High- versus low-viscosity cement vertebroplasty and kyphoplasty for osteoporotic vertebral compression fracture: a meta-analysis.

BACKGROUND: To compare high- versus low-viscosity bone cement on the clinical outcomes and complications in patients with Osteoporotic vertebral compression fractures (OVCFs) who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). METHODS: PubMed, Embase, and the Cochrane Library were searched for papers published from inception up to February 2021 for potentially eligible studies comparing high- versus low-viscosity cement for PVP/PKP. The outcomes were the leakage rate, visual analog scale (VAS), and Oswestry Disability Index (ODI). RESULTS: Eight studies (558 patients; 279 in each group) were included. The meta-analysis showed that the leakage rate was lower with high-viscosity cement than with low-viscosity cement (OR = 0.23, 95%CI 0.14-0.39, P < 0.001; I2 = 43.5%, Pheterogeneity = 0.088); similar results were observed specifically for the disk space, paravertebral space, and peripheral vein, but there were no differences regarding the epidural space and intraspinal space. The VAS was decreased more significantly with high-viscosity cement than with low-viscosity cement (WMD = - 0.21, 95%CI - 0.38, - 0.04, P = 0.015; I2 = 0.0%, Pheterogeneity = 0.565). Regarding the ODI, there was no difference between high- and low-viscosity cement (WMD = - 0.88, 95%CI - 3.06, 1.29, P = 0.426; I2 = 78.3%, Pheterogeneity < 0.001). CONCLUSIONS: There were lower cement leakage rates in PVP/PKP with high-viscosity bone cement than low-viscosity bone cement. The two groups have similar results in ODI, but the VAS scores favor high-viscosity bone cement. Therefore, the administration of high-viscosity bone cement in PVP/ PKP could be a potential option for improving the complications of leakage in OVCFs, while the clinical efficacy of relieving pain is not certain.

Characteristics and correlation analysis of spino-pelvic sagittal parameters in elderly patients with lumbar degenerative disease.

BACKGROUND: Retrospective analysis of the characteristics and correlation of spino-pelvic sagittal parameters in elderly patients with lumbar degenerative disease. METHODS: Eighty-seven patients with lumbar degenerative disease, with an average age of 75.4 years old, were enrolled in the observation group. They were all from the orthopedics department of Beijing Hospital and got enrolled in this study from August 2015 to October 2017. Another 80 volunteers, with an average age of 74.5 years old, were enrolled in the control group. Standing lateral radiographs of the full-length spine were taken for all subjects. The following spino-pelvic sagittal parameters were measured: sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). Statistical analysis was performed to compare the differences of the parameters between groups, and the correlation analysis was also performed. RESULTS: SVA, PI, and PT of the observation group were significantly higher than those of the control group (p < 0.01), while LL and SS were significantly lower in the observation group (p < 0.01). No significant differences were found in TK between the two groups. The correlation analyses showed that PI was significantly correlated with SS and PT in both the observation group (p < 0.01) and the control group (p < 0.01), so as the SVA-PI (p < 0.05) and SVA-PT (p < 0.01). SS-PT was also significantly correlated in the observation group (p < 0.01) and in the control group (p < 0.05). LL was significantly correlated with all the other parameters in the observation and control groups, including SVA (p < 0.01; p < 0.01), TK (p < 0.01; p < 0.01), PI (p < 0.01; p < 0.01), SS (p < 0.01; p < 0.01), and PT (p < 0.01; p < 0.01). SVA-SS (p < 0.05), TK-PI (p < 0.05), and TK-SS (p < 0.01) were significantly correlated in the control group but not in the observation group. CONCLUSION: Reduced coordination of the spine and pelvis in elderly patients with lumbar degenerative disease was observed. Many of the cases were in the state of sagittal imbalance, with the trunk center of gravity moving forward, the integral sagittal alignment becoming straight, and the pelvic posterior tilt increasing. Pelvic parameters were significantly correlated with each other, which may affect the sagittal curve of the spine. LL was a core parameter that significantly correlated with various sagittal parameters.

Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures.

OBJECTIVE: Percutaneous vertebroplasty (PVP) is a surgical procedure that has been widely used to treat patients suffering from osteoporotic vertebral compression fractures (OVCFs). The procedure involves injection of bone cement into a fractured vertebra. In this study, we investigated whether the distribution of the cement in the vertebral body is related to the occurrence of recompression after surgery. PATIENTS AND METHODS: A total of 172 patients diagnosed with OVCF, from January 2008 to June 2013, were retrospectively reviewed. Fifty of these patients experienced recompression after surgery during the follow-up period (recompression group), and 122 patients had no recompression observed during the follow-up period (control group). Statistical analysis was performed to compare clinical and operative parameters between these two groups. RESULTS: Differences were found in bone cement distribution between the recompression group and control group (P=0.001). Patients with bone cement distributed around both upper and lower endplates had a significantly less incidence of recompression (4/50 patients), when compared to other patterns of cement distribution (eg, below upper endplate, above lower endplate, and in the middle of vertebral body). The logistic multiple regression analysis also indicated that patients with bone cement distributed around both the upper and lower endplates had a lower risk of recompression when compared to patients with bone cement distributed in the middle of vertebral body (odds ratio =0.223, P=0.003). CONCLUSION: We herein suggest that the control of bone cement distribution during surgery provides beneficial effects on reducing the risks of recompression after PVP treatment in patients with OVCF.

[Effects of different repair methods in treatment of supraspinatus tendon tear: experiment with rabbits].

OBJECTIVE: To compare the effects of different repair methods in treatment of supraspinatus tendon tear. METHODS: Forty-five New Zealand rabbits aged 4 approximately 6 months underwent cutting off of the left supraspinatus tendon for the width of 8 mm, and then were randomly divided into 3 equal groups: Group A, undergoing suture anchor simple suture; Group B, undergoing suture anchor mattress suture; and Group C, undergoing transosseous mattress suture. Eight weeks after the operation the rabbits were killed. The shoulder girdles of 12 rabbits randomly selected from each group were used for mechanical test to determine the intensity strength of the supraspinatus tendon, and the left shoulder girdler of the other rabbits underwent decalcification, HE staining, and histological study to observe the healing of the end point of the supraspinatus tendon. RESULTS: Two rabbits. One in Group A and on in Group B underwent infection. The healing rate was 93.33% for both Groups A and B, and was 100% for Group C, however without significant differences among them (all>0.05). The mean maximum tension loads of the supraspinatus tendon of Groups A, B, and C were 82.39+/-20.70 N, 81.80+/-20.31 N, and 88.58+/-17.24 N respectively, however without significant differences among them (F=0.44, >0.05). Histological examination showed that at the end point the supraspinatus tendons of Groups A and B connected to the lamellar bone and that three-zone structure (tendon, cartilage, and bone) could be found at the end point of the supraspinatus tendon in Group C, but compared with the normal end point, the number of cartilage cells decreased. CONCLUSION: The effects of the 3 suture methods are not significantly different from each other for the repair of supraspinatus tendon in respect to healing rate and healing strength, but compared with the suture anchor simple suture method and suture anchor mattress suture method, the transosseous mattress suture method shows greater post-healing strength of tension and the tendon healing situation is closer to the normal tendon structure.

[Evaluation of the postoperative quality of life in the elderly over 80 years old who underwent hip hemiarthroplasty for femoral neck fracture].

OBJECTIVE: To evaluate the postoperative quality of life of aged patients (> 80 years old) who underwent hip hemiarthroplasty for femoral neck fracture one year ago. METHODS: From February 1995 to February 2001, 52 elderly patients (> 80 years old) underwent the hip hemiarthroplasty after femoral neck fractures. There were 28 males and 24 females, with the average age of 84.2 years old (ranged from 80 - 95 years old). The fracture type was Garden III or IV, and all the patients underwent the hip hemiarthroplasty of domestic prosthesis. Before the operation, most of them were accompanied with pre-existed diseases. Harris hip score including symptoms and the ability of daily life at the one year after operation was adopted for the follow-up. Postoperative A-P and lateral X-ray of hip joint in different phase were also assayed. RESULTS: Forty-six patients (88.46%) were free of pain and satisfied their operations, only 6 patients (11.54%) complained about slight pain. Twenty-four patients (46.2%) were able to walk without any assistant, 24 patients (46.2%) managed to walk by walker, 4 patients (7.7%) could only lie on the bed or move by wheel chair. Postoperatively, patients with neurological diseases such as Parkinson dementia, Senile dementia, cerebrovascular diseases got poor result of the quality of life. However, the other comorbid diseases such as cardiovascular diseases, diabetes mellitus, chronic renal failure, chronic bronchitis did not affect the result. Thirty-eight patients had the postoperative X-ray when they were followed up. Postoperatively, the X-ray were taken from 3 months to 5 years and 6 months, averaged 54.2 months. Sclerotic line were discovered around the shaft of prosthesis only in 3 patients. No complications such as femoral head central dislocation or hip osteoarthritis were found. CONCLUSION: Operative treatment could be actively adopted for aged femoral neck fracture patients without surgical contraindication, which can contribute to obtain the motion ability, reduce complication caused by lying in bed, and keep a good quality of life.