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1.
Ann Otol Rhinol Laryngol ; 132(1): 105-109, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35152775

RESUMO

OBJECTIVES AND METHODS: We report a unique case of Bow Hunter's syndrome with a dominant aberrantly coursing right vertebral artery (VA), presenting with persistent dizziness and syncope despite previous decompressive surgery at vertebral levels C5-C6. RESULTS: Re-evaluation with computed tomography-scan during provocation of dizziness by neck rotation revealed compression of the right VA at level C6 from against the ipsilateral posterior border and superior cornu of the thyroid cartilage. Laryngoplasty resulted in complete resolution of symptoms. CONCLUSION: This extremely rare cause of Bow's Hunter's syndrome should be considered, especially in refractory cases after neurosurgical decompression, and surgical management is straightforward and successful.


Assuntos
Mucopolissacaridose II , Lesões do Pescoço , Fraturas da Coluna Vertebral , Insuficiência Vertebrobasilar , Humanos , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/diagnóstico por imagem , Mucopolissacaridose II/complicações , Cartilagem Tireóidea/diagnóstico por imagem , Cartilagem Tireóidea/cirurgia , Tontura/complicações , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Lesões do Pescoço/complicações
2.
Bone ; 166: 116601, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36336262

RESUMO

Following primary fractures and percutaneous kyphoplasty (PKP), patients have a high risk of incurring a subsequent vertebral fracture (SVF). Given that SVF is a consequence of mechanical deterioration of the vertebra, we sought to examine whether vertebral strength derived from QCT-based finite element analysis (i.e., BCT) can predict the risk of SVF. Sixty-six patients who underwent PKP were categorized into two groups: control or non-SVF group (age: 70 ± 7 years; n = 40) and SVF group (age: 69 ± 8 years; n = 26). BCT was performed on L4 or L3 vertebrae to noninvasively measure vertebral strength. Vertebral strength was also estimated based upon the geometry and material properties of the vertebra. Additionally, trabecular volumetric bone mineral density (vBMD) and L1 Hounsfield unit (HU) were measured. t-Test, χ2 test or Mann Whitney U test were used to compare differences in these parameters between the two groups. The predictive abilities of BCT strength and other measured parameters were evaluated using the receiver operating characteristic (ROC) analysis. Results showed no significant difference in either vBMD or L1 HU between the control and SVF groups (p > 0.05), whereas BCT-computed and estimated vertebral strength values were significantly reduced by 33 % and 24 % for the SVF group relative to the non-SVF group, respectively. ROC curve indicated that BCT strength had the largest area under the curve, compared to other parameters. These results suggest that BCT-computed vertebral strength may serve as a surrogate for assessing risk of SVF.


Assuntos
Fraturas da Coluna Vertebral , Humanos , Pessoa de Meia-Idade , Idoso , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Densidade Óssea , Vértebras Lombares/lesões , Análise de Elementos Finitos
3.
Bone ; 166: 116605, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36347433

RESUMO

PURPOSE: Early initiation of anti-osteoporosis medications (AOMs) is recommended for patients on long-term glucocorticoid (GC) therapy. This study aimed to clarify the real-world effectiveness of AOMs against incident hip and vertebral fractures in patients undergoing GC therapy using the nationwide health insurance claims database of Japan (NDBJ). METHODS: Patients aged ≥50 years who were prescribed GC (≥5 mg/day prednisolone or equivalent) for ≥90 days and who were followed up regarding AOM prescription and hip and clinical vertebral fracture incidences for the subsequent 1080 days between 2012 and 2018 were selected from NDBJ. Associations of AOMs prescribed within 90 days since GC therapy initiation with hip or vertebral fracture risk were evaluated by Cox proportional hazards regression using propensity score inverse probability weighting (IPW) for receiving any AOM or individual AOMs. RESULTS: In total, 96,475 women and 98,385 men were included in the analysis; 38.0 % of women and 27.6 % of men received AOMs. Patients who received any AOM and those who received bisphosphonates or denosumab had a significantly lower risk of hip and clinical vertebral fractures than those who received no AOM in both sexes after propensity score IPW. Teriparatide was associated with an increased risk of both fractures in women and an increased risk of clinical vertebral fractures in men. Selection biases such as confounding by indication might have caused an underestimation of AOMs' protective effects. CONCLUSIONS: Bisphosphonates and denosumab were associated with a lower fracture incidence in patients on long-term GC therapy in real-world settings.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Masculino , Humanos , Feminino , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/prevenção & controle , Fraturas da Coluna Vertebral/complicações , Conservadores da Densidade Óssea/uso terapêutico , Glucocorticoides/efeitos adversos , Denosumab/uso terapêutico , Japão/epidemiologia , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Difosfonatos/uso terapêutico , Fraturas Ósseas/etiologia , Seguro Saúde , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Fraturas por Osteoporose/etiologia , Fraturas do Quadril/prevenção & controle
4.
J Long Term Eff Med Implants ; 33(1): 75-82, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36382707

RESUMO

Recent literature has determined that operative times for the obese population are greater for both elective and nonelective orthopedic procedures. If time allotted for a given surgical procedure is used as a measure of procedural difficulty, then consideration can be given for using an additional coding modifier (i.e., Modifier 22) for the increased skill and effort associated with longer procedures. A retrospective chart review was conducted on all patients who underwent surgical treatment for an acute fracture about the pelvis at an urban level-1 trauma center from October 1, 2010 through October 31, 2018. After allowing for both inclusion and exclusion criteria, 102 patients with acetabular fractures and 55 patients with pelvic ring injuries were included in this investigation. The obese population within the acetabular fracture cohort demonstrated significantly longer mean times for the duration of surgery, total time in spent in the operating room, and duration under anesthesia (P values of 0.038, 0.05 and 0.035, respectively). Similar results were observed with the pelvic ring injury cohort, with significantly longer procedural times (P = 0.019), total time in the operating room (P = 0.034), and total duration under anesthesia (P = 0.0395). A trend towards a greater risk of infection was found in obese patients (7%) when compared with nonobese patients (1.6%) within the acetabular fracture subset (P = 0.093). Operative duration for acetabular fractures and pelvic ring injuries is significantly longer in the obese population. Furthermore, this indicates that a Modifier 22 may be justified for the surgical treatment of these injuries in the obese and morbidly obese patient populations.


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Obesidade Mórbida , Ossos Pélvicos , Fraturas da Coluna Vertebral , Humanos , Ossos Pélvicos/cirurgia , Ossos Pélvicos/lesões , Estudos Retrospectivos , Duração da Cirurgia , Acetábulo/cirurgia , Acetábulo/lesões , Fraturas Ósseas/cirurgia , Pelve/lesões
5.
BMC Musculoskelet Disord ; 23(1): 976, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368989

RESUMO

BACKGROUND: The trabecular bone score (TBS) is reported to be an independent predictor of fracture risk in patients with primary or secondary osteoporosis. However, there have been few reports on its use in the Japanese population. This study aimed to investigate the risk factors for vertebral fracture in the Japanese population and to evaluate the usefulness of TBS. METHODS: This cross-sectional study involved 279 patients aged 60-90 years in whom bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA). TBS was calculated based on the DXA scans. The presence or absence of vertebral fractures was assessed from T11 to L5. The patients were divided into those with vertebral fractures (VF group, n = 104) and those without vertebral fractures (non-VF group, n = 175). RESULTS: Of the 104 patients in the VF group, 75 had 1 vertebral fracture and 29 had 2 or more fractures. The mean TBS was 1.28 in the VF group and 1.35 in the non-VF group (p < 0.001). The mean BMD values at the lumbar spine and femoral neck were lower in the VF group (p < 0.001). The areas under the receiver-operating characteristic curve for incidence of vertebral fractures were 0.700, 0.737, and 0.689 for TBS, lumbar spine BMD, and femoral neck BMD, respectively. Multiple logistic regression analysis identified lumbar spine BMD, TBS, and female sex as significant risk factors for vertebral fractures. The proportion of patients in the group with osteoporosis or osteopenia who had vertebral fractures was higher in those with a low TBS (≤ 1.23) than in those with a non-low TBS (> 1.23). CONCLUSION: TBS was a significant indicator of vertebral fractures in the Japanese population and might contribute to identifying patients with vertebral fractures, particularly those with osteopenia who need pharmacologic therapy.


Assuntos
Doenças Ósseas Metabólicas , Fraturas Ósseas , Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Humanos , Feminino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/complicações , Osso Esponjoso/diagnóstico por imagem , Estudos Transversais , Japão/epidemiologia , Absorciometria de Fóton , Densidade Óssea , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Fraturas Ósseas/complicações , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/complicações
6.
Sci Rep ; 12(1): 19404, 2022 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-36371412

RESUMO

Whilst the majority of the literature suggests that balloon kyphoplasty (BKP) can relieve pain associated with vertebral compression fractures (VCFs), evidence of high-viscosity cement (HVC) vertebroplasty (VP) or low viscosity cement (LVC) BKP for the treatment of VCFs at the levels of high and mid-thoracic vertebrae remains limited. The purpose of this study was to identify the different outcomes between HVC VP and LVC BKP used to repair high (T4-6) and mid (T7-9)-thoracic VCFs. A total of 114 patients with painful collapsed single-level vertebrae at high to mid-thoracic level who had undergone HVC VP or LVC BKP at a single tertiary medical center was reviewed retrospectively. All patients were divided into the HVC VP group (n = 72) and the LVC BKP group (n = 42). Clinical outcomes including demographic data and visual analogue scale (VAS) were compared. Radiographic data were collected preoperatively, postoperatively, and at final follow-up. More volume (ml) of cement injection was seen in the LVC BKP group (4.40 vs. 3.66, p < 0.001). The operation time (minutes) of the HVC VP group was significantly less than that of the LVC BKP group (33.34 vs. 39.05, p = 0.011). Leakage rate of cement was also fewer in the HVC VP group (26/72 vs. 27/42, p = 0.004). Compared with preoperative data, the VAS was improved after surgery in both groups. The LVC BKP group corrected more middle vertebral body height and local kyphosis angle than the HVC VP group. The outcomes of LVC BKP were not superior to that of HVC VP. HVC VP might be a good alternative to LVC BKP in the treatment of osteoporotic VCFs in high to mid-thoracic spine.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Fraturas por Compressão/cirurgia , Fraturas por Compressão/tratamento farmacológico , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/tratamento farmacológico , Viscosidade , Estudos Retrospectivos , Fraturas por Osteoporose/cirurgia , Cimentos Ósseos/uso terapêutico , Vértebras Torácicas/cirurgia , Dor/tratamento farmacológico , Cimentos de Ionômeros de Vidro , Resultado do Tratamento
7.
Medicine (Baltimore) ; 101(45): e31785, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397329

RESUMO

OBJECTIVE: To investigate the clinical efficacy of Percutaneous Kyphoplasty (PKP) in male and female patients. METHOD: The clinical data of patients treated with PKP in our hospital from January 2018 to October 2020 were analyzed retrospectively. These patients were divided into female group and male group according to gender differences. The visual analogue scale (VAS) and activity function score (LAS) were recorded before operation, immediately after operation and 1 year after operation, and postoperative complications such as cement leakage and recurrent vertebral fracture were recorded. The above observation indexes between the 2 groups were statistically compared. RESULTS: A total of 171 patients (118 in female group and 53 in male group) were included. There was no other difference between the 2 groups except that thoracic vertebral fracture was more common in women (P < .05). The VAS of female group and male group were (7.14 ±â€…0.61) and (7.11 ±â€…0.51) before operation, (3.05 ±â€…0.66) and (2.89 ±â€…0.64) after operation, 1 year after operation (1.10 ±â€…0.50) and (1.02 ±â€…0.37). There was no difference in each period between the 2 groups (P > .05). But there was a significant decrease after operation, which was recognized between the 2 groups (P < .05); The activity scores of female group and male group were (3.08 ±â€…0.48) and (3.07 ±â€…0.43) before operation, (1.86 ±â€…0.42) and (1.85 ±â€…0.50) after operation, 1 year after operation (1.01 ±â€…0.92) and (1.02 ±â€…0.14). There was no difference in each period between the 2 groups (P > .05). But there was a significant decrease after operation, which was recognized between the 2 groups (P < .05). Postoperative cement leakage was revealed in 21 cases (12.28%), 16 cases (13.56%) in female group and 5 cases (9.43%) in male group, which was no significant difference between the 2 groups. During the 1-year follow-up, postoperative recurrent vertebral fracture was revealed in 4 cases (2.34%), 2 cases (1.69%) in the female group and 2 case (3.77%) in the male group, which was also no significant difference between the 2 groups. CONCLUSION: Patients treated with PKP can immediately get pain relief and activity function improvement. PKP is a safe and effective minimally invasive surgery for both female and male patients.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas da Coluna Vertebral , Feminino , Humanos , Masculino , Cifoplastia/efeitos adversos , Fraturas da Coluna Vertebral/cirurgia , Fraturas por Compressão/cirurgia , Estudos Retrospectivos , Cimentos Ósseos/efeitos adversos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 101(45): e30796, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397346

RESUMO

Spinal fractures are common intra-articular fractures. Osteoporosis is a common and frequent disease among the elderly with a poor prognosis and a high risk of spinal fractures. However, the underlying factors for spinal fractures in patients with osteoporosis are unclear. A total of 105 patients with osteoporosis were recruited. Clinical and followed-up information was recorded. And vitamin B12, vitamin B2, vitamin A, and vitamin B9 in the blood were tested. Pearson's chi-squared and spearman tests were performed to analyze the correlation between spinal fractures and relative parameters. Univariate and multivariate logistic regression, univariate and multivariate Cox proportional hazards regression analysis. There exists strong relation between the expression level of vitamin B12 and spinal fractures. Pearson's chi-square and Spearman correlation test showed a strong association between vitamin B12 and vitamin B9 and a spinal fracture. Univariate logistic regression analysis showed that vitamin B12 and vitamin B9 were significantly associated with a spinal fracture. Multivariate logistic regression analysis showed that vitamin B12 was associated considerably with a spinal fracture. In addition, Cox regression analysis showed that vitamin B12 expression was significantly associated with maintenance time from recovery to recurrence (MTRR) of spinal fractures in patients with osteoporosis. Enhanced vitamin B12 is significantly correlated with the poor prognosis of patients with osteoporosis and the increasing incidence of a spinal fracture. The higher the vitamin B12, the higher the risk of spinal fracture and the shorter the time to spinal fracture recurrence.


Assuntos
Osteoporose , Fraturas da Coluna Vertebral , Humanos , Idoso , Vitamina B 12 , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/complicações , Osteoporose/epidemiologia , Ácido Fólico , Biomarcadores
9.
Front Endocrinol (Lausanne) ; 13: 1013597, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36387886

RESUMO

Purpose: This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric bone mineral density (vBMD) derived from quantitative CT (QCT) between those with a grade 1 vertebral fracture and non-fractured individuals. Materials and methods: 3,457 participants were enrolled in the China Action on Spine and Hip Status (CASH) study and had upper abdominal CT examinations. Vertebral fractures were identified by Genant's semi-quantitative method from lateral CT scout views or CT sagittal views. L1-3 vBMD was measured by Mindways QCT Pro v5.0 software. The characteristics of different fracture severity groups were compared using one-way ANOVA, independent-samples t-tests, and Kruskal-Wallis H-tests. Results: 1267 males (aged 62.77 ± 9.20 years) and 2170 females (aged 61.41 ± 9.01 years) were included in the analysis. In men, the prevalence of VF increased from 14.7% at age<50 years to 23.2% at age ≥70 years, and in women from 5.1% at age<50 years to 33.0% at age ≥70 years. Differences in mean age and vBMD were found between the different fracture grade groups. After age stratification, vBMD differences in men aged < 50 years old disappeared (p = 0.162) but remained in the older age bands. There was no significant difference in mean vBMD between those with multiple mild fractures and those with a single mild fracture. Conclusion: In women, the prevalence of VF increased rapidly after age 50, while it grew more slowly in men. In general, with the exception of men <50 years old, participants with a grade 1 VF had lower vBMD than non-fractured individuals. The majority of women younger than 50 with a grade 1 VF had normal bone mass. We recommend that a vertebral height reduction ratio of <25% be diagnosed as a deformity rather than a fracture in people under the age of 50. The presence of multiple mild fractured vertebrae does not imply lower BMD.


Assuntos
Fraturas Ósseas , Fraturas Múltiplas , Fraturas da Coluna Vertebral , Pessoa de Meia-Idade , Masculino , Idoso , Humanos , Feminino , Densidade Óssea , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , China/epidemiologia
10.
Medicine (Baltimore) ; 101(44): e31604, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343049

RESUMO

This study investigates the incidence and risk factors of new vertebral body collapse (VC) after posterior instrumented spinal fusion in patients older than 70 years. This retrospective study analyzed the data of elderly patients who underwent posterior instrumented spinal fusion in the thoracolumbar spine between January 2013 and December 2017. The 2 subsamples comprised of patients who had experienced vertebral compression fracture (VCF) before the index spinal surgery (group 1, n = 324) and those who had not (group 2, n = 1040). We recorded and analyzed their baseline characteristics, their underlying comorbidities, and the details of their current instrumented spinal fusion. The incidences of new VC and screw loosening were recorded. In groups 1 and 2, the incidences of new VC were 31.8% and 22.7%, respectively, and those of new VC with screw loosening were 25.6% and 33%, respectively. The risk factor was upper screw level at the thoracolumbar junction (hazard ratio [HR] = 2.181, 95% confidence interval [CI]: 1.135-4.190) with previous VCF. The risk factors were age ≥ 80 years (HR = 1.782, 95% CI: 1.132-2.805), instrumented levels > 4 (HR = 1.774, 95% CI: 1.292-2.437), and peptic ulcer (HR = 20.219, 95% CI: 2.262-180.731) without previous VCF. Clinicians should closely monitor new VC after posterior instrumented spinal fusion in elderly patients with previous VCF with upper screw level at the thoracolumbar junction and in patients without previous VCF aged ≥ 80 years, with instrumented levels > 4 and peptic ulcer.


Assuntos
Fraturas por Compressão , Úlcera Péptica , Fraturas da Coluna Vertebral , Fusão Vertebral , Idoso , Humanos , Fusão Vertebral/efeitos adversos , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/etiologia , Fraturas por Compressão/epidemiologia , Fraturas por Compressão/cirurgia , Fraturas por Compressão/complicações , Incidência , Estudos Retrospectivos , Corpo Vertebral , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Fatores de Risco , Úlcera Péptica/complicações , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesões
11.
Medicine (Baltimore) ; 101(44): e28073, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343062

RESUMO

INTRODUCTION: Talar neck fractures are injuries which frequently result in adverse outcomes or impairment of functional activity. Four groups were identified according to Hawkins classification and Canale modification. We present a female patient with a fractured neck of the talus associated with talonavicular dislocation, but intact tibiotalar and subtalar joints; an injury pattern not fulfilling the criteria described in the Hawkins classification. PATIENT CONCERNS: A 46-year-old woman missed a step and fell down stairs with an immediate painful right ankle and inability to bear weight. DIAGNOSIS: Talar neck fracture with an unusual isolated talonavicular dislocation. INTERVENTIONS: Temporary closed reduction followed by open reduction and internal fixation were performed. OUTCOMES: The patient had excellent functional and radiological outcomes following surgical management. CONCLUSION: We discuss the management of this rare case in addition to a review of the current literature to provide the best evidence-based recommendations for this injury pattern.


Assuntos
Fraturas Ósseas , Luxações Articulares , Lesões do Pescoço , Fraturas da Coluna Vertebral , Tálus , Feminino , Humanos , Pessoa de Meia-Idade , Tálus/diagnóstico por imagem , Tálus/cirurgia , Tálus/lesões , Fraturas Ósseas/cirurgia , Fixação Interna de Fraturas , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Luxações Articulares/complicações , Redução Aberta , Fraturas da Coluna Vertebral/complicações , Lesões do Pescoço/complicações
12.
Artigo em Inglês | MEDLINE | ID: mdl-36361195

RESUMO

The trabecular bone score (TBS) estimates bone microarchitecture and can be used to evaluate the risk of osteoporotic fractures independently of bone mineral density (BMD). In this retrospective case-control study, we tested and compared the ability of TBS and lumbar spine BMD (LS-BMD) to predict vertebral fragility fractures. The inclusion criteria were female sex, age range 50-90 years, menopause, and clinical risk factors for osteoporosis. Patients with secondary osteoporosis were excluded. LS-BMD and TBS were measured at the L1-L4 vertebral level. The ability of the two diagnostic systems in predicting vertebral fragility fractures was assessed by combining LS-BMD and TBS according to the Bayesian "OR rule" (the diagnosis is negative only for those negative for both tests, and it is positive for those who were positive for at least one test) or to the "AND rule" (the diagnosis is positive only for those positive to both tests and is negative for those negative for at least one test). Of the 992 postmenopausal women included, 86 had a documented vertebral fragility fracture. At the cutoff value used in the present study, the TBS and LS-BMD showed a similar diagnostic ability to predict vertebral fragility fractures, having positive predictive values (PPV) of, respectively, 13.19% and 13.24%. Negative predictive values (NPV) were, respectively, 95.40% and 94.95%. Compared to that of each single diagnostic system, the "OR-rule" significantly increased the NPV to 97.89%, while no statistically significant differences were found by using the "AND-rule". In conclusion, the present study highlights the possibility that combining LS-BMD and TBS could improve their predictive ability in diagnosing vertebral fragility fractures, and that there is a significant probability of absence of fractures in women who test negative to both diagnostic systems.


Assuntos
Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Densidade Óssea , Osso Esponjoso , Teorema de Bayes , Estudos de Casos e Controles , Estudos Retrospectivos , Pós-Menopausa , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Osteoporose/complicações , Vértebras Lombares/diagnóstico por imagem , Absorciometria de Fóton
13.
Sci Rep ; 12(1): 18868, 2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36344575

RESUMO

This study introduced a novel point "O" puncture approach for percutaneous kyphoplasty (PKP) in patients with L4 or L5 osteoporotic vertebral compression fracture (OVCF) and evaluated its clinical and radiographic outcomes. Between September 2019 and December 2020, we compared the clinical and radiographic outcomes in 31 cases (36 vertebrae) using the "O" entry point PKP intervention (O-PKP) and 31 cases (37 vertebrae) using transverse the process-pedicle approach PKP intervention (T-PKP). No serious postoperative complications were observed in any of the participants. Only two T-PKP patients experienced intervertebral disc space leakage. Compared with the T-PKP patients, the O-PKP patients showed shorter operative time and fluoroscopy times (P < 0.05), comparable blood loss and cement volume (P > 0.05), improved VAS and ODI scores at the final follow-up (P < 0.05), better increases in the vertebral compression ratio (P < 0.05), comparable Cobb angle (P > 0.05), comparable anteroposterior bone cement distribution, enhanced bilateral bone cement distribution (P < 0.05), and larger sagittal and transverse angles (P < 0.05). Herein, O-PKP was indicated for patients with L4 or L5 OVCF. This puncture approach showed significant advantages over T-PKP not only in terms of pain relief, surgery and fluoroscopy times but also in the puncture angle, vertebral reconstruction, and symmetrical cement distribution.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Humanos , Cifoplastia/efeitos adversos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Fraturas por Compressão/complicações , Cimentos Ósseos/uso terapêutico , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/complicações , Estudos Retrospectivos , Resultado do Tratamento , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Fraturas por Osteoporose/etiologia , Coluna Vertebral , Punções/efeitos adversos
14.
BMC Musculoskelet Disord ; 23(1): 959, 2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36344957

RESUMO

BACKGROUND: Minimally invasive percutaneous transpedicular screw fixation (MIPTSF) is generally accepted as a minimally invasive treatment for thoracolumbar fracture. However, hidden blood loss (HBL) caused by this procedure is usually disregarded. This study aimed to investigate the amount of HBL and its influencing factors after MIPTSF in thoracolumbar fracture. METHODS: Between October 2017 and December 2020, a total of 146 patients (106 males and 40 females, age range 21-59 years) were retrospectively examined, and their clinical and radiological data were recorded and analyzed. The Pearson or Spearman correlation analysis was used to investigate an association between patient's characteristics and HBL. Multivariate linear regression analysis was performed to elucidate the related clinical or radiological factors of HBL. RESULTS: A substantial amount of HBL (164.00 ± 112.02 ml, 40.65% of total blood loss (TBL)) occurred after transpedicular screw internal fixation. Multivariate linear regression analysis revealed that HBL was positively associated with TBL (p < .001), percentage of vertebral height loss (VHL) (p < .001), percentage of vertebral height restoration (VHR) (p < .001), numbers of fractured vertebrae (P = .013), and numbers of fixed vertebral segments (P = .002). CONCLUSION: A large amount of HBL was incurred in patients undergoing MIPTSF in thoracolumbar fracture. More importantly, TBL, percentage of VHL, percentage of VHR, the numbers of fractured vertebrae and fixed vertebral segments were independent risk factors for HBL.


Assuntos
Parafusos Pediculares , Fraturas da Coluna Vertebral , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesões , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Parafusos Ósseos/efeitos adversos , Resultado do Tratamento
15.
BMC Musculoskelet Disord ; 23(1): 953, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36329449

RESUMO

OBJECTIVE: To compare the breakage risk of lengthened sacroiliac screws and ordinary sacroiliac screws to treat unilateral vertical sacral fractures and provide a reference for clinical application. METHODS: A finite element model of Tile C pelvic ring injury (unilateral type Denis II fracture of the sacrum) was produced. The sacral fractures were fixed with a lengthened sacroiliac screw and ordinary sacroiliac screw in 6 types of models. The maximal von Mises stresses and stress distributions of the two kinds of screws when standing on both feet were measured and compared. RESULTS: The maximal von Mises stress of the lengthened screw was less than that of the ordinary screw. Compared with ordinary screw, the stress distribution in the lengthened screw was more homogeneous. CONCLUSIONS: The breakage risk of screws fixed in double segments is lower than that of screws fixed in single segments, the breakage risk of lengthened screws is lower than that of ordinary screws, and the breakage risk of screws fixed in S2 segments is lower than that of screws fixed in S1 segments.


Assuntos
Fraturas Ósseas , Fraturas da Coluna Vertebral , Humanos , Sacro/diagnóstico por imagem , Sacro/cirurgia , Sacro/lesões , Análise de Elementos Finitos , Parafusos Ósseos/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia
16.
Medicina (Kaunas) ; 58(11)2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36363539

RESUMO

Background and Objectives: Although urogenital injuries are common in severely injured patients, their diagnosis is often delayed. Predicting genitourinary injuries (GUI), especially in the immediate stages post injury, remains a challenge. This study aims to evaluate and determine positive predictive factors for the presence of GUI in polytrauma patients. Subsequently, these factors shall be used to develop an easy-to-use scoring system, deployable directly in the emergency setting. Materials and Methods: This study evaluates all severely injured patients with an Injury Severity Score (ISS) ≥ 16 admitted to the emergency departments of two German university hospitals between 2016 and 2020. These patients were retrospectively scanned for injuries of the thoracic and/or lumbar spine and/or the pelvic girdle. Demographic data was analyzed alongside trauma mechanism, type of injuries, mortality, length of hospital stays, surgeries, laboratory results, and urological treatment. Subgroup analysis was performed to compare patients with and without GUIs using t-tests. Conducting a binary logistic regression model, the significant factors were combined to create a scoring system, which was further analyzed for accuracy. Results: In total, 413 patients with an average ISS of 33.8 ± 15.0 were identified, and 47 patients (11.4%) sustained urogenital injuries with an average Abbreviated Injury Scale (AIS) score of 2.3 ± 1.1 (range: 1-5). The severity of the pelvic girdle injury correlated with the presence of urogenital injuries (p = 0.002), while there was no correlation with spinal injuries. Moreover, most GUIs resulted from motorcycle accidents (p < 0.001) and 87.2% of these patients were male. Patients with GUI were significantly more likely to show macrohematuria (p < 0.001) on admission and were more severely injured overall (ISS > 34). There was no significant difference in the length of intensive care unit (ICU) stay, the days until discharge, or death rates. Conclusions: Factors or circumstances which reliably predict the presence of GUI were found to include the male sex, a motorcycle accident, high severity of pelvic girdle fractures, macrohematuria on admission to the emergency department, and an ISS > 34. With these findings, we introduce the 'Urotrauma in Polytrauma patients with Pelvic and/or Spinal injuries' (UPPS) score for easier prediction of GUI in the emergency setting.


Assuntos
Fraturas Ósseas , Traumatismo Múltiplo , Fraturas da Coluna Vertebral , Traumatismos da Coluna Vertebral , Humanos , Masculino , Feminino , Estudos Retrospectivos , Hematúria , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico , Fraturas Ósseas/complicações , Fraturas Ósseas/epidemiologia , Traumatismos da Coluna Vertebral/complicações
17.
J Orthop Surg Res ; 17(1): 504, 2022 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-36434588

RESUMO

BACKGROUND CONTEXT: Posterior percutaneous long-segment internal fixation and open fixation with long-segment screws have been used to treat thoracolumbar fractures in ankylosing spondylitis patients. PURPOSE: To observe the clinical effect of posterior percutaneous long-segment internal fixation in 26 ankylosing spondylitis (AS) patients with thoracolumbar fractures. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Forty-seven AS patients who were diagnosed with thoracolumbar fractures and treated from December 2014 to December 2018. OUTCOME MEASURES: Visual analog scale score, Cobb angle, American Spinal Injury Association Grade, SF-Qualiveen score, pedicle screw misplacement rate, operative duration, blood loss, complications, bed rest duration and modified MacNab score. METHODS: All patients were divided into the percutaneous group (PG) and the open group. Twenty-six patients were treated with percutaneous long-segment internal fixation, and the remaining 21 underwent open fixation with long-segment screws. The minimum follow-up period was 12 months. RESULTS: The operations were successful in both groups. A patient in the PG showed class C wound healing, while the others showed class A healing, and some patients experienced perioperative complications. All patients were followed up for 12-48 months (mean, 33.81 months), and all patients showed clinical osseous fracture healing. Significant differences were found in operative duration, intraoperative blood loss and postoperative bed rest duration between the two groups (P < 0.05). No significant difference was found in improvement of the visual analog scale score, Cobb angle of spinal kyphosis or neurological function after the operation (P > 0.05). CONCLUSIONS: As a minimally invasive procedure, posterior percutaneous long-segment internal fixation requires less time, results in less blood loss and causes less trauma. This procedure can also improve patients' pain, neurological function and kyphotic deformity and achieve effects similar to those of traditional methods. With this curative clinical effect, this procedure can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients, especially for elderly patients with underlying diseases and high surgical risk.


Assuntos
Fraturas Ósseas , Cifose , Fraturas da Coluna Vertebral , Espondilite Anquilosante , Humanos , Idoso , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
18.
J Orthop Surg Res ; 17(1): 507, 2022 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-36434651

RESUMO

BACKGROUND: Many surgeons have encountered patients who could not immediately undergo surgery to treat spinal fractures because they had associated injuries and/or because a complete diagnosis was delayed. For such patients, practitioners might assume that delays could mean that the eventual reduction would be insufficient. However, no report covered risk factors for insufficient reduction of fractured vertebra including duration from injury onset to surgery. The purpose of this study is to investigate the risk factors for insufficient reduction after short-segment fixation of thoracolumbar burst fractures. METHODS: Our multicenter study included 253 patients who sustained a single thoracolumbar burst fracture and underwent short-segment fixation. We measured the local vertebral body angle (VBA) on roentgenograms, before and after surgery, and then calculated the reduction angle and reduction rate of the fractured vertebra by using the following formula: [Formula: see text] A multiple logistical regression analysis was performed to identify risk factors for insufficient reduction. The factors that we evaluated were age, gender, affected spine level, time elapsed from injury to surgery, inclusion of vertebroplasty with surgery, load-sharing score (LSS), AO classification (type A or B), preoperative VBA, and the ratio of canal compromise before surgery. RESULTS: There were 140 male and 113 female patients, with an average age of 43 years, and the mean time elapsed between injury and surgery was 3.8 days. The mean reduction angle was 12°, and the mean reduction rate was 76%. The mean LSS was 6.4 points. Multiple linear regression analysis revealed that a higher LSS, a larger preoperative VBA, a younger age, and being female disposed patients to having a larger reduction angle and reduction rate. The time elapsed from injury to surgery had no relation to the quality of fracture reduction in the acute period. CONCLUSIONS: Our findings indicate that if there is no neurologic deficit, we might not need to hurry surgical reduction of fractured vertebrae in the acute phase.


Assuntos
Fraturas Cominutivas , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Masculino , Feminino , Lactente , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Vértebras Torácicas/lesões , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Fatores de Risco
19.
Neurol India ; 70(Supplement): S135-S143, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412360

RESUMO

Background: Accuracy of screw placement is one of the important factors necessary for adequate union in odontoid fractures with malposition rates as high as 27.2% with standard techniques. Objective: To evaluate efficacy of intraoperative O-arm assistance in improving accuracy of anterior odontoid screw placement and clinco-radiological outcome in type II and III odontoid fractures. Material and Methods: In this retrospective study, surgery consisted of anterior odontoid screw fixation under intraoperative O-arm assistance over 5 years. Demographical, clinical, radiological, operative details and postoperative events were retrieved from hospital database and evaluated for fusion and surgical outcome. Results: 50 patients (Mean age 34.6 years, SD 14.10, range: 7-70 years; 44 males and 6 females) with Type II and Type III odontoid fracture underwent O-arm assisted anterior screw placement. The mean interval between injury and surgery was 12 days (range 1-65 days). Mean operating time was 132.2 min ± SD 33.56 with average blood loss of 93 ml. ±SD 61.46. With our technique, accurate screw placement was achieved in 100% patients. At the mean follow-up of 26.4 month (SD13.75), overall acceptable fusion rate was 97.8% with non-union in 2.2% patients. Morbidity occurred in two patients; one patient developed fixation failure while other patient had nonunion which was managed with posterior C1-C2 arthrodesis. We had surgical mortality in one patient due to SAH. So overall our procedure was successful in 94% patients and among patients whose follow-up was available, acceptable fusion rates of 97.8% were achieved. Conclusion: We conclude that use of intraoperative three-dimensional imaging using O-arm for anterior odontoid screw fixation improves accuracy and leads to improved radiological and clinical outcomes. It further enables us to extend the indications of odontoid screw fixation to selected complex Type II and rostral Type III odontoid fractures.


Assuntos
Fixação Interna de Fraturas , Processo Odontoide , Fraturas da Coluna Vertebral , Cirurgia Assistida por Computador , Adulto , Feminino , Humanos , Masculino , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Imageamento Tridimensional/métodos , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/lesões , Processo Odontoide/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Criança , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Idoso
20.
Neurol India ; 70(Supplement): S296-S301, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412384

RESUMO

Background: Ankylosing spondylitis (AS) is a seronegative arthropathy which results in pathological ossification of the ligaments, disc, endplates and apophyseal structures. Cervical spinal fractures are more common in patients with ankylosing spondylitis than in patients without ankylosing spondylitis due to coexistent osteoporosis and kyphotic alignment of the spine. The risk of fracture-dislocation and associated spinal cord injury is also more in these patients. Management of cervical spine fractures in patients with ankylosing spondylitis is more challenging. Case Description: We report a 56-year-old male patient who presented to our emergency department following a road traffic accident. He had ASIA B spinal cord injury at C7 level. CT scan revealed a C6-7 fracture-dislocation with features suggestive of AS. The fracture involved all the three columns and extended through C7 body anteriorly and through the C6-7 disc posteriorly. The treating team was not aware that he had AS, and thus, precautions related to his head position were not taken. He underwent reduction of the fracture-dislocation and 360° fixation. Conclusions: The management of cervical spine fractures in patients with ankylosing spondylitis is challenging. They need long segment fixation in their preoperative spinal alignment. Proper preoperative planning can result in good outcome.


Assuntos
Vértebras Cervicais , Luxações Articulares , Traumatismos da Medula Espinal , Fraturas da Coluna Vertebral , Espondilite Anquilosante , Humanos , Masculino , Pessoa de Meia-Idade , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Vértebras Cervicais/lesões , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Lesões do Pescoço/complicações , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/patologia , Acidentes de Trânsito , Fusão Vertebral/métodos , Fixação Interna de Fraturas/métodos
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