A New Method of Krackow Suture Combined with Nice Knot for the Treatment of Inferior Patellar Fractures.

Introduction: We present a new surgical technique of Krackow suture combined with vertical Nice knot for the treatment of inferior patellar fractures and report the clinical results. Patients and Methods: Seventeen consecutive patients admitted with inferior patellar fractures over a 2-year period from June 2019 to February 2022 were prospectively enrolled. The AO classification was 34-A1. All patients underwent open reduction and fixation with Krackow sutures in combination with vertical Nice knot. Postoperative follow-up was performed for at least 1 year to evaluate knee function. Results: The mean age of seventeen patients was 53.2 ± 9.5 years (39-68 years), and all patients were followed up for more than 12 months. The operation time was 54.6 ± 7.7 min (42-68 min). No patients had nonunion, joint stiffness, and joint pain. All cases achieved bony union at an average of 9.9 ± 1.5 weeks (8-13 weeks) after surgery. At the last follow-up, there was no significant difference in range of motion between the injured knee (129.7 ± 3.3°, range 125-135°) and the unaffected knee (130.8 ± 3.8°, range 126-137°) (t = 0.28, P > 0.05). The mean Bostman score of the knee joint was 29.6 ± 0.7, including 15 excellent cases (88.2%) and two good case (11.8%). Conclusion: Krackow sutures combined with vertical Nice knots are stable and reliable in the treatment of inferior patellar fractures. Knee rehabilitation can be performed immediately after surgery and satisfactory knee function can be achieved. It is a safe, simple, and reliable alternative surgical method, and patients do not need to bear the secondary surgical injury of removing the internal fixation material. Therefore, it is suitable for the application of clinical promotion. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-01093-0.

Progress of research on the diagnosis and treatment of bone cystic echinococcosis.

Bone cystic echinococcosis (CE) is one of the most complex and dangerous of all echinococcoses. The lack of typical imaging features and clinical manifestations makes diagnosis and treatment of this disease difficult. X-ray and computed tomography (CT) images of bone CE are similar to those of bone cysts, giant-cell bone tumors, and bone metastases, but magnetic resonance imaging (MRI) shows good diagnostic value due to excellent soft-tissue imaging features. Serological tests cannot be used as a definitive diagnostic method for bone CE due to cross-reactivity, which can lead to false-positive or false-negative results. The development of novel antigens can open new frontiers in the diagnosis of the disease. Currently, views conflict on how to diagnose and treat bone CE. Both surgical and pharmacological treatments can be used, but determining which is appropriate is difficult due to the different sites and clinical manifestations of bone CE. Radical resection is not indicated for large-bone injuries, and Pharmacotherapy becomes important. This article reviews the progress of research into the pathogenesis and clinical manifestations of, and diagnostic strategies and treatment options for, bone CE. We aimed to provide a reference for clinical diagnosis and -treatment options.

N6-methyladenosine reader YTHDF3 contributes to the aerobic glycolysis of osteosarcoma through stabilizing PGK1 stability.

PURPOSE: N6-methyladenosine (m6A) modification is a pivotal transcript chemical modification of eukaryotics, which has been identified to play critical roles on tumor metabolic reprogramming. However, the functions of m6A-reading protein YTH N6-methyladenosine RNA-binding protein 3 (YTHDF3) in osteosarcoma is still unclear. This research planned to investigate the bio-functions and mechanism in osteosarcoma tumorigenesis. METHODS: The aerobic glycolysis of osteosarcoma cells were calculated by glucose uptake, lactate production analysis, ATP analysis and metabolic flux analysis for extracellular acidification rate (ECAR). Molecular binding was identified by RIP-qPCR, RNA decay analysis. RESULTS: Results indicated that YTHDF3 is upregulated in the osteosarcoma tissue samples and cells, and closely correlated to the poor prognosis of osteosarcoma patients. Functionally, gain and loss-of-functional assays illustrated that YTHDF3 promoted the proliferation and aerobic glycolysis of osteosarcoma cells in vitro, and accelerated the tumor growth in vivo. Mechanistically, a m6A-modified PGK1 mRNA functioned as the target of YTHDF3, and YTHDF3 enhanced the PGK1 mRNA stability via m6A-dependent manner. CONCLUSIONS: In conclusion, these findings indicated that YTHDF3 functioned as an oncogene in osteosarcoma tumorigenesis through m6A/PGK1 manner, providing a therapeutic strategy for human osteosarcoma.

Comparative efficacy of 5 suture configurations for arthroscopic rotator cuff tear repair: a network meta-analysis.

BACKGROUND: Rotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. So far, different arthroscopic techniques including single row (SR), double row (DR), modified Mason-Allen (MMA), suture bridge (SB) and transosseous (TO) have been identified to repair rotator cuff. However, no study has reported the comparative efficacy of these 5 suture configurations. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO. METHODS: A systematic literature was searched from PubMed, EBSCO-MEDLINE, Web of Science, google scholar and www.dayi100.com , and checked for the inclusion and exclusion standards. The network meta-analysis was conducted using Review Manager 5.3 and SATA 15.0 software. RESULTS: Thirty-four studies were eligible for inclusion, including 15 randomized controlled trials, 17 retrospective and 2 prospective cohort studies, with total 3250 shoulders. Two individual reviewers evaluated the quality of the 34 studies, the score form 5 and 9 of 10 were attained according to the Newcastle-Ottawa Scale for the 17 retrospective and 2 prospective studies. There was no significant distinction for the Constant score among 5 groups in the 16 studies with 1381 shoulders. The treatment strategies were ranked as MMA, DR, SB, SR and TO. In ASES score, 14 studies included 1464 shoulders showed that no significant differences was showed among all 5 groups after surgery. Whereas the efficacy probability was TO, MMA, DR, SB and SR according to the cumulative ranking curve. The healing rate in 25 studies include 2023 shoulders was significant in both SR versus DR [risk ratio 0.45 with 95% credible interval (0.31, 0.65)], and SR versus SB [risk ratio 0.45 (95% credible interval 0.29, 0.69)], and no significant in the other comparison, the ranking probability was MMA, SB, DR, TO and SR. CONCLUSION: Based on the clinical results, this network meta-analysis revealed that these 5 suture configurations shows no significant difference. Meanwhile, suture bridge may be the optimum treatment strategy which may improve the healing rate postoperatively, whereas the DR is a suboptimal option for arthroscopic rotator cuff repairs.

Circular RNA circNRIP1 plays oncogenic roles in the progression of osteosarcoma.

Osteosarcoma (OS) is the most common malignant bone tumor in children and adolescents. Increasing evidence suggests that aberrant expression of circRNAs is associated with the occurrence and progression of many cancers. Here, we investigated the role of circNRIP1 in osteosarcoma and explored its possible underlying mechanisms. Three pairs of osteosarcoma tissues and adjacent normal tissues were applied to the detection of altered expression of circRNAs through circRNAs microarray. And the level of circNRIP1 expression was elevated in osteosarcoma tissues. Compared with that in adjacent normal tissue, circNRIP1 expression level was obviously elevated in 100 osteosarcoma tissues. Besides, circNRIP1 knockdown inhibited proliferation and migration, promoted apoptosis of osteosarcoma cells. Bioinformatic analysis demonstrated circNRIP1 contributed to FOXC2 expression by sponging miR-199a. Furthermore, METTL3 elevated circNRIP1 expression level via m6A modification. In short, METTL3-induced circNRIP1 exerted an oncogenic role in osteosarcoma by sponging miR-199a, which may provide new ideas for the treatment of osteosarcoma.

Esophageal perforation following pedicle screw placement for the treatment of upper thoracic spinal tuberculosis: a case report and review of the literature.

BACKGROUND: The technique of posterior pedicle screw fixation has already been widely applied in the treatment of upper thoracic spinal tuberculosis. However, lesions of tuberculosis directly invade the vertebrae and surrounding soft tissues, which increases the risk of esophageal perforation induced by the posterior pedicle screw placement. Herein, we report the first case of esophageal perforation following pedicle screw placement in the upper thoracic spinal tuberculosis, and describe the underlying causes, as well as the treatment and prognosis. CASE PRESENTATION: A 48-year-old female patient with upper thoracic spinal tuberculosis presented sputum-like secretions from the wound after she was treated with one-stage operation through the posterolateral approach. Endoscopy was immediately conducted, which confirmed that the patient complicated with postoperative esophageal perforation caused by screws. CT scan showed that the right screw perforated the anterior cortex of the vertebrae and the esophagus at the T4 level. Fortunately, mediastinal infection was not observed. The T4 screw was removed, Vacuum Sealing Drainage (VSD) was performed, and jejunum catheterization was used for enteral nutrition. After continuous treatment with sensitive antibiotics for 2.5 months and 5 times of VSD aspiration, the infected wound recovered gradually. With 18-month follow-up, the esophagus healed well, without symptoms of dysphagia and stomach discomfort, and CT scan showed that T2-4 had complete osseous fusion without sequestrum. CONCLUSION: Tuberculosis increases the risk of postoperative esophageal perforation in a certain degree for patients with upper thoracic tuberculosis. The damages to esophagus during the operation should be prevented. The screws with the length no more than 30 mm should be selected. Moreover, close monitoring after operation should be conducted to help the early identification, diagnosis and treatment, which could help preventing the adverse effects induced by the delayed diagnosis and treatment of esophageal perforation.

Overview of Therapeutic Effects of Statins on Inflammatory Diseases Through Regulating Adhesive Molecules.

Simvastatin, lovastatin, rosuvastatin, pravastatin and cerivastatin belong to the statin family, which are competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A. As the rate-limiting enzyme in the pathway of cholesterol metabolism, statins are classically prescribed to patients as lipidlowering agents. However, statins also possess several extra bioactivities, including anti-inflammatory, antiviral and anti-tumor. Interestingly, the most essential mechanism of these activities is that statins could regulate the expression of cell adhesion molecules (CAMs), especially, targeting lymphocytes function-associated molecules (LFA)-1, macrophage (Mac)-1 and intercellular adhesion molecules (ICAM)-1. Therefore, in this paper, we discussed the regulatory effect of statins on CAMs among different diseases. In addition, we provided speculation for the role of statins in treating orthopedic disease.

Positive feedback loop SP1/MIR17HG/miR-130a-3p promotes osteosarcoma proliferation and cisplatin resistance.

Long noncoding RNAs (lncRNAs) have been identified to be critical regulator in the osteosarcoma (OS) tumorigenesis. However, the role of lncRNA MIR17HG in the OS proliferation and chemotherapy resistance is still unclear. Here, this research aims to investigate the function of lncRNA MIR17HG in the OS proliferation and cisplatin resistance. Clinically, results revealed that higher MIR17HG expression was associated with shorter overall survival. Functional investigations indicated that MIR17HG promoted the proliferation, invasion and cisplatin resistance of OS cells in vitro, and the MIR17HG knockdown inhibited the growth in vivo. Mechanistically, MIR17HG targeted the miR-130a-3p/SP1 axis, moreover, transcription factor SP1 bind with the MIR17HG promoter region to promote its expression. Taken together, MIR17HG displays the tumor-promotive role in the progression of OS through SP1/MIR17HG/miR-130a-3p/SP1 feedback loop. Our findings might help us to offer novel therapeutic strategies for OS.

Advances in antiviral polysaccharides derived from edible and medicinal plants and mushrooms.

Despite the number of approved antivirals has considerably increased, these existing drugs are not always efficacious or well-tolerated and drug-resistant virus strains are rapidly emerging. Nowadays, many polysaccharides as independent or the main bioactive ingredients have been approved as medicines. The present report aims to provide systematically reorganized information on antiviral polysaccharides derived from edible and medicinal plants and mushrooms (PsEMPM) to people for better utilization of them. PsEMPM can inhibit the infection of viruses by interfering with a few steps in the virus life cycle and/or improving the host antiviral immune responses. Polyanionic nature and sulfates are in many cases required antiviral potency of PsEMPM, while it not only is a function of high charge density but also associated with distinct structural specificities. Plenty of efforts have been devoted to achieving the discovery of novel antiviral polysaccharides, however, the detailed structural characteristics of PsEMPM still merit further in-depth investigation.

Application of transforaminal-lumbar interbody fusion technology combined with lesion clearance and chemotherapy via catheter for the treatment of spinal tuberculosis.

The aim of the present study was to analyze the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis (TB) treated by application of transforaminal-lumbar interbody fusion technology combined with lesion clearance and chemotherapy via catheter (TCLC). Posterior debridement and indwelling catheterization in the lesion area were performed for direct injection of anti-TB drugs, so as to reduce the recurrence rate. The present prospective study comprised 26 patients with active thoracolumbar spinal TB who underwent TCLC at Hong Hui Hospital affiliated to Xi'an Jiaotong University (Xi'an, China). The kyphotic Cobb angle at presentation, after surgery and at the final follow-up were 22.7±9.8, 9.8±7.3 and 10.3±8.8°, respectively, with an average correction of 13.1±5.4° after surgery, and a loss of correction of 1.8±1.0° at the final follow-up. The rate of correction and loss of correction were 56.6 and 8.3%, respectively. At six months after the surgery, all abnormal erythrocyte sedimentation rates and C-reactive protein levels had returned to normal. The average time to union was ~5 months. All patients had bony union and improved neurological function, with their daily activity returning to normal. In conclusion, in the present study, application of TCLC for the treatment of spinal TB achieved satisfactory healing of lesions. The surgical treatment for spinal TB comprised the removal of the disease as far as possible, and the local administration of anti-TB chemotherapy to the lesion is key to successful treatment.

Early versus delayed decompression for traumatic cervical spinal cord injury: application of the AOSpine subaxial cervical spinal injury classification system to guide surgical timing.

PURPOSE: Application of AOSpine subaxial cervical spine injury classification system to explore the optimal surgical decompression timing for different types of traumatic cervical spinal cord injury (CSCI). METHODS: A single-center prospective cohort study was conducted that included patients with traumatic CSCIs (C3-C7) between February 2015 and October 2016. After enrollment, patients underwent either early (< 72 h after injury) or late (≥ 72 h after injury) decompressive surgery of the cervical spinal cord. Each group was divided into A0, A1-4, B, C/F4 and F1-3 subgroups. The primary outcomes were ordinal changes in the ASIA Impairment Scale (AIS) and the Spinal Cord Independence Measure III (SCIM version 3) at a 12-month follow-up. The secondary outcomes included length of hospital stay, postoperative neurological deterioration, other complications and mortality. RESULTS: A total of 402 patients were included. Of these, 187 patients underwent early decompression surgery, and 215 patients underwent delayed decompression surgery. Statistical results included the following comparisons of the early vs late groups: AIS improvement ≥ 1 grade (combined groups: P < 0.0001; A0: P = 0.554; A1-4: P = 0.084; B: P = 0.013; C/F4: P = 0.040; F1-3: P = 0.742); AIS improvement ≥ 2 grades, P = 0.003 for all groups; SCIM version 3 (combined groups: P < 0.0001; A0: P = 0.126; A1-4: P = 0.912; B: P = 0.006; C/F4: P = 0.111; F1-3: P = 0.875). CONCLUSION: Type A and F1-3 fractures are not required to undergo aggressive early decompression. Type B and type C/F4 fractures should receive early surgical treatment for better clinical outcomes. These slides can be retrieved under Electronic Supplementary Material.

"Temporary" Short Segment Fixation in Treating Adolescent Lumbar Spondylolysis.

BACKGROUND: We have introduced a new operation for isthmic spondylolysis in adolescents and evaluated its clinical efficacy. METHODS: A total of 30 adolescent patients with isthmic spondylolysis and chronic low back pain underwent "temporary" short-segmental pedicle screw combined with transverse device fixation and isthmic bone graft repair treatment. Radiograph and computed tomography images were evaluated during regular follow-up examinations to confirm successful bone graft fusion, after which the fixation was removed. Lumbar magnetic resonance imaging was performed before and 1 year after fixation surgery and 1 year after fixation removal. Modic and Pfirrmann grading standards were used to observe the effect of "temporary" fixation on the corresponding vertebral endplate and intervertebral disc. RESULTS: All 30 patients had complete follow-up data available at 2 years postoperatively. The low back pain symptoms had disappeared completely, and radiographs and computed tomography showed that the isthmus in all patients had achieved bony fusion. With removal of the internal fixation, motion of the fixed segment recovered. "Temporary" rigid internal fixation did not increase the corresponding vertebral endplate or intervertebral disc degeneration. CONCLUSIONS: "Temporary" short-segmental pedicle screw combined with transverse device fixation is a simple and effective method for adolescent isthmic spondylolysis with rigid internal fixation and accelerated bone graft fusion.

An innovative technique for osteoporotic vertebral compression fractures - vertebral osteotome with side-opening cannula.

OBJECTIVE: This study is to assess an innovative technique - a vertebral osteotome (VO) combined with side-opening injection cannula for percutaneous vertebroplasty (PVP). METHODS: A retrospective study by propensity score matching. From January 2016 to April 2016, 63 patients who were diagnosed with monosegmental osteoporotic vertebral compression fracture received the innovative technique. The epidemiologic data, surgical indexes, and recovery outcomes were collected in the follow-up period. Propensity score matching identified 63 pairs form historical controls by traditional unilateral PVP approach in 2015 using six independent variables: age, sex, preoperative visual analog score (VAS), Oswestry Disability Index (ODI), body mass index, and bone mineral density. RESULTS: The surgical duration and cement distribution were longer and larger in patients by VO method. Besides, postoperative VAS and ODI in the VO group were lower than those in the control group. However, there were no differences in radiation exposure times, improvement of Cobb angle, cement leakage, or adjacent vertebral fracture between two groups. Cement volume in the VO group was less than that in the control group. CONCLUSION: This new innovative technique makes PVP safe and effective. Although it lasts longer, the restoration rate of vertebral height and cement distribution can be improved, which contributes to a better pain relief.

Is percutaneous kyphoplasty the better choice for minimally invasive treatment of neurologically intact osteoporotic Kümmell's disease? A comparison of two minimally invasive procedures.

PURPOSE: The purpose of this study was to compare and evaluate the safety and efficacy of percutaneous vertebroplasty at a hyperextension position (PVPHP) and percutaneous kyphoplasty at a hyperextension position (PKPHP) for the treatment of osteoporotic Kümmell's disease. METHODS: This study was a retrospective, single-centre study. There were 35 patients with osteoporotic Kümmell's disease who were analyzed. Twenty-two of them underwent PVPHP and the other 13 patients underwent PKPHP from January 2013 to January 2015. The volume of bone cement injection and operation costs were compared. We compared the visual analogue score (VAS) and vertebral Cobb's angle at pre-operation, the second day after operation, and the final follow-up. We compared the Oswestry disability index (ODI) score at the pre-operation and the final follow-up. RESULTS: There were no significant differences in gender, age, course of disease, bone mineral density (BMD), and mean follow-up time between the two groups (P > 0.05). Regarding the costs of the operation, the PKPHP group was significantly higher than the PVPHP group (P < 0.05). Compared with the pre-operation (P < 0.05), the post-operative ODI score, VAS, and Cobb's angle of the two groups were improved significantly. Even though the correction of Cobb's angle in the PKPHP group was slightly better than the PVPHP position group, there were no significant differences between two groups (P > 0.05). At the final follow-up, the Cobb's angle was increased in both groups, but there was no significant difference (P > 0.05). There was no significant difference in the bone cement leakage rate between the two groups (P > 0.05). CONCLUSION: For the treatment of Kümmell's disease, PVPHP and PKPHP are both safe and effective, but PVPHP is more economical and can be considered a preferred method of treatment.

Long Noncoding RNA CRNDE Promotes Multiple Myeloma Cell Growth by Suppressing miR-451.

It has been determined that long noncoding RNAs (lncRNAs) are identified as a potential regulatory factor in multiple tumors as well as multiple myeloma (MM). However, the role of colorectal neoplasia differentially expressed (CRNDE) in the pathogenesis of MM remains unclear. In this study, we found that the CRNDE expression level, in MM samples and cell lines, is higher than that in the control detected by real-time qPCR, which is also closely related to tumor progression and poor survival in MM patients. Knockdown of CRNDE significantly inhibits the proliferative vitality of MM cells (U266 and RPMI-8226), induces cell cycle arrest in the G0/G1 phase, and promotes apoptosis. After being transfected with siRNA, miR-451 expression observably increases. Bioinformatics analysis and luciferase assay reveal the interaction by complementary bonding between CRNDE and miR-451. Pearson's correlation shows that CRNDE is negatively correlated to miR-451 expression in human MM samples. Subsequently, miR-451 inhibitor rescues the inhibited tumorigenesis induced by CRNDE knockdown. Our study illustrates that lncRNA CRNDE induces the proliferation and antiapoptosis capability of MM by acting as a ceRNA or molecular sponge via negatively targeting miR-451, which could act as a novel diagnostic marker and therapeutic target for MM.

Factors Affecting Delayed Union of Vertebral Fractures Following Percutaneous Kyphoplasty.

BACKGROUND: Although percutaneous kyphoplasty (PKP) could achieve rapid pain relief for the elderly with osteoporotic vertebral compression fracture (OVCF), some patients still had risks of suffering vertebrae delayed union which led to persisting pain and vertebral collapse. Preventing the delayed vertebral union could reduce the further morbidities and medical costs for patients with OVCF after PKP. OBJECTIVES: To explore the factors involved in delayed vertebral union after PKP in patients with OVCF. STUDY DESIGN: Retrospective analysis. SETTING: All data were from Hong-Hui hospital in Xi'an. METHODS: There were 580 patients treated using single-segment PKP between January 2011 and January 2012. Demographics, clinical data, types of vertebral fracture, and surgical data were collected to analyze the factors associated with delayed vertebral union after PKP. RESULTS: Twenty-nine patients (5%) experienced delayed vertebral union. Univariate analyses showed that preoperative bone mineral density (BMD), cement consumption, intravertebral cleft, restoration rate of vertebral height, and improvement in kyphotic angle were associated with delayed union of vertebrae after PKP (P < 0.05). Multivariate analysis revealed that preoperative BMD (odds ratio (OR) = 0.452, 95% confidence interval (CI): 0.207 - 0.987, P = 0.046), intravertebral cleft (OR = 9.156, 95% CI: 3.712 - 22.585, P < 0.001), and restoration rate of vertebral height (OR = 2.731, 95% CI: 1.622 - 4.599, P < 0.001) were independently associated with delayed union of vertebrae. LIMITATIONS: A multi-center study is recommended to confirm our findings and explore the factors related to vertebrae delayed union. CONCLUSIONS: Preoperative BMD, intravertebral cleft, and restoration rate of vertebral height could be factors independently associated with delayed union of vertebrae after PKP in patients with OVCF.Key words: Percutaneous kyphoplasty, delayed union, osteoporotic vertebral compression fracture.

Bone Grafting of Atlantoaxial Joints and Occipitocervical or Atlantoaxial Fusion for the Reduction and Fixation of Basilar Invagination with Atlantoaxial Dislocation by a Posterior Approach: A Preliminary Study.

BACKGROUND: Basilar invagination (BI) with atlantoaxial dislocation (AAD) is a complex disease to manage. We have developed a new technique of bone grafting the atlantoaxial joints and occipitocervical fusion using a posterior approach for the reduction and fixation of BI with AAD with complete retention of the C2 nerve root. METHODS: Thirty-two patients underwent bone grafting of the atlantoaxial joints and occipitocervical fusion for the reduction and fixation of BI with AAD by the posterior approach in our department between January 2015 and February 2016. All patients underwent plain radiography, computed tomography (CT) scanning, and magnetic resonance imaging evaluation. The atlantodens interval and cervicomedullary angle were evaluated preoperatively and 5 days after surgery on sagittal reconstructed CT scans to evaluate BI with AAD. CT scans of sagittal reconstruction were acquired at each follow-up until bone fusion was confirmed. RESULTS: All patients were followed up for 6-19 months. No patient required re-exploration for failure of implant fixation. At the last follow-up, all patients had achieved fusion (32/32). Japanese Orthopedic Association score, atlantodens interval, and cervicomedullary angle were significantly improved in these patients compared with preoperative measurements (P < 0.05). The duration of symptoms ranged from 5 days to 11 months (mean duration, 2 months). No serious complication was observed. CONCLUSIONS: In this preliminary study, our operation technique could treat BI with AAD by using only a posterior approach, which could retain C2 nerve roots and fuse atlantoaxial joints. This technique may be extended to other diseases requiring treatment by C1-C2 fusion.

Percutaneous Kyphoplasty Evaluated by Cement Volume and Distribution: An Analysis of Clinical Data.

BACKGROUND: Percutaneous kyphoplasty (PKP) could achieve rapid pain relief for older patients with osteoporotic vertebral compression fractures (OVCFs). Bone cement in PKP was the key factor keeping the stabilization of the vertebral body. However, the same amount of cement can distribute differently in a vertebral body and can thereby result in different surgery outcomes. Therefore, the volume and distribution of bone cement should be considered as 2 distinct variables to evaluate the effectiveness of PKP. OBJECTIVES: On the basis of comparing surgery outcomes between patients with different recovery states measured by visual analog scores (VAS) and exploring the relationships among bone cement, surgery outcomes, and degrees of pain relief, the objective of the study is to determine the best combination of cement volume and cement distribution for PKP. STUDY DESIGN: Retrospective study. METHODS: There were 220 patients with 220 vertebra who received PKP in our hospital from January 2011 to January 2013. According to the different pain relief degrees, patients were divided into 2 groups. The epidemiological data, surgical outcomes, and complications were compared between the 2 groups. A receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of bone cement on patient recovery state. A correlation analysis was used to analyze the relationships between bone cement and surgery outcomes. Moreover, logistic regression was also used to assess the safety of cement injection. RESULTS: There were 77 recuperators and 143 non-recuperators in our study. There were no differences in epidemiological data between the 2 groups. However, the surgery duration, cement volume, cement distribution, restoration rate of vertebral height, and improvement of kyphotic angle in the recuperator group were all higher than those in the non-recuperator group. The area under the ROC curve of cement distribution as a predictor of pain relief was better than that of cement volume (0.77 vs. 0.65, P < 0.05). Cement distribution had a sensitivity of 62% and a specificity of 84% when it was at 0.49. Cement volume had a sensitivity of 49% and a specificity of 82% when it was at 3.80 mL. All patients were then divided into 4 parts based on the 2 values. Extensive cement distribution (more than or equal to 0.49) was discovered to noticeably increase the recuperative rate both for a small cement volume (less than 3.80 mL) and a large cement volume (more than or equal to 3.80 mL). A small cement volume with an extensive distribution had the same recuperative effect as a large cement volume with a confined distribution (x² = 2.880, P = 0.090). When the cement volume was constant, cement distribution was positively correlated with the restoration rate of vertebral height and improvement of the kyphotic angle (r² = 0.207, P < 0.01; r² = 0.159, P = 0.02), but cement distribution was not a risk factor for cement leakage or adjacent vertebral fractures (OR = 35.760, 95%CI: 0.096 - 13291.207, P > 0.05; OR = 0.051, 95% CI: 0.011 - 1.032, P > 0.05). Although a large cement volume may contribute to the restoration of vertebral height (r² = 0.153, P < 0.05), it was found to be a risk factor for adjacent vertebral fractures (OR = 1.733, 95% CI: 1.158 - 2.595, P < 0.05). LIMITATIONS: The distribution of cement in fractured vertebra was not calcuated accurately. CONCLUSIONS: The diagnostic value of cement distribution is better than that for cement volume in relieving patient pain. A cement distribution above 0.49 with a small cement volume should be suggested for PKP. An extensive cement distribution can improve the kyphotic angle and vertebral height effectively, and it does not cause cement leakage or adjacent vertebral fractures. KEY WORDS: Psteoporotic vertebral compression fractures percutaneous kyphoplasty cement volume cement distribution.

The efficacy of local continuous chemotherapy and postural drainage in combination with one-stage posterior surgery for the treatment of lumbar spinal tuberculosis.

BACKGROUND: The objective of this study was to compare the outcomes of one-stage posterior surgery involving debridement, bone grafting, and instrumentation with and without local continuous chemotherapy and postural drainage for the treatment of lumbar spinal tuberculosis. METHODS: From January 2009 to January 2013, 109 patients with lumbar spinal tuberculosis were treated in our center using a posterior surgical approach. Patients underwent one-stage posterior debridement, bone grafting, and instrumentation, without (group A) and with (group B) local continuous chemotherapy and postural drainage. Clinical and radiographic results for the two groups were analyzed and compared. Clinical efficacy was evaluated based on surgery duration and blood loss. The Frankel scale was used to evaluate neurological function. A visual analog scale was used to assess low back pain. Bone graft fusion and instrumentation failure were monitored by radiography, and tuberculosis activity was monitored by erythrocyte sedimentation rate (ESR) and C-reactive protein testing. RESULTS: Groups A and B contained 52 and 57 patients, respectively. Patients were followed for 18-36 (mean, 26.64 ± 4.2) months. All bone grafts ultimately fused, but the fusion rate was significantly more rapid in group B [6.4 ± 0.5 (range, 5-10) months] than in group A [8.9 ± 0.6 (range, 6-12) months; P < 0.05]. At 6 weeks postoperatively, ESR levels differed significantly between groups A and B (24.6 ± 1.5 vs. 16.3 ± 1.1 mm/h; P < 0.05). ESR levels normalized in both groups at 16 weeks. CONCLUSIONS: Local continuous chemotherapy and postural drainage effectively eliminated infection foci caused by abscess remnants and accelerated interbody bone fusion in patients with lumbar spinal tuberculosis undergoing one-stage posterior surgery involving debridement, bone grafting, and instrumentation.