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Objective:To investigate the effects of internal fixation with pedicle screw via modified Wiltse approach combined with transpedicular bone grafting on the vertebral body and complications of senile osteoporotic vertebral compression fractures (OVCF) .Methods:Ninety-four elderly patients with osteoporotic vertebral compression fractures who were admitted to Hangzhou Fuyang Traditional Chinese Medicine Orthopedics Hospital from Oct. 2018 to Oct. 2019 were selected as the research objects. The patients were divided into control group and observation group according to the random ball touch method. For 47 cases, the control group underwent posterior short-segment reduction and internal fixation combined with transpedicular bone grafting, and the observation group underwent modified Wiltse approach pedicle internal fixation combined with transpedicular bone grafting. The two groups were observed and compared in terms of surgery related indicators, the condition of the injured vertebrae, the recovery of the vertebral body, the length of hospitalization and fracture healing time, and the incidence of complications.Results:In comparison of the operation-related indexes between the two groups, the intraoperative blood loss, 3d postoperative visual analogue scale (VAS) score and operation time of the observation group were significantly lower, than those of the control group ( P<0.05) . In comparison of the condition of the injured vertebrae between the two groups, there was no significant difference in the ratio of the loss rate of the injured vertebrae Cobb angle, vertebral body sagittal plane index, and vertebral body height between the two groups before operation ( P>0.05) . The loss rates of Cobb angle and vertebral body height of the injured vertebrae in the two groups were lower than that before operation at 3 days after operation, and the sagittal index of the vertebral body was higher than before operation at 1 year after operation ( P<0.05) . The loss rate of Cobb angle and vertebral body height of the injured vertebral body in the observation group was significantly lower than that of the control group at 3 days postoperatively, and the vertebral body sagittal plane index was significantly higher than that of the control group at 1 year postoperatively ( P<0.05) . Comparing the recovery of injured vertebrae between the two groups, there was no statistically significant difference between the preoperative oswestry disability index (ODI) scores of the two groups ( P>0.05) , the improvement rate of Cobb angle and the recovery rate of vertebral body height in the observation group, ODI scores at 3 months after operation were significantly higher than those of the control group ( P<0.05) . The hospitalization time and fracture healing time of the observation group were significantly lower than those of the control group ( P<0.05) . The total incidence of complications in the observation group (4.26%) was significantly lower than the total incidence of complications in the control group (19.15%) ( P<0.05) . Conclusion:The combined use of internal fixation with pedicle screw via modified Wiltse approach combined with transpedicular bone grafting in treatment of elderly OVCF can reduce the amount of intraoperative blood loss, shorten the operation time and hospital stay and fracture healing time, improve the Cobb angle of the injured vertebra, promote the recovery of the height and function of the injured vertebra, and reduce the incidence of complications.
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BACKGROUND; Some scholars have classified osteoporotic vertebral compression fractures based on X-ray and MRI findings. However, little is reported on the morphological types and distribution rules of fracture areas in osteoporotic vertebral compression fractures. OBJECTIVE; To investigate and summarize the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI. METHODS; Clinical data from 352 patients with osteoporotic vertebral compression fractures, 73.07 years of age, including 69 males and 283 females admitted at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2011 to June 2017 were retrospectively reviewed. After admission, CT multi-planar reconstruction, MRI and bone mineral density measurements were conducted in each patient. Fresh osteoporotic vertebral compression fractures were confirmed in 477 vertebrae according to clinical manifestations and imaging findings. Fracture areas were defined as shade compact or bright line based on CT multi-planar reconstruction or bone marrow edema on the MRI. Morphological type and distribution of fracture areas were recorded by two experienced spinal surgeons and one senior radiologist independently. The study protocol was approved by the Ethic Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine in China with an approval No. ZYYECKYJ[2017]057. RESULTS AND CONCLUSION: Fracture areas of 472 vertebrae were indicated distinctly on the MRI, whereas the fracture areas of 5 vertebrae were unclear. Meanwhile, fracture areas of 469 vertebrae were shown clearly on the CT multi-planar reconstruction, but the areas of 8 vertebrae were obscure on the CT. Fracture areas of 5 vertebrae were unclear in both CT and MRI. There was no significant difference between CT and MRI in the observation of fracture areas (P=0.402). Finally, fracture areas of 8 vertebrae could not be described accurately on CT, MRI or both. In the sagittal plane of CT and MRI, morphological types of fracture areas of 469 vertebrae were divided into impacted fracture area (n=311, 66.31%) and cleft fracture area (n=158, 33.69%). Of the 158 cleft fracture areas, 26 vertebrae contained gas, 28 vertebrae contained liquid, and 7 vertebrae included both gas and liquid. Of the 469 vertebrae, the location of fracture areas was divided into 5 types: Superior (n=238, 50.75%), inferior (n=80,17.06%), anterior (n=21, 4.48%), central (n=110, 23.45%) and mixed (n=20, 4.26%). These findings indicate that the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures can be effectively distinguished by CT multi-planar reconstruction and MRI, which is important for early diagnosis and further treatment of fresh osteoporotic vertebral compression fractures.
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BACKGROUND: It remains disputed whether bone filling bag vertebroplasty and percutaneous kyphoplasty have different treatment efficacy in the treatment of thoracolumbar osteoporotic compression fractures. OBJECTIVE: To systematically analyze the efficacy and safety of bone filling bag vertebroplasty and percutaneous kyphoplasty in the treatment of thoracolumbar osteoporotic compression fractures. METHODS: A computer-based online search of CNKI, Wanfang, VIP, CBM, EMBASE, MEDLINE, and Cochrane libraries was performed to retrieve randomized controlled trial studies regarding bone filling bag vertebroplasty and percutaneous kyphoplasty in the treatment of thoracolumbar osteoporotic compression fractures published before February 2019. Two researchers independently conducted literature screening and data extraction. According to the Cochrane Collaboration Network standard, the quality of the randomized controlled trial studies was evaluated one by one. The studies that met the inclusion criteria were analyzed using the RevMan5. 3 software. RESULTS AND CONCLUSION: Six randomized controlled trial studies were included. A total of 517 patients were included in the final analysis. Among them, 257 patients received bone filling bag vertebroplasty and 260 patients received percutaneous kyphoplasty. Meta-analysis showed that there were no significant differences in postoperative Visual Analogy Score (MD=0. 00, 95%CI: -0. 09-0. 10, P=0. 94), vertebral height recovery (SMD=0. 11, 95%CI: -0. 26-0. 48, P=0. 57), and Oswestry Disability Index (MD=1. 47, 95%CI: -0. 45-3. 39, P=0. 13) between these two surgical procedures. But postoperative Cobb angle (MD=-1. 08, 95%CI: -1. 47 to -0. 70, P < 0. 000 01) and bone cement leakage rate (RR=0. 24, 95%CI: 0. 13-0. 45, P < 0. 000 01) were significantly different between these two surgical procedures. Bone filling bag vertebroplasty exhibits significant advantages in improving postoperative Cobb angle and reducing bone cement over percutaneous kyphoplasty. These two surgical procedures have similar clinical outcomes such as postoperative Visual Analogy Score, vertebral height recovery, and Oswestry Disability Index. Therefore, a large number of high-quality multicenter randomized controlled trials are needed to provide more evidence.
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OBJECTIVE@#To investigate the clinical effect of percutaneous pedicle screw fixation(PPSF) combined with percutaneous vertebroplasty (PVP) in the treatment of Genant Ⅲ degree osteoporotic vertebral compression fractures (OVCFs).@*METHODS@#The hospitalized 83 patients with Genant Ⅲ degree OVCFs treated by PPSF combined with PVP from June 2015 to June 2017 were retrospectively analyzed, and 83 patients treated by PVP alone from January 2013 to June 2016 were randomly selected as the control group. There were 19 males and 64 females with an average age of (73.6±11.0) years in combined group with treatment of PPSF and PVP. There were 15 malesand 68 females with an average age of (75.5±10.6) years in control group. The anterior edge height of the vertebral body and Cobb angle before operation, 1 day, and 6, 12, 24 months after operation were compared between two groups. Visual analogue scale(VAS) and Oswestry Disability Index (ODI) were used to assess the pain level and daily lumbar dysfunction for patients, respectively. The complications were observed.@*RESULTS@#The follow-up time of all patients was more than 2 years. The combined group and control group were (24.3±10.2) months and (27.5±14.8) months, respectively. There were no statistically significant differences in the anterior edge height of the vertebral body and Cobb angle at 1 day after surgery between two groups (>0.05), and there were statistically significant differences at 6, 12, 24 months after surgery between two groups (<0.01). The difference in ODI and VAS scores at 6 and 12 months after operation between two groups was statistically significant (<0.05). Postoperative complications incontrol group were higher than those in the combined group.@*CONCLUSION@#PPSF combined with PVP for the treatment of Genant Ⅲ degree OVCFs is superior to PVP alone in terms of vertebral height loss, patient satisfaction, and complications.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Fractures, Compression , Osteoporotic Fractures , Pedicle Screws , Retrospective Studies , Spinal Fractures , Treatment Outcome , VertebroplastyABSTRACT
OBJECTIVE@#To explore the clinical effect of zoledronic acid combined with vitamin K2 regimen in percutaneous vertebroplasty for multi-segment osteoporotic vertebral compression fractures(OVCFs).@*METHODS@#This study was a retrospective control study. A total of 364 patients with OVCFs who were admitted to our spinal surgery department from January 2014 to January 2017 were selected as the study subjects. According to whether zoledronic acid combined with vitamin K2 was used to treat osteoporosis after surgery, the patients were divided into control group and experimental group. Among them, 257 patients in the control group were treated with calcium carbonate and vitamin D regimen, while 107 patients in the experimental group were treated with zoledronic acid combined with vitamin K2 regimen on the basis of the control group. Visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to evaluate the clinical effect. Pre- and post-operative bone mineral density of lumbar spine and proximal femur, vertebral height ratio of responsible vertebral body and Cobb angle of vertebral body were observed by image data. Serological indicators related to bone metabolism were detected by laboratory. The complications such as fever, dizziness, osteoarthritis, muscular and soft tissue pain and adjacent vertebral re-fracture were compared between two groups.@*RESULTS@#There was no significant difference in general data between the two groups (0.05);VAS score in the experimental group was significantly lower than that in the control group 1 month, 3 months and 1 year after operation(0.05), and at the 24 hours, 3 months, 1 year after operation, the experimental group was significantly lower than the control group (0.05). The vertebral height ratio of the responsible vertebral body in experimental group was significantly higher than that in control group and Cobb angle in experimental group was significantly lower than that in control group at 3 months and 1 year after operation (0.05), but at 3 months and 1 year after operation, the bone mineral density of lumbar spine and proximal femur in experimental group was significantly lower than that in control group (0.05). At 1 year after operation the total type I collagen amino-terminal elongation peptide and β-collagen degradation products in experimental group was significantly lower than that in the control group (<0.05), but the 25-hydroxyvitamin D operation in experimental group was significantly higher than that in control group(<0.05). The incidence of postoperative complications such as fever, dizziness, osteoarthritis, muscle and soft tissue pain and adjacent vertebral re-fracture in experimental group was significantly lower than that in control group (<0.05).@*CONCLUSION@#Zoledronic acid injection combined with vitamin K2 regimen can be used for anti-osteoporosis treatment of OVCFs vertebroplasty. It has a definite curative effect and a high safety factor. It is worth popularizing.
Subject(s)
Humans , Bone Cements , Fractures, Compression , Kyphoplasty , Osteoporotic Fractures , Retrospective Studies , Spinal Fractures , Treatment Outcome , Vertebroplasty , Vitamin K 2 , Zoledronic AcidABSTRACT
OBJECTIVE@#To investigate the clinical efficacy of vertebral body stent (VBS) system and percutanous kyphoplasty (PKP) combined with zoledronic acid for the treatment of severely osteoporotic compression vertebral fractures (OVCFs).@*METHODS@#The clinical data of 48 patients with osteoporotic thoracolumbar fractures treated from December 2017 to December 2018 were retrospectively analyzed, including 13 males and 35 females, aged 55 to 92 years old with an average (71.2±10.5) years. All patients were treated with VBS system PKP surgery, and zoledronic acid injection was used for anti-osteoporosis treatment after operation. The VAS scores ODI, the height of diseasedvertebral lost were compared before operation, 3 d and half a year after operation, and whether there was re-fracture of diseased or adjacent vertevrae after operation was observed.@*RESULTS@#Before operation, 3 d and half a year after operation, VAS scores were 7.60±0.12, 3.00±0.46, 1.20±0.23, ODI were(82.00±0.32)%, (30.00±1.50) %, (18.00±0.16) %, the height of diseased vertebral lost were (12.00±0.43) mm, (3.00± 0.15) mm, (3.60±0.51) mm respectively. Postoperative VAS score, ODI, the height of diseased vertebral lost were obviously improved (0.05). All the 48 patients were followed up with an average time of (6.6±0.5) months. All the incisions healed at grade A after operation, and no re-fracture of diseased vertebrae or adjacent vertebrae was found at the final follow-up.@*CONCLUSION@#VBS system and PKP combined with zoledronic acid in the treatment of OVCFs not only may effectively relieve the pain in the thoracolumbar back, improve the mobility of the thoracolumbar, but also can restore the height of the vertebral body to the maximum extent, and prevent the re-fracture of the affected vertebrae and adjacent vertebrae, which is worthy to spread in clinic.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Cements , Fractures, Compression , Kyphoplasty , Osteoporotic Fractures , Retrospective Studies , Spinal Fractures , Stents , Treatment Outcome , Zoledronic AcidABSTRACT
OBJECTIVE@#From the perspective of clinical application to analyze the effectiveness and reliability of CPC/PMMA bone cement in percutaneous kyphoplasty (PKP) for the treatment of elderly patients with osteoporotic thoracolumbar fractures.@*METHODS@#A retrospective analysis was performed on 62 patients with osteoporotic compression fracture of single-vertebral thoracic or lumbar segment who underwent PKP surgery and had a bone density less than or equal to -3.0 SD from February 2016 to December 2016. Among them, 23 patients were in CPC/PMMA group, with an average age of (77.6±2.2) years old, 39 patients in PMMA group, with an average age of (77.1±1.1) years old. The indexes between two groups were compared, including the visual analogue scale (VAS), height ratio of anterior vertebra (AVHR), local Cobb angle, cement leakage, new adjacent vertebral fracture(NAVF).@*RESULTS@#There were no significant difference in gender, age, follow-up time and preoperative VAS, AVHR, local Cobb angle between two groups (>0.05), at the 1 day after operation, VAS, AVHR, local Cobb angle in all patients got obvious improvement (0.05). At the same time, there was no statistically significant difference in the incidence of new adjacent vertebral fracture and cement leakage (>0.05). The pain in both groups continued to improve at follow up after operation (<0.05), the local Cobb angle increased (<0.05) and AVHR decreased slightly (<0.05). However, the images of conventional methods (X-ray or CT) could not find signs about CPC degeneration and new bone ingrowth.@*CONCLUSION@#CPC/PMMA composite bone cement is safe and reliablein PKP for treatment of elderly patients with osteoporotic thoracolumbar fractures, which can effectively relieve pain and maintain vertebral body stability. It has the same curative effect as PMMA bone cement. It was worthy to research more in future, although no direct evidences support the CPC/PMMA composite bone cement can reduce the incidence of adjacent vertebral fracture, CPC degeneration or new bone ingrowth.
Subject(s)
Aged , Humans , Bone Cements , Dinucleoside Phosphates , Fractures, Compression , Kyphoplasty , Osteoporotic Fractures , Polymethyl Methacrylate , Reproducibility of Results , Retrospective Studies , Spinal Fractures , Treatment Outcome , VertebroplastyABSTRACT
OBJECTIVES: Osteoporotic vertebral compression fractures (OVCFs) affect the elderly population, especially postmenopausal women. Percutaneous kyphoplasty is designed to treat painful vertebral compression fractures for which conservative therapy has been unsuccessful. High-viscosity cement can be injected by either a hydraulic pressure delivery system (HPDS) or a balloon tamp system (BTS). Therefore, the purpose of this study was to compare the safety and clinical outcomes of these two systems. METHODS: A random, multicenter, prospective study was performed. Clinical and radiological assessments were carried out, including assessments of general surgery information, visual analog scale, quality of life, cement leakage, and height and angle restoration. RESULTS: Using either the HPDS or BTS to inject high-viscosity cement effectively relieved pain and improved the patients' quality of life immediately, and these effects lasted at least two years. The HPDS using high-viscosity cement reduced cost, surgery time, and radiation exposure and showed similar clinical results to those of the BTS. In addition, the leakage rate and the incidence of adjacent vertebral fractures after the HPDS treatment were reduced compared with those after treatment using the classic vertebroplasty devices. However, the BTS had better height and angle restoration abilities. CONCLUSIONS: The percutaneous HPDS with high-viscosity cement has similar clinical outcomes to those of traditional procedures in the treatment of vertebral fractures in the elderly. The HPDS with high-viscosity cement is better than the BTS in the treatment of mild and moderate OVCFs and could be an alternative method for the treatment of severe OVCFs.
Subject(s)
Humans , Female , Middle Aged , Aged , Aged, 80 and over , Bone Cements/therapeutic use , Drug Delivery Systems/methods , Fractures, Compression/surgery , Osteoporotic Fractures/surgery , Bone Cements/chemistry , Treatment OutcomeABSTRACT
OBJECTIVE@#To explore the therapeutic efficacy of manual reduction combined with percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures(OVCFs) with intravertebral clefts.@*METHODS@#The clinical data of 94 patients with osteoporotic vertebral compression fractures with intravertebral clefts treated from January 2014 to January 2017 were retrospectively analyzed. The patients were divided into group A and group B according to different operative methods. In group A, 45 patients were treated with unilateral approach PVP, including 17 males and 28 females, aged (75.35±11.82) years old, with a bone density T-value of (-4.28±0.65) g/cm³; in group B, 49 patients treated with manual reduction combined with unilateral approach PVP, including 19 males and 30 females, aged (76.79±9.64) years old, with a bone density T-value of (-4.33±0.72) g/cm³. The operation time, bone cement injection volume and postoperative complications of two groups were recorded. The VAS and ODI scores of two groups were analyzed respectively at 1, 12, 18 months after operation. Vertebral height and kyphosis Cobb angle of two groups were compared immediately after surgery and 12, 18 months after operation. The distribution of bone cement in the vertebral body was observed and its distribution excellent rate was calculated.@*RESULTS@#There was no significant difference in operation time between two groups. The amount of bone cement injection was(8.42±1.24) ml in group A and(9.19±1.09) ml in group B, and the difference between two groups was statistically significant(0.05), but group A was higher than group B at 12 and 18 months after operation (<0.05). The vertebral height and Cobb angle before surgery, immediately after surgery, and 12, 18 months after surgery in group A were(59.17±1.42)%, (85.95±2.19)%, (75.27±3.45)%, (68.34±2.24)% and(23.83±3.37)°, (15.26±2.61)°, (17.63±2.16)°, (19.46±2.54)°, and in group B were(59.31±1.87)%, (89.19±2.53)%, (88.62±2.51)%, (88.59±2.62)% and(24.72±3.78)°, (14.91±2.28)°, (15.48±2.55)°, (15.86±2.81)°. Vertebral height Immediately after surgery was greater in group B than in group A and Cobb angle in group B was smaller than in group A (<0.05). During follow-up, there was no significant change in vertebral height in group B, while vertebral body recollapse in group A(<0.05).@*CONCLUSIONS@#In the treatment of osteoporotic vertebral compression fractures with intravertebral clefts, the manual reduction combined with PVP is more effective than single PVP, which can effectively prevent vertebral body recollapse and improve the long-term efficacy of patients.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Cements , Fractures, Compression , Osteoporotic Fractures , Retrospective Studies , Spinal Fractures , Treatment Outcome , VertebroplastyABSTRACT
OBJECTIVE@#To observe the effect of temperature contrast injection procedure on prevention and reduction of bone cement leakage in vertebroplasty (PVP).@*METHODS@#The clinical data of 42 patients(48 vertebral bodies) with osteoporotic vertebral compression fractures(OVCFs) treated from July 2014 to July 2018 were retrospectively analyzed. There were 19 males and 23 females, aged from 62 to 80 years old with an average of 72 years. The vertebral fracture segment was T₈-L₅, including 30 lumbar vertebrae and 18 thoracic vertebrae. The course of the disease ranged from 3 d to 2 months. Twenty cases (20 vertebral bodies) were treated by single vertebroplasty (group A) and 22 cases (28 vertebral bodies) were treated by temperature contrast injection procedure(group B). The operative time, amount of bone cement injection, VAS score at 3 days after surgery, leakage rate and refracture rate were compared between two groups.@*RESULTS@#The operative time, amount of bone cement injection and VAS score at 3 days after surgery in group B were (40.05±7.78) min, (3.93±0.19) ml, (3.55±0.74) points, respectively, and in group A were(38.90±6.81) min, (4.03±0.24) ml, (4.05±1.00) points, there was no significant difference between two groups(>0.05). The leakage rate in group B was lower than that in group A (9.1% vs 40.0%, 0.05).@*CONCLUSIONS@#Temperature contrast injection procedure is an effective method to reduce the bone cement leakage in vertebroplasty.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Cements , Fractures, Compression , Osteoporotic Fractures , Retrospective Studies , Spinal Fractures , Temperature , Treatment Outcome , VertebroplastyABSTRACT
OBJECTIVE@#To evaluate the therapeutic effects and bone cement distribution of unilateral percutaneous kyphoplasty (PKP) with oriented bone cement injector for thoracolumbar osteoporotic vertebral compression fractures (OVCFs).@*METHODS@#The clinical data of 211 patients (211 vertebrae) with thoracolumbar osteoporotic compression fractures underwent PKP between July 2016 to July 2018 were retrospectively analyzed. All punctures were performed unilaterally:102 patients in observation group used oriented bone cement injector including 30 males and 72 females with an average age of (68.4±8.9)years old; 109 patients in regular group used traditional bone cement injector including 32 males and 77 females with an average age of (70.4±9.2) years old. The two groups were compared in terms of duration of operation, cement volume, visual analogue scale(VAS), Oswestry Disability Index(ODI), distribution of bone cement, bone cement leakage and Cobb angle modified rate.@*RESULTS@#There were no significant difference in gender, age and fracture vertebra between the two groups(>0.05). No significant difference was found between two groups in duration of operation, cement volume, VAS, ODI and Cobb angle(>0.05). In observation group, 10 cases occurred cement leakages, with leakage rate of 9.80%; and in regular group, 11 cases occurred cement leakage, with leakage rate of 10.09%. There was no significant difference in the cement leakage rate between two groups(>0.05). In observation group, proportion rate of I-IV degree in cement distribution was 60.78%, 19.61%, 9.80%, 9.80%, respectively; while 39.45%, 22.93%, 22.93%, 14.68% in regular group. The I degree of cement cross-filling rate was better in observation group than in regular group(0.05). From T10 to L₅, I degree bone cement distribution rate of both groups showed decline trend. The I degree cement cross-filling rate in L₁-L₅ was 50% in observation group and 30.23% in regular group(<0.05).@*CONCLUSIONS@#Oriented bone cement injector can control the direction of bone cement dispersion and achieve effective distribution of bilateral bone cement using unilateral puncture and satisfactory surgical results. It is feasible and effective for unilateral PKP treatment of OVCFs.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Bone Cements , Fractures, Compression , Kyphoplasty , Osteoporotic Fractures , Retrospective Studies , Spinal Fractures , Treatment Outcome , VertebroplastyABSTRACT
OBJECTIVE@#To explore the efficacy of bilateral sagittal cross percutaneous kyphoplasty(PKP) for preventing recurrent fracture of the cemented vertebrae.@*METHODS@#From January 2017 to June 2017, 85 patients with single-segment osteoporotic vertebral compression fractures(OVCFs) were treated by bilateral sagittal cross PKP(cross group). There were 35 males and 50 females with an average age of (70.1±8.3) years old in cross group. Another 85 patients with single-segment OVCFs were treated by traditional PKP (traditional group). There were 37 males and 48 females with an average age of (73.3±9.5) years old in traditional group. The cement distribution condition, recurrent fracture of the cemented vertebrae, the anterior vertebral body height and sagittal Cobb angle, visual analogue scale(VAS) were observed in two groups.@*RESULTS@#All patients underwent operation successfully. The follow-up time were (11.8±4.5) months in cross group and (12.1±3.7) months in traditional group. In cross group, all patients' bone cement touched the upper and lower endplates of the vertebral body while 67 cases (78.8%) in traditional group did with significant difference between two groups (0.05).@*CONCLUSIONS@#Bilateral sagittal cross PKP was a simple, safe and effective technique which can make bone cement distribute in the fractured vertebral body and contact the upper and lower endplates of the vertebral body, thus preventing the recurrent fracture of the cemented vertebrae.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Fractures, Compression , Kyphoplasty , Osteoporotic Fractures , Spinal Fractures , Treatment Outcome , VertebroplastyABSTRACT
OBJECTIVE@#To explore the application of three-dimensional CT and image classification in the treatment of osteoporotic vertebral compression fracture(OVCFs) by percutaneous vertebroplasty(PVP).@*METHODS@#A total of 90 patients with OVCFs who were treated with PVP in Linqu People's Hospital of Shandong Province from April 2016 to March 2018 were selected as subjects. There were 31 males and 59 females, aged from 63 to 84 years old. Bone mineral density measurements were performed in all patients to confirm the presence of osteoporosis and imaging examinations were performed to confirm the presence of vertebral fractures. The fracture area was determined by MRI fat surpressed image before operation and three-dimensional modeling was performed to calculate the volume of fracture area. Three dimensional CT imaging of bone cement in fracture area was performed after PVP and the volume ratio of bone cement in fracture area was calculated by computer aided design software, by which patients were divided into groups for study. Forty-one patients whose volume ratio of bone cement in fracture area less than 50% are control group and the rest of 90 patients are observation group. Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were collected in two groups before operation and 1 day, 3 months after operation. The amount of bone cement was recorded after operation.@*RESULTS@#All operations were successful. There were 3 cases of cement leakage in control group and 4 cases in observation group. All patients had no obvious clinical symptoms. After continuous observation and follow-up for 3 months, no complications such as adjacent vertebral fracture, infection, bone cement displacement were found. There was no significant difference in bone cement doses and bone cement leakage between two groups(>0.05). There was no significant difference in preoperative VAS and ODI between two groups(>0.05). All VAS and ODI obviously decreased(<0.05) at 1 day after operation and in observation group the decrease was more significant (<0.05). At 3 months after operation there was no significant difference between two groups. This may have been due to basically healing of vertebral fractures at 3 months after surgery and the pain was no longer significantly related.@*CONCLUSIONS@#PVP can significantly improve clinical symptoms of OVCFs and bone cement filling in fracture area is the key to the short-term effect of PVP.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Cements , Fractures, Compression , Osteoporotic Fractures , Retrospective Studies , Spinal Fractures , Tomography, X-Ray Computed , Treatment Outcome , VertebroplastyABSTRACT
Objective To compare the clinical efficacy of high-viscosity and ordinary bone ce-ment in percutaneous vertebral plasty for treatment of osteoporotic vertebral compression fractures.Meth-ods Collected 80 osteoporotic vertebral compression fractures(OVCF)cases treated by percutaneous ver-tebroplasty(PVP). The patients were randomized into the high-viscosity group(high-viscosity bone ce-ment,50 patients)and the control group(ordinary bone cement,50 patients).Record the basic information of patients,visual analogue scale(VAS)and oswestry disability index(ODI)were used to evaluate the pain and lumbar function;through measuring the Cobb of X ray,film to compare the recovery of Cobb in two groups.Calculate and compare the incidence of leakage of bone cement and adjacent vertebral fracture in two groups. Results There were no statistically significant difference of VAS,ODI and Cobb in two groups compared with preoperative's(P>0.05).Immediately,3 days and 6 months after PVP,VAS,ODI and Cobb were reduced compared with baseline,the difference was statistically significant(P<0.05),the corresponding time point after operation,VAS,ODI and Cobb of high-viscosity group were lower than the control group,the difference was statistically significant(P<0.05).After PVP,the bone cement leakage rate were 18%(9/50)and 32%(16/50)in high-viscosity group and control group respectively(P <0.05).After PVP,the incidence of adjacent vertebral body fracturewere were 2%(1/50)and 6%(3/50) in high-viscosity group and control group respectively(P<0.05).Conclusion There are better clinical curative effect and less postoperative complications of OVCF patients treated with high-viscosity bone ce-ment in PVP.
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<p><b>OBJECTIVE</b>To analyze the clinical outcome of kyphoplasty on costal pain which develops following thoracic osteoporotic compression fractures and evaluate the factors related to costal pain.</p><p><b>METHODS</b>From May 2014 to May 2016, a total of 188 patients with thoracic osteoporotic compression fractures undergoing kyphoplasty were reviewed retrospectively. The patients were divided into two groups: the costal pain group included patients who had costal pain after a vertebral fracture and the no costal pain group included patients without costalgia. Visual analogue scale(VAS)and Oswestry Disability Index(ODI)of all patients were measured preoperatively and 3 days, 1 month, 6 months postoperatively respectively. Gender, age, the fracture level, bone mineral density, vertebral body fracture type, and fracture severity were compared between two groups, and the causes of costal pain were analyzed.</p><p><b>RESULTS</b>Among 188 patients, 38 patients (20.2%) complained of costal pain with back pain. The mean follow-up time was 8.3 months (ranged from 6 to 15 months). The VAS and ODI score of two groups decreased after operation, and there was significant difference between pre-operation and post-operation(<0.05). There was significant difference in VAS score and ODI score between two groups at 3 days and 1 month postoperatively (<0.05). There was no significant difference in VAS score and ODI score between two groups at 6 months postoperatively (<0.05). The incidence of applanation-type deformity and severe fracture in the costal group were higher. The fracture type and fracture severity showed significantly difference between two groups(<0.05).</p><p><b>CONCLUSIONS</b>The fracture type and fracture severity had significant relation to costal pain of thoracic osteoporotic compression fractures. The kyphoplasty effect on costal pain may not be effective, especially during early post-operation period.</p>
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Objectives:To investigate the clinical outcomes of unilateral percutaneous vertebroplasty(PVP) by using curved injection needle in osteoporotic vertebral compression fractures(OVCFs).Methods:From January 2015 to January 2016,47 patients(14 males and 33 females) with OVCFs were enrolled in this study.The patients were 53-89 years old (66.4±6.5 years),36 cases were single segmental vertebral fracture,11 cases were double segment vertebral fracture.T9 fracture occured in 7 cases,T10 fracture in 7 cases,T11 fracture in 9 cases,T12 fracture in 13 cases,L1 fracture in 12 cases,L2 fracture in 9 cases,and L3 fracture in 1 case.The fluoroscopy time and bone cenent dosage were recorded.The VAS score,ODI,relative height restoration of vertebra and Cobb angle were compared between preoperation and postoperation.The bone cement leakage(venous leakage and perivertebral leakage) and other complications were observed.Results:The average fluoroscopy time was 1.6±0.3nin,the average bone cement dosage was 6.7±1.2ml.Bone cement leakage occured in 11 cases with the rate of 23.4％.The patients were followed up for 3-12 months (6.5±1.3 months).The VAS,ODI,the relative height of injured vertebra and the local Cobb angle before operation,at 2 days after operation and final follow-up were:7.6±1.3,(71.4±3.2)％,0.48±0.21,15.5°±4.2°;2.2±1.0,(27.2± 2.6)％,0.82±0.17,7.2°±2.8°;1.7±0.7,(26.5±2.7)％,0.80±0.15,7.5°±3.7°.At 2 days after operation and final follow-up,the VAS score,ODI score,the relative height and Cobb angle of injured vertebra were significantly improved when compared to those before operation (P＜0.05);There was no significant difference between 2 days after operation and final follow-up(P＞0.05).Conclusions:The advantages of unilateral PVP by using curved injection needleless in OVCFs are less fluoroscopy time,even distribution of bone cement,and less leakage.
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Objective To study the value of zoledronic acid combined with psychological intervention in osteoporotic vertebral compression fractures in percutaneous balloon kyphoplasty (PKP). Methods 72 patients with osteoporotic vertebral fractures underwent PKP operation from August 2013 to August 2015 were randomly divided into observation group and control group,with 36 cases,in each group. The patients in the control group were given salmon calcitonin after operation. The patients in the observation group were given zoledronic acid after operation. Both patients were given psychological care. The total effective rate of clinical treatment and the incidence of secondary osteoporotic vertebral compression fractures,Visual analogue pain scale before and after treatment (VAS), Oswestry dysfunction index questionnaire (ODI) score, bone mineral density T value changes were compared between the two groups. Results The total effective rate was 94.44% in the observation group and 77.78% in the control group (P<0.05). The recurrence fracture rate was significantly lower than that of the control group (P<0.05). After treatment, the scores of VAS and ODI in the observation group were significantly lower than those in the control group (P<0.05). The T value of bone mineral density was significantly higher than that of the control group (P<0.05). Conclusion Zoledronic acid combined with psychological intervention can effectively improve the effective rate of PKP after osteoporotic vertebral compression fractures, increase bone density and reduce the incidence of fracture, which is worthy of clinical application.
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The clinical effects of two different methods-high-viscosity cement percutaneous vertebroplasty (PVP) and low-viscosity cement percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCFs) were investigated. From June 2010 to August 2013, 98 cases of OVCFs were included in our study. Forty-six patients underwent high-viscosity PVP and 52 patients underwent low-viscosity PKP. The occurrence of cement leakage was observed. Pain relief and functional activity were evaluated using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), respectively. Restoration of the vertebral body height and angle of kyphosis were assessed by comparing preoperative and postoperative measurements of the anterior heights, middle heights and the kyphotic angle of the fractured vertebra. Nine out of the 54 vertebra bodies and 11 out of the 60 vertebra bodies were observed to have cement leakage in the high-viscosity PVP and low-viscosity PKP groups, respectively. The rate of cement leakage, correction of anterior vertebral height and kyphotic angles showed no significant differences between the two groups (P>0.05). Low-viscosity PKP had significant advantage in terms of the restoration of middle vertebral height as compared with the high-viscosity PVP (P<0.05). Both groups showed significant improvements in pain relief and functional capacity status after surgery (P<0.05). It was concluded that high-viscosity PVP and low-viscosity PKP have similar clinical effects in terms of the rate of cement leakage, restoration of the anterior vertebral body height, changes of kyphotic angles, functional activity, and pain relief. Low-viscosity PKP is better than high-viscosity PVP in restoring the height of the middle vertebra.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Administration, Cutaneous , Bone Cements , Chemistry , Therapeutic Uses , Follow-Up Studies , Fractures, Compression , Pathology , Rehabilitation , General Surgery , Kyphoplasty , Methods , Osteoporosis , Pathology , Rehabilitation , General Surgery , Pain , Diagnosis , Pain Measurement , Recovery of Function , Physiology , Spinal Fractures , Pathology , Rehabilitation , General Surgery , Spine , Pathology , General Surgery , Treatment Outcome , Viscosity , Visual Analog ScaleABSTRACT
Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures (OVCFs) after kyphoplasty. This finite element study was to examine whether short segment pedicle screw fixation (PSF) with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs. By simulating cement augmentation with or without short segment pedicle screw fixation (PSF), two tridimensional, anatomically detailed finite element models of the T10-L2 functional spinal junction were developed. The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations. The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra. The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae. Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.
Subject(s)
Humans , Computer Simulation , Finite Element Analysis , Fracture Fixation, Internal , Methods , Kyphoplasty , Methods , Osteoporotic Fractures , Pedicle Screws , Postoperative Complications , Spinal Fractures , Spine , Diagnostic Imaging , General SurgeryABSTRACT
Objective To study the efficacy of alendronate in treatment of postoperative residual pain with osteoporotic vertebral compression fractures(OVCF) of vertebroplasty.Methods 62 patients with OVCF from September 2013 to October 2014 were divided into observation group and control group, each had 31 cases.All patients were given calcium carbonate D3 tablets 1 day after surgery, observation group were given alendronate on this basis.The degree of pain score between two groups pre-and post-treatment two weeks, one month, two months were observed and compared.Pain improvement in two groups were observed, and activity ability score, painkiller use and bone mineral density between two groups pre-and post-treatment were compared.Results The pain scores in observation group a month postoperative was (0.8 ±0.4) points and (0.4 ±0.2) points after two months, were significantly lower than those in control group[(1.6 ±0.7) points, (1.1 ±0.8) points, P<0.05].The excellent rate of pain improvement in observation group(83.87%) was significantly higher than that in control group (58.06%, P <0.05) .After treatment, activity ability score in observation group was (1.13 ±0.53) points and painkiller usage was (0.44 ±0.07) times per day, all significantly lower than those in control group [(1.79 ±0.89) points, (0.89 ±0.12) times per day, P<0.05].BMD level in observation group was (5.78 ±1.02)%, higher than that in control group[(3.21 ±0.79)%, P<0.05].Conclusion Alendronate in treatment of osteoporotic vertebral compression fractures vertebroplasty postoperative residual pain has good early outcome and low adverse reactions, and security is relatively high.