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1.
Zhongguo Gu Shang ; 34(1): 26-33, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33666016

RESUMO

OBJECTIVE: To establish a three-dimensional finite element model of osteoporosis and to study the stiffness recovery of injured vertebrae and stress analysis of adjacent vertebrae after percutaneous vertebroplasty under different perfusion and distribution conditions by simulating fluid flow into the vertebral body. METHODS: A male healthy volunteer was selected. CT scans were performed from T11 to L2. Mimics 15.0 and ABAQUS 6.11 software were used to extract CT images. The vertebral model of osteoporotic fracture was established. The flow physical field and conduction and diffusion physical field were coupled to simulate the process and parts of the injection of bone cement into the vertebral fracture model. The amount of bone cement injected into the vertebral fracture model was 2 ml, 4 ml, 6 ml respectively. The diffusion range of bone cement was simulated on the image, and the post injection model of bone cement was obtained. Vertical downward, forward and backward pressure of 300 N were applied on the surface of the model to simulate vertebral movement. The stress changes of upper and lower vertebrae and diseased vertebrae under different conditions were calculated. RESULTS: (1) The VonMises stress of T12 inferior endplate was the largest in the three states before and after fracture.(2) The VonMises stress of the intervertebral disc and each endplate after fracture was significantly higher than before fracture. When percutaneous vertebroplasty was applied, as the amount of bone cement injection increases, the VonMises stress of the adjacent vertebral endplates increases. In the diseased vertebrae, as the amount of bone cement increases, the VonMises stress of the vertebral body endplate showed a downward trend. CONCLUSION: Reliable biomechanical model of lumbar vertebral fracture can be established by using CT scanning data through software simulation. Vertebral fracture and vertebroplasty will cause biomechanical changes of adjacent vertebral bodies. With the increase of bone cement injection, the influence of biomechanical changes will increase significantly. Neighbouring vertebral fractures are more likely. For this experiment, percutaneous vertebroplasty has a suitable amount of cement injection of 4 ml.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Fenômenos Biomecânicos , Cimentos para Ossos , Análise de Elementos Finitos , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/cirurgia , Masculino , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia
2.
Arch Osteoporos ; 16(1): 36, 2021 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-33611644

RESUMO

OBJECTIVE: The incidence of fractures in pregnancy and lactation-associated osteoporosis (PLO) is very low. Some fracture cases of PLO are associated with vertebral compression fractures, while malleolar fractures in patients with PLO are rarely reported before. CASE REPORT: A 31-year-old Han Chinese patient presented with a malleolar fracture 3 months after delivery, while she was still breastfeeding. Temporary closed reduction and plaster external fixation were performed in the emergency room. Then the patient was admitted to the orthopedic trauma ward for surgery and diagnosed as PLO by dual-energy X-ray absorptiometry (DEXA). After preoperative evaluation, the patient underwent open reduction and internal fixation. With the diagnosis of PLO, the patient was treated with weaning, bisphosphonate, and supplementation of calcium carbonate and vitamin D. During the 12-month follow-up period, the results of DEXA and laboratory examination improved gradually, and the internal fixation was removed 12 months after surgery. CONCLUSION: Orthopedic doctors should not ignore the possibility of PLO to avoid misdiagnosis of perinatal women with fractures. Improvement of functional recovery of fractures can be achieved with accurate diagnosis and individual treatment.


Assuntos
Fraturas por Compressão , Osteoporose , Complicações na Gravidez , Fraturas da Coluna Vertebral , Absorciometria de Fóton , Adulto , Densidade Óssea , Aleitamento Materno , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Lactação , Osteoporose/diagnóstico por imagem , Gravidez , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 20-25, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448194

RESUMO

Objective: To investigate the risk factors of adjacent fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Methods: A total of 2 216 patients who received PVP due to symptomatic OVCF between January 2014 and January 2017 and met the selection criteria were selected as study subjects. The clinical data was collected, including gender, age, height, body mass, history of smoking and drinking, whether the combination of hypertension, diabetes, coronary arteriosclerosis, chronic obstructive pulmonary disease (COPD), bone mineral density, the number of fractured vertebrae, the amount of cement injected into single vertebra, the cement leakage, and whether regular exercise after operation, whether regular anti-osteoporosis treatment after operation. Firstly, single factor analysis was performed on the observed indicators to preliminarily screen the influencing factors of adjacent fractures after PVP. Then, logistic regression analysis was carried out for relevant indicators with statistical significance to screen risk factors. Results: All patients were followed up 12-24 months, with an average of 15.8 months. Among them, 227 patients (10.24%) had adjacent fractures. The univariate analysis showed that there were significant differences between the fracture group and non-fracture group in age, gender, preoperative bone density, history of smoking and drinking, COPD, the number of fractured vertebrae and the amount of bone cement injected into the single vertebra, as well as regular exercise after operation, regular anti-osteoporosis treatment after operation ( P<0.05). Further multivariate logistic regression analysis showed that the elderly and female, history of smoking, irregular exercise after operation, irregular anti-osteoporosis treatment after operation, low preoperative bone density, large number of fractured vertebrae, and small amount of bone cement injected into the single vertebra were risk factors for adjacent fractures after PVP in OVCF patients ( P<0.05). Conclusion: The risk of adjacent fractures after PVP increases in elderly, female patients with low preoperative bone mineral density, large number of fractured vertebrae, and insufficient bone cement injection. The patients need to quit smoking, regular exercise, and anti-osteoporosis treatment after PVP.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Cimentos para Ossos , Feminino , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos
4.
BMC Surg ; 21(1): 65, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514359

RESUMO

BACKGROUND: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell's disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. METHODS: The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb's angle were assessed by imaging. RESULTS: All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. CONCLUSION: PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
5.
BMC Surg ; 21(1): 22, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407356

RESUMO

BACKGROUND: Symptomatic osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. However, there are no clear surgical treatment criteria for patients with these different symptoms. Therefore, this study aims to explore the surgical approaches for the treatment of OVCF with different symptoms and evaluate the feasibility of these surgical approaches. METHODS: We retrospectively analyzed 238 symptomatic OVCF patients who entered our hospital from June 2013 to 2016. According to clinical characteristics and imaging examinations, these patients were divided into I-V grades and their corresponding surgical methods were developed. I, old vertebral fracture with no apparent instability, vertebral augmentation; II, old vertebral fracture with local instability, posterior reduction fusion internal fixation; III, old fractures with spinal stenosis, posterior decompression and reduction fusion and internal fixation; IV, old vertebral fracture with kyphosis, posterior osteotomy with internal fixation and fusion; V, a mixture of the above types, posterior osteotomy (decompression) with internal fixation and fusion. Postoperative visual analog score (VAS), oswestry disability index (ODI) scores, sagittal index (SI) and ASIA grades of neurological function were observed. RESULTS: All 238 patients were followed up for 12-38 months, with an average follow-up of 18.5 months. After graded surgery, the VAS score, ODI score, and vertebral sagittal index SI of 238 patients were significantly improved, and the difference between the last follow-up results and the preoperative comparison was statistically significant (P ˂ 0.05). Besides, the postoperative ASIA grades of 16 patients with nerve injury were improved from 14 patients with preoperative grade C, 2 patients with grade D to 4 patients with postoperative grade D and 12 patients with postoperative grade E. CONCLUSION: In this study, we concluded that graded surgery could better treat symptomatic old OVCF and restore spinal stability. This provides clinical reference and guidance for the treatment of symptomatic old OVCF in the future.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Fixação Interna de Fraturas , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
6.
Tech Vasc Interv Radiol ; 23(4): 100701, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308580

RESUMO

Vertebral compression fractures (VCFs) result from either trauma or a pathologic process that weakens the bone by conditions such as osteoporosis or tumor. The incidence of VCFs has been rising over the last few decades in accordance with the aging population. These fractures can result in severe pain, physical limitation and disability, as well as increased morbidity and mortality. Patients with VCFs are optimally treated by accurate and early diagnosis and treatment. An effective method to treat these fractures is percutaneous vertebral augmentation, which is a set of minimally invasive procedures that stabilizes osseous fractures, provides immediate pain relief, and improves quality of life. Vertebral augmentation procedures include vertebroplasty, kyphoplasty, and vertebral augmentation with implants. Each of these techniques is described in general terms in this article. The ideal candidate for vertebral augmentation is a patient with a symptomatic fracture seen on cross-sectional imaging in which nonsurgical management has failed and has positive signs on physical examination with no absolute contraindication. This procedure should be done with the appropriate equipment and personnel in a facility designed for this purpose. After the procedure, the patient should undergo the appropriate follow-up to ensure optimal recovery. Additionally, it is essential that the patient receives appropriate therapy for the underlying disorder that predisposed them to the vertebral fracture.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia , Radiografia Intervencionista , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Tomada de Decisão Clínica , Protocolos Clínicos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/fisiopatologia , Humanos , Cifoplastia/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Vertebroplastia/efeitos adversos
8.
Zhongguo Gu Shang ; 33(12): 1179-83, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369329

RESUMO

OBJECTIVE: To study effects of postoperative regular training of core muscle strength guided by the concept of enhanced recovery after surgery (ERAS) on the rehabilitation of elderly patients with osteoporotic lumbar vertebral compression fracture after vertebroplasty (PVP) and kyphoplasty(PKP). METHODS: Ninety-four elderly patients with osteoporotic lumbar compression fractures who underwent PKP or PVP from January 2016 to January 2018 and met inclusion criteria were divided into observation group and control group. All the patients were treated with routine anti osteoporosis therapy after operation. There were 47 patients in the observationgroup, including 18 males and 29 females, with an average age of (62.62±3.21) years old;in the control group, there were 47 cases, including 17 males and 30 females, with an average age of (62.38±2.84) years old. The patients in the control group were trained by traditional way, and the patients in observation group were instructed to conduct regular training of core muscle strength according to ERAS concept. The patients were followed up for 1, 3 and 6 months after operation. Patients' conditions were quantitatively evaluated according to Barthel scale, JOA low back pain score and Oswestry Disability Index, and the differences in treatment effects between two groups were statistically analyzed and compared. RESULTS: All the patients were followed up, and the Barthel scale, JOA low back pain score and Oswestry Disability Index score of the observation group were all better than those of the control group on the 1st and the 3rd months after surgery(P< 0.05). The Oswestry Disability Index score of the observation group on the 6th month after surgery were superior to those of the control group (P<0.05). However, there was no significantly difference in JOA low back pain score and Barthel scale between two groups at 6 months after surgery (P>0.05). The comparison of Barthel scale, JOA low back pain score and Oswestry Disability Index before and after the operation of 1, 3 and 6 months between the two groups were significantly improved (P<0.05). CONCLUSION: Early regular core strength training has a positive effect on early functional recovery and improvement of life ability after PKP or PVP for elderly patients with osteoporotic lumbar compression fractures, which is in line with the concept of accelerated rehabilitation surgery.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Recuperação Pós-Cirúrgica Melhorada , Feminino , Fraturas por Compressão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
9.
Pain Res Manag ; 2020: 3947368, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33376566

RESUMO

Osteoporotic vertebral compression fracture (OVCF) is a common cause of pain and disability and is steadily increasing due to the growth of the elderly population. To date, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are almost universally accepted as appropriate vertebral augmentation procedures for OVCFs. There are many advantages of vertebral augmentation, such as short surgical time, performance under local anaesthesia, and rapid pain relief. However, there are certain issues regarding the utilization of these vertebral augmentations, such as loss of vertebral height, cement leakage, and adjacent vertebral refracture. Hence, the treatment for OVCF has changed in recent years. Satisfactory clinical results have been obtained worldwide after application of the OsseoFix System, the SpineJack System, radiofrequency kyphoplasty of the vertebral body, and the Kiva VCF treatment system. The following review discusses the development of the current techniques used for vertebral augmentation.


Assuntos
Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Feminino , Humanos , Masculino , Resultado do Tratamento
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1281-1287, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063494

RESUMO

Objective: To compare the short-term effectiveness and safety of unipedicular versus bipedicular percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) with posterior wall broken. Methods: The clinical data of 68 patients with OVCF with posterior wall broken and without posterior ligament complex injury and spinal cord nerve injury between June 2013 and December 2018 were retrospectively analyzed. According to the different operative approaches, the patients were divided into two groups: group A (36 cases received PKP via bilateral pedicle puncture) and group B (32 cases received PKP via unilateral pedicle paracentesis). There was no significant difference between the two groups in gender, age, fracture vertebra distribution, time from injury to operation, preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), and height of injured vertebra ( P>0.05). The operation time, intraoperative fluoroscopy times, and bone cement volume were recorded and compared between the two groups. The VAS score and ODI score were used to evaluate the effectiveness before operation, at 1 day and 6 months after operation; the height of injured vertebra was measured on the lateral X-ray film, and the recovery height of injured vertebra at 1 day after operation and the loss height of injured vertebra at 6 months after operation were calculated; the intraoperative and postoperative complications of the two groups were recorded. Results: The operation time, intraoperative fluoroscopy times, and bone cement volume of group B were significantly less than those of group A ( P<0.05). All patients were followed up 10-35 months, with an average of 18 months. During the operation, there were 2 cases (5.56%) of cement leakage in group A and 9 cases (28.13%) in group B, showing significant difference ( χ 2=4.808, P=0.028). There was no adverse reactions of bone cement, iatrogenic spinal cord injury, infection of puncture port, or other complications in the two groups. During the follow-up period, there were 3 cases (8.3%) of adjacent vertebral fractures in group A and 2 cases (6.3%) in group B, showing no significant difference between the two groups ( χ 2=0.027, P=0.869). The height of injured vertebra of the two groups at 1 day and 6 months after operation were significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the height of injured vertebrae and the recovery height of injured vertebra at 1 day after operation between the two groups ( P>0.05). However, at 6 months after operation, the height of injured vertebra in group B was significantly lower than that in group A ( P<0.05), and the loss height of injured vertebra in group B was significantly higher than that in group A ( P<0.05). The VAS score and ODI score at 1 day and 6 months after operation were significantly improved when compared with preoperative ones in both groups ( P<0.05), but there was no significant difference between the two groups ( P>0.05). Conclusion: Both bipedicular and unipedicular PKP can obtain satisfactory effectiveness for the treatment of OVCF with posterior wall broken, but the former may have advantages of lower cement leakage rate and less height loss.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas da Coluna Vertebral , Fraturas por Compressão/cirurgia , Humanos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral
11.
Medicine (Baltimore) ; 99(44): e22468, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126302

RESUMO

RATIONAL: Vertebral compression fracture (VCF) is one of the most common diseases in spinal surgery. Traditional percutaneous vertebroplasty (PVP) under fluoroscopy is an effective method to treat vertebral compression fracture. However, there is still a risk of vascular nerve injury and infection caused by inaccurate or repeated puncture. Therefore, the purpose of this paper was to assess the accuracy of unilateral PVP guided by screw view model of navigation (SVMN) for VCF. PATIENT CONCERNS: A 59-year-old female patient suffered high falling injury, and with back pain as its main clinical symptom. DIAGNOSES: The patient was diagnosed with a L1 VCF. INTERVENTIONS: We placed the puncture needle under the guidance of SVMN to reach the ideal position designed before operation, and then injected the bone cement to complete the percutaneous kyphoplasty (PKP). OUTCOMES: The operative time was 29.5 minutes, the puncture time was 1 time, the fluoroscopy time was 2.9 minutes, and the bone cement distribution was satisfactory. VAS and ODI scores were significant improved postoperatively. No surgical complications, including neurovascular injury and infection, were observed during 28-month follow up. LESSONS: The SVMN guided percutaneous puncture needle insertion in PKP operation for VCF is an effective and safety technique. Besides, the SVMN has also been a contributor to reduce radiation doses and replace conventional fluoroscopy.


Assuntos
Fraturas por Compressão/cirurgia , Vértebras Lombares/lesões , Neuronavegação/métodos , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Cimentos para Ossos , Feminino , Humanos , Cifoplastia/métodos , Pessoa de Meia-Idade , Punções/métodos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(38): e22046, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957325

RESUMO

Kyphoplasty (KP) is an effective method for treating osteoporotic vertebral compression fractures (OVCFs). Although the bipedicular approach is considered the main treatment approach, the unipedicular approach has also been shown to be effective. This study aimed to retrospectively compare the radiological and clinical outcomes of unipedicular and bipedicular KP in the treatment of single-level OVCFs.In total, 96 patients with single-level OVCF who received KP were divided into 2 groups: the unipedicular group, in which 28 patients underwent KP via the unipedicular approach, and the bipedicular group, in which 68 patients underwent KP via the bipedicular approach. Clinical results, radiological findings, and complications were compared between the groups. The clinical results were evaluated for up to 1 year after surgery using a numerical rating scale score. The radiological findings were compared in terms of recovery of the lowest vertebral body height at the same location on radiographs taken both 1 day and 1 year after surgery. The degrees of recovery of the kyphotic angle (KA) were simultaneously compared. The surgical time, amount of cement used, and any postoperative complications were also compared.Both groups showed significant improvements in all clinical and radiological parameters until 1 year after surgery. The unipedicular group required significantly lower amounts of cement than the bipedicular group (unipedicular: 4.4 ±â€Š0.8 mL, bipedicular: 5.6 ±â€Š1.0 mL, P = .00), but there were no significant differences in the clinical and radiological results for up to 1 year after surgery. There were no significant differences in leakage of intradiscal cement, appearance of adjacent vertebral compression fractures within 1 year of surgery, and surgical time.Unipedicular and bipedicular KP significantly reduced the pain experienced by patients with single-level OVCF, restored vertebral height, and corrected the KA, which remained stable for at least 1 year after treatment. Unipedicular KP required lower amounts of cement than bipedicular KP and was as effective as bipedicular KP in terms of radiological and clinical outcomes. The results of this study have level three evidence and grade B recommendation.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Idoso , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Medição da Dor , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem
14.
Medicine (Baltimore) ; 99(27): e20770, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629657

RESUMO

BACKGROUND: Osteoporosis and related complications have been increasing with the aging population. Osteoporotic vertebral compression fractures (OVCFs) are the most common among all osteoporotic fractures. The purpose of this study was performed to compare the efficiency and safety of vertebroplasty versus conservative treatment for acute OVCFs. METHODS: The conduct of this study followed the Declaration of Helsinki principles and the reporting of this study adhered to the Consolidated Standards of Reporting Trials guidelines for randomized controlled trials. Written informed consent was obtained from every participant. Participants were randomly assigned (1:1) to receive either vertebroplasty or control group. The primary outcome was pain relief at 1 month and 1 year, measured with a Visual Analogue Scale score. The secondary outcomes were Roland-Morris Disability Questionnaire, short form score, European Quality of Life-5 Dimensions, and postoperative complications. RESULTS: We hypothesize that vertebroplasty will provide a rapid decrease of pain and an early return to daily life activities compared with the control group. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5624).


Assuntos
Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Tratamento Conservador/métodos , Fraturas por Compressão/terapia , Humanos , Pessoa de Meia-Idade , Fraturas por Osteoporose/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fraturas da Coluna Vertebral/terapia , Vertebroplastia/métodos
15.
Spine (Phila Pa 1976) ; 45(15): E927-E932, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675605

RESUMO

STUDY DESIGN: Retrospective review. OBJECTIVE: To ascertain impact of preprocedural magnetic resonance imaging (MRI) or nuclear medicine Tc99m-DMP scintigraphy on the treatment plan when compared with plain films and/or computed tomography prior to vertebral augmentation procedures. SUMMARY OF BACKGROUND DATA: Over 1 million vertebral compression fractures (VCFs) occur in the United States annually with over 150,000 individuals hospitalized each year. Physical examination and history are essential to the workup of VCFs, but imaging remains necessary for confirming the diagnosis. VCFs can be imaged with various modalities and there is limited data on the comparative effectiveness of different imaging modalities. METHODS: Six hundred fifty consecutive patients treated with vertebral augmentation at a single institution between May of 2013 and April of 2018 were reviewed. Preprocedure imaging of the spine obtained within 30 days prior to the procedure were reviewed. Preprocedure imaging results were cross-referenced against the levels treated by vertebral augmentation to determine whether there was a change in the levels treated after receiving an MRI or NM imaging study. RESULTS: Three hundred sixty-three patients had adequate imaging for inclusion. One hundred fifty-four of these 363 patients (42.4%) had an alteration of their treatment plan based upon the MR or NM imaging. Fewer vertebral levels were treated in 33, different levels were treated in 41, and more levels were treated in 80 patients. CONCLUSION: MRI or nuclear medicine bone scan imaging prior to vertebral augmentation altered the location and number of levels treated in a large percentage of patients, adding specificity to treatment over findings on radiographs or computed tomography alone. LEVEL OF EVIDENCE: 3.


Assuntos
Fraturas por Compressão/diagnóstico por imagem , Cifoplastia/métodos , Imagem por Ressonância Magnética/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Vertebroplastia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/metabolismo , Fraturas por Compressão/cirurgia , Humanos , Espectroscopia de Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Cintilografia/métodos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Compostos de Sulfidrila , Agregado de Albumina Marcado com Tecnécio Tc 99m
16.
Pain Physician ; 23(4): E343-E352, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709180

RESUMO

BACKGROUND: The BenchMarket Medical (BMM) Vertebral Compression Fracture (VCF) Registry, now known as Talosix, is a collaborative effort between Talosix (the authorized registry vendor), Noridian Healthcare Solutions, and clinicians to gather outcomes evidence for cement augmentation treatments in patients with acute painful osteoporotic VCFs. The VCF Registry was designed to provide outcomes evidence to inform the Medicare payer's "coverage with evidence development" decision to authorize reimbursement for cement augmentation treatments. OBJECTIVES: The purpose of this article was to present a pathway for appropriate use of vertebral augmentation based on the findings of the VCF Registry. STUDY DESIGN: Prospective observational data, including patient characteristics, diagnosis, process of care, and patient-reported outcomes (PROs) for pain and function, were collected from patients undergoing cement augmentation treatment. The PROs were collected at baseline, 1, 3, and 6 months following the procedure. SETTING: The VCF Registry is a national ongoing registry with no specified end time or designated sample size. METHODS: Primary outcomes were pain improvement measured using the Numeric Rating Scale and function improvement, measured using the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included cement leakage, new neurologic deficits, adverse events, readmissions, and death. RESULTS: The VCF Registry delivered outcomes data to support Noridian's "coverage with evidence development" decision. A total of 732 patients were included in this study. Registry outcomes confirmed postmarket evidence of highly significant pain relief with mean pain score improvement of 6.5/10 points at 6 months. Function also improved significantly with mean RMDQ score change of 11.4/24 points 6 months after surgery. Results also showed the safety and reliability of cement augmentation. LIMITATIONS: The nature of the registry data is that it contains nonrandomized, nonplacebo controlled data and should not be perceived as such. The real-world setting and the large number of patients within the dataset should increase the external validity of the findings. CONCLUSIONS: Cement augmentation treatments of patients with acute painful VCFs reliably results in highly significant benefits of pain decrease and functional improvement for this Medicare population. KEY WORDS: Vertebral compression fractures, osteoporosis, kyphoplasty, back pain, registry.


Assuntos
Cimentos para Ossos , Fraturas por Compressão/cirurgia , Cifoplastia/normas , Sistema de Registros , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/normas , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos/uso terapêutico , Gerenciamento Clínico , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/epidemiologia , Humanos , Cifoplastia/métodos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/cirurgia , Manejo da Dor/métodos , Manejo da Dor/normas , Medição da Dor/métodos , Medição da Dor/normas , Estudos Prospectivos , Reprodutibilidade dos Testes , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/epidemiologia , Resultado do Tratamento , Estados Unidos/epidemiologia , Vertebroplastia/métodos
17.
Pain Physician ; 23(4): E377-E388, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709184

RESUMO

BACKGROUND: Intraspinal cement leakage is a catastrophic complication of percutaneous vertebroplasty (PVP). Percutaneous endoscopic spinal surgery (PESS) for intraspinal cement leakage has rarely been reported. OBJECTIVES: To evaluate the therapeutic effectiveness of PESS for intraspinal cement leakage following PVP. STUDY DESIGN: This was a retrospective study approved by the ethics committee of our institution. SETTING: Department of Orthopedics from an affiliated hospital. METHODS: Twelve patients with neurologic impairments resulting from intraspinal cement leakage after PVP were treated with PESS for spinal decompression from May 2014 to June 2018. Computed tomography and 3-dimensional reconstruction were used to confirm the vertebral level of cement leakage. The surgical index, neurologic function, and clinical results were recorded in this study. RESULTS: The leaked cement of all patients was successfully removed under PESS, and no severe intraoperative complications were reported in our study. The operation time ranged from 43 to 119 minutes (mean, 65.5 minutes). The amount of intraoperative blood loss was 64.25 ± 9.62 mL. The lengths of postoperative hospital stays were 5.25 ± 2.53 days. The follow-up rate was 83.3% (10/12). The follow-up time ranged from 14 to 30 months (mean, 22 months). The Visual Analog Scale scores of foraminal leaks improved from 6.50 ± 0.93 preoperatively to 1.75 ± 0.71 at the last follow-up (P < 0.05). Neurologic function was evaluated by Japanese Orthopaedic Association 29 scores, which improved from 18.75 ± 1.06 to 22.70 ± 1.64 (P < 0.0001). The good and excellent rates were 80% according to the modified Macnab criteria. LIMITATIONS: This study is limited by the volume of patients and the deep learning curve needed for PESS. CONCLUSIONS: PESS, as a minimally invasive technique, can achieve targeted spinal cord decompression and may be a safe and effective alternative approach to conventional procedures for cement leakage after PVP. KEY WORDS: Endoscopes, cement leakage, minimally invasive surgery, percutaneous vertebroplasty.


Assuntos
Cimentos para Ossos/efeitos adversos , Neuroendoscopia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Vertebroplastia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Vertebroplastia/métodos
18.
Pain Physician ; 23(4): E409-E416, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709187

RESUMO

BACKGROUND: Bone cement distribution patterns in percutaneous kyphoplasty (PKP) is the key factor in keeping the vertebral stabilization and curative effect. However, the same cement volume can result in different bone cement distribution patterns and can thereby lead to different clinical outcomes. Therefore we investigated associations between cement distribution patterns and the occurrence rates of recompression in cemented vertebrae after PKP for patients with osteoporotic vertebral compression fractures (OVCFs). OBJECTIVES: The study focuses attention on the influence of compact and dispersive cement distribution patterns in PKP for patients with OVCFs. STUDY DESIGN: A retrospective cohort study. SETTING: An affiliated people's hospital of a university. METHODS: According to different cement distribution patterns, patients were assigned to 4 groups. The demographic data, radiographic data, and clinical outcomes were compared between the 4 groups. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated before and 2 days after PKP. Moreover, the relationships between bone cement and clinical outcomes were analyzed. The epidemiologic data, clinical outcomes, and complications of the 4 groups were assessed. Comparisons of the radiologic and clinical results of the 4 groups were made pre- and postoperatively. Anterior height of fractured vertebrae (AH), the kyphotic Cobb angle, and the volumetric cubage index of the fractured vertebrae were measured. RESULTS: A total of 104 subjects were retrospectively analyzed and followed up (median age, 75.01 ± 8.42 years; age range, 56-94 years). The mean procedure duration was 61.26 ± 23.05 minutes (range, 30-140 minutes). The mean follow-up was 12.1 ± 2.2 months (range, 2-15 months). Statistically, there was no significant difference in terms of gender, age, body mass index, and bone mineral density (P > 0.05). The incidence of cement leakage was significantly lower in group A than those in the other groups. The total amount of bone cement injected into 104 cases (104 vertebral bodies in total) was 848.5 mL, and the amount of bone cement injected into a single vertebral body was 7.94 ± 1.38 mL. The amount of bone cement injection in each group was the lowest (6.80 ± 1.66 mL) in group D, followed by (7.94 ± 1.38 mL) group B, and the highest (8.96 ± 1.68 mL) in group A, with a statistically significant difference between the 4 groups (P < 0.05). No serious complications were observed during the follow-up periods. The AH and Cobb angle improved significantly for the 4 groups (P < 0.05). The VAS score decreased from 3.55 ± 0.54, 3.53 ± 0.65, 3.40 ± 0.58, and 3.40 ± 0.66 preoperatively to 0.18 ± 0.39, 0.23 ± 0.41, 0.20 ± 0.40, and 0.15 ± 0.36 at 48 hours postoperatively. The ODI score dropped from 35.65 ± 4.54, 36.45 ± 4.72, 34.12 ± 4.86, and 35.65 ± 4.34 preoperatively to 15.47 ± 1.32, 15.32 ± 1.34, 15.23 ± 1.26, and 15.73 ± 1.17 at 48 hours postoperatively. LIMITATIONS: Our estimation of the vertebral body volume is imprecise. In addition, the number of subjects with OVCFs was small in this retrospective study. The volume of the fractured vertebra was not calculated accurately. CONCLUSIONS: Significant associations between cement distribution patterns and bone cement leakage affected the clinical outcome in patients after PKP. A higher incidence of bone cement leakage was observed in patients with treated vertebrae exhibiting a single-dispersive or single-compact pattern. KEY WORDS: Percutaneous kyphoplasty, osteoporotic vertebral compression fracture, bone cement distribution patterns.


Assuntos
Cimentos para Ossos/uso terapêutico , Fraturas por Compressão/diagnóstico por imagem , Cifoplastia/métodos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Cifose/complicações , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
19.
Clin Orthop Surg ; 12(2): 209-216, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32489543

RESUMO

Background: The evidence for the efficacy and safety of balloon kyphoplasty (BKP) in treating the Vietnamese patients is sparse. There is no convincing evidence regarding BKP's efficacy in Vietnamese patients, especially in the patients with thoracic osteoporotic vertebral compression fractures (VCFs). This article aims to evaluate the outcomes of restoring the body height of the compressed thoracic vertebrae in patients undergoing BKP. Methods: We prospectively enrolled 65 consecutive patients with thoracic VCFs (73 vertebrae) due to osteoporosis who were treated with BKP between June 2018 and May 2019. Results: A trocar was inserted through the pedicle in 84.9% (62/73) and beside the pedicle in 15.1% (11/73). The mean amount of mixed cement injected was 4.1 ± 1.1 mL (range, 1.5-7 mL). Cement leakage was radiographically confirmed in 30.8% of 65 patients. Among patients with complications caused by cement extravasation, the leakage was through the anterior margin of the vertebrae in 15.4%, through the vertebral disc in 12.3%, and through the posterior margin of the vertebrae in 3.1%. In the last 3.1% of patients, there was no clinically notable lesions of the nerve roots or spinal cord. The mean visual analog scale score decreased significantly from 7.3 ± 1.1 preoperatively to 3.3 ± 0.6 at 24 hours after surgery, and then to 1.2 ± 1.1 at 3 months after surgery (p < 0.01). The mean reduction in Cobb angle measured on standing radiographs after treatment was 3.7°, showing statistical significance (p < 0.01). Conclusions: BKP is a minimally invasive treatment effective for immediate pain relief, early motor rehabilitation, and humpback correction. The present study provided convincing evidence to support the use of BKP by spine surgeons and clinical specialists in treating osteoporotic thoracic VCFs in Vietnamese patients.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Vietnã
20.
Medicine (Baltimore) ; 99(25): e20524, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569172

RESUMO

BACKGROUND: It is currently controversial whether unilateral or bilateral balloon kyphoplasty (BKP) is superior in terms of postoperative outcomes in treatment of osteoporotic vertebral compression fracture (OVCF). In this context, the aim of this study was to prospectively evaluate and compare the radiographic and clinical outcomes of BKP using unilateral and bilateral approaches. METHODS: This was a randomized controlled study and was approved by the Severance Institutional Review Board in our hospital. The study protocol was designed in accordance with the Declaration of Helsinki guidelines. Patients who complained of chronic back pain secondary to OVCF, which occurred in thoracic lumbar region over 6 months and met the criteria of osteoporosis were the candidates for this procedure. A total of 150 patients were randomized to undergo either unilateral or bipedicular BKP. The outcomes measures inculded pain score, Oswestry Dysfunction Index, compression ratio, kyphotic angle, operation time, and postoperative complications. RESULTS: We were able to directly compare the outcomes of unilateral versus bilateral BKP and might reveal a better technique in OVCF. TRIAL REGISTRATION: this study protocol was registered in Research Registry (researchregistry5543).


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Humanos
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