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1.
Clin Interv Aging ; 19: 289-301, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38434576

RESUMO

Purpose: The purpose of this study is to compare the refracture rate of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery, respectively. Refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded. Results: The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p<0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p<0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than in the bilateral PKP group (p<0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p<0.01). Conclusion: Both PCVP and PKP were safe and effective treatments for OVCF. The PCVP had lower refracture rate of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.


Assuntos
Fraturas por Compressão , Cifoplastia , Cifose , Fraturas da Coluna Vertebral , Humanos , Fraturas da Coluna Vertebral/cirurgia , Fraturas por Compressão/cirurgia , Coluna Vertebral , Cifose/cirurgia , Cimentos Ósseos/uso terapêutico
2.
Zhongguo Gu Shang ; 37(2): 135-41, 2024 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-38425063

RESUMO

OBJECTIVE: To evaluate the feasibility and accuracy of virtual preoperative planning and 3D-printed templates for pre-contoured plates for the treatment of posterior wall fractures of the acetabulum. METHODS: A retrospective analysis of 29 patients with posterior acetabular wall fractures treated between August 2017 and March 2021 were divided into 2 groups based on whether to use preoperative virtual planning and 3D printed template. In 3D-printing group, there were 14 patients, including 10 males and 4 females; aged from 21 to 53 years old;CT-based virtual surgical planning was done using Mimics and 3-Matic software and 3D-printed templates for pre-contoured plates were adopted. In conventional group, there were 15 patients, including 10 males and 5 females;aged from 19 to 55 years old;conventional method of intra-operative contouring to adapt the plate to the fracture region was adopted. Blood loss, surgical time, radiographic quality of reduction, and hip function were compared between groups. RESULTS: The difference in operation time and intraoperative blood loss was significant(P<0.05). Twenty-three patients were followed up from 12 to 30 months, and the fractures in both groups healed with a healing time of 3 to 6 months. At the last follow-up, the Merle d'Aubign-Postel score of the 3D printed group was lower than that of the conventional group(P<0.05), with no significant differences in walking ability, hip mobility and total score(P>0.05). In 3D printing group, 6 cases were excellent, 5 cases were good, 3 cases were fair;in conventional group, 5 cases were excellent, 5 cases were good, 4 cases were fair, 1 case was worse;no significant difference between two groups(P>0.05). CONCLUSION: Virtual preoperative planning and 3D-printed templates for pre-contoured plates can reduce operative time and the blood loss of surgery, improve the quality of reduction. This method is efficient, accurate and reliable to treat acetabular posterior wall fractures.


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Fraturas da Coluna Vertebral , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos , Fraturas do Quadril/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Acetábulo/lesões , Impressão Tridimensional , Placas Ósseas , Resultado do Tratamento
3.
J Int Med Res ; 52(3): 3000605241236054, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38468383

RESUMO

OBJECTIVE: Lumbar fractures are the most common spinal injuries, and surgery is required for severe fracture. This study aimed to investigate the variations in motion and stress in varying states of activity after minimally invasive and traditional open pedicle screw placement for L1 vertebral fracture stabilization. METHODS: We studied a male volunteer (26 years old) with no history of chronic back pain or lumbar spine trauma. We used the finite element method for this investigation. Using finite element software, we created a three-dimensional model of L1 vertebral compression fracture. We also constructed models for four percutaneous pedicle screws spanning the fractured vertebra and four screws traversing the damaged vertebra with transverse fixation. RESULTS: In all three-dimensional movement directions, the open pedicle fixation system experienced maximum stress higher than its percutaneous counterpart. With axial spinal rotation, von Mises stress on the traditional open pedicle screw was considerably lower than that with percutaneous pedicle fixation, but peak stress was elevated at the transverse connection. Traditional open pedicle fixation displayed less maximum displacement than percutaneous pedicle internal fixation. CONCLUSIONS: During axial spinal movements, high peak stress is observed at the transverse connection. Patients should avoid excessive axial rotation of the spine during recovery.


Assuntos
Fraturas por Compressão , Parafusos Pediculares , Fraturas da Coluna Vertebral , Humanos , Masculino , Adulto , Fraturas da Coluna Vertebral/cirurgia , Análise de Elementos Finitos , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Vértebras Torácicas/cirurgia , Fenômenos Biomecânicos , Fixação Interna de Fraturas/métodos
4.
BMC Musculoskelet Disord ; 25(1): 216, 2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38481188

RESUMO

BACKGROUND: To achieve good bone fusion in anterior column reconstruction for vertebral fractures, not only bone mineral density (BMD) and bone metabolism markers but also lever arms due to bone bridging between vertebral bodies should be evaluated. However, until now, no lever arm index has been devised. Therefore, we believe that the maximum number of vertebral bodies that are bony and cross-linked with the contiguous adjacent vertebrae (maxVB) can be used as a measure for lever arms. The purpose of this study is to investigate the surgical outcomes of anterior column reconstruction for spinal fractures and to determine the effect of bone bridging between vertebral bodies on the rate of bone fusion using the maxVB as an indicator of the length of the lever arm. METHODS: The clinical data of 81 patients who underwent anterior column reconstruction for spinal fracture between 2014 and 2022 were evaluated. The bone fusion rate, back pain score, between the maxVB = 0 and the maxVB ≥ 2 patients were adjusted for confounding factors (age, smoking history, diabetes mellitus history, BMD, osteoporosis drugs, surgical technique, number of fixed vertebrae, materials used for the anterior props, etc.) and analysed with multivariate or multiple regression analyses. The bone healing rate and incidence of postoperative back pain were compared among the three groups (maxVB = 0, 2≦maxVB≦8, maxVB ≧ 9) and divided by the maxVB after adjusting for confounding factors. RESULTS: Patients with a maxVB ≥ 2 had a significantly higher bone fusion rate (p < 0.01) and postoperative back pain score (p < 0.01) than those with a maxVB = 0. Among the three groups, the bone fusion rate and back pain score were significantly higher in the 2≦maxVB≦8 group (p = 0.01, p < 0.01). CONCLUSIONS: Examination of the maxVB as an indicator of the use of a lever arm is beneficial for anterior column reconstruction for vertebral fractures. Patients with no intervertebral bone bridging or a high number of bone bridges are in more need of measures to promote bone fusion than patients with a moderate number of bone bridges are.


Assuntos
Osteoporose , Fraturas da Coluna Vertebral , Fusão Vertebral , Humanos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Osteoporose/complicações , Resultado do Tratamento , Dor nas Costas/complicações , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Estudos Retrospectivos , Vértebras Torácicas/cirurgia
5.
BMJ Case Rep ; 17(3)2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38471702

RESUMO

Multilevel-instrumented fusion is a common surgical technique used to treat adult spinal deformity (ASD), but it can occasionally lead to rare complications such as sacral insufficiency fractures. The impact of sacral fractures on spinopelvic parameters, particularly pelvic incidence (PI), has not been thoroughly investigated even though they have been documented in the literature. Here, we present a case of a patient who underwent a Th11-sacrum instrumented fusion for ASD. She underwent a revision surgery 18 months after the first procedure to treat proximal junctional pain brought on by a localised kyphosis of the rods. An asymptomatic sacral fracture was discovered during the radiological evaluation: the PI had increased from 71° to 103° between the 2 surgical procedures.


Assuntos
Fraturas de Estresse , Cifose , Fraturas da Coluna Vertebral , Fusão Vertebral , Adulto , Feminino , Humanos , Sacro/cirurgia , Fraturas de Estresse/complicações , Estudos Retrospectivos , Cifose/complicações , Fraturas da Coluna Vertebral/etiologia , Fusão Vertebral/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Vértebras Lombares/cirurgia
6.
Artigo em Inglês | MEDLINE | ID: mdl-38441133

RESUMO

We present three cases of posterior wall acetabulum fractures occurring in pediatric patients with open triradiate cartilage for whom preoperative magnetic resonance imaging was obtained and open reduction and internal fixation was done. All patients had excellent outcomes at an average of 68-week follow-up. Failure to adequately recognize the severity of pediatric acetabulum fractures can lead to detrimental long-term sequelae in acetabular development when treated nonsurgically. Management of this rare injury is not well reported in the literature. We highlight the utility of MRI in evaluating potential nonosseous injury and examining the articular surface to guide surgical management.


Assuntos
Fraturas do Quadril , Fraturas da Coluna Vertebral , Humanos , Criança , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Cartilagem , Imageamento por Ressonância Magnética
7.
PLoS One ; 19(3): e0299325, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38457423

RESUMO

PURPOSE: Vertebral compression fractures are often treated with vertebroplasty, and filling the injured vertebrae with bone cement is a key part of vertebroplasty. This meta-analysis was performed to compare the clinical efficacy and safety of mineralized collagen-polymethylmethacrylate (MC-PMMA) and polymethylmethacrylate (PMMA) bone cement in the treatment of vertebral compression fractures by vertebroplasty. METHODS: A computerized search of the published literature on mineralized collagen-polymethylmethacrylate and polymethylmethacrylate bone cement in the treatment of vertebral compression fractures was conducted in the China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, Embase, and Cochrane Library. The search was carried out from the time the database was created to March 2023 and 2 researchers independently conducted literature searches to retrieve a total of 884 studies, of which 12 were included in this meta-analysis. Cochrane systematic review methods were used to assess the quality of the literature and a meta-analysis was performed using ReviewManager 5.4 software. RESULTS: The results of the present meta-analysis showed that in postoperative adjacent vertebral fractures [OR = 0.25; 95% CI (0.15, 0.41)], postoperative cement leakage [OR = 0.45; 95% CI (0.30, 0.68)], Oswestry Disability Index (ODI) scores in the first 3 days after surgery [OR = -0.22; 95% CI (-0.42, -0.03)], ODI score at 6-12 months postoperatively [OR = -0.65; 95% CI (-0.97, -0.32)], visual analog scale (VAS) score at 6-12 months postoperatively [OR = -0.21; 95% CI (-0.46, 0.04)], and 1-year postoperative CT values [OR = 5.56; 95% CI (3.06, 8.06)], the MC-PMMA bone cement group was superior to the PMMA bone cement group. However, the differences between the two groups were not statistically different in terms of cement filling time, cement filling volume, operation time, intraoperative bleeding, hospitalization time, postoperative (<1 week, 3-6 months) vertebral body posterior convexity Cobb's angle, postoperative (<1 week, 6-12 months) vertebral body anterior margin relative height, postoperative (≤3 days, 1-3 months) pain VAS score and postoperative (1-3 months) ODI score. CONCLUSIONS: Compared with PMMA bone cement, the application of MC-PMMA bone cement is advantageous in reducing postoperative complications (adjacent vertebral fracture rate, cement leakage rate), pain relief, and functional recovery in the long-term postoperative period (>6 months), but there is still a need for more high-quality randomized controlled studies to provide more adequate evidence.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Cimentos Ósseos/uso terapêutico , Cimentos Ósseos/química , Polimetil Metacrilato/uso terapêutico , Polimetil Metacrilato/química , Fraturas da Coluna Vertebral/cirurgia , Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Cifoplastia/métodos , Resultado do Tratamento , Colágeno , Dor/tratamento farmacológico , Estudos Retrospectivos
8.
Sci Rep ; 14(1): 5602, 2024 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-38453997

RESUMO

This investigation examined the clinical implications of mild vertebral fractures in older community-dwelling residents. Focusing on the locomotion health of older individuals, the earlier reported Obuse study enrolled 415 randomly sampled Japanese residents aged between 50 and 89 years, 411 of whom underwent X-ray evaluations for pre-existing vertebral fractures. A blinded assessment of vertebral fractures based on Genant's criteria was conducted on the T5-L5 spine for rating on a severity scale. Grade 1 mild fractures were not linked to age in males, but increased with aging in females. Female participants had fewer Grade 1 and 2 fractures (P = 0.003 and 0.035, respectively) but more Grade 3 fractures (P = 0.013) than did males independently of age (Grade 1, 2, and 3: 25%, 16%, and 9% in females and 40%, 22%, and 6% in males, respectively). Weak negative correlations were observed between the number of fractures and bone mineral density in females for all fracture grades (Spearman's rho: 0.23 to 0.36, P < 0.05). Our study showed that Grade 1 mild vertebral fractures in males lacked pathological significance, while in females they potentially indicated fragility fractures and were related to poor lumbopelvic alignment.


Assuntos
Vida Independente , Fraturas da Coluna Vertebral , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Coluna Vertebral , Densidade Óssea
9.
BMC Musculoskelet Disord ; 25(1): 203, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38454411

RESUMO

BACKGROUND: This study aimed to determine if the hybrid short-segment (HSS) technique is a good alternative to the intermediate-segment (IS) and long-segment (LS) techniques in pedicle screw fixations for acute thoracolumbar burst fractures (TLBFs). METHODS: In this retrospective evaluation, we examined 43 patients who underwent surgical treatments, including one- or two-level suprajacent (U) and infrajacent (L) pedicle screw fixations, for acute single-level TLBFs with neurological deficits between the T11 and L2 levels from July 2013 to December 2019. Among these patients, 15 individuals underwent HSS (U1L1), 12 received IS (U2L1), and 16 underwent LS (U2L2) fixations. Supplemental kyphoplasty of the fractured vertebral bodies was performed exclusively in the HSS group. Our analysis focused on assessing blood loss and surgical duration. Additionally, we compared postoperative thoracolumbar kyphotic degeneration using the data on Cobb angles on lateral radiographic images acquired at three time points (preoperatively, postoperative day 1, and follow-up). The end of follow-up was defined as the most recent postoperative radiographic image or implant complication occurrence. RESULTS: Blood loss and surgical duration were significantly lower in the HSS group than in the IS and LS groups. Additionally, the HSS group exhibited the lowest implant complication rate (2/15, 13.33%), followed by the LS (6/16, 37.5%) and IS (8/12, 66.7%) group. Implant complications occurred at a mean follow-up of 7.5 (range: 6-9), 9 (range: 5-23), and 7 (range: 1-21) months in the HSS, IS, and LS groups. Among these implant complications, revision surgeries were performed in two patients in the HSS group, two in the IS group, and one in the LS group. One patient treated by HSS with balloon kyphoplasty underwent reoperation because of symptomatic cement leakage. CONCLUSIONS: The HSS technique reduced intraoperative blood loss, surgical duration, and postoperative implant complications, indicating it is a good alternative to the IS and LS techniques for treating acute single-level TLBFs. This technique facilitates immediate kyphosis correction and successful maintenance of the corrected alignment within 1 year. Supplemental kyphoplasty with SpineJack® devices and high-viscosity bone cements for anterior reconstruction can potentially decrease the risk of cement leakage and related issues.


Assuntos
Fraturas Cominutivas , Fraturas por Compressão , Cifoplastia , Cifose , Parafusos Pediculares , Fraturas da Coluna Vertebral , Humanos , Parafusos Pediculares/efeitos adversos , Cifoplastia/efeitos adversos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/complicações , Estudos Retrospectivos , Fixação Interna de Fraturas/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesões , Fraturas por Compressão/cirurgia , Cimentos Ósseos/uso terapêutico , Cifose/diagnóstico por imagem , Cifose/cirurgia , Cifose/complicações , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
10.
J Med Case Rep ; 18(1): 94, 2024 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-38459542

RESUMO

INTRODUCTION: Scapular anatomical neck fractures are among the most infrequent shoulder girdle fractures. Only seven radiologically confirmed cases of scapular anatomical neck fractures have been documented in the literature to date, of which only one case underwent delayed surgery. CASE PRESENTATION: A 34-year-old male Persian patient with morbid obesity was diagnosed with a scapula anatomical neck fracture after a motor vehicle collision. The radiographic assessment of the patient indicated an increase in the scapular glenopolar angle (73.9°). Due to concurrent chest and head injuries, surgical intervention was deferred until 6 weeks following the injury. The posterolateral limited Dupont-Evrard approach was used because of the patient's extremely high body mass index. Two plates were utilized to achieve stable fixation of the glenoid neck fracture. Following a 1 year follow-up period, complete fracture union was successfully attained, resulting in a constant score of 79. CONCLUSIONS: The most accurate radiographic indicators of these fractures are a superior fracture line located laterally to the coracoid process, a small inferior spike, and an elevated glenopolar angle. The only tendon attached to the glenoid is the long head of the triceps, making these fractures unstable; therefore, surgery is required in the majority of instances. The small size of the fractured component makes stabilization more difficult. Overall, anatomical scapular neck fractures are extremely uncommon and distinguished from other scapular fractures by their unique radiological and biomechanical characteristics. This case highlights the challenges encountered when managing scapular fractures in patients with morbid obesity. The delayed surgical intervention and the choice of surgical approach tailored to the patient's specific anatomical and physiological considerations proved to be effective in achieving a favorable outcome.


Assuntos
Fraturas Ósseas , Obesidade Mórbida , Fraturas da Coluna Vertebral , Masculino , Humanos , Adulto , Estudos Retrospectivos , Fraturas Ósseas/diagnóstico por imagem , Escápula/diagnóstico por imagem , Escápula/cirurgia , Radiografia , Resultado do Tratamento , Fixação Interna de Fraturas/métodos
11.
Turk Neurosurg ; 34(2): 250-255, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38497177

RESUMO

AIM: To compare the clinical and radiological outcomes of unilateral percutaneous kyphoplasty (PKP) surgeries performed using 3D printing technology in patients with osteoporotic compression fractures to conventional unilateral PKP surgeries. MATERIAL AND METHODS: Patients with acute painful single-level osteoporotic vertebral compression fracture (OVCF) who need surgical treatment were divided into two groups: group A (patients who had 3D template-guided PKP) and group B (patients who conventional PKP). To compare the two surgical procedures, Total Absorbed Radiation Dose (TARD), pre- and postoperative visual analog scale (VAS) scores, and Total Surgery Time (TST) were calculated and compared between groups in both surgical groups. RESULTS: A total of 44 patients with single-level OVCF who were experiencing acute pain were successfully operated on, with 22 patients in each group. TARD (2.6 ± 0.4 mGy vs. 6.1 ± 1.9 mGy, p < 0.05) and TST (12.4 ± 2.6 min vs. 20.2 ± 3.2 min, p < 0.05) differed significantly different between groups A and B. There was no statistically significant difference between the patient groups in preoperative and postoperative VAS values (p > 0.05). Cement leakage was lower in group A (3/22, 13.6%) than in group B (6/22, 27.3%) (p > 0.05). There were no neurological complications or infections in either group. CONCLUSION: When compared to the conventional procedure, the unilateral percutaneous kyphoplasty method was supported by a 3D printing guide template. By reducing operative time and radiation exposure, tt has resulted in a more effective surgical procedure for patients and a safer surgical procedure for surgeons and anaesthesiologists.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Cifoplastia/efeitos adversos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral , Vertebroplastia/métodos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia
12.
Pain Physician ; 27(3): E327-E336, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38506685

RESUMO

BACKGROUND: Kummell's disease (KD) and osteoporotic vertebral compression fracture (OVCF) are commonly found in patients with osteoporosis. Several studies have been conducted on bone cement distribution in OVCF or KD; a comparison between the 2 diseases is rarely reported. OBJECTIVES: To compare the clinical efficacy and bone cement distribution difference between KD and OVCFs after percutaneous kyphoplasty (PKP). STUDY DESIGN: This was a retrospective, nonrandomized controlled study. SETTING: Department of Orthopedics from an affiliated hospital. METHODS: From January 2018 to December 2020, 61 patients who underwent PKP surgery for single KD or OVCF and met the inclusion criteria were retrospectively reviewed. All patients were assigned to 2 groups: the KD group and the OVCF group. Clinical and radiologic characteristics, including the bone cement volume, leakage, bone cement dispersion scale, anterior vertebral height (AVH), median vertebral height (MVH), posterior vertebral height (PVH), Cobb angle and Visual Analog Scale (VAS) were analyzed and compared using Mimics three-dimensional (3D) reconstruction images and 3D reconstruction computed tomography, preoperatively, postoperatively, and 2 years after the operation, respectively. The correlations between the bone cement dispersion scale and the VH improvement rate (VHIR), VH change rate (VHCR), VAS improvement rate (VASIR), and follow-up VAS improvement rate (f-VASIR) were also evaluated. RESULTS: The mean follow-up time was 24.0 months. Postoperative VH, Cobb angle, vertebra volume, and VAS score were significantly improved in the 2 groups (P < 0.05). There was no statistical difference in postoperative parameters between the 2 groups. While a strong positive correlation between VHIR and bone cement dispersion scale was observed in the OVCF group (P < 0.01), no significant correlation between VHIR and bone cement dispersion scale was found in the KD group. There was no correlation between VASIR and bone cement dispersion scale in both groups. Compared with postoperation, VH was lower in both groups in later follow-up, and the difference between the 2 groups was statistically significant (P < 0.05). VH, VAS, f-VASIR, and VHCR had a worse manifestation in the KD group than in the OVCF group. However, no significant correlation was found between VHCR, f-VASIR, and bone cement dispersion scale in the 2 groups. LIMITATIONS: This study was limited by the non-randomized design, small sample size, and lack of a comprehensive follow-up period. CONCLUSIONS: Although there was no significant difference in the bone cement distribution and early clinical efficacy between KD and OVCF patients under the same surgical plan and surgeon, OVCF patients exhibited better long-term radiologic and clinical outcomes.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas da Coluna Vertebral , Espondilose , Humanos , Fraturas da Coluna Vertebral/cirurgia , Fraturas por Compressão/cirurgia , Cimentos Ósseos/uso terapêutico , Estudos Retrospectivos
13.
Pain Physician ; 27(3): E337-E343, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38506686

RESUMO

BACKGROUND: Vertebral compression fractures (VCFs) can affect the entire spinopelvic complex and cause unpredictable patterns of back pain due to their effects on spinal tensegrity and biomechanical compensation. They can lead to significant morbidity and mortality in the aging population and are difficult to diagnose. We aimed to establish a relationship between VCFs and sacroiliac (SI) joint pain. OBJECTIVES: Demonstration of SI joint (SIJ) pain relief at up to 6 months after kyphoplasty (KP) in patients with VCFs and diagnosed SI dysfunction. STUDY DESIGN: Retrospective study. SETTING: All patients were from a private chronic pain and orthopedics practice in the northeastern United States. METHODS: Fifty-one patients with VCFs diagnosed through imaging and SIJ dysfunction diagnosed through 2 diagnostic SIJ blocks who had failed conservative management were considered for KP. Numeric Rating Scale (NRS 11) scores were recorded at the baseline, after each SIJ block, and at 4 weeks and then 6 months after KP. RESULTS: Forty-nine patients underwent KP. At 4 weeks after the procedure, there was an 84% average reduction in NRS scores from the baseline (P < 0.01). At 6 months after the procedure, there was an 80% reduction in NRS scores from the baseline (P < 0.01). LIMITATIONS: Larger sample sizes and a randomized control trial would be important steps in furthering the relationship between VCFs and SIJ. CONCLUSION: VCFs can cause a referred pain pattern to the SIJ that is best treated by KP for long-term management.


Assuntos
Fraturas por Compressão , Fraturas da Coluna Vertebral , Humanos , Idoso , Fraturas por Compressão/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Articulação Sacroilíaca , Artralgia , Dor Pélvica
14.
Health Expect ; 27(2): e14017, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38488427

RESUMO

INTRODUCTION: In the United Kingdom, fractures of the cervical dens process in older and/or frail patients are usually managed nonsurgically in a hard collar. However, hard collars can lead to complications and this management approach is now being questioned, with growing interest in maximising patients' short-term quality-of-life. It is vital that patients' perspectives are considered; yet, there is a dearth of literature examining the aspect. To help inform wider decision-making about use of collar/no collar management of dens fractures in older/frail people, we explored older/frail people's experience of the two management approaches and how they affected their perceived quality-of-life. METHODS: We interviewed older and/or frail adults with a recent dens fracture (aged ≥65 years or with a clinical frailty score of ≥5) or their caregiver. Participants were recruited from both arms of a clinical trial comparing management using a hard collar for 12 weeks (SM) with early removal of the collar (ERC) and were interviewed following randomisation and again, 12-16 weeks later. Data were analysed using a framework approach. RESULTS: Both participant groups (SM/ERC) reported substantial, negative quality-of-life (QoL) experiences, with the fall itself and lack of access to care services and information being frequent major contributory factors. Many negative experiences cut across both participant groups, including pain, fatigue, diminished autonomy and reduced involvement in personally meaningful activities. However, we identified some subtle, yet discernible, ways in which using SM/ERC reinforced or alleviated (negative) QoL impacts, with the perceived benefits/burdens to using SM/ERC varying between different individuals. CONCLUSION: Study findings can be used to support informed decision-making about SM/ERC management of dens fractures in older/frail patients. PATIENT OR PUBLIC CONTRIBUTION: Public and patient involvement contributors were involved in the study design, development of interview topic guides and interpretation of study findings.


Assuntos
Idoso Fragilizado , Fraturas da Coluna Vertebral , Adulto , Idoso , Humanos , Fraturas da Coluna Vertebral/cirurgia , Qualidade de Vida , Dor , Projetos de Pesquisa
15.
J Orthop Surg Res ; 19(1): 185, 2024 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-38491520

RESUMO

INTRODUCTION: When needed operative treatment of sacral fractures is mostly performed with percutaneous iliosacral screw fixation. The advantage of navigation in insertion of pedicle screws already could be shown by former investigations. The aim of this investigation was now to analyze which influence iliosacral screw placement guided by navigation has on duration of surgery, radiation exposure and accuracy of screw placement compared to the technique guided by fluoroscopy. METHODS: 68 Consecutive patients with sacral fractures who have been treated by iliosacral screws were inclouded. Overall, 85 screws have been implanted in these patients. Beside of demographic data the duration of surgery, duration of radiation, dose of radiation and accuracy of screw placement were analyzed. RESULTS: When iliosacral screw placement was guided by navigation instead of fluoroscopy the dose of radiation per inserted screw (155.0 cGy*cm2 vs. 469.4 cGy*cm2 p < 0.0001) as well as the duration of radiation use (84.8 s vs. 147.5 s p < 0.0001) were significantly lower. The use of navigation lead to a significant reduction of duration of surgery (39.0 min vs. 60.1 min p < 0.01). The placement of the screws showed a significantly higher accuracy when performed by navigation (0 misplaced screws vs 6 misplaced screws-p < 0.0001). CONCLUSION: Based on these results minimal invasive iliosacral screw placement guided by navigation seems to be a safe procedure, which leads to a reduced exposure to radiation for the patient and the surgeon, a reduced duration of surgery as well as a higher accuracy of screw placement.


Assuntos
Fraturas Ósseas , Parafusos Pediculares , Fraturas da Coluna Vertebral , Cirurgia Assistida por Computador , Humanos , Ílio/diagnóstico por imagem , Ílio/cirurgia , Ílio/lesões , Sacro/diagnóstico por imagem , Sacro/cirurgia , Sacro/lesões , Cirurgia Assistida por Computador/métodos , Fixação Interna de Fraturas/métodos , Fluoroscopia/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia
16.
Int Wound J ; 21(3): e14745, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38484743

RESUMO

This research is intended to evaluate the efficacy of percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) in osteoporotic vertebral compression fracture (OVCF), which is associated with post-operative pain. Eligible studies were screened by searching multiple databases and sources such as PubMed, Cochrane and EMBASE for search terms updated to October 2023, and relevant literature sources were searched. Randomized, controlled, prospective or retrospective, and cohort studies were eligible. For the analysis of the primary results, an analysis of the data was carried out, such as mean difference (MD) or odds ratio (OR), and 95% confidence interval (CI). In the present research, 1933 research was screened in 4 databases, and 30 articles were chosen to be examined under strict exclusion criteria. No statistical significance was found in the use of bone cement in the PVP group and PKP (MD, -0.60; 95% CI, -1.40, 0.21, p = 0.15); PKP was associated with a reduced risk of cement leak compared with PVP group (OR, 2.18; 95% CI, 1.38, 3.46, p = 0.0009); no statistical significance was found in the wound VAS score in PVP operation compared with that of PKP (MD, 0.16; 95% CI, -0.07, 0.40, p = 0.17); no statistical significance was found between the time of PVP operation and the time of PKP operation (MD, -2.65; 95% CI, -8.91, 3.60, p = 0.41). Compared with PVP technology, the PKP treatment of osteoporotic vertebral compression fractures reduces post-operative cement leakage, but there is no significant difference in the number of operative cement and wound VAS after operation. Nor did there appear to be a statistically significant difference in time between the two operations.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Cifoplastia/métodos , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Estudos Retrospectivos , Estudos Prospectivos , Fraturas por Osteoporose/cirurgia , Resultado do Tratamento , Cimentos Ósseos , Dor Pós-Operatória
17.
Medicine (Baltimore) ; 103(12): e37430, 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38518046

RESUMO

RATIONALE: There is still information about pregnancy- and lactation-associated osteoporosis, which is a type of osteoporosis that occurs in women with normal bone in the late pregnancy or lactation period. PATIENT CONCERNS: Six cases of pregnancy- and lactation-associated osteoporosis diagnosed in our Endocrinology and Orthopedics Departments from January 2018 to June 2020 were retrospectively studied. The baseline characteristics, clinical features, laboratory findings, radiological manifestations, and follow-up outcomes were analyzed and compared with previous reports. DIAGNOSES: All six patients underwent magnetic resonance imaging scans and vertebral compressive fractures were detected in four patients. OUTCOMES: All six patients received conservative treatment and no surgical intervention. After a mean follow-up of 27.3 months (range 24-31 months), the symptoms of the six patients were significantly relieved, although four patients still had low back pain to varying degrees.


Assuntos
Osteoporose , Complicações na Gravidez , Fraturas da Coluna Vertebral , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Densidade Óssea , Osteoporose/etiologia , Osteoporose/tratamento farmacológico , Lactação , Aleitamento Materno , Fraturas da Coluna Vertebral/complicações , Complicações na Gravidez/tratamento farmacológico
18.
Pol Merkur Lekarski ; 52(1): 104-111, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38518241

RESUMO

OBJECTIVE: Aim: To evaluate the influence of the degree of detail of the nature of the pathomorphological changes in the osteoligamentous structures on the tactics of treating the patients with the traumatic damage to the thoracolumbar junction. PATIENTS AND METHODS: Materials and Methods: A retrospective analysis of the treatment tactics was carried out in 96 patients with a traumatic injury of the thoracolumbar junction, both those who underwent a surgical treatment and those who underwent a conservative therapy. The lesions were classified using F. Magerl and AOSpine classifications; the neurological status was assessed according to the ASIA scale, the nature of the damage was specified using the McCormack criteria. The statistical data processing was performed using the Random Forest machine learning algorithm. RESULTS: Results: The nature of the injury makes it possible to unambiguously determine the optimal method of therapy when using the F. Magerl classification with a probability of 58.33%, while in relation to the AOSpine classification this figure is 55.21%. When building the models that include the nature of the damage, the level of the neurological disorders and the McCormack criteria, it was found that the use of the F. Magerl classification demonstrates an error in unambiguously determining the most effective treatment method at the level of 26.04%, while the use of AOSpine this figure was 21.88%. CONCLUSION: Conclusions: The application of the AOSpine classification is more promising for the development of a multifactorial algorithm for the treatment of the traumatic injuries of the thoracolumbar junction.


Assuntos
Fraturas da Coluna Vertebral , Humanos , Fraturas da Coluna Vertebral/cirurgia , Estudos Retrospectivos , Vértebras Lombares/cirurgia , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesões , Tratamento Conservador
19.
Arch Osteoporos ; 19(1): 19, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38512565

RESUMO

This retrospective study compared the efficacy of anabolic agents (romosozumab and teriparatide) with that of alendronate in preventing subsequent vertebral body fractures (SVBFs) after balloon kyphoplasty (BKP). All anabolic agents significantly reduced SVBFs. Romosozumab was most effective in increasing bone mineral density (BMD) and completely suppressed distant vertebral body fractures. INTRODUCTION: To determine optimal anti-osteoporosis medications, we compared romosozumab and teriparatide to alendronate as a control from perioperative BKP to the 1st postoperative year for treatment and secondary fracture prevention in osteoporosis. METHODS: A total of 603 patients who underwent initial BKP for osteoporotic vertebral fractures were evaluated and categorized into five groups based on drug administration: romosozumab (group R, 155 patients), twice-weekly teriparatide (group TW, 48), weekly teriparatide (group W, 151), daily teriparatide (group D, 138), and alendronate (control) (group C, 111). The 1-year incidence of SVBFs, BMD change rate, and probability of requiring BKP were compared among the groups. RESULTS: SVBF incidence was 3.9%, 6.5%, 8.3%, 6.0%, and 14.4% in groups R, D, TW, W, and C, respectively, with all other groups exhibiting significantly lower rates than group C. The groups that administered the anabolic agents had a notably lower incidence of distant fractures than group C. Compared with group C, group R showed significantly higher BMD change rates in lumbar vertebral bodies at 4, 8, and 12 months and group D at 12 months. Anabolic agent groups exhibited significantly higher improvement rates than group C after conservative treatment alone. CONCLUSION: The anabolic agents were found to be more effective at reducing the incidence of SVBF (especially distant vertebral fractures) than alendronate. These agents decreased the rate of repeat BKP even after the occurrence of a fracture. Overall, the use of an anabolic agent for the treatment of osteoporosis after BKP is better than the use of alendronate, even when treatment is initiated in the perioperative stage.


Assuntos
Anabolizantes , Conservadores da Densidade Óssea , Fraturas por Compressão , Cifoplastia , Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Humanos , Corpo Vertebral , Teriparatida/uso terapêutico , Alendronato/uso terapêutico , Estudos Retrospectivos , Anabolizantes/farmacologia , Anabolizantes/uso terapêutico , Osteoporose/tratamento farmacológico , Osteoporose/complicações , Fraturas por Osteoporose/terapia , Densidade Óssea , Fraturas da Coluna Vertebral/complicações , Fraturas por Compressão/cirurgia , Conservadores da Densidade Óssea/uso terapêutico , Conservadores da Densidade Óssea/farmacologia
20.
Traffic Inj Prev ; 25(3): 445-453, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38441948

RESUMO

OBJECTIVE: This study investigated the effects of different seatbelt geometries and load-limiting levels on the kinematics and injury risks of a reclined occupant during a whole-sequence frontal crash scenario, using simulations with the Active SAFER Human Body Model (Active SHBM). METHODS: The Active SHBM was positioned in a reclined position (50°) on a semi-rigid seat model. A whole-sequence frontal crash scenario, an 11 m/s2 Automated Emergency Braking (AEB) phase followed by a frontal crash at 50 km/h, was simulated. The seatbelt geometry was varied using either a B-pillar-integrated (BPI) or Belt-in-seat (BIS) design. The shoulder belt load-limiting level of the BPI seatbelt was also varied to achieve either similar shoulder belt forces (BPI_Lower_LL) or comparable upper body displacements (BPI_Higher_LL) to the BIS seatbelt. Kinematics of different body regions and seatbelt forces were compared. The risks of sustaining a mild traumatic brain injury (mTBI), two or more fractured ribs (NFR2+), and lumbar spine vertebral fractures were also compared. RESULTS: During the pre-crash phase, head, first thoracic vertebra, and first lumbar vertebra displacements were greater with the BPI seatbelt than with the BIS, mainly due to the lack of initial contact between the torso and the seatbelt. Pelvis pre-crash displacements, however, remained consistent across seatbelt types. In the in-crash phase, variations in shoulder belt forces were directly influenced by the different load-limiting levels of the shoulder belt. The mTBI (around 20%) and NFR2+ (around 70-100%) risks were amplified with BPI seatbelts, especially at higher load-limiting force. However, the BPI design demonstrated reduced lumbar spine fracture risks (from 30% to 1%). CONCLUSIONS: The BIS seatbelt appears promising, as seen with the reduced mTBI and NFR2+ risks, for ensuring the protection of reclined occupants in frontal crashes. However, additional solutions, such as lap belt load limiting, should be considered to reduce lumbar spine loading.


Assuntos
Concussão Encefálica , Fraturas da Coluna Vertebral , Humanos , Acidentes de Trânsito , Corpo Humano , Cintos de Segurança , Vértebras Lombares/lesões , Fenômenos Biomecânicos
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