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BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) contribute to back pain and functional limitations in older individuals, with percutaneous vertebroplasty (PVP) emerging as a minimally invasive treatment. However, further height loss post-PVP prompts investigation into contributing factors. AIM: To investigate the factors associated with further height loss following PVP with cement augmentation in OVCF patients. METHODS: A total of 200 OVCF patients who underwent successful PVP between January 2021 and December 2022 were included in this study. "Further height loss" during 1 year of follow-up in OVCF patients with bone edema was defined as a vertical height loss of ≥ 4 mm. The study population was divided into two groups for analysis: The "No Further Height Loss group (n = 179)" and the "Further Height Loss group (n = 21)." RESULTS: In comparing two distinct groups of patients, significant differences existed in bone mineral density (BMD), vertebral compression degree, prevalence of intravertebral cleft (IVF), type of bone cement used, and cement distribution patterns. Results from binary univariate regression analysis revealed that lower BMD, the presence of IVF, cleft distribution of bone cement, and higher vertebral compression degree were all significantly associated with further height loss. Notably, the use of mineralized collagen modified-poly(methyl methacrylate) bone cement was associated with a significant reduction in the risk of further height loss. In multivariate regression analysis, lower BMD and the presence of IVF remained significantly associated with further height loss. CONCLUSION: Further height loss following PVP in OVCF patients is influenced by a complex interplay of factors, especially lower BMD and the presence of IVF. These findings underscore the importance of assessing and managing these factors when addressing height loss following PVP in OVCF patients.
RESUMO
OBJECTIVE: To evaluate the clinical feasibility and safety of percutaneous screw fixation in the management of vertically unstable pelvic fractures. METHODS: Forty S1 CT films of orthopedic patients aged 18 - 73, were analyzed so as to provide the best screw entrance point and angle for screw entrance. The data thus obtained were used on 14 patients with unequivocally vertical unstable pelvic fractures, 11 cases being of Tile C(1) type, 2 of C(2) type, and 1 of C type, 9 males and 5 females, aged 19 to 68. All the patients received heavy traction to reduce displacement before the surgery. Percutaneous pelvic screw fixation of the disrupted pelvic ring was performed when the patients were in the supine position, and then fixation of sacroiliac joint was performed when the patients were in the prone position. RESULTS: S1 CT scanning showed an average distance from the standard screw entrance point to the backbone of 10.78 cm (9.80 - 12.00 cm), and a standard screw entrance angle of 61.24 degrees (52.18 - 68.20 degrees). Anatomic reduction was achieved in all 14 patients. One patient had neurological deficit due to the screw penetrating into 1/2 of the intervertebral foramen, but the side-effect was released when the screw was removed 21 days after operation. A 6-24 months postoperative follow-up revealed that all the patients had recovered from fracture and resumed their previous work. CONCLUSION: With advantages including simple procedures, better bony stability, minimal invasion of compromised soft tissue and limited blood loss, percutaneous screw fixation is a practical technique which can be widely used to treat vertical unstable pelvic fracture.