Application value of bone cement containing rhbFGF and RHBMP-2 in PKP treatment of osteoporotic lumbar compression fracture / 中国骨伤

OBJECTIVE@#To investigate the effect of bone cement containing recombinant human basic fibroblast growth factor (rhbFGF) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in percutaneous kyphoplasty(PKP)treatment of osteoporotic vertebral compression fracture(OVCF).@*METHODS@#A total of 103 OVCF patients who underwent PKP from January 2018 to January 2021 were retrospectively analyzed, including 40 males and 63 females, aged from 61 to 78 years old with an average of (65.72±3.29) years old. The injury mechanism included slipping 33 patients, falling 42 patients, and lifting injury 28 patients. The patients were divided into three groups according to the filling of bone cement. Calcium phosphate consisted of 34 patients, aged(65.1±3.3) years old, 14 males and 20 females, who were filled with calcium phosphate bone cement. rhBMP-2 consisted of 34 patients, aged (64.8±3.2) years old, 12 males and 22 females, who were filled with bone cement containing rhBMP-2. And rhbFGF+rhBMP-2 consisted of 35 patients, aged (65.1±3.6) years old, 14 males and 21 females, who were filled with bone cement containing rhbFGF and rhBMP-2. Oswestry disability index (ODI), bone mineral density, anterior edge loss height, anterior edge compression rate of injured vertebra, visual analog scale (VAS) of pain, and the incidence of refracture were compared between groups.@*RESULTS@#All patients were followed for 12 months. Postoperative ODI and VAS score of the three groups decreased (P<0.001), while bone mineral density increased (P<0.001), anterior edge loss height, anterior edge compression rate of injured vertebra decreased first and then slowly increased (P<0.001). ODI and VAS of group calcium phosphate after 1 months, 6 months, 12 months were lower than that of rhBMP-2 and group rhbFGF+rhBMP-2(P<0.05), bone mineral density after 6 months, 12 months was higher than that of rhBMP-2 and group calcium phosphate(P<0.05), and anterior edge loss height, anterior edge compression rate of injured vertebra of group rhbFGF+rhBMP-2 after 6 months and 12 months were lower than that of group rhBMP-2 and group calcium phosphate(P<0.05). There was no statistical difference in the incidence of re-fracture among the three groups (P>0.05).@*CONCLUSION@#Bone cement containing rhbFGF and rhBMP-2 could more effectively increase bone mineral density in patients with OVCF, obtain satisfactory clinical and radiological effects after operation, and significantly improve clinical symptoms.

Risk analysis of re⁃fracture after percutaneous kyphoplasty in elderly patients with osteoporotic thoracolumbar compression fractures and construction of a columnar graph prediction model / 解剖学报

Objective To investigate the risk factors for re-fracture after percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic thoracolumbar compression fractures and to construct a line graph prediction model. Methods One hundred and eighty-two elderly patients with osteoporotic thoracolumbar compression fractures treated with PKP from January 2016 to November 2019 were selected for the study‚ and the patients were continuously followed up for 3 years after surgery. Clinical data were collected from both groups; Receiver operating characteristic (ROC) curve analysis was performed on the measures; Logistic regression analysis was performed to determine the independent risk factors affecting postoperative re-fracture in PKP; the R language software 4. 0 “rms” package was used to construct a predictive model for the line graph‚ and the calibration and decision curves were used to internally validate the predictive model for the line graph and for clinical evaluation of predictive performance. Results The differences between the two groups were statistically significant (P0. 22‚ which could provide a net clinical benefit‚ and the net clinical benefit was higher than the independent predictors. Conclusion BMD‚ number of injured vertebrae‚ single-segment cement injection‚ cement leakage‚ pre-and post-PKP vertebral height difference‚ and posterior convexity angle change are independent risk factors affecting the recurrent fracture after PKP in elderly patients with osteoporotic thoracolumbar compression fracture‚ and this study constructs a column line graph model to predict the recurrent fracture after PKP in elderly patients with osteoporotic thoracolumbar compression fracture as a predictor for clinical. This study provides an important reference for clinical prevention and treatment‚ and has clinical application value.

Efficacy of Percutaneous Kyphoplasty Versus Percutaneous Vertebroplasty for Kummell's Disease:A Systematic Review and Meta-Analysis / 医学研究杂志

Objective To evaluate the clinical efficacy and safety of percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of Kummell'disease.Methods Databases of Cochrane Library,PubMed,Medline,Embase,Web of Science,CNKI,VIP,Wanfang Data and CBM were used to search clinical studies on percutaneous kyphoplasty virus percutaneous vertebroplasty in the treatment of Kummell's disease from database inception until June 1st,2022.Literature screening was performed according to the speci-fied inclusion and exclusion criteria.In strict compliance with Cochrane's systematic evaluation principle,authors reasonably screened,e-valuated and analyzed the quality of the retrieved papers and then the evaluating indicator of postoperative ODI,JOA,VAS,operation time and intraoperative complications in each included study was evaluated in Review Manager 5.4software.Results Nine papers were included,involving 243 patients in the percutaneous vertebroplasty group and 222 patients in the percutaneous kyphoplasty group.Percu-taneous kyphoplasty had advantages in postoperative ODI score,cement leakage,and postoperative Cobb's angle,which was statistically significant(P＜0.05),but the operation time was longer and the postoperative VAS score improved poorly.There was no significant difference in intraoperative bleeding and height of the postoperative vertebral margin(P＞0.05).Conclusion In the surgical treatment of Kummell's disease,percutaneous vertebral kyphoplasty can more effectively improve the postoperative ODI score,and reduce the post-operative Cobb's angle and the risk of cement leakage compared to the traditional percutaneous vertebroplasty.It has more advantages in improving the clinical efficacy and reducing the postoperative risk.However,the conclusions of this study require more high-quality,multi-angle and large-sample studies in the future.

Effect of injury degree of osteoporotic vertebral compression fracture on bone cement cortical leakage after percutaneous kyphoplasty / 中国修复重建外科杂志

OBJECTIVE@#To analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications.@*METHODS@#A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed.@*RESULTS@#Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra ( r=0.493, P<0.001).@*CONCLUSION@#The incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.

Effects of percutaneous kyphoplasty assisted by Huoxue Yigu Decoction on the bone healing and postoperative recovery of lumbar function in elderly patients with osteoporotic vertebral compression fractures / 国际中医中药杂志

Objective:To explore the effects of percutaneous kyphoplasty (PKP) assisted by Huoxue Yigu Decoction on bone healing and postoperative recovery of lumbar function in elderly patients with osteoporotic vertebral compression fractures (OVCF).Methods:Randomized controlled trial. A total of 79 elderly patients with OVCF admitted to Zhongshan Hospital Affiliated to Fudan University were enrolled as the research objects between October 2017 and February 2021. According to random number table method, they were divided into observation group (40 cases) and control group (39 cases). The patients in the control group were treated with PKP, then they were given off-bed activities with thoracolumbar braces at 2 d after surgery and the braces were removed at 1 month after surgery, while the observation group was treated with Huoxue Yigu Decoction for 7 d on the basis of control group treatment. Before surgery and at 3 months after surgery, TCM syndromes were scored. The lumbar function was evaluated by Japanese Orthopedic Association (JOA). The pain degree was evaluated by visual analogue scale (VAS) at 7 d and 1 month after surgery. Before surgery and at 7 d after surgery, levels of serum osteocalcin and bone alkaline phosphatase (BALP) were detected by radioimmunoassay. The levels of serum IL-1, IL-6 and TNF-α were detected by ELISA. The erythrocyte aggregation index, whole blood viscosity and plasma viscosity were detected by full-automatic blood rheometer. Before and at 3 months after surgery, loss rate of anterior margin vertebral height and sagittal kyphosis Cobb angle were detected by X-ray films. The bone mineral density (BMD) of femoral shaft was measured by dual-energy bone densitometer. The occurrence of postoperative complications was recorded.Results:There was no significant difference in total response rate between the observation group and control group [97.5% (39/40) vs. 92.3% (36/39); χ2=0.29, P=0.590]. At 3 months after surgery, scores of TCM syndromes in observation group were significantly lower than that of the control group ( t=5.63, P<0.01), and JOA score was significantly higher than that of the control group ( t=3.93, P<0.01). At 1 month after surgery, VAS score in observation group was significantly lower than that of the control group ( t=6.90, P<0.01). At 7d after surgery, levels of osteocalcin [(4.19±0.65) μg/L vs. (3.21±0.61) μg/L, t=6.91] and BMD [(0.86±0.17) g/cm 2vs. (0.71±0.15) g/cm 2, t=4.16] in observation group were significantly higher than those in the control group ( P<0.01), while BALP [(20.07±3.19) U/L vs. (22.16±3.52) U/L, t=2.77] was significantly lower than that of the observation group ( P<0.01). At 3 months after surgery, loss rate of anterior margin vertebral height and sagittal kyphosis Cobb angle in observation group were significantly lower than those in the control group ( t=2.59, 2.81, P<0.01). At 7d after surgery, erythrocyte aggregation index, whole blood viscosity and plasma viscosity in observation group were significantly lower than those in the control group ( t=2.92, 6.33, 4.64, P<0.01), and levels of serum IL-1, IL-6 and TNF-α were significantly lower than those in the control group ( t=2.33, 2.47, 3.45, P<0.01). There was no significant difference in incidence of postoperative complications between observation group and control group [2.50% (1/40) vs. 10.26% (4/39); χ2=2.00, P>0.05]. Conclusion:Huoxue Yigu Decoction can alleviate postoperative pain, promote bone healing and recovery of lumbar function, improve blood circulation and reduce inflammation level in elderly OVCF patients undergoing PKP.

Risk factors for residual pain after percutaneous kyphoplasty for osteoporotic vertebral fractures / 中华创伤骨科杂志

Objective:To analyze the risk factors for residual pain after percutaneous kyphoplasty (PKP) for osteoporotic vertebral fractures (OVF).Methods:Retrospectively analyzed were the patients with OVC who had been treated at Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University by single level PKP from January 2020 to December 2021. They were 40 men and 181 women, with an age of (69.6±8.2) years. By the pain score of visual analogue scale (VAS) on the postoperative day 3, they were assigned into 2 groups: a residual pain group (VAS≥4) and a control group (VAS<4). The general demographics, radiographic and surgical related data of the 2 groups were analyzed by single factor analysis, including their gender, age, bone mineral density, body mass index, glucocorticoid usage, follow-up time, duration of symptoms, fracture location, severity of fracture compression, intravertebral cleft, middle column involvement, thoracolumbar fascia injury, anesthesia method, puncture method, volume of bone cement injected, cement-endplates contact, pattern of cement distribution, cement leakage, vertebral height restoration, preoperative cobb angle and correction of cobb angle. The P<0.1 factors screened were further analyzed by the multivariate logistic regression to determine the final variables. Results:In the present study, 19 patients were assigned into the residual pain group and 202 patients the control group. The univariate analysis showed that body mass index ( P=0.059), intravertebral cleft ( P=0.049) and thoracolumbar fascia injury ( P< 0.001) increased the risk for residual pain. The multivariate logistic regression analysis showed that thora-columbar fascia injury was an independent risk factor for residual pain ( OR=6.127, 95% CI: 2.240 to 16.755, P<0.001). Conclusion:Thoracolumbar fascia injury is an independent risk factor for residual pain after PKP for OVF.

Effectiveness of TiRobot-assisted and free-hand percutaneous kyphoplasty via pedicle of vertebra in treatment of osteoporotic vertebral compression fracture of thoracic vertebra / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of TiRobot-assisted and C-arm X-ray fluoroscopy assisted percutaneous kyphoplasty (PKP) via pedicle of vertebra in the treatment of osteoporotic vertebral compression fracture (OVCF) of thoracic vertebrae.@*METHODS@#The clinical data of 85 patients with OVCF of thoracic vertebrae who were admitted between January 2020 and March 2023 and met the selection criteria was retrospectively analyzed including 40 patients (50 vertebrae) undergoing PKP assisted by TiRobot (group A) and 45 patients (50 vertebrae) undergoing PKP assisted by C-arm X-ray fluoroscopy (group B). There was no significant difference in the comparison of baseline data such as gender, age, body mass index, bone mineral density T-value, fracture segment, trauma history, and preoperative numerical rating scale (NRS) score, Oswestry disability index (ODI), and Cobb angle of injured vertebra between the two groups ( P>0.05). The effectiveness evaluation indexes of the two groups, including the operation time, the volume of injected cement, the times of fluoroscopies, the length of hospital stay, and the occurrence of postoperative complications were collected and compared. Anteroposterior and lateral X-ray films and CT of the injured vertebra were reviewed at 1 day after operation to observe whether there was cement leakage and to evaluate the distribution of cement in the injured vertebra. Before and after operation, pain was assessed using the NRS score, dysfunction was assessed using the ODI, and vertebral height recovery was assessed by measuring the Cobb angle of the injured vertebrae by X-ray films.@*RESULTS@#Both groups of patients successfully completed the operation, the operation time, the volume of injected cement, the times of fluoroscopies, and the length of hospital stay in group A were significantly less than those in group B ( P<0.05). The patients in two groups were followed up 4-12 months (mean, 9.6 months). Bone cement leakage occurred in 5 vertebrae in group A and 15 vertebrae in group B after operation, all of which leaked to the intervertebral space and around the vertebral body, and the patients had no obvious clinical symptoms. The difference of bone cement leakage between the two groups was significant ( P<0.05). No severe complication such as intraspinal leakage, infection, or vascular embolism was found in the two groups. At 1 day after operation, the distribution index of bone cement in group A was mostly grade Ⅴ, which was well dispersed; while in group B, it was mostly grade Ⅱ and grade Ⅴ; the difference of bone cement distribution index between the two groups was significant ( P<0.05). The NRS score, ODI, and Cobb angle of injured vertebra in both groups were significantly improved at 1 day after operation when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indexes between the two groups before and after operation ( P>0.05).@*CONCLUSION@#TiRobot-assisted unilateral PKP in the treatment of OVCF of thoracic vertebrae is safe and effective, which can reduce the X-ray transmission times during operation, shorten the operation time, reduce the volume of bone cement injection, and thus decrease incidence of bone cement leakage.

Long-term efficacy and BMP-7/25- (OH) -D-3 levels of percutaneous kyphoplasty in the treatment of elderly osteoporotic thoracolumbar compression fractures / 中华内分泌外科杂志

Objective:To analyze the long-term efficacy of percutaneous kyphoplasty (PKP) assisted with vitamin D in the treatment of elderly thoracolumbar single vertebral osteoporotic vertebral compression fractures (OVCF) and its effect on transfected bone morphogenetic protein-Effects of 7 (BMP-7) /25-hydroxyvitamin D3 [ (25- (OH) -D3] levels.Methods:106 elderly patients with fresh OVCF of thoracic and lumbar vertebrae who were treated with PKP in Li Huili Hospital of Ningbo Medical Center from Jun. 2017 to Jun. 2021 were selected as the research object, and they were divided into two groups according to the random number table method (53 cases in each group) . Both groups were treated with PKP and received conventional anti-osteoporosis treatment and rehabilitation training. On this basis, patients in the treatment group were given vitamin D therapy. Before treatment and 1, 3, 6, and 12 months after treatment, the degree of pain improvement, Cobb angle improvement, bone mineral density, vertebral body compression rate, vertebral body function recovery and serum BMP-7, 25- (OH) -D3 level, and the cement leakage rate of all subjects within 1 year of follow-up was recorded.Results:Two patients in the observation group and 3 patients in the control group lost to follow-up. Comparing the results of before treatment and 12 months after treatment: the control group’s BMD increased from 0.585±0.042 to 0.755±0.0641; BMP-7 increased from 80.02±6.24 to 129.87±10.52;25- (OH) -D3 increased from 9.15±2.16 to 13.52±2.64;and the treatment group’s BMD increased from 0.576±0.039 to 0.868±0.079; BMP-7 increased from 78.36±6.20 to 153.41±12.70; 25- (OH) -D3 increased from 9.01±2.12 to 16.24±2.81; the treatment group had higher increase ( P<0.05) . Meanwhile the control group’s Cobb angle decreased from 13.54±1.81 to 8.05±1.05; vertebral body compression rate decreased from 28.41±3.47 to 19.86±2.29; ODI score decreased from 74.42±7.37 to 24.08±2.41; VAS score decreased from7.54±0.81 to 2.65±0.25,and the treatment group’s Cobb angle decreased from 13.70±1.89 to 7.42±0.97;vertebral body compression rate decreased from 28.97±3.62 to 18.86±2.02; ODI score decreased from75.78±7.43 to 21.39±2.08; VAS score decreased from7.70±0.891 to 2.32±0.20,while the treatment group decreased more ( P<0.05) . In addition, the vertebral refracture rate in the control group was 22.00% (11/50) , while the vertebral refracture rate in the treatment group was 5.88% (3/51) , and there was a significant difference between the groups ( χ 2=5.125, P=0.024) . Conclusion:PKP combined with vitamin D in the treatment of elderly thoracolumbar OVCF can significantly improve the levels of BMP-7 and 25- (OH) -D3, better restore bone mineral density, vertebral body function and correct kyphosis, with a more ideal long-term efficacy.

Effect analysis of treating osteoporotic vertebral fracture combined reduction vertebroplasty with kyphoplasty / 中国综合临床

Objective:To compare postural reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCFs).Methods:From January 2019 to January 2020,68 patients with OVCFs who met the inclusion and exclusion criteria in the Second Hospital of Tangshan Hebei Province were included in the observation study. A prospective randomized controlled study was used. The matched groups were divided into PVP combined group (adjust the overextension of the operating table by 20°-30°, if the posture reduction fails, pry the puncture needle on both sides in reverse according to the compression degree of the end plate before operation, and inject bone cement) and PKP group (do not adjust the operating table before operation, insert a balloon and expand on both sides after operation, and inject bone cement), with 34 cases in each group. The Cobb angle of the injured vertebrae was measured by taking the anterior and lateral X-ray film of the patient's lumbar spine before operation. The degree of pain and low back function were evaluated by visual analogue scale (VAS) and Oswetry disability index (ODI). The operation time and fluoroscopy times were recorded during the operation. On the second day after operation, the anterior and lateral X-ray of lumbar spine were taken to measure the Cobb angle of injured vertebrae. All patients were underwent computed tomography (CT) check the bone cement for leakage, record the VAS score, and record the ODI 3 months after operation to evaluate the patient's function. Follow up at the end of 12 months after operation to count the treatment cost and re-fracture of the patient. The data analysis and measurement data were compared by independent sample t-test between the two groups, paired sample t-test was used for intra-group comparison before and after operation. χ 2 test was used for counting data comparison between two groups. Results:All patients were followed up for 12 months. The operation time ((42.7±5.9) min), fluoroscopy times ((20.0±3.6) times) and treatment cost ((19 153±601) yuan) in the PVP combined group were better than those in the PKP Group ((67.4±7.3) min, (30.1±5.9) times, (27 496±669) yuan), and the difference was statistically significant ( t values were 15.39, 8.46, 54.12; all P<0.001). Cobb angle: Postoperative Cobb angle of injured vertebrae in the two groups (PVP combined group (10.7±4.5)°) and (PKP group (13.4±3.8)°) decreased compared with preoperative (PVP combined group (17.0±5.1)°) and (PKP group (16.7±5.1)°) ( t values were 10.61, 5.61; all P=0.001), and PVP combined group recovered better than PKP group, with statistically significant difference ( t=2.70, P=0.009). VAS score: Postoperative (PVP combined group (3.9±1.5) points) and (PKP group (4.1±1.6) points) was lower than preoperative the scores of (PVP combined group (6.9±1.1) points) and (PKP group (7.1±0.9) points), and the difference was statistically significant ( t values were 8.63, 8.88; all P=0.001). There was no significant difference in VAS scores between the two groups ( t=0.48, P=0.630). ODI scores: The scores of (PVP combined group (0.315±0.068)) and (PKP group (0.319±0.077)) after operation were lower than preoperative (PVP combined group (0.574±0.066), (PKP group (0.553±0.075)), and the difference was statistically significant ( t values were 18.54, 14.16, all P=0.001). There was no significant difference in ODI between the two groups ( t=0.25, P=0.803). There was no statistical significance in the two groups of postoperative bone cement leakage (χ 2=0.22, P=0.642). In PVP combined group, 1 case was re-fractured due to trauma, and there was no re-fracture in PKP group. Conclusion:Postural reduction combined with percutaneous needle prying reduction of PVP and PKP can alleviate the pain, improve the postoperative function and restore kyphosis in patients with OVCFs. Postural reduction combined with needle prying reduction of PVP has more advantages in operation time, radiation injury to doctors and patients, treatment cost, and the effect of correcting deformity is more significant.

Clinical efficacy of percutaneous balloon-expandable vertebral body stenting for elderly patients with osteoporotic vertebral compression fractures / 西安交通大学学报(医学版)

【Objective】 To evaluate the safety and efficacy of balloon-expandable vertebral body stenting （VBS） in treating elderly patients with osteoporotic vertebral compression fractures. 【Methods】 Thirty-eight elderly patients with osteoporotic vertebral compression fractures were randomly divided into two groups according to the parity of their hospital admission numbers to receive VBS and traditional percutaneous kyphoplasty （PKP）， respectively. The two groups were compared regarding changes in the intensity of pain， functional score， imaging parameters related to vertebral compression， and sagittal Cobb angle as well as the incidence of bone cement leakage after treatment， to evaluate the safety and efficacy of VBS. 【Results】 All the patients underwent the operations smoothly， which were performed with the bilateral percutaneous puncture technique under local anesthesia by the same surgeon， and were followed up for more than half a year. Both VBS group and PKP group showed significant improvement in the visual analogue scale score， the Oswestry disability index， the height of the fractured vertebral body， and the Cobb angle at 3 days， 1 month， 3 months and 6 months after treatment （all P<0.05）. There were significant differences in those indicators between the two groups （all P<0.05）. 【Conclusion】 VBS is an effective treatment approach for elderly patients with osteoporotic vertebral compression fractures. It can effectively recover fractured vertebral body height， relieve patients’ pain， and have fewer complications such as bone cement leakage.

Perioperative nursing of robot assisted percutaneous kyphoplasty for senile osteoporotic vertebral compression fractures / 中国实用护理杂志

Objective:To summarize the perioperative nursing points of percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic vertebral compression fractures assisted by robots, so as to provide reference for orthopedic nursing.Methods:From July 2019 to February 2021, the data of 72 patients undergoing robot-assisted PKP in the spinal surgery of the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The perioperative nursing points were summarized, and the nursing experience was summarized. The nursing under the new measures of precise minimally invasive treatment was analyzed and discussed. The length of hospital stay, postoperative ambulation time, complications and satisfaction survey results of patients were collected and recorded. The Numerical Rating Scale(NRS) score, Self-rating Anxiety Scale(SAS) score and Oswestry Disability Index (ODI) score before and after surgery were compared. The correlation analysis of the scores of various factors was combined to comprehensively evaluate the surgical and nursing effects.Results:All patients had no complications related to machine use during and after operation, and their symptoms were improved to varying degrees. Fifty-seven cases of indwelling catheter, catheter time (19.00±14.24) h. The preoperative hospitalization time was (6.16±2.22) d, and the postoperative hospitalization time was (1.94±0.99) d. Postoperative bed time was (16.34±6.81) h. Postoperative nursing satisfaction was (98.55±2.44)%.The postoperative NRS and SAS scores were (1.00±0.55) and (32.06±5.33) points, respectively, which were lower than those before operation (3.51 ± 0.71) and (39.08±8.86) points, and the differences were statistically significant ( t values were 33.976, 8.184, P<0.01). There were statistically significant differences in six indicators of ODI scores before and after surgery, including low back pain, walking, standing, sitting, sleep and self-care ( P<0.01). Correlation analysis showed that there was a strong correlation between the six ODI score factors and the NRS score. The four factors of sitting, walking, low back pain and standing were highly correlated with SAS. Conclusions:The implementation of good perioperative nursing management for patients with PKP assisted by robot can effectively promote the rehabilitation of patients, reduce the incidence of complications and improve patient satisfaction.

Effect of unilateral percutaneous kyphoplasty combined with hyperextension reduction in the treatment of fresh osteoporotic vertebral compression fractures / 中国综合临床

Objective:To compare the effect and clinical significance of unilateral and bilateral percutaneous kyphoplasty (PKP) combined with hyperextension reduction in the treatment of fresh osteoporotic vertebral compression fracture (OVCF).Methods:The clinical data of OVCF patients treated in Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from January to December 2018 were retrospectively analyzed.A total of 62 patients were included.According to the surgical approach, 62 patients were divided into unilateral puncture approach group and bilateral puncture approach group, with 31 cases in each group.The patients in the unilateral puncture group were treated with limb hyperextension reduction combined with unilateral PKP.In the bilateral puncture approach group, limb hyperextension reduction combined with bilateral PKP was used.The changes of visual analogue pain scale (VAS), Oswestry disability index (ODI), vertebral anterior height, vertebral midline height and Cobb angle were observed and compared before operation, 1 day and 2 weeks after operation.At the same time, the operation time, intraoperative fluoroscopy times, intraoperative bone cement injection and adverse reactions were compared between the two groups.Results:The VAS scores of patients in the unilateral puncture approach group before operation, 1 day and 2 weeks after operation were (8.10±0.17), (2.20±0.26) and (1.90±0.39), respectively.The scores of bilateral puncture approach group were (8.10±0.13), (2.30±0.26) and (2.00±0.30), respectively.The results of repeated measurement ANOVA showed that F intra-group=13 790.444, P<0.001, F inter-group=1.951, P=0.168, F interaction=0.735, P=0.481.There were significant differences in VAS scores between the two groups 1 day and 2 weeks after operation (all P<0.05). There was significant difference in VAS score between the two groups 1 day after operation and 2 weeks after operation (all P<0.05). The ODI scores of patients in the unilateral puncture group before operation, 1 day and 2 weeks after operation were (40.30±5.30), (23.20±3.40), (22.30±4.49) points respectively, and those in the bilateral puncture group were (41.00±4.49), (21.90±2.48), (20.70±5.70) points, respectively.The results of repeated measurement ANOVA showed that F intra-group=339.046, P<0.001, F inter-group=1.385, P=0.244, F interaction=1.083, P=0.342.There were significant differences in ODI scores between the two groups 1 day and 2 weeks after operation (all P<0.05). There was significant difference in ODI score between the two groups 1 day after operation and 2 weeks after operation (all P<0.05). The anterior height of vertebral body in unilateral puncture group was (18.26±2.40), (21.97±1.17), (22.03±1.35) mm before operation, 1 day and 2 weeks after operation, and that in bilateral puncture group was (18.94±1.80), (22.06±2.79), (20.29±1.19) mm.The results of repeated measurement ANOVA showed that F intra-group=51.228, P<0.001, F inter-group=1.594, P=0.212, F interaction=6.452, P=0.002.There were significant differences in the anterior vertebral height between the two groups 1 day and 2 weeks after operation (all P<0.05). The height of vertebral midline in the unilateral puncture group was (17.97±2.14), (26.13±1.43), (26.00±1.79) mm before operation, 1 day and 2 weeks after operation, and in the bilateral puncture group was (18.84±1.77), (24.74±1.77), (24.68±2.06) mm.The results of repeated measurement ANOVA showed that F intra-group=358.837, P<0.001, F inter-group=3.850, P=0.054, F interaction=9.117, P<0.001.There were significant differences in the height of vertebral midline between the two groups 1 day and 2 weeks after operation (all P<0.05). The Cobb angles in the unilateral puncture group were (21.74±2.11)°, (11.77±1.91)° and (10.94±1.12)° before operation, 1 day and 2 weeks after operation, respectively, and in the bilateral puncture group were (22.13±2.50)° and (12.0±2.38)° and (11.71±1.37°, respectively.The results of repeated measurement ANOVA showed that F intra-group=674.732, P<0.001, F inter-group=1.975, P=0.165, F interaction=0.376, P=0.688.There were significant differences in Cobb angle between the two groups 1 day and 2 weeks after operation (all P<0.05). There were significant differences in operation time ((52.0±3.8) min and (67.0±6.7) min), intraoperative fluoroscopy times ((15.0±5.8) times and (32.0±6.1) times), and bone cement injection volume ((4.6±0.3) mL and (5.0±0.1) mL) between unilateral puncture approach group and bilateral puncture approach group (all P<0.001). Conclusion:Unilateral and bilateral PKP combined with hyperextension reduction can alleviate the pain of OVCF, restore the lost vertebral height and correct kyphosis.The unilateral puncture approach PKP combined with hyperextension reduction has the advantages of shorter operation time, concise operation process, fewer times of intraoperative fluoroscopy and less use of bone cement.

Warm needling moxibustion plus PKP for vertebral compression fracture due to kidney deficiency and blood stasis: a randomized controlled trial / 针灸推拿医学（英文版）

Objective: To explore the efficacy and mechanism of warm needling moxibustion plus percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) due to kidney deficiency and blood stasis. Methods: A total of 70 OVCF patients were randomized into a control group and an observation group, with 35 cases in each group. The control group was given PKP treatment, and the observation group was treated with warm needling moxibustion on the basis of the treatment in the control group. The visual analog scale (VAS) and Oswestry disability index (ODI) were scored and the Cobb angle of fractured vertebrae was measured before and after treatment. The re-fracture rate of the adjacent vertebrae was recorded at 1-year follow-up. The serum levels of transforming growth factor (TGF)-β1 and omentin-1 were measured before and after treatment. Results: After treatment, the VAS and ODI scores in both groups decreased (all P<0.05), and all the scores in the observation group were lower than those in the control group (both P<0.05). After treatment, the Cobb angle of fractured vertebrae in both groups decreased (both P<0.05), and the Cobb angle in the observation group was smaller than that in the control group (P<0.05). At 1-year follow-up, the re-fracture rate of the adjacent vertebrae in the observation group was lower than that in the control group (P<0.05). After treatment, the serum levels of TGF-β1 and omentin-1 in both groups increased significantly (all P<0.05), and the serum levels of TGF-β1 and omentin-1 in the observation group were higher than those in the control group (both P<0.05). Conclusion: The treatment of warm needling moxibustion plus PKP can relieve pain, improve dysfunction, promote healing of the injured vertebrae, and reduce the re-fracture rate of the adjacent vertebrae in patients with OVCF due to kidney deficiency and blood stasis, which may be related to the increase of serum TGF-β 1 and omentin-1 levels.

Effect of Sarcopenia on the Efficacy of Percutaneous Kyphoplasty in the Treatment of Osteoporotic Spinal Compression Fractures in Elderly Patients / 中国医学科学院学报

Objective To investigate the effect of sarcopenia on the efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic spinal compression fracture(OSCF)in elderly patients. Methods From February 2017 to June 2018,a total of 77 elderly patients who met the inclusion and exclusion criteria were included in this study.Grip strength of dominant hand was measured by an electronic grip dynamometer with cut-off values of 27 kg for males and 16 kg for females.The cross-sectional area of the pedicle level muscle of the 12th thoracic vertebra(T12)was measured by chest CT.The skeletal muscle index(SMI)was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height.The SMI cut-off value used to diagnose sarcopenia was 42.6 cm

A combination of digital design and three-dimensional printing to assist treatment of thoracolumbar compression fractures using percutaneous kyphoplasty / 《全球健康杂志（英文）》

Objective:To evaluate the clinical efficacy of the preoperative digital design combined with three-dimensional(3D) printing models to assist percutaneous kyphoplasty (PKP) treatment for thoracolumbar compression frac-tures.Methods:From January 2018 to August 2020,we obtained data of 99 patients diagnosed thoracolumbar com-pression fractures.These patients were divided into control group (n =50) underwent traditional PKP surgery,and observation group (n =49) underwent preoperative digital design combined with 3D printing model assisted PKP treatment.The clinical efficacy was evaluated with five parameters,including operation time,number of intraoperative radiographs,visual analogue scale (VAS) score,Cobb Angle change,and high compression rate of injured vertebrae.Results:There were statistically significant differences of operation time and number of intraoperative radio-graphs between the two groups (P ＜ 0.05).For VAS score,Cobb Angle change and vertebral height compression rate,all of these three parameters were significantly improved when the patients accepted surgery treatment in two groups (P ＜ 0.05).However,there were no significant differences between control group and observation group for these three parameters either before or after surgery (P ＞ 0.05).Conclusions:Through the design of preoperative surgical guide plate and the application of 3D printing model to guide the operation,the precise design of preoperative surgical puncture site and puncture Angle of the injured vertebra was realized,the number of intraoperative radiographs was reduced,the operation time was shortened and the operation efficiency was improved.

Short-term effectiveness comparison of unipedicular versus bipedicular percutaneous kyphoplasty for osteoporotic vertebral compression fractures with posterior wall broken / 中国修复重建外科杂志

Objective: To compare the short-term effectiveness and safety of unipedicular versus bipedicular percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) with posterior wall broken. Methods: The clinical data of 68 patients with OVCF with posterior wall broken and without posterior ligament complex injury and spinal cord nerve injury between June 2013 and December 2018 were retrospectively analyzed. According to the different operative approaches, the patients were divided into two groups: group A (36 cases received PKP via bilateral pedicle puncture) and group B (32 cases received PKP via unilateral pedicle paracentesis). There was no significant difference between the two groups in gender, age, fracture vertebra distribution, time from injury to operation, preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), and height of injured vertebra ( P>0.05). The operation time, intraoperative fluoroscopy times, and bone cement volume were recorded and compared between the two groups. The VAS score and ODI score were used to evaluate the effectiveness before operation, at 1 day and 6 months after operation; the height of injured vertebra was measured on the lateral X-ray film, and the recovery height of injured vertebra at 1 day after operation and the loss height of injured vertebra at 6 months after operation were calculated; the intraoperative and postoperative complications of the two groups were recorded. Results: The operation time, intraoperative fluoroscopy times, and bone cement volume of group B were significantly less than those of group A ( P0.05). However, at 6 months after operation, the height of injured vertebra in group B was significantly lower than that in group A ( P0.05). Conclusion: Both bipedicular and unipedicular PKP can obtain satisfactory effectiveness for the treatment of OVCF with posterior wall broken, but the former may have advantages of lower cement leakage rate and less height loss.

Robot-guided percutaneous kyphoplasty in treatment of multi-segmental osteoporotic vertebral compression fracture / 中国修复重建外科杂志

Objective: To evaluate the safety and effectiveness of robot-guided percutaneous kyphoplasty (PKP) in treatment of multi-segmental thoracolumbar osteoporotic vertebral compression fracture (OVCF). Methods: A clinical data of 63 cases with multi-segmental thoracolumbar OVCF without neurologic deficit treated with PKP between October 2017 and February 2019 were analyzed retrospectively. The patients were divided into robot-guided group (33 cases) and traditional fluoroscopy group (30 cases). There was no significant difference in gender, age, fracture segment, bone mineral density, and preoperative visual analogue scale (VAS) score, midline vertebral height, and Cobb angle between the two groups ( P>0.05). The time to establish the tunnel, the times of fluoroscopy, the dose of fluoroscopy, the deviation of puncture, the distribution of bone cement, the leakage of bone cement, the puncture angle, and the postoperative VAS score, midline vertebral height, and Cobb angle were recorded and compared. Results: The patients in two groups were followed up 11-13 months (mean, 12 months). Compared with traditional fluoroscopy group, the time to establish the tunnel, the times and dose of fluoroscopy in robot-guided group were significantly lower, the deviation of puncture was slighter, the distribution of bone cement was better, and the puncture angle was larger, the differences between the two groups were significant ( P0.05). Conclusion: Robot-guided PKP in treatment of multi-segmental thoracolumbar OVCF can shorten the operation time, improve the accuracy of puncture, reduce the times and dose of fluoroscopy, reduce the leakage of bone cement, and achieve better cement distribution.

Effect of percutaneous kyphoplasty with different phases bone cement for treatment of osteoporotic vertebral compression fractures / 中国修复重建外科杂志

Objective: To compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF). Methods: The clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups ( P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients' symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded. Results: The injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups ( t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups ( χ2=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation ( P0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups ( P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant ( χ2=4.105, P=0.043; χ2=4.661, P=0.031). Conclusion: Bone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.

Zolidronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic compression fractures: A meta-analysis of bone density improvement, recurrent vertebral fractures prevention, and long-term efficacy evaluation / 中国组织工程研究

BACKGROUND: The clinical application of zoledronic acid in the treatment of osteoporosis lacks systematic scientific evaluation and evidence-based basis. Therefore, the clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture is still uncertain. OBJECTIVE: To systematically evaluate the efficacy of zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture. METHODS: A computer search of all randomized controlled studies and clinical trials of zolidronic acid combined with percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture published in CNKI, Wanfang, VIP, CBM, PubMed and Cochrane prior to September 2019 was performed. The experimental group was treated with zoledronic acid and percutaneous kyphoplasty, while the control group was treated with percutaneous kyphoplasty. Literature screening and data extraction were conducted by the two researchers independently. The quality of the included randomized controlled trials was evaluated one by one according to the Cochrane collaboration standards. Meta-analysis was performed on RevMan 5.3 for those that met the inclusion criteria. RESULTS AND CONCLUSION: (1) Five randomized controlled trials were included, including 175 in the experimental group and 184 in the control group. (2) Meta-analysis results showed that the bone mineral density was higher in the experimental group than in the control group [MD=0.12, 95%CI(0.08, 0.17), P < 0.000 01]. The visual analogue scale score was lower in the experimental group than that of the control group 6 and 12 months after treatment [MD=0.46, 95%CI(0.18, 0.75), P=0.002; MD=0.85, 95%CI(0.20, 1.50), P=0.01]. At 1 year after treatment, Oswestry disability index was lower in the experimental group than in the control group [MD=6.59, 95%CI(4.77，8.41), P < 0.000 01]. Bone cement leakage rate and recurrence rate of vertebral fractures were lower in the experimental group than in the control group [OR=0.22, 95%CI(0.08, 0.59), P=0.003; OR=0.18, 95%CI(0.07, 0.50), P=0.000 8]. Vertebral height recovery and kyphotic Cobb angle were not significantly different between the two groups [MD=0.65, 95%CI(-0.27, 1.56), P=0.16; MD=-0.60, 95%CI(-2.45, 1.25), P=0.53]. (3) Results showed that compared with percutaneous kyphoplasty alone, zoledronic acid combined with percutaneous kyphoplasty has significant advantages in improving bone mineral density, reducing the recurrence rate of vertebral fracture, improving the long-term clinical symptoms of patients, preventing the bone cement leakage, but a large number of high-quality multi-center randomized controlled studies are still needed to provide more sufficient evidence in the later stage.

Facet joint injection versus percutaneous kyphoplasty for mild vertebral fragility fractures: Rapid analgesia and restoration of spinal stability / 中国组织工程研究

BACKGROUND: Percutaneous kyphoplasty (PKP) for the treatment of osteoporotic compression fractures has been widely recognized in clinical practice, but clinicians are still impelled to seek for new treatment regimens due to complications such as bone cement leakage and adjacent vertebral re-fracture. OBJECTIVE: To compare the therapeutic efficacy of facet joint injection (FJI) and PKP in the treatment of mild vertebral fragility fractures. METHODS: Forty-six patients with mild vertebral fragility fractures (osteoporotic fractures) were divided into FJI group and PKP group according to the treatment regimens. The two groups of patients were treated with FJI and PKP separately based on standardized anti-osteoporosis treatment. The data of each group were recorded before and 1 week, 1, 3, 6, and 12 months after treatment. The analgesic efficacy was evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI). Spine stability was evaluated by anterior vertebral height, kyphotic angle and lumbar spine density and the incidence of re-fracture were compared. The study protocol was implemented in line with the ethic requirements of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences in China. Informed consent was obtained from each patient. RESULTS AND CONCLUSION: Intragroup comparison: VAS and ODI scores of patients in both groups were significantly decreased in each period after treatment compared with the baseline (P 0.05). After treatment, the anterior vertebral body height and kyphosis angle in the PKP group were better than those in the FJI group (P 0.05). Standardized anti-osteoporosis treatment with either FJI or PKP can provide effective analgesia for patients with mild vertebral fragility fracture, and PKP has certain advantages in rapid analgesia and recovery of spinal stability.