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Femoral head fracture is commonly seen in high-energy injury. However, compression fracture of femoral head is more rare. In most classifications of femoral head fracture, the compression is unusually involved. A case about acute traumatic dislocation of hip joint with compression fracture of femoral head is reported, involving a patient who hurt himself by riding electric bike and hitting the flower bed. He came to our hospital complaining of pain and limited motion of his right leg. The diagnosis of right hip anterior dislocation with the compression fracture of femoral head was confirmed by medical history, physical examination and imaging. Closed reduction of hip dislocation was performed in an emergency. Then we transplanted the bone cartilage from the non-weight-bearing area under the femoral head to the collapsed weight-bearing area, fixing it with countersunk hollow screws, and then the non-weight-bearing donor area was reconstructed with autogenous iliac bone, using surgical hip dislocation. The anatomical structure of the femoral head was therefore restored successfully during the operation. Three months after surgery, the X-ray showed that the femoral head was smooth and the cartilage graft was well fixed. Eight months after surgery, the patient gradually increased the bearing weight from partial to full according to his own condition, and there was no obvious pain in hip. After 24-month follow-up, we found the X-rays showed good reduction and fixation of the femoral head fracture. The CT scan showed no necrosis or cystic degeneration. He got well-active and passive movement in hip joint, and got no pain when walking with burden. For the patient with hip dislocation and compression fracture of femoral head, early joint reduction and non-weight-bearing osteocartilage transplantation can restore the anatomical structure of the weight-bearing area of the femoral head, to avoid traumatic osteoarthritis, and to improve the long-term quality of life of patients.
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Objective:To compare the clinical efficacies of precision targeted and traditional percutaneous vertebroplasty (PVP) in the treatment of refracture of injured vertebra after operation for Kümmell disease.Methods:A retrospective cohort study was conducted to analyze the clinical data of 23 Kümmell disease patients suffering from refracture of injured vertebra after PVP in Zhengzhou Orthopedic Hospital from October 2014 to October 2018. The patients included 7 males and 16 females, aged 53-89 years [(69.3±3.5)years]. There were 11 patients of stage I Kümmell disease and 12 patients of stage II Kümmell disease. The vertebral distribution of fracture was T 11 (3 patients), T 12 (9 patients), L 1 (8 patients) and L 2 (3 patients). Eleven patients received traditional PVP treatment (traditional PVP group) and 12 patients received precision targeted PVP treatment (targeted PVP group). The operation time, amount of bone cement injection and filling of bone cement in the fracture space were compared between the two groups. The visual analogue score (VAS) and Oswestry disability index (ODI) were also compared before operation, at 2 days, 1 month, 3 months, 6 months after operation, and at the last follow-up. The rates of bone cement leakage and re-collapse of injured vertebra were observed in the two groups. Results:The patients were followed up for 12-36 months [(24.2±2.6)months]. There were no significant differences in the operation time or amount of bone cement injection between the two groups (all P>0.05). All the fracture spaces in the targeted PVP group were fully filled with bone cement, while 4 patients in the traditional PVP group showed inadequate filling of the fracture area ( P<0.05). The VAS values in the targeted PVP group were (8.9±0.5)points, (1.6±0.2)points, (1.7±0.1)points, (1.8±0.1)points, (1.9±0.3)points, and (1.8±0.4)points before operation, at 2 days, 1 month, 3 months, 6 months after operation and at the last follow-up; and those in the traditional PVP group were (9.1±0.9)points, (1.8±0.4)points, (1.8±0.2)points, (2.0±0.4)points, (2.1±0.2)points, and (2.4±0.3)points, respectively. The VAS values of both groups were significantly decreased at 2 days, 1 month, 3 months, 6 months after operation, and at the last follow-up compared with those before operation (all P<0.05), but there was no significant difference between different time points after operation (all P>0.05). No significant differences were found in the VAS values between the two groups before operation and at 2 days, 1 month, 3 months and 6 months after operation (all P>0.05). However, the VAS value in the targeted PVP group was significantly lower than that in the traditional PVP group at the last follow-up ( P<0.05). The ODI values in the targeted PVP group were 38.5±4.3, 7.2±2.3, 7.3±2.0, 7.2±1.8, 7.3±2.4, and 7.4±2.5 before operation and at 2 days, 1 month, 3 months, 6 months after operation, and at last follow-up; and those in the traditional PVP group were 37.8±4.1, 7.5±2.5, 7.7±1.9, 7.9±2.4, 8.1±2.6, and 9.6±2.4, respectively. The ODI values of both groups were significantly decreased at 2 days, 1 month, 3 months, 6 months after operation and at the last follow-up compared with those before operation (all P<0.05), but there were no significant differences between different time points after operation (all P>0.05). The ODI values were not significantly different between the two groups before operation and at 2 days, 1 month, 3 months, 6 months after operation (all P>0.05), but the ODI value in the targeted PVP group was significantly lower than that in the traditional PVP group at the last follow-up ( P<0.05). There were no significant differences in the rates of bone cement leakage or re-collapse of injured vertebra between the two groups (all P>0.05). Conclusion:Compared with traditional PVP treatment for refracture of injured vertebra after operation for Kümmell disease, targeted PVP can make bone cement injection fully dispersed, greatly reduce pain and promote functional recovery.
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Objective:To study the clinical effect of balloon compression closure kyphoplasty in the treatment of fresh single-segment vertebral compression fracture.Methods:A retrospective study was used to analyze the clinical data of 80 patients with osteoporotic vertebral compression fracture (OVCF) admitted to Gansu Provincial Hospital of Traditional Chinese Medicine from June 2019 to June 2021. They were divided into two groups according to the surgical methods: the simple percutaneous kyphoplasty (PKP) group and the percutaneous kyphoplasty compression group, with 40 patients in each group. The PKP group was routinely treated with PKP, and the PKP compression group was treated with balloon compression occlusion technology on the basis of the PKP group. The amount of bone cement injected, the leakage of bone cement, the height of the anterior edge of the injured vertebra, the Cobb angle of kyphosis, the visual analogue score (VAS) and the Oswestry dysfunction index (ODI) were compared between the two groups. The measurement data conforming to the normal distribution were expressed as ( ± s), and the comparison between the two groups was conducted by t-test; The counting data were expressed by n(%) and the comparison between the two groups adopts Chi-square or Fisher exact probability. Results:The amount of bone cement injected and the leakage rate of bone cement in the PKP compression group were significantly higher than those in the simple PKP group ( P<0.05). The height of the anterior edge of the injured vertebra in the two groups was significantly higher than that before the operation on the first day and three months after the operation ( P<0.05). The Cobb angle, VAS score and ODI index of the injured vertebra in the two groups were significantly lower than that before the operation on the first day and three months after the operation ( P<0.05). The height of the anterior edge of the injured vertebra in the PKP compression group was significantly higher than that in the PKP group ( P<0.05). The Cobb angle of kyphosis in the PKP compression group was significantly lower than that in the simple PKP group at 1 day and 3 months after operation ( P<0.05). There was no significant difference in VAS score between PKP compression group and PKP group on 1 day after operation ( P>0.05), and compared with PKP group on 3 months after operation ( P<0.05). There was no significant difference in the ODI index between the PKP compression group and the two groups 1 day and 3 months after PKP ( P>0.05). Conclusion:Balloon compression closure technology can significantly reduce the leakage of bone cement in PKP and increase the amount of bone cement injected, which is beneficial to reduce the pain of vertebral body and improve the function of OVCF patients, and can improve the clinical treatment effect, which is worth promoting.
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Objective:To compare Jack dilator-kyphoplasty (DKP) and balloon-kyphoplasty (BKP) for osteoporotic vertebral compression fracture (OVCF) in postoperative vertebral height loss and adjacent intervertebral disc degeneration.Methods:A total of 94 OVCF patients were treated and fully followed up at Department of Orthopaedic Surgery, The First Hospital Affiliated to Nanjing Medical University from May 2007 to October 2016. Of them, 30 were subjected to DKP and 64 to BKP. In DKP group, there were 18 males and 12 females, with an age of (72.4±9.2) years, a bone density of (-3.99±0.88) SD and a disease course of (0.7±0.4) months; in BKP group, there were 28 males and 36 females, with an age of (71.6±14.3) years, a bone density of (-4.08±0.63) SD and a disease course of (0.6±0.3) months. The 2 groups were compared in terms of change in the height of injured vertebrae, disc height index percentage (DHIP) and Pfirrmann grading of adjacent disc degeneration at preoperation, 2 days and 36 months after operation.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). The anterior and middle heights of injured vertebrae and DHIP at postoperative 36 months were significantly lower than those at postoperative 2 days in both groups ( P<0.05). There was no significant difference between the 2 groups in DHIP at 36 months after operation (79.86%±4.48% versus 80.24%±6.85%) ( t=0.277, P=0.782). By the Pfirrmann grading, 36 and 84 patients had intervertebral disc degeneration in DKP and BKP groups respectively. There was no significant difference in the incidence of intervertebral disc degeneration between the 2 groups (60.0% versus 65.6%) (χ 2=0.560, P=0.454). Conclusions:In the OVCF treatment, DKP and BKP may potentially cause height loss of the injured vertebrae and degeneration of adjacent intervertebral disc, but no difference was found in disc degeneration between the 2 modes.
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The symptomatic chronic thoracolumbar osteoporotic vertebral fracture (SCOVF) is complex in symptom and pathological character. Various treatment methods are employed for SCOVF, but there still lacks standard criteria for proper selection. Therefore, Spine Trauma Division of Chinese Association of Orthopedic Surgeons together with the relevant experts formulated and released the clinical guideline on surgical treatment for SCOVF. Due to space limitations, the guideline did not make full elaboration and analysis on some recommendations. In this study, the authors aim to interpret some key clinical issues in the diagnosis, choice of operation methods and choice of internal fixation methods of SCOVF, hoping to help peers better grasp the connotation of the guideline and apply it correctly in clinical practice.
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Objective:To evaluate the effects of percutaneous kyphoplasty(PKP)and percutaneous vertebroplasty(PVP)operation in elderly patients with osteoporotic vertebral compression fracture(OVCF).Methods:From June 2019 to June 2020, a total of 58 patients with OVCF aged over 60 and under 80 years who had a loss of more than one-third of the anterior margin height of vertebral and agreed to participate in the study were randomly divided into PKP group and PVP group.The visual analogue pain scale(VAS)score, SF-36 quality of life score, anterior height of fractured vertebral body, leakage of bone cement, refracture and cost of high-value consumables were observed at the time point before operation, 1 day, 1 month, 3 month, 6 month, 12 month after operation.Results:VAS scores in PKP and PVP groups were decreased after operation as compared with preoperation( F=115.380, 175.010, both P<0.001). VAS score was lower in the PKP group than in the PVP group at 6 months after operation with statistically significant difference( t=2.219, P=0.031), and no statistically significant difference at other time points between the two groups(all P>0.05). In the PKP and PVP groups, the height of the anterior edge of the vertebral body recovered significantly on the first day after operation, and there was a significant difference in the height compared with that before operation( F=43.020, 51.010, both P<0.001). The SF-36 scores at the latter time point in PKP and PVP groups were increased as compared with the previous time point.The increment of the SF-36 scores was statistically significant at 1 month after operation than pre-operation, and also at 3 months after operation than at 1 month after operation.The leakage rate of bone cement was 37.0%(10/27)in PKP group and 25.0%(7/28)in PVP group, with no significant difference between the two groups( χ2=0.930, P=0.391). The refracture rate was 3.7%(1/27)in PKP group and 7.1%(2/28)in PVP group, with no significant difference between the two groups( χ2=0.000, P=1.000). The cost of high-value consumables for single segment fracture was 46 490 yuan in PKP group, and 36 700 yuan in PVP group.The cost of PKP group was higher than that of PVP group. Conclusions:PKP and PVP operation in the treatment of osteoporotic vertebral compression fractures have good effects in aspect of analgesia, restoring vertebral height and improving patients' quality of life.The analgesic effect is slightly better in PKP group than in PVP group.PVP group has more advantages in health economics.
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Objective:To investigate the clinical effects of anterior cage inserting for old thoracolumbar fractures with kyphosis through facet joint approach.Methods:A retrospective analysis was conducted on 32 patients with old thoracolumbar fractures complicated with kyphosis admitted from January 2018 to December 2019, including 14 males and 18 females. The average age was 47.3±13.1 years (range, 26-70 years). Thoracolumbar injury classification (TLICS) scores of patients with initial injury were 3-5 points, with an average of 4.0 points. After 6.3±2.9 months (range, 3-16 months) conservative treatment, intractable thorax and lumbar or back pain still existed. Anterior cage inserting via articular protrusion was performed in 15 cases and posterior screw placement and bone grafting fusion of injured vertebrae was performed in 17 cases. Preoperative sagittal Cobb angle was 27.0°±3.9° and 26.8°±4.6° in the anterior cage inserting group and fixation on fractured vertebrae group ( t=0.07, P=0.946), respectively. Sagittal vertical axis (SVA) was 4.2±1.8 cm and 4.1±2.1 cm ( t=0.14, P=0.887), respectively. The number of patients with ASIA impairment scale (AIS) of the anterior cage inserting group before surgery was 1 in grade C, 4 in grade D and 10 in grade E. However, the number of that in fixation on fractured vertebrae group was 2 in grade C, 2 in grade D and 13 in grade E. There was no significant difference between the two groups (χ 2=1.34, P=0.520). Results:All 32 patients were followed up for 12.2±3.1 months in the anterior cage inserting group and 12.0±3.3 months in fixation on fractured vertebrae group. The operative duration of the anterior cage inserting group and fixation on fractured vertebrae was 128±24.5 min and 123±40.6 min ( t=0.42, P=0.681). The intraoperative blood loss was 485±12.6 ml and 478±16.3 ml ( t=0.13, P=0.894), respectively. At the last follow-up, the improvement rate of VAS score of the anterior cage inserting group was higher than that of fixation on fractured vertebrae group (90%±10% vs. 75%±20%, t=3.17, P=0.004). The height of anterior margin of injured vertebra in the two groups was increased by 1.02±0.10 cm and 0.29±0.14 cm, the change rate of anterior cage inserting group was higher than that of fixation on fractured vertebrae group (67.1%±31.5% vs. 19.0%±14.9%, t=16.29, P<0.001). The sagittal Cobb angle of the anterior cage inserting group was significantly lower than that of fixation on fractured vertebrae group (7.4°±1.5° vs. 11.6°±2.5°, t=-5.85, P<0.001). The SVA of anterior cage inserting group was lower than that of fixation on fractured vertebrae group (1.1±0.6 cm vs. 1.6±0.6 cm, t=2.35, P=0.025). There were 15 patients in AIS grade E in the anterior cage inserting group, while 1 patient in grade D and 16 patients in grade E in fixation on fractured vertebrae group without significant difference between the two groups (χ 2=0.83, P=0.706). Conclusion:The treatment of old thoracolumbar fractures with kyphosis through facet joint approach and anterior fixation could achieve satisfied effects and could relieve pain symptoms of thoracolumbar and back, compared with posterior fusion for injured vertebra with nail and bone grafting.
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Objective:To evaluate the efficacy of percutaneous curved kyphoplasty (PCKP) for the treatment of osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective cohort study was conducted to analyze the clinical data of 70 patients with OVCF admitted to Third People′s Hospital of Datong from May 2020 to December 2021, including 32 males and 38 females, aged 60-89 years [(73.0±8.7)years]. The patients were treated with PCKP (PCKP group, n=20) or percutaneous vertebroplasty (PVP) (PVP group, n=50). The operation time, intraoperative blood loss, length of hospital stay, excellent rate of bone cement distribution at postoperative 1 day, and leakage rate of bone cement were compared between the two groups. In addition, anterior height ratio of the injured vertebrae, upper and lower Cobb angle, visual analogue scale (VAS), and Oswestry dysfunction index (ODI) were measured preoperatively and at postoperative 24 hours and 3 months. Results:All patients were followed up for 3-4 months [(3.0±0.6)months]. There were no significant differences in the operation time, intraoperative blood loss, and length of hospital stay between the two groups (all P>0.05). At postoperative 1 day, the excellent rate of bone cement distribution was 100% in PCKP group (excellent in 13 patients, good in seven, poor in zero), significantly higher than 82% in PVP group (excellent 21 patients, good in 20, and poor in nine). The leakage rate of bone cement was 0%(0/20) in PCKP group, lower than 20% (10/50) in PVP group ( P<0.05). There were no significant differences in the anterior height ratio of injured vertebrae, upper Cobb angle, lower Cobb angle, VAS and ODI between the two groups before operation (all P>0.05). At postoperative 1 day, PCKP group showed significantly higher anterior height ratio of injured vertebrae and significantly lower upper Cobb angle, lower Cobb angle, VAS, and ODI than those in PVP group ( P<0.05 or 0.01). At postoperative 3 months, PCKP group still showed significantly higher anterior height ratio of injured vertebrae and significantly lower upper Cobb angle and lower Cobb angle than those in PVP group ( P<0.05 or 0.01), but there was no significant difference in VAS and ODI between the two groups (all P>0.05). In PCKP group, the anterior height ratio of the injured vertebrae was significantly increased and the upper Cobb angle, lower Cobb angle, VAS, and ODI index were significantly decreased at postoperative 1 day and 3 months when compared with those before operation (all P<0.05). In PVP group, there were no significant changes in the anterior height ratio of the injured vertebrae, upper Cobb angle, and lower Cobb angle at postoperative 1 day and 3 months when compared with those before operation (all P>0.05), but the VAS and ODI were significantly lowered at postoperative 1 day and 3 months when compared with those before operation (all P<0.05). Conclusion:Compared with PVP, PCKP has better diffusion effect of bone cement in the injured vertebrae and lower incidence of bone cement leakage in the treatment of OVCF, which can effectively promote height recovery of the injured vertebrae, relieve the pain early, and improve spinal function.
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Objective:To investigate the effect of percutaneous kyphoplasty on the vertebral height and Cobb angle in elderly patients with osteoporotic thoracolumbar compression fractures.Methods:Seventy elderly patients with osteoporotic thoracolumbar compression fractures who were admitted to the Affiliated Hospital of Hubei University of Traditional Chinese Medicine from March 2019 to March 2020 were selected as the study objects. They were grouped according to the random number table method, with 35 patients in each group. The patients in the observation group were treated with multi-point balloon expansion percutaneous kyphoplasty, and the patients in the control group were treated with single balloon expansion percutaneous kyphoplasty. The Visual Analogue Scale (VAS) and Oswestry Dysfunction Index (ODI) score were compared between the two groups before and after treatment. The relative height of injured vertebrae, Cobb angle, bone cement diffusion volume ratio, operation time, radiation exposure time and bone cement injection volume were recorded.Results:There was no significant difference in VAS and ODI score between the two groups before operation (all P>0.05). At 12 months after operation, the VAS and ODI score of the two groups were lower than those before operation (all P<0.05), and the ODI score of the observation group was significantly lower than that of the control group ( P<0.05). At 12 months after operation, the relative height of injured vertebrae in the observation group was higher than that in the control group, and the local Cobb angle was significantly lower than that in the control group (all P<0.05). The total effective rate of the observation group was significantly higher than that of the control group (94.28% vs 82.86%, P<0.05). Compared with the control group, the observation group had higher proportion of grade Ⅱ in the diffusion volume ratio of bone cement and more bone cement injection, and longer operation time (all P<0.05), while there was no significant difference in the radiation exposure time between the two groups ( P>0.05). Conclusions:The treatment of percutaneous kyphoplasty with multi-point expansion of balloon under overextended posture can more effectively improve the relative height of injured vertebrae and improve local Cobb angle of elderly patients with osteoporotic thoracolumbar compression fractures, and does not increase the risk of bone cement leakage. It is worthy of clinical application and promotion.
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Objective:To investigate the clinical efficacy of percutaneous kyphoplasty (PKP) versus percutaneous vertebroplasty (PVP) in the treatment of single-segment osteoporotic vertebral compression fractures (OVCF) in the older adult patients. Methods:A total of 117 older adult patients with single-segment OVCF who received treatment in Binzhou Central Hospital from January 2016 to March 2018 were included in this study. They were randomly assigned to undergo either PVP (observation group, n = 60) or PKP (control group, n = 57). Therapeutic effects, treatment cost and the incidence of complications were compared between the two groups. Results:In the observation group, the amount of bone cement, operative time, treatment cost and the amplitude of increase in vertebral height post-operation relative to preoperative vertebral height were (4.69 ± 1.94) mL, (27.59 ± 5.81) minutes, (6 537.24 ± 898.36) yuan, (2.54 ±1.37) mm, respectively, and they were (5.78 ± 2.04) mL, (38.63 ± 8.17) minutes, (24 371.85 ± 2 365.54) yuan, (8.65 ± 1.48) mm, respectively in the control group. There were significant differences in these indices between the two groups ( t = 6.18, 9.25, 10.26, 7.23, all P < 0.05). Before treatment, there were no significant differences in Cobb angle and vertebral compression rate between the two groups (both P > 0.05). After treatment, Cobb angle of injured vertebrae in the control group was significantly lower than that in the observation group [(9.25 ± 2.36)° vs. (20.38 ± 3.87)%, t = 10.25, P < 0.05]. Vertebral compression rate in the control group was significantly lower than that in the observation group [(20.06 ± 3.53)% vs. (24.76 ± 5.35)%, t = 6.23, P < 0.05]. There was no significant difference in the incidence of complications between the two groups [26.67% (16/60) vs. 17.54% (10/57), χ2 = 8.92, P < 0.05). Conclusion:PVP is more simple and less expensive in the clinical treatment of OVCF than PKP, but PKP is more effective and has lower incidence of complications than PVP. PKP can be preferred if there is no concern about economic and medical conditions.
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Objective:To analyze the diagnostic value of X-ray, CT and MRI multimodal images in the vertebral compression fractures caused by osteolytic metastases and osteoporosis.Methods:The basic clinical data and X-ray, CT, MRI imaging data of 102 patients with vertebral compression fractures from January 2019 to May 2021 in Jiangnan Hospital (Xiaoshan Traditional Chinese Medicine) Affiliated to Zhejiang University of Traditional Chinese Medicine were retrospectively analyzed. Among them, vertebral compression fractures caused by osteolytic metastases was in 47 cases, and vertebral compression fractures caused by osteoporosis was in 55 cases.Results:The age and osteoporosis rate in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis: (61.95 ± 11.84) years old vs. (72.37 ± 12.55) years old and 4.3% (2/47) vs. 83.6% (46/55), the body mass index and pain visual analogue score were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis: (22.58 ± 3.85) kg/m 2 vs. (18.11 ± 2.79) kg/m 2 and (8.31 ± 2.91) scores vs. (7.02 ± 2.72) scores, and there were statistical differences ( P<0.05); there was no statistical difference in gender composition ( P>0.05). The rates of vertebral body wedge shape and double concave shape in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis: 2.80% (3/107) vs. 60.82% (104/171) and 6.54% (7/107) vs. 29.82% (51/171), the rates of flat shape and posterior margin swelling were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis: 75.70% (81/107) vs. 9.36% (16/171) and 14.95% (16/107) vs. 0, and there were statistical differences ( P<0.01); the rates of pedicle involvement and soft tissue mass in patients with vertebral compression fractures caused by osteolytic metastases were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis: 68.09% (32/47) vs. 1.82% (1/55) and 46.81% (22/47) vs. 0, while the rate of linear image signal in vertebral body was significantly lower than that in patients with vertebral compression fractures caused by osteoporosis: 0 vs. 96.36% (53/47), and there were statistical difference ( P<0.01); there was statistical difference in MRI signals ( P<0.01), vertebral compression fractures caused by osteolytic metastases were mainly characterized by low T 1 high T 2 and low T 1 low T 2, while vertebral compression fractures caused by osteoporosis was mainly characterized by low T 1 high T 2; the rates of disc compression and widening in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis: 4.26%(2/47) vs. 34.55% (19/55) and 2.13%(1/47) vs. 18.18% (10/55), and there were statistical differences ( P<0.01 or <0.05). The accuracies of multimodal imaging in the diagnosis of vertebral compression fractures caused by osteolytic metastases and osteoporosis were significantly higher than those of X-ray, CT and MRI (89.4% vs. 51.1%, 72.3%, 83.0%; 90.9% vs. 52.7%, 60.0%, 78.2%), and there were statistical differences( P<0.05). Conclusions:Multimodal imaging is helpful to improve the diagnostic accuracy of vertebral compression fractures caused by osteolytic metastases and osteoporosis, to reduce the clinical misdiagnosis rate, with important reference value for the differential diagnosis of the two diseases.
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ABSTRACT Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants. Level of Evidence V, Expert Opinion.
RESUMO A evidência científica atual aponta para a importância de obter restauração anatómica dos corpos vertebrais com fraturas em compressão, tal como acontece em outras articulações do corpo humano, de modo a garantir uma coluna biomecânica e funcionalmente mais próxima da prévia à fratura. Consideramos que a redução anatómica destas fraturas apenas se consegue na totalidade com a aplicação de implantes intravertebrais expansíveis, restaurando a morfologia das plataformas vertebrais e assim proporcionando uma cicatrização do disco intervertebral mais adequada. Isto permite minimizar a progressão para alterações disco e osteodegenerativas desse segmento vertebral e dos níveis adjacentes, bem como em idosos evitar a sobrecarga anterior dos corpos adjacentes consequente ao achatamento pós- -traumático e assim minimizar o risco de fraturas vertebrais adjacentes. A capacidade de redução da fratura e de manutenção da altura do corpo vertebral ao longo do tempo, bem com a sua aplicação percutânea transpedicular, torna os implantes intravertebrais expansíveis uma opção muito atrativa no tratamento destas fraturas. Os autores apresentam os conceitos de redução direta e indireta de fraturas vertebrais, revêm a biomecânica, características e indicações dos implantes intravertebrais expansíveis, finalizando com uma proposta de atualização do algoritmo de tratamento cirúrgico das fraturas vertebrais em compressão que inclui a aplicação de implantes intravertebrais expansivos. Nível de Evidência V, Opinião do Especialista.
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OBJECTIVE@#To explore the clinical results of modified medial incision in the treatment o f Pilon fracture with medial column compression and evaluate its safety.@*METHODS@#Thirty-one patients of Pilon fracture with medial column compressiom accepted surgical treatments in the Department of Foot and Ankle at Honghui Hospital of Xi'an Jiaotong University from January 2015 to January 2019. According to the imaging data at admission, 31 cases were diagnosed as closed Pilon fractures, and both preoperative X-ray and 3D CT scan were shown as medial column compressive fractures. All patients underwent modified medial incision with complete data, including 23 males and 8 females;ranging in age from 22 to 65 years old, with an average of (39.5±16.2) years old. All patients underwent modified medial approach combined with other approaches to expose the broken end of fracture. The time from trauma to operation ranging from 7 to 20 days, with a mean of(9.5±5.5) days. The incision and fracture healing were followed up regularly after operation.@*RESULTS@#All patients were followed up with an average of(15.7±5.5) months(ranged, 13 to 25 months). Preoperative and postoperative routine X-ray and 3D CT examination showed anatomical reduction in 8 cases, and the anatomical reduction rate was 25.81%. Up to the latest follow-up, all 31 fractures had achieved bone healing, and the healing time ranged from 11 to 22 weeks, with a mean of (14.3±4.7) weeks. At the latest follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores ranged from 75 to 89, with a mean of 80.5±4.9, 24 patients got a good result, 7 fair.@*CONCLUSION@#The improved medial approach for Pilon fracture can directly expose the posterior medial, medial and anterior medial of the distal tibia. After reduction under direct vision, the medial compressed and collapsed articular surface are fixed. The clinical curative effect is satisfactory and the wound complications are less. It is recommended for Pilon fracture where compression of the medial articular surface is predominant.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Ankle Fractures/surgery , Ankle Joint/surgery , Fracture Fixation, Internal/methods , Tibial Fractures/surgery , Treatment OutcomeABSTRACT
Objective:To investigate the clinical effectiveness of vertebroplasty for osteoporotic vertebral compression fractures in the elderly aged 90 years and over.Methods:Clinical data of 64 elderly patients aged 90 years and over who had undergone percutaneous vertebroplasty for vertebral compression fractures between January 2015 and January 2021 were retrospectively analyzed.Changes in preoperative and postoperative pain, intraoperative bone cement leakage, postoperative pneumonia, bedsores, urinary tract infections, lower extremity venous thrombosis and changes in preoperative and postoperative physical mobility were evaluated.Pain scores, physical mobility scores, bone cement extravasation and complications such as re-fractures of the vertebral body, postoperative pneumonia, bedsores, urinary tract infections and thrombosis were recorded before surgery, 3 and 30 days after surgery.Results:The visual analogue scale(VAS)scores of 64 patients before surgery, 3 and 30 days after the procedure were 8.34±1.12, 2.17±1.45 and 1.83±1.15, retrospectively( F=540.876, P<0.01). The physical mobility scores before surgery, 3 and 30 days after the procedure were 2.83±0.94, 1.59±0.70 and 1.39±0.60, retrospectively( F=65.492, P<0.01). There were 18 cases(28.13%)of bone cement leakage during surgery, 4 cases(6.25%)of pneumonia within 30 days after surgery, 9 cases(14.06%)of urinary tract infections, 3 cases(4.69%)of lower extremity venous thrombosis, 1 case(1.56%)of bedsores, and 2 cases(3.13%)of vertebral re-fractures after surgery.No patient died during the 30-day follow-up. Conclusions:Percutaneous vertebroplasty can reduce pain and improve physical mobility and is an effective and safe minimally invasive treatment for elderly patients with spinal compression fractures aged 90 years and over.
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Objective:To evaluate the diagnostic value of spectral CT calcium suppression (CaSupp) technique in acute and chronic thoracolumbar compression fractures.Methods:A total of 31 patients with thoracolumbar compression fractures were given spectral CT and MR scans from March to October 2020 in the Second Hospital of Shanxi Medical University. Acute and chronic vertebral fractures were diagnosed by doctor A and B based on CaSupp diagram, and the consistency between the two doctors was evaluated by Kappa test. CT values of fractured vertebra and adjacent normal vertebra were measured on conventional CT and CaSupp graphs respectively, and the CT value difference between fractured vertebra and adjacent vertebra was calculated. Independent sample t-test was used to compare the conventional CT value and CT value difference, CaSupp CT value and CT value difference between acute and chronic fractured vertebra. Using MRI as the gold standard, the ROC curves were drawn to evaluate the subjective diagnostic efficacy of physicians and the diagnostic efficacy of each quantitative parameter. DeLong test was used to compare the area under the curve (AUC) of each quantitative parameter in pairs. Results:The number of vertebral bodies in acute and chronic compression fractures diagnosed by MRI was 48 and 11 respectively. The Kappa value of subjective diagnosis of acute and chronic vertebral fractures by doctors A and B was 0.782, and the AUC, sensitivity, specificity were 0.882 and 0.857, 85.4% and 89.6%, 90.9% and 81.8%, respectively. The differences of conventional CT value, CaSupp CT value and CaSupp CT value difference between acute and chronic compression fractures were statistically significant (all P<0.05), and the AUC values of conventional CT value, CaSupp CT value, conventional CT value difference and CaSupp CT value difference were 0.824, 0.930, 0.706 and 0.934, respectively. Pair comparison showed that the AUC of the CaSupp CT value and CaSupp CT value difference was greater than that of conventional CT value difference, with statistically significant differences ( Z=2.014, P=0.044, Z=2.028, P=0.043), while there were no statistically significant differences between other AUC values (all P>0.05). Conclusion:The dual-layer detector spectral CT CaSupp technique has high value in differentiating acute and chronic thoracolumbar compression fractures, and the CaSupp CT value and CaSupp CT value difference are recommended for diagnosis.
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RESUMEN Fundamento: las fracturas de la meseta tibial son lesiones traumáticas frecuentes por lo general son provocadas por mecanismos de compresión vertical en varo o valgo, de allí la incidencia de fracturas abiertas con pérdida de piel no son frecuentes, ya que estas responden por lo general a mecanismos directos. Objetivo: presentar el caso de una paciente con fractura abierta de la meseta tibial tipo VI de Schatzker J. Presentación del caso: paciente de 61 años de edad, mestiza, femenina sin antecedentes mórbidos de salud, la cual sufre accidente del tránsito al proyectarse contra un camión y es traída al servicio de urgencias de Ortopedia y Traumatología por presentar dolor e inflamación a nivel de la rodilla y pierna izquierda, que le impide la marcha y los movimientos, además de presentar herida avulsiva de base distal que se comunicaba con el foco de fractura. El examen radiográfico simple de la rodilla izquierda en proyecciones anteroposterior y lateral mostró solución de continuidad del tejido óseo a nivel de la zona metafiso-epifisaria de la tibia proximal izquierda. El tratamiento definitivo de la paciente consistió en la colocación de tornillo canulado y fijación externa tipo Hoffman 1® mediante dos anclajes en el fémur y tibia. Conclusiones: las fracturas de la meseta tibial tipo VI de Schatzker J, son lesiones traumáticas de difícil tratamiento debido a su asociación a complicaciones como: comunicación con el exterior y pérdida de piel. La fijación externa es un método de osteosíntesis útil y de fácil aplicación, que permite el tratamiento de estas lesiones complicadas.
ABSTRACT Background: tibial plateau fractures are common traumatic lesions due to vertical compression in varus and valgus. That is why open fractures associated to skin loss are not so frequent, because they are caused by direct mechanisms. Objetive: to present the case of a patient with an open fracture of the tibial plateau type VI by Schatzker J. Case report: a 61 year old mixed race, woman without health morbid antecedents, who after having a traffic accident was taken to emergency room of Orthopedics and Traumatology complaining of pain, swelling and limitation of movement of the left knee and leg. Simple imaging examination in antero-posterior and lateral views showed a structural break in the continuity of bone at epiphysis and metaphysis in the left proximal tibia. Definite treatment consisted of an osteosynthesis with cannulated screw and fixation by an external device type Hoffmann 1 with two pins in femur and tibia respectively. Conclusions: tibial plateau fractures type VI according to Schatzker J classification system are difficult to treat because of associated lesions and complications as open fractures and skin loss. External fixation is a useful and easy method to fix complex fractures as tibial plateau fractures.
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Objective: To explore the value of dual-energy CT hydroxyapatite (HAP)-water decomposition technique in differential diagnosis of acute and chronic vertebral compression fractures (VCF). Methods: Data of 31 patients with thoracolumbar VCF were retrospectively analyzed. Taken MRI results as reference standards, the visual evaluation of fusing pseudo-color images of virtual nonhydroxyapatite (VNHAP) was conducted by physicians. The sensitivity, specificity and accuracy of visual assessment in diagnosis of acute VCF were calculated. Compare relative water content in vertebrae was measured in VNHAP grayscale images. ROC curve analysis was performed to evaluate the diagnostic efficiency of relative water content in vertebrae for acute VCF. Results: MRI showed 80 compressed vertebral bodies among 31 patients, including 46 lumbar vertebrae and 34 thoracic vertebrae, 45 acute VCF and 35 chronic VCF. For visual analysis of VNHAP images, the sensitivity was 93.33% (42/45), specificity was 97.14% (34/35), and accuracy was 95.00% (76/80). The relative water content in vertebrae of acute VCF was (1 015.82±11.90)mg/cm3, significantly higher than that of chronic compression fractures (996.99±9.29)mg/cm3(P<0.05). ROC curve showed taken 1 003.20 mg/cm3 as the cutoff value of the relative water content in vertebrae in diagnosis of acute compression fractures, the sensitivity was 88.89%, specificity was 82.86%, and the AUC was 0.92. Conclusion: Dual-energy CT HAP-water decomposition technique can be used to differential diagnose acute and chronic VCF, and the diagnostic efficiency of visual assessment is higher than that of quantitative image evaluation.
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OBJECTIVE@#To study effects of postoperative regular training of core muscle strength guided by the concept of enhanced recovery after surgery (ERAS) on the rehabilitation of elderly patients with osteoporotic lumbar vertebral compression fracture after vertebroplasty (PVP) and kyphoplasty(PKP).@*METHODS@#Ninety-four elderly patients with osteoporotic lumbar compression fractures who underwent PKP or PVP from January 2016 to January 2018 and met inclusion criteria were divided into observation group and control group. All the patients were treated with routine anti osteoporosis therapy after operation. There were 47 patients in the observationgroup, including 18 males and 29 females, with an average age of (62.62±3.21) years old;in the control group, there were 47 cases, including 17 males and 30 females, with an average age of (62.38±2.84) years old. The patients in the control group were trained by traditional way, and the patients in observation group were instructed to conduct regular training of core muscle strength according to ERAS concept. The patients were followed up for 1, 3 and 6 months after operation. Patients' conditions were quantitatively evaluated according to Barthel scale, JOA low back pain score and Oswestry Disability Index, and the differences in treatment effects between two groups were statistically analyzed and compared.@*RESULTS@#All the patients were followed up, and the Barthel scale, JOA low back pain score and Oswestry Disability Index score of the observation group were all better than those of the control group on the 1st and the 3rd months after surgery(@*CONCLUSION@#Early regular core strength training has a positive effect on early functional recovery and improvement of life ability after PKP or PVP for elderly patients with osteoporotic lumbar compression fractures, which is in line with the concept of accelerated rehabilitation surgery.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Enhanced Recovery After Surgery , Fractures, Compression/surgery , Kyphoplasty , Osteoporotic Fractures/surgery , Spinal Fractures/surgery , Treatment Outcome , VertebroplastyABSTRACT
OBJECTIVE: Although surgical intervention, such as percutaneous vertebroplasty (PVP), is the standard treatment for osteoporotic vertebral compression fractures (OVCFs), its effectiveness and safety are unclear. Therefore, this study compared the safety and efficacy of conservative treatment with that of PVP for acute OVCFs. METHODS: Patients with single-level OVCFs who were treated conservatively with a transdermal fentanyl patch (TFP) or with PVP between March 2013 and December 2017 and followed-up for more than 1 year were retrospectively evaluated. Patients with pathologic fractures, fractures of more than two columns, or a history of PVP were excluded. Clinical outcomes (visual analog scale [VAS] scores) and radiographic factors were evaluated, including changes in the compression rate of the corresponding vertebral body at onset and after 12 months, sagittal Cobb angle at onset and after 6 and 12 months, and the incidence of adjacent compression fractures. RESULTS: Of the 131 patients evaluated, 75 were treated conservatively using TFPs and 56 underwent PVP. We divided the patients into TFP and PVP groups. Their baseline characteristics (including sex, level of fracture, and bone mineral density T-scores) were similar, but the TFP group was significantly younger. The overall VAS score for pain showed a greater decrease during the first month (1 week after PVP) in the PVP group but remained similar in the two groups thereafter. The compression rate after 12 months increased in the TFP group but decreased in the PVP group. Five patients in the PVP group, but none in the TFP group, experienced adjacent compression fractures within 12 months. CONCLUSION: We compared clinical and radiological outcomes between the TFP and PVP groups. The immediate pain reduction effect was superior in the PVP group, but the final clinical outcome was similar. Although the PVP group had a better-preserved compression rate than the TFP group for 1 year, the development of adjacent fractures was significantly higher. Although TFPs seemed to be beneficial in reducing the failure rate of conservative treatment, the possibility of side effects (22.6%, 17 out of 75 patients, in this study) should be carefully monitored.
Subject(s)
Humans , Bone Density , Fentanyl , Fractures, Compression , Fractures, Spontaneous , Incidence , Retrospective Studies , VertebroplastyABSTRACT
OBJECTIVE: Osteoporosis is one of the most common causes of vertebral compression fractures (VCFs). Teriparatide, a recombinant human parathyroid hormone, is the first anabolic agent for the treatment of osteoporosis. The aim of this study was to determine whether 3 months of teriparatide could be effective for patients with osteoporotic VCF at the thoracolumbar spine. METHODS: We reviewed 25 patients with thoracolumbar osteoporotic compression fractures between July 2012 and October 2016 who could be followed up for more than 1 year. Patients were divided into 2 groups depending on the use of teriparatide: 14 patients received teriparatide through subcutaneous injection (group I) and 11 patients did not receive teriparatide (group II). Demographic data, bone mineral density, hospitalization period, changes in the visual analogue scale (VAS) score, body mass index, and medical history such as smoking, alcohol, diabetes, and steroid usage were reviewed. Radiographs were also reviewed to evaluate vertebral body compression percentages and kyphotic angles. RESULTS: Overall changes of VAS score between injury and follow-up were statistically improved in both groups at 2 to 3 weeks post-injury. However, difference in VAS improvement at a specific time between the 2 groups was not statistically significant. Overall kyphotic angle and compression percentage between injury and follow-up time were increased in group II than those in group I, although the difference between the 2 groups was not statistically significant. CONCLUSION: Three-month of teriparatide did not show protective effects on progression of fractured vertebral body collapse or kyphotic changes in patients with osteoporosis.