2.6. (b) Unstable vertebral compression fractures. Natural progression of the fracture usually leads to healing of the vertebral deformity into one piece. However, in some cases, vertebral instability remains after the fracture. This is the cause of persistent pain. This has been described in Kummell’s disease and in postural changes. Treatment options: In patients with non-healing vertebrae, bone cement can produce stability and pain relief, as well as maintain posture and correct deformity. (c) Severe osteoporosis. Another group of patients with multiple vertebral fractures and progressive postural changes is severe osteoporosis, in which patients tend to have diffuse back pain that involves the entire back. Patients have difficulty standing for long periods of time. Treatment options: Increasingly, the experience with vertebroplasty is that the osteoporotic spine can be considered as a whole. Six segmental vertebrae can be strengthened with bone cement in a single procedure, and more segmental vertebrae can be treated in a second or third procedure if necessary. It has been reported in the literature that of the more than 500 cases treated, 30% of the patients had five or more segments injected with bone cement. The results of the surgery were significant pain relief and the ability to get the patient back on their feet. Our study confirmed that the postoperative results of single, multiple vertebral compression fractures are consistent with those reported in the foreign literature. Thus, patients with osteoporotic spinal vertebral compression fractures undergoing vertebroplasty can significantly improve their quality of life.