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1.
Medicine (Baltimore) ; 99(11): e19354, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176057

RESUMO

RATIONALE: Leakage of bone cement is a common complication after percutaneous kyphoplasty. In rare cases, bone cement can leak into the venous system, which can be life threatening, especially when it causes an embolism in the heart. PATIENT CONCERNS: A 79-year-old female patient developed chest pain with chest tightness 3 weeks after the percutaneous kyphoplasty. DIAGNOSES: Initially, negative fluoroscopy results and elevated myocardial enzymes suggested that the patient's chest pain and chest tightness symptoms were manifestations of coronary heart disease. However, in the subsequent computed tomography (CT) examination, foreign bodies in the heart and pulmonary vessels were found. INTERVENTIONS: The patient underwent emergency surgery to remove the bone cement and repair the tricuspid valve. OUTCOMES: The postoperative course was uneventful and the patient was discharged on the 13th day after surgery. LESSONS: If a patient develops chest pain with chest tightness after percutaneous kyphoplasty, the clinicians must be vigilant and take into account the limited sensitivity of fluoroscopy and use chest computer tomography and echocardiogram as the first choice and thereby prevent serious consequences.


Assuntos
Cimentos para Ossos/efeitos adversos , Embolia/etiologia , Embolia/cirurgia , Corpos Estranhos/diagnóstico por imagem , Cifoplastia/efeitos adversos , Fraturas da Coluna Vertebral/cirurgia , Idoso , Cimentos para Ossos/uso terapêutico , Ecocardiografia/métodos , Embolia/diagnóstico por imagem , Feminino , Fluoroscopia/métodos , Seguimentos , Corpos Estranhos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Cifoplastia/métodos , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
2.
Rev Med Suisse ; 16(685): 492-497, 2020 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-32167251

RESUMO

Should we continue to treat patients suffering from an acute osteoporotic vertebral fracture with vertebroplasty ? What is the potential benefit ? What are its indications ? What are its risks ? Which way to perform it ? How to manage the osteoporosis evaluation and therapy ? In 2009 we published the «â€…CHUV consensus ¼ on the management of vertebral osteoporotic fractures by vertebroplasty. We here propose an update including recent knowledge on the management of vertebral fractures by bone insufficiency by percutaneous cementoplasty.


Assuntos
Fraturas por Osteoporose/cirurgia , Guias de Prática Clínica como Assunto , Vertebroplastia , Consenso , Humanos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
3.
Artigo em Inglês | MEDLINE | ID: mdl-32131965

RESUMO

PURPOSE OF THE STUDY In this randomized prospective study, we monitored and compared perioperative changes in skeletal muscle enzymes blood levels in open and mini-invasive stabilization of thoracolumbar spine fractures. The established hypothesis was to confirm higher blood levels of muscle enzymes in open stabilization. MATERIAL AND METHODS This study included 38 patients with the mean age of 46.4 years. 19 injuries were managed in an open procedure and 19 procedures were mini-invasive. Venous blood was taken intermittently at short intervals to determine the levels of skeletal muscle enzymes. The catalytic concentration of creatine kinase was determined via an enzymatic UV-test, and the concentration of myoglobin via electro-chemiluminescent immunoassay. Enzyme levels were processed statistically. The Wilcoxon test was used. RESULTS The median increase in the values of both enzymes is higher in the mini-invasive method than in the open method in both the surgery phase for the injury and in the extraction phase. The median increase in the values of both enzymes is higher in both methods for the primary procedure phase compared to the extraction phase. All results are statistically significant at p of <0.05. All tests were calculated using the MATLAB Statistics Toolbox. DISCUSSION A very surprising finding, when testing the hypothesis of the levels increasing mainly in open stabilization, was confirming the opposite. Both enzymes were higher in the mini-invasive approach to stabilising the spine after the injury, but also after the extraction. This contradicts the available literature. However, this can be explained by the methodology of enzyme levels determination in the previously published studies. We believe that this phenomenon can be partially caused by an iatrogenic mini-compartment of muscles in the postoperative period, absence of wound drainage, but also by higher muscle contusion when inserting bolts through the tubes via small incisions, when the tubes penetrate to the entry points relatively violently and the muscles in this area are affected more than in the classical skeletization. CONCLUSIONS Analysis of biochemical changes in open and mini-invasive surgery did not confirm the hypothesis that levels of creatine kinase and myoglobin enzymes increase especially in open stabilization. On the contrary, they were statistically significantly higher in mini-invasive procedures. Key words: creatine kinase, myoglobin, muscle enzymes, spine fracture, spine surgery, miniinvasive surgery.


Assuntos
Creatina Quinase , Doenças Musculares , Mioglobina , Fraturas da Coluna Vertebral , Creatina Quinase/metabolismo , Humanos , Vértebras Lombares , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Doenças Musculares/diagnóstico , Doenças Musculares/etiologia , Mioglobina/metabolismo , Estudos Prospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas
4.
Zhongguo Gu Shang ; 33(2): 111-5, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133807

RESUMO

OBJECTIVE: To investigate the guiding significance of lumbar quantitative computed tomography (QCT) in percutaneous vertebroplasty (PKP) for osteoporotic vertebral compression fractures (OVCF). METHODS: The clinical data of 90 patients with OVCF underwent PKP from December 2017 to December 2018 were retrospectively analyzed. There were 24 femalesand66males, withanaverage agedof (74.47±6.60) yearsold. Allpatientswere received QCT examination before surgery, andaccording to the QCT value oflumbarspine, the patientswere dividedinto osteopenia decrease group (80 to 120 g/L, 17 cases, 30 vertebrae), osteoporosis group (40 to 80 g/L, 44 cases, 66 vertebrae) and severe osteoporosis group (<40 g/L, 29 cases, 39 vertebrae). Bone cement was injected into vertebral body, AP and lateral X-rays were done during operation. The diffusion and leakage of bone cement in injured vertebrae of patients with different QCT values were observed. Unilateral approach was used for patients whose bone cement diffused beyond the midline of the vertebral body, otherwise, and bilateral approach was adopted, and guiding significance of QCT in PKP for OVCF was analyzed. RESULTS: In 90 cases of 135 vertebrae, 72 cases of 98 vertebral bone cement diffused beyond the midline, accounting for 72.59%. Unilateral approach was used for the 72 patients whose bone cement diffused beyond the midline of the vertebral body, among them, there were 5 cases with 8 vertebrae in osteopenia group, 40 cases with 55 vertebrae in osteoporosis group and 27 cases with 35 vertebrae in severe osteoporosis group. There was significant difference in the bone cement dispersion between three groups (χ2=41.397, P=0.000). Moreover, no bone cement leakage occurred in osteopenia group, 3 cases of 4 vertebrae occurred in osteoporosis group and 2 cases of 3 vertebrae in severe osteoporosis group. However, none of the patients with bone cement leakage caused nerve injury and other symptoms, and there was no significant difference in bone cement leakage between the three groups (χ2=2.242, P=0.326). CONCLUSION: According to the QCT examination of lumbar spine, defining the degree of osteoporosis and guiding the puncture method can shorten the operation time, reduce the number of fluoroscopy, and effectively improve the safety of vertebroplasty.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos para Ossos , Fraturas por Compressão/cirurgia , Humanos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
5.
Zhonghua Wai Ke Za Zhi ; 58(3): 161-164, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187918

RESUMO

Vertebral compression fractures(VCFs) are severe and common complications of osteoporosis. Most VCFs were caused by osteopenia or osteoporosis. Nevertheless, spinal metastases probably result in pathological fractures that easily confused with osteoporotic vertebral compression fractures(OVCFs). Using biopsy during vertebral augmentation(VA) is considered as the golden standard protocol to rule out pathological VCFs. Up to data, conventionally using biopsy during VA is suggested by more and more researchers to confirm the etiology of VCFs and to avoid missed diagnosis and misdiagnosis of spinal metastases with pathological vertebral fractures as the first manifestation. For patients with spinal metastases, histological evaluation of vertebral biopsy specimens is convenient for further treatment.


Assuntos
Fraturas por Compressão/cirurgia , Osteoporose/complicações , Fraturas da Coluna Vertebral/cirurgia , Biópsia , Fraturas por Compressão/etiologia , Humanos , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral/patologia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(6): e19053, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028424

RESUMO

RATIONALE: Traditionally, transpedicular approach was used in the treatment of osteoporotic lumbar compression fracture. In order to avoid the risks of pedicle disruption and spinal canal intrusion, extrapedicular approache has been attempted. The aim of the article is to present the modified extrapedicular kyphoplasty technique for the treatment of osteoporotic lumbar compression fracture. PATIENT CONCERNS: A 62-year-old woman suffered from severe low back pain after an accidental fall 10 days ago. Low back pain was obvious when turning over and getting out of bed. It was not relieved after bed rest and conservative treatment. Visual analog scale (VAS) of low back pain was 8 points and Oswestry disability index score was 80%. DIAGNOSIS: Magnetic resonance imaging showed osteoporotic vertebral compression fracture of L2 and L3. INTERVENTIONS: We performed modified extrapedicular kyphoplasty for the patient. The technique has a standardized operating procedure. The puncture point of skin is determined according to preoperative computer tomography and X-ray. The puncture point of vertebral body is located at the outer upper edge of the pedicle. The puncture direction is from the upper edge of the pedicle to the lower edge of the contralateral pedicle. OUTCOMES: The operation time was 20 minutes. The intraoperative blood loss was 5 mL. The amount of bone cement was 4 mL in L2 and 5 mL in L3. VAS of low back pain was 2 points in 1 day after surgery. Preoperative symptoms were significantly improved. LESSONS: Modified extrapedicular kyphoplasty is a safe and effective technique for the treatment of osteoporotic lumbar compression fracture, which should be promoted and applied.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/cirurgia , Perda Sanguínea Cirúrgica , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Duração da Cirurgia , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
Khirurgiia (Mosk) ; (2): 84-88, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105261

RESUMO

A 55-year-old patient M. with compression fractures of Th7-Th8 underwent Th7-Th8 decompressive laminectomy, Th6-Th9 transpedicular spine fusion procedure on January 31, 2017. After that, multiple myeloma was diagnosed at the National Research Center for Hematology. Computed tomography revealed misplacement of a left Th6 screw, its anterior cortical perforation and penetration into the aorta. Signs of intramural hematoma were noticed in this area. The patient was referred to the Petrovsky National Research Center of Surgery. Two-stage surgical approach was preferred. Endovascular repair of the thoracic aorta (TEVAR) was followed by revision of transpedicular fusion system and reinstallation of the screw. Operation was performed on July 14, 2017. Postoperative period was uneventful.


Assuntos
Aorta Torácica , Hematoma , Fraturas da Coluna Vertebral , Fusão Vertebral , Hematoma/etiologia , Humanos , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Torácicas , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(7): e19037, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049800

RESUMO

RATIONALE: We present a rare case of a traumatic intradural ruptured disc associated with a mild vertebral body compression fracture along with a review of the relevant medical literature. An intradural ruptured disc often occurs due to chronic degenerative diseases and is rarely due to trauma. It can cause irreversible neurological complications if the appropriate treatment is not planned. PATIENT CONCERNS: A 32-year-old male presented with motor paraparesis (grade 3/5), right ankle dorsiflexion, and great toe dorsiflexion (grade 1/5), along with radiating pain at his right L4 and L5 sensory dermatome following a fall. DIAGNOSES: Computed tomography revealed a compression fracture of the L2 body. Lumbar magnetic resonance imaging showed an intradural mass-like lesion on the ventral side of his spinal cord and an epidural mass-like lesion on the dorsal side of his spinal cord, indicating a hematoma. INTERVENTIONS: An emergency L2 laminectomy was performed to remove the space-occupying lesions and to decompress the cauda equina and nerve root. The mass-like lesion was removed. No other lesions were found in the spinal canal. OUTCOMES: Pathologic examination of the intradural mass lesion revealed fibrocartilage similar to that found in disc material. The patient still continued to experience motor weakness at the 1-year follow-up examination. LESSONS: We report a rare case of a traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture. Early diagnosis and prompt surgical intervention are essential, as is performing a magnetic resonance imaging or computed tomography myelogram promptly to evaluate the spinal canal when there are unexplained neurologic symptoms. An intraspinal canal evaluation should be completed before the postural reduction of the vertebral body fracture to prevent any neurological complications.


Assuntos
Fraturas por Compressão/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes por Quedas , Adulto , Descompressão Cirúrgica , Fraturas por Compressão/diagnóstico por imagem , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Laminectomia , Imagem por Ressonância Magnética , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(7): e19046, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049803

RESUMO

INTRODUCTION: It is well known that the main segments of spinal fracture is thoracolumbar (T11-L11). Therefore, in addition to the lumbar, the lower thoracic vertebra (T9-T12) often has the clinical needs of implantation of cortical bone trajectory (CBT) screws. However, the anatomic parameters of the lower thoracic vertebrae are quite different from those of the lumbar vertebrae, which means that if CBT screws are to be implanted in the lower thoracic vertebrae, the selection of the screw entry point, the length, diameter, angle and path of the screws in each segment need to be redefined. Methods In this part, 3-dimensional finite element model was established to analyze the stress and fixation efficiency of CBT screws in thoracic vertebrae after 5000 times of fatigue loading of normal model and osteoporosis model. Discussion If the outcomes indicate the trial is feasible and there is evidence to provide some basic anatomical parameters for CBT screw implantation in the lower thoracic spine, so that the ideal insertion point, length, diameter, and angle of CBT screw in different segments of the lower thoracic spine were determined.Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026915.Registered on September 26, 2019.


Assuntos
Procedimentos Ortopédicos/instrumentação , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Fenômenos Biomecânicos , Parafusos Ósseos , Osso Cortical/anatomia & histologia , Osso Cortical/cirurgia , Estudos de Viabilidade , Feminino , Análise de Elementos Finitos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Vértebras Torácicas/anatomia & histologia , Adulto Jovem
10.
Radiologe ; 60(2): 138-143, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31989205

RESUMO

BACKGROUND: Despite optimal drug-conservative therapy, a relevant percentage of patients with vertebral compression fractures (WKF) do not experience any relevant improvement in their pain symptoms. Vertebroplasty (VP) and kyphoplasty (KP) are described in the literature as percutaneous interventional procedures for the treatment of WKF. OBJECTIVE: Assessment of the effectiveness of the VP and KP in the treatment of WKF and discussion of the procedures in the context of the current literature. MATERIAL AND METHODS: Presentation of the fundamentals of VP and KP and their further developments. Description of indications and contraindications. Discussion of the current literature and recommendations of the individual professional associations. RESULTS: In patients with vertebral compression fractures, VP or KP of the affected vertebral body leads to a pain reduction in more than 90% of cases. Clinically relevant complications occur in less than 1% of interventions. CONCLUSION: VP and KP are a safe and effective method for treating painful WKF. Optimal patient selection improves the clinical outcome.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas da Coluna Vertebral , Vertebroplastia , Contraindicações , Humanos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
11.
J Surg Res ; 246: 123-130, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31569034

RESUMO

BACKGROUND: National changes in health care disparities within the setting of trauma care have not been examined within Accountable Care Organizations (ACOs) or non-ACOs. We sought to examine the impact of ACOs on post-treatment outcomes (in-hospital mortality, 90-day complications, and readmissions), as well as surgical intervention among whites and nonwhites treated for spinal fractures. MATERIALS AND METHODS: We identified all beneficiaries treated for spinal fractures between 2009 and 2014 using national Medicare fee for service claims data. Claims were used to identify sociodemographic and clinical criteria, receipt of surgery and in-hospital mortality, 90-day complications, and readmissions. Multivariable logistic regression analysis accounting for all confounders was used to determine the effect of race/ethnicity on outcomes. Nonwhites were compared with whites treated in non-ACOs between 2009 and 2011 as the referent. RESULTS: We identified 245,704 patients who were treated for spinal fractures. Two percent of the cohort received care in an ACO, whereas 7% were nonwhite. We found that disparities in the use of surgical fixation for spinal fractures were present in non-ACOs over the period 2009-2014 but did not exist in the context of care provided through ACOs (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.44, 1.28). A disparity in the development of complications existed for nonwhites in non-ACOs (OR 1.09; 95% CI 1.01, 1.17) that was not encountered among nonwhites receiving care in ACOs (OR 1.32; 95% CI 0.90, 1.95). An existing disparity in readmission rates for nonwhites in ACOs over 2009-2011 (OR 1.34; 95% CI 1.01, 1.80) was eliminated in the period 2012-2014 (OR 0.85; 95% CI 0.65, 1.09). CONCLUSIONS: Our work reinforces the idea that ACOs could improve health care disparities among nonwhites. There is also the potential that as ACOs become more familiar with care integration and streamlined delivery of services, further improvements in disparities could be realized.


Assuntos
Organizações de Assistência Responsáveis/estatística & dados numéricos , Fixação de Fratura/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Organizações de Assistência Responsáveis/economia , Idoso , Idoso de 80 Anos ou mais , Grupos de Populações Continentais/estatística & dados numéricos , Redução de Custos/economia , Redução de Custos/estatística & dados numéricos , Grupos Étnicos , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/economia , Gastos em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/organização & administração , Mortalidade Hospitalar , Humanos , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/estatística & dados numéricos , Fatores Socioeconômicos , Fraturas da Coluna Vertebral/economia , Estados Unidos/epidemiologia
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1486-1490, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823545

RESUMO

Objective: To investigate the safety and effectiveness of pedicle screw implantation via vertebral arch-transverse pathway in clinical application by a prospective randomized controlled trial. Methods: Twenty-four patients who were admitted between May 2015 and June 2017 and met the selection criteria for thoracic pedicle screw fixation were included in the study. According to the random number table method, they were divided into the trial group (screw implantation via vertebral arch-transverse pathway) and the control group (traditional screw implantation technology), with 12 patients in each group. There was no significant difference between the two groups in age, gender, cause of injury, injured segment, and the interval between injury and operation (P>0.05). The time of screw implantation was recorded and compared between the two groups. The acceptable rate of screw implantation and the penetration rate of pedicle wall were calculated after operation. Results: The time of screw implantation of trial group was (5.08±1.74) minutes, which was significantly shorter than that of control group [(5.92±1.66) minutes], and the difference was significant (t=4.258, P=0.023). Patients in both groups were followed up 1-2 years, with an average of 1.5 years. During the follow-up, no failure of internal fixation occurred. At 1 week after operation, the screw implantation in trial group was rated as gradeⅠin 54 screws, gradeⅡ in 3 screws, and grade Ⅲ in 2 screws, with the acceptable rate of 93.61%. The screw implantation in control group was rated as gradeⅠin 40 screws, grade Ⅱin 10 screws, grade Ⅲ in 8 screws, and grade Ⅳ in 1 screw, with the acceptable rate of 84.75%. There was significant difference in the acceptable rate of screw implantation between the two groups (χ2=3.875, P=0.037). The penetration rate of pedicle wall in trial group was 8.47% (5/59), which was significantly lower than that in the control group [32.20% (19/59); χ2=4.125, P=0.021]. Conclusion: Compared with the traditional technique, the pedicle screw implantation via vertebral arch-transverse pathway can obtain a good position of the screw canal with higher accuracy and simpler operation.


Assuntos
Parafusos Pediculares , Fraturas da Coluna Vertebral , Fixação Interna de Fraturas , Humanos , Vértebras Lombares , Estudos Prospectivos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(50): e18217, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852080

RESUMO

To evaluate the influence of various distributions of bone cement on the clinical efficacy of percutaneous kyphoplasty (PKP) in treating osteoporotic vertebrae compression fractures.A total of 201 OVCF patients (30 males and 171 females) who received PKP treatment in our hospital were enrolled in this study. According to the characteristic of cement distribution, patients were divided into 2 groups: group A ("H" shaped group), the filling pattern in vertebral body were 2 briquettes and connected with / without cement bridge; and group B ("O" shaped group), the filling pattern in vertebral body was a complete crumb and without any separation. Bone mineral density, volume of injected cement, radiographic parameters, and VAS scores were recorded and analyzed between the 2 groups.All patients finished at least a 1-year follow-up and both groups had significant improvement in radiographic parameters and clinical results. No significant differences in BMD, operation time, bleeding volume, or leakage of cement were observed between the 2 groups. Compared with group B, group A had a larger use of bone cement, lower proportion of unipedicular approach, and better VAS scores at 1 year after surgery.Both "H" and "O" shaped distribution pattern can improve radiographic data and clinical outcomes effectively. However, "H" shaped distribution can achieve better clinical recovery at short-term follow-up.


Assuntos
Cimentos para Ossos , Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Vértebras Lombares/lesões , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Idoso , Densidade Óssea , Feminino , Seguimentos , Fraturas por Compressão/diagnóstico , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Fraturas por Osteoporose/diagnóstico , Período Pós-Operatório , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Medicine (Baltimore) ; 98(50): e18285, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852104

RESUMO

RATIONALE: Compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition is a rare condition. Vertebral body compression fracture and high serum progesterone lead to extraosseous hemangioma enlargment cause narrowing the spinal canal which contribute to compressive myelopathy relate to pregnancy. PATIENT CONCERNS: We report a case of compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition in a 35-year-old woman. The patient complained unable to walk and experienced intense pain in the back. DIAGNOSIS: Based on the clinical features and imaging studies, the patient underwent a T4-T6 laminectomy. Histopathology consistent with vertebral hemangioma. INTERVENTIONS: The patient underwent laminectomy for decompression. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, there was no involvement of the lamina by the tumor. The epidural tumor was removed through the spaces lateral to the thecal sac. Vertebroplasty was performed through T5 pedicles bilaterally and 7 ml of polymethylmethacrylate (PMMA) cement was injected. T4-T6 pedicle screw fixation was performed for segmental fixation and fusion. OUTCOMES: Six months after resection of the tumor the patient remained asymptomatic. She reported no low back pain and had returned to her normal daily activities, with no radiographic evidence of recurrence on MRI. Physical examination revealed that superficial and deep sensation was restored to normal levels in the lower extremities. LESSONS: The occurrence of compressive myelopathy of pregnancy related vertebral hemangiomas is quite unusual. It can lead to serious neurologic deficits if not treated immediately. So, prompt diagnosis is important in planning optimal therapy and preventing morbidity for patients.


Assuntos
Fraturas por Compressão/complicações , Hemangioma/complicações , Parto , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/complicações , Vértebras Torácicas , Adulto , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/cirurgia , Hemangioma/diagnóstico , Hemangioma/cirurgia , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Vertebroplastia/métodos
15.
Rev Med Suisse ; 15(670): 2027-2031, 2019 Nov 06.
Artigo em Francês | MEDLINE | ID: mdl-31696677

RESUMO

Osteoporotic vertebral compression fracture is a frequent health problem in older persons that results in pain, morbidity but remains underdiagnosed. Although percutaneous vertebroplasty has been available for almost 30 years, the first randomized controlled trial was published only in 2007. Since then, multiple controlled studies mostly failed to definitely conclude about the benefits of this procedure, with meta-analyses of randomized controlled studies reporting rather negative results. This paper discusses the place of percutaneous vertebroplasty in the management of osteoporotic vertebral compression fractures in older persons.


Assuntos
Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Idoso , Humanos , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(44): e10281, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689741

RESUMO

BACKGROUND: It is unclear whether surgery or conservative treatment is more suitable for elderly patients with type II and type III odontoid fractures. We performed this meta-analysis to compare the efficacy of surgical and conservative treatments for type II and type III odontoid fractures. METHODS: A literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library in January 2017. Only articles comparing surgery with conservative treatment in elderly patients with type II and type III odontoid fractures were selected. After 2 authors independently assessed the retrieved studies, 18 articles were included in this meta-analysis, and the primary endpoints were the nonunion rate and mortality rate. The secondary outcomes were patient satisfaction, complications, and the length of the hospital stay. The quality of the included studies was evaluated using the modified Newcastle-Ottawa scale. Sensitivity analyses were performed for high-quality studies, and the publication bias was evaluated using a funnel plot. RESULTS: Lower nonunion (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.18-0.40, P < .05) and mortality rates (OR: 0.52, 95% CI: 0.34-0.79, P < .05) confirmed the superiority of surgery in treating type II and type III fractures. The secondary outcomes differed. Patients in the surgery group felt more satisfied with the outcome (OR: 3.44, 95% CI: 1.19-9.95, P < .05), and the complications were similar in the 2 groups (OR: 1.14, 95% CI: 0.78-1.68, P = .5), whereas patients in conservative groups spent less time in the hospital (OR: 5.10, 95% CI: 2.73-7.47, P < .05). The results of the subgroup analyses and sensitivity analysis were similar to the original outcomes, and no obvious publication bias was observed in the funnel plot. CONCLUSION: Most elderly (younger than 70 years) patients with type II or type III odontoid fractures should be considered candidates for surgical treatment, due to the higher union rate and lower mortality rate, while statistically significant differences were not observed in the population with an advanced age (older than 70 years). Therefore, the selection of the therapeutic approach for elderly patients with odontoid fractures requires further exploration. Simultaneously, based on our meta-analysis, a posterior arthrodesis treatment was significantly superior to the anterior odontoid screw treatment.


Assuntos
Tratamento Conservador/mortalidade , Fixação de Fratura/mortalidade , Processo Odontoide/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/efeitos adversos , Tratamento Conservador/métodos , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Humanos , Tempo de Internação/estatística & dados numéricos , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Fraturas da Coluna Vertebral/classificação
18.
Medicine (Baltimore) ; 98(44): e17776, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689843

RESUMO

RATIONALE: To our knowledge, this is the first report of traumatic combined vertical atlanto-occipital dislocation (AOD) and atlanto-axial dislocation (AAD) with 2-part fracture of the atlas. PATIENT CONCERNS: The first case was of a 31-year-old woman admitted to the emergency room comatose after a traffic accident. The second case was of a 21-year-old woman admitted to the emergency room comatose after a fall. DIAGNOSES: Traumatic combined vertical AOD and AAD with 2-part fractures of the atlas was diagnosed using plain radiography, 2-dimensional computed tomography, and/or magnetic resonance imaging of the cervical spine. INTERVENTION: The first patient received immediate intubation and cardiopulmonary resuscitation in the emergency room. The second patient also received immediate intubation in the emergency room. After her vitals stabilized, she underwent occipitocervical fusion with instrumentation. OUTCOMES: The first patient died 2 days after the accident. The second patient remained quadriplegic in a ventilatory-dependent state at 1 year after surgery. She continues to receive comprehensive rehabilitation. LESSONS: Immediate respiratory support and surgical stabilization are important for saving lives in this kind of extremely unstable and fatal complex upper cervical spine injury.


Assuntos
Articulação Atlantoaxial/lesões , Articulação Atlantoccipital/lesões , Atlas Cervical/lesões , Luxações Articulares/cirurgia , Fraturas Cranianas/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Articulação Atlantoaxial/cirurgia , Articulação Atlantoccipital/cirurgia , Atlas Cervical/cirurgia , Feminino , Humanos , Luxações Articulares/etiologia , Fraturas Cranianas/etiologia , Fraturas da Coluna Vertebral/etiologia , Fusão Vertebral/métodos , Adulto Jovem
19.
Medicine (Baltimore) ; 98(44): e17857, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689878

RESUMO

The aim of this study was to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) in Kambin triangle approach for the treatment of osteoporotic vertebral compression fractures (OVCFs).Between November 2017 and September 2018, 109 patients (144 vertebral bodies) with OVCFs, with a mean age of 76.7 ±â€Š9.9 years (55-96 years), underwent PVP in Kambin triangle approach. The time of operation, the volume of bone cement, the incidence of complication, the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score, the position of puncture needles, and the spread of polymethylmethacrylate (PMMA) in vertebral body (VB) were recorded.All patients had been completed the operation successfully and were followed up 9.1 ±â€Š2.9 months. The average operation time of each VB was 24.0 ±â€Š3.5 minutes. The average volume of cement was 4.8 ±â€Š0.6 ml. The mean VAS scores were 8.4 ±â€Š0.7 preoperatively, 1.6 ±â€Š0.6 at the first day postoperatively, and 1.2 ±â€Š0.6 at the last follow-up. The mean ODI scores were 70.97 ±â€Š7.73 preoperatively, 27.99 ±â€Š4.12 at the first day postoperatively, and 19.65 ±â€Š3.49 at the last follow-up. The position of puncture needles in the VB was: 119 vertebral puncture needles reached the midline, 15 were close to the midline, and 10 exceeded the midline. The spread of PMMA in the VB was: type 1 in 81 levels (56.3%), type 2 in 37 (25.7%), type 3 in 18 (12.5%), type 5 in 8 (5.5%), and no case in type 4. One case developed pneumothorax after operation. No other complications (hematoma, cement embolism, spinal cord, and nerve injury) occurred.Kambin triangle approach in PVP, which can deliver the puncture needle to the midline of VB easily and with excellent cement distribution, is a safe and effective method.


Assuntos
Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Polimetil Metacrilato , Complicações Pós-Operatórias , Estudos Retrospectivos , Vertebroplastia/efeitos adversos
20.
BMC Surg ; 19(1): 178, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31771582

RESUMO

BACKGROUND: Although various studies have described the outcomes and complications of each treatment for OF 4 in osteoporotic vertebral compression fractures (OVCFs), there is still no consensus on the optimal treatment regimen. This study aimed to investigate the clinical effect of OF 4 in patients with OVCFs treated with percutaneous vertebroplasty (PV) compared with PV in combination with intermediate bilateral pedicle screw fixation (IBPSF). METHODS: A total of 110 patients with OF 4 in OVCFs from January 2011 to December 2013 were reviewed retrospectively and divided into two groups (group A: PV, group B: PV + IBPSF). According to the guidelines of the German Society for Orthopaedics and Trauma (DGOU), OF 4 consists of 3 fracture types. The clinical and radiographic assessments were observed preoperatively, postoperatively, and during follow-up. RESULTS: The patients were followed for an average of 60.50 ± 15.20 months (group A) and 58.20 ± 17.60 months (group B) without significant differences. No significant differences were found in BMD, BMI and cement volume between the two groups, but differences were found for operation time, blood loss, and hospitalization time. The VAS and ODI scores improved better significantly at the final follow-up in group B but not in group A. Compared with the preoperative values, the postoperative kyphosis angle and loss of fractured segment height significantly improved, but the difference between the groups was significant after 3 months postoperatively. The loss of angular correction and fractured segment height in group A were greater than those in group B. A total of 15 cases of cement leakage were observed in group A and 8 cases in group B, and no complications or revision surgeries were observed in either group. Thirteen new fractures occurred (11 in group A and 2 in group B), which was significant. CONCLUSION: PV with IBPSF could provide effective restoration and maintenance of fractured segment height and segment alignment as well as a lower rate of complications of OF 4 in OVCFs.


Assuntos
Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Estudos de Coortes , Feminino , Fixação Interna de Fraturas , Humanos , Cifose/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Parafusos Pediculares , Período Pós-Operatório , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
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