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1.
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
2.
Neurocirugia (Astur : Engl Ed) ; 33(6): 275-283, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36333086

RESUMO

INTRODUCTION: The ankylosed spine is prone to increased fractures risk even after minor trauma. The lower cervical spine is most frequently injured, and fractures of the ankylosed spine tend to precipitate spinal cord injury (SCI). The objective of the current study is to assess the incidence, management, and outcomes of patients with ankylosis of the spine sustaining a cervical fracture with associated SCI over a 7-year period. MATERIAL AND METHODS: Prospective cohort study. Patients referred to the institution with a cervical fracture associated with SCI on a background of AS or DISH from 2009 to 2017 were reviewed. Demographics, mechanism of injury, fracture type, neurological level of injury, time to surgery, surgical management, neurological status (AIS), spinal cord independence measure (SCIMIII) scale at admission and discharge, and hospital length of stay. In September 2019 the summative data was analyzed using NDI, VAS, SV-QLI/SCI and length of survival were analyzed for statistical significance. Pathological fractures and dementia were excluded. RESULTS: 1613 patients with traumatic SCI were admitted in this period of whom 37 (12 AS and 25 DISH) met the inclusion criteria (mean age 65 years AS; 67 DISH). Fracture-dislocation was the most frequent fracture type (33% AS patients, 24% DISH patients). C4 was the most common neurological level of injury. SCIMIII score at admission was 1 point and 59 at discharge. AIS at admission was A (50%). At time of discharge no patient had neurologically deteriorated. Post-discharge mortality was 58% in AS patients and 32% in DISH patients (p=0.13). CONCLUSIONS: Both AS and DISH patients have high levels of disability and mortality associated with trauma to the cervical spine. Despite their distinct clinical differences, in this cohort there were no statistically significant differences between AS and DISH patients regarding fracture type, SCIMIII, AIS, hospital stay, mortality, VAS, and SV-QLI/SCI after cervical fracture over 7 years follow-up.


Assuntos
Hiperostose Esquelética Difusa Idiopática , Lesões do Pescoço , Traumatismos da Medula Espinal , Fraturas da Coluna Vertebral , Espondilite Anquilosante , Humanos , Idoso , Hiperostose Esquelética Difusa Idiopática/complicações , Espondilite Anquilosante/complicações , Assistência ao Convalescente , Estudos Prospectivos , Alta do Paciente , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia , Lesões do Pescoço/complicações
3.
Pan Afr Med J ; 42: 259, 2022.
Artigo em Francês | MEDLINE | ID: mdl-36338565

RESUMO

Vertebral compression fractures represent an important part of daily trauma in spine surgery. Their management is codified thanks to the different classifications available to us. The combination of a compression fracture and bi-pedicular involvement of the same vertebra usually leads to extensive surgical management. The main objective of this case report is to share our experience with a minimally invasive osteosynthesis technique performed on this type of fracture. The patient was 61 years old and fell from a 3.5 m high roof. Clinically, he had no sensory-motor deficit. He presented back pain at 8/10 on a visual analogue scale (VAS). The Computed tomography scan revealed a compression fracture of the 4th lumbar vertebra (L4) type A.3 according to the AO classification. There was also bi-pedicular involvement of L4. He underwent minimally invasive surgical management consisting of a combination of kyphoplasty with percutaneous isolated bilateral intra-pedicular osteosynthesis. We observed a rapid sedation of the pain with a VAS of 2/10 at the first day and 0/10 at 3 months. Bone healing was achieved at 3 months on computed tomography (CT) scan. At 18 months, there was no evidence of secondary displacement of the material. Sagittal and frontal balance was satisfactory. The patient had returned to a clinical state like that prior to the accident. The aim of this case was to propose a less invasive surgical alternative for the management of bi-pedicular vertebral compression fractures. In this case, a combination of kyphoplasty with percutaneous isolated bilateral intra-pedicular osteosynthesis resulted in a rapid recovery after surgery and a return to the pre-accident condition.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Ftirápteros , Fraturas da Coluna Vertebral , Masculino , Animais , Humanos , Pessoa de Meia-Idade , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Cifoplastia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Vértebras Lombares/cirurgia , Resultado do Tratamento
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(11): 1400-1406, 2022 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-36382459

RESUMO

Objective: To explore the feasibility and effectiveness of vertebroplasty with reverse designed unilateral targeted puncture in treatment of osteoporotic vertebral compression fracture (OVCF) by comparing with curved unilateral puncture. Methods: A total of 52 patients with OVCF met selection criteria and were admitted between January 2019 and June 2021 were selected as the research objects. According to the random number table method, they were divided into two groups ( n=26). In trial group, the reverse designed unilateral targeted puncture was used in the percutaneous vertebroplasty (PVP); while the control group used the curved unilateral puncture. There was no significant difference in gender, age, bone mineral density (T value), cause of injury, time from injury to operation, the level of responsible vertebral body, pedicle diameter of the planned puncture vertebral body, and preoperative visual analogue scale (VAS) score, anterior vertebral height, and Cobb angle between the two groups ( P>0.05). The operation time, bone cement injection volume and leakage, intraoperative radiation exposure times, and hospitalization costs in the two groups were recorded. VAS score was used to evaluate the relief degree of low back pain after operation. X-ray film was used to review the diffusion degree of bone cement in the responsible vertebral body, and Cobb angle and anterior vertebral height were measured. Results: The operation was successfully completed in the two groups. Patients in the two groups were followed up 12-18 months, with an average of 13.6 months. The operation time, volume of injected bone cement, intraoperative radiation exposure times, and hospitalization costs in the trial group were significantly lower than those in the control group ( P<0.05). With the prolongation of time, the low back pain of the two groups gradually relieved, and the VAS score significantly decreased ( P<0.05). And there was no significant difference in VAS score between the two groups at each time point ( P>0.05). There were 2 cases (7.6%) of bone cement leakage in the trial group and 3 cases (11.5%) in the control group, and no significant difference was found in the incidence of bone cement leakage and the diffusion degree of bone cement between the two groups ( P>0.05). Imaging examination showed that compared with pre-operation, the anterior vertebral height of the two groups significantly increased and Cobb angle significantly decreased at 2 days and 1 year after operation ( P<0.05); while compared with 2 days before operation, the anterior vertebral height of the two groups significantly decreased and Cobb angle significantly increased at 1 year after operation ( P<0.05). There was no significant difference in the above indexes between the two groups at different time points after operation ( P>0.05). Conclusion: Compared with curved unilateral puncture, the use of reverse designed unilateral targeted puncture during PVP in the treatment of OVCF can not only achieve similar effectiveness, but also has the advantages of less radiation exposure, shorter operation time, and less hospitalization costs.


Assuntos
Fraturas por Compressão , Cifoplastia , Dor Lombar , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Fraturas por Compressão/cirurgia , Estudos Prospectivos , Cimentos Ósseos/uso terapêutico , Fraturas da Coluna Vertebral/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Punção Espinal , Vertebroplastia/métodos , Fraturas por Osteoporose/cirurgia
5.
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
Processo Odontoide , Fraturas da Coluna Vertebral , Cirurgia Assistida por Computador , Masculino , Feminino , Humanos , Adulto , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Imageamento Tridimensional/métodos , Fixação Interna de Fraturas , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Tomografia Computadorizada por Raios X , Parafusos Ósseos
6.
Neurol India ; 70(Supplement): S129-S134, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412359

RESUMO

Objective: When there is a complete slippage of facet joints of C1 over C2 such that there is no contact between the articulating surfaces of C1 and C2, the condition is known as atlantoaxial spondyloptosis (AAS). AAS represents an extremely rare manifestation of atlantoaxial instability. This study was performed to highlight the presentation, radiological features, and management of unilateral AAS in pediatric patients. Material and Methods: We retrospectively identified four pediatric patients with AAS from our hospital records in the last 6 years (2014-2019). Results: Among the four patients with unilateral AAS, three were posttraumic and one was diagnosed with craniovertebral junction tuberculosis (CVJ TB). All the patients had a varying degree of spastic quadriparesis on presentation. One patient with CVJ TB presented with neck tilt. All patients with traumatic unilateral AAS were associated with an odontoid fracture. These patients underwent C1-C2 fixation with complete reduction of spondyloptosis using the techniques of joint manipulation and joint remodeling with a posterior only approach. Complete reduction of AAS in patients with trauma was also associated with the realignment of the odontoid fracture. All patients improved neurologically after surgery and achieved excellent correction of the deformity on a follow-up imaging. Conclusion: Pediatric unilateral AAS is an extremely rare phenomenon. A single-stage posterior approach with C1-C2 fixation is a feasible technique for the treatment of this seemingly difficult to correct deformity in pediatric patients and the clinical outcomes are excellent.


Assuntos
Articulação Atlantoaxial , Processo Odontoide , Fraturas da Coluna Vertebral , Espondilolistese , Humanos , Criança , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Articulação Atlantoaxial/lesões , Estudos Retrospectivos , Espondilolistese/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/complicações
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(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
9.
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
10.
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
11.
Medicine (Baltimore) ; 101(46): e31544, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401370

RESUMO

BACKGROUND: High viscosity cement (HVC) and low viscosity cement (LVC) have been used to treat osteoporotic vertebral compression fractures (OVCFs). Our study was to assess the safety and efficacy of HVC and LVC in treating OVCFs. METHODS: We searched the electronic database for randomized controlled trials of HVC and LVC to treat OVCFs. Random-effects model was performed to pool the outcomes about operation time, visual analogue scale (VAS), bone cement injection volume, oswestry disability index (ODI), bone cement leakage and adjacent vertebral fractures. RESULTS: Twelve randomized trials were included in the meta-analysis. The 2 groups had similar changes in terms of bone cement injection volume, ODI and adjacent vertebral fractures. The HVC group showed shorter operation time and better VAS score improvement. The bone cement leakage rate of the HVC group was significantly better than LVC group (P < .00001).According to the location of bone cement leakage, in the leakages of the veins (P < .00001), the intervertebral disc (P < .00001), the paravertebral area (P = .003) and the intraspinal space (P = .03), the HVC group were significantly better than the LVC group. CONCLUSIONS: In terms of bone cement injection volume, ODI and adjacent vertebral fractures, the 2 group are equivalent. HVC had a shorter operation time, lower bone cement leakage rate and better VAS score improvement, compared with LVC.


Assuntos
Fraturas por Compressão , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Cimentos Ósseos/uso terapêutico , Viscosidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Materiais Dentários
12.
PLoS One ; 17(11): e0276930, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36441717

RESUMO

BACKGROUND: Percutaneous vertebroplasty (PVP) has been used widely to treat osteoporotic vertebral compression fractures (OVCFs). However, it has many disadvantages, such as excessive radiation exposure, long operation times, and high cement leakage rates. This study was conducted to explore the clinical effects and safety of the use of a three-dimensional (3D)-printed body-surface guide plate to aid PVP for the treatment of OVCFs. METHODS: This prospective cohort study was conducted with patients with OVCFs presenting between October 2020 and June 2021. Fifty patients underwent traditional PVP (group T) and 47 patients underwent PVP aided by 3D-printed body-surface guide plates (3D group). The following clinical and adverse events were compared between groups: the puncture positioning, puncture, fluoroscopy exposure and total operation times; changes in vertebral height and the Cobb angle after surgery relative to baseline; preoperative and postoperative visual analog scale and Oswestry disability index scores; and perioperative complications (bone cement leakage, neurological impairment, vertebral infection, and cardiopulmonary complications. RESULTS: The puncture, adjustment, fluoroscopy, and total operation times were shorter in the 3D group than in group T. Visual analog scale and Oswestry disability index scores improved significantly after surgery, with significant differences between groups (both p < 0.05). At the last follow-up examination, the vertebral midline height and Cobb angle did not differ between groups. The incidence of complications was significantly lower in the 3D group than in group T (p < 0.05). CONCLUSION: The use of 3D-printed body-surface guide plates can simplify and optimize PVP, shortening the operative time, improving the success rate, reducing surgical complications, and overall improving the safety of PVP.


Assuntos
Fraturas por Compressão , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Estudos Prospectivos , Vertebroplastia/efeitos adversos , Punções , Cimentos Ósseos , Impressão Tridimensional
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.
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
16.
J Coll Physicians Surg Pak ; 32(10): 1295-1299, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36205274

RESUMO

OBJECTIVE: To evaluate the efficacy of percutaneous uniplanar pedicle screw (PUPS) combined with injured vertebra fixation for treating thoracolumbar burst fracture and provide technique notes. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, China, from February 2019 to December 2021. METHODOLOGY: Patients who had undergone PUPS internal fixation for thoracolumbar burst fracture were followed up for more than 12 months in the General Hospital of Central Theater Command, Wuhan, China. The operation time, intraoperative blood loss, and hospital stay were recorded. Visual analysis scale (VAS), score of low back pain, ODI (oswestry disability endex), anterior vertebral height (AVH), Cobb angle were documented before and after the operation, Also, the complications and postoperative tail shank angles (TSA) were documented. RESULTS: All 23 patients were followed up for more than 12 months without re-fracture, loosening or breakage of the screw and rod. The operation time, intraoperative blood loss, and hospital stay were 51.34±8.30 minutes, 75.67±16.55 minutes, and 9.86±1.96 days respectively. VAS and ODI scores after the operation were significantly lower than before (p <0.05). The AVH and Cobb angle after operation were significantly better as compared with those before the operation (p <0.05), but no statistically significant difference was found in those two values at 1 week, 3 months, and 12 months after operation (p >0.05). No statistically significant difference was found in TSA after the operation (p >0.05). CONCLUSIONS: PUPS combined with injured vertebra fixation reveals satisfactory efficacy for thoracolumbar burst fracture with well reduction of the fracture, the AVH, and Cobb angle maintenance. KEY WORDS: Percutaneous uniplanar pedicle screw, Minimally invasive surgery, Thoracolumbar vertebral body fracture, Injured vertebra fixation.


Assuntos
Parafusos Pediculares , Fraturas da Coluna Vertebral , Benzopiranos , Perda Sanguínea Cirúrgica , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Fenóis , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
17.
Front Immunol ; 13: 971947, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36189242

RESUMO

Background: The mortality rate in patients with ankylosing spondylitis (AS) and cervical fracture is relatively high. Objectives: This study aimed to investigate the instantaneous death risk and conditional survival (CS) in patients with AS and cervical fracture. We also studied the relationship between surgical timing and the incidence of complications. Methods: This national multicentre retrospective study included 459 patients with AS and cervical fractures between 2003 and 2019. The hazard function was used to determine the risk of instantaneous death. The five-year CS was calculated to show the dynamic changes in prognosis. Results: The instantaneous death risk was relatively high in the first 6 months and gradually decreased over time in patients with AS and cervical fracture. For patients who did not undergo surgery, the instantaneous risk of death was relatively high in the first 15 months and gradually decreased over time. For patients with American Spinal Injury Association impairment scale (ASIA) A and B, the 5-year CS was 55.3% at baseline, and improved steadily to 88.4% at 2 years. Odds ratios (ORs) for pneumonia, electrolyte disturbance, respiratory insufficiency, and phlebothrombosis decreased as the surgery timing increased. Conclusion: Deaths occurred mainly in the first 6 months after injury and gradually decreased over time. Our study highlights the need for continued surveillance and care in patients with AS with cervical fractures and provides useful survival estimates for both surgeons and patients. We also observed that early surgery can significantly increase functional recovery, and decrease the incidence of complications and rehospitalisation.


Assuntos
Fraturas da Coluna Vertebral , Espondilite Anquilosante , Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Eletrólitos , Humanos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/cirurgia
18.
Bratisl Lek Listy ; 123(11): 791-794, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36254636

RESUMO

Patients with vertebral compression fractures are often indicated for balloon kyphoplasty. Many of them are elderly with severe comorbidities, which puts them at high risk for general anaesthesia. Surgery under infiltration of local anaesthetic with or without mild sedation is therefore the preferred technique used by many surgeons. However, patients reported moderate­to­severe pain during the procedure. A combination of regional anaesthesia with analgo-sedation offers an interesting alternative to general anaesthesia as well as infiltration administered by the surgeon. In this article we present, apart from general anaesthesia, various regional anaesthetic techniques suitable for high-risk patients, including neuraxial anaesthesia, paravertebral block as well as a novel "erector spinae plane block" at the level of the fractured vertebra. We explore their effectiveness and safety profile, as well as advantage of supplementation of adequate analgo-sedation (Ref. 40). Keywords: erector spinae plane block, kyphoplasty, regional anaesthesia, paravertebral block, neuraxial anaesthesia.


Assuntos
Fraturas por Compressão , Cifoplastia , Bloqueio Nervoso , Fraturas da Coluna Vertebral , Idoso , Anestésicos Locais , Fraturas por Compressão/etiologia , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia
19.
Medicina (Kaunas) ; 58(10)2022 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-36295591

RESUMO

Vertebral augmentation has been used to treat painful vertebral compression fractures and metastatic lesions in millions of patients around the world. An international group of subject matter experts have considered the evidence, including but not limited to mortality. These considerations led them to ask whether it is appropriate to allow the subjective measure of pain to so dominate the clinical decision of whether to proceed with augmentation. The discussions that ensued are related below.


Assuntos
Fraturas por Compressão , Fraturas da Coluna Vertebral , Acidente Vascular Cerebral , Vertebroplastia , Humanos , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Dor , Resultado do Tratamento
20.
In Vivo ; 36(6): 2999-3009, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36309394

RESUMO

BACKGROUND/AIM: Regarding the surgical treatment of incomplete burst fractures of the spine, no optimal standard procedure has been established. While previous studies have focused on radiological and surgical outcome parameters, the literature has not elucidated economic aspects of various surgical treatment options in detail yet. This study aimed to investigate whether open and minimal-invasive approaches differ in their economic profit gain. Furthermore, we examined whether a single-stage or two-stage approach of anterior-posterior fusion was more profitable. PATIENTS AND METHODS: By analyzing retrospectively data of 129 patients who underwent surgical procedure due to isolated incomplete burst fractures, we examined the economic profit and radiological parameter of open pedicle screw insertion, minimal-invasive techniques (percutaneous screws, percutaneous screws combined with SpineJack®, kyphoplasty or SpineJack®), and anterior-posterior fusion. RESULTS: Percutaneous screws in combination with SpineJack® gained significantly higher profit and higher profit per day of hospital length of stay. Profit was similar after single-stage and two-stage approach of vertebral body replacement. No significant difference in radiological outcome after 24 months was detected between the various surgical techniques. CONCLUSION: From a financial aspect, our finding suggests that application of percutaneous screws in combination with SpineJack® may generate the highest economic profit gain regarding treatment of incomplete burst fracture.


Assuntos
Fraturas Cominutivas , Fraturas da Coluna Vertebral , Humanos , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Estudos Retrospectivos , Vértebras Lombares , Fixação Interna de Fraturas/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
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