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1.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(2): 153-158, 2021 Apr 28.
Artigo em Chinês | MEDLINE | ID: mdl-33966691

RESUMO

Objective To investigate the effect of sarcopenia on the efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic spinal compression fracture(OSCF)in elderly patients. Methods From February 2017 to June 2018,a total of 77 elderly patients who met the inclusion and exclusion criteria were included in this study.Grip strength of dominant hand was measured by an electronic grip dynamometer with cut-off values of 27 kg for males and 16 kg for females.The cross-sectional area of the pedicle level muscle of the 12th thoracic vertebra(T12)was measured by chest CT.The skeletal muscle index(SMI)was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height.The SMI cut-off value used to diagnose sarcopenia was 42.6 cm2/m2for males and 30.6 cm2/m2 for females.Sarcopenia is confirmed when both grip strength and SMI are below the cut-off values.The patients with OSCF all received PKP.The patients in the sarcopenia and non-sarcopenia groups were compared in terms of age,gender,body weight,operation duration,the amount of bleeding,time to ambulation,hospital stay,visual analogue scale(VAS)before and 1 month after operation,Oswestry disability index(ODI)1 month after operation as well as the incidence of refracture within 1 year after operation. Results Gender,body weight,operation duration,the amount of bleeding and the preoperative VAS score showed no significant difference between the two groups(χ2=3.563,P=0.059;t=0.406,P=0.686;t=1.119,P=0.267;t=-0.166,P=0.868;z=-1.076,P=0.282).The patients in the sarcopenia group showed longer time to ambulation,longer hospital stay,higher VAS score and ODI 1 month after operation than those in the non-sarcopenia group(t=3.938,P<0.001;t=5.655,P<0.001;z=-4.562,P<0.001;z=-5.222,P<0.001).There was no significant difference in the incidence of refracture within 1 year after operation between the two groups(χ2=0.596,P=0.440).Linear regression results showed that age did not affect the hospital stay,rehabilitation duration,VAS score or ODI(P=0.519,P=0.870,P=0.332,P=0.126),whereas sarcopenia had significant effects(P<0.001,P=0.001,P<0.001,P<0.001). Conclusions Sarcopenia with OSCF has poorer limb function recovery.Reasonable rehabilitation exercise and dietary therapy are necessary for patients with sarcopenia.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Sarcopenia , Fraturas da Coluna Vertebral , Idoso , Feminino , Fraturas por Compressão/cirurgia , Humanos , Masculino , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Sarcopenia/complicações , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(16): e25396, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879670

RESUMO

ABSTRACT: To identify the risk factors of the secondary fractures for osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP).We conducted a search of relevant articles using Cochrane Library, PubMed, Medline, Science Direct, Embase, the Web of Science and other databases. The time range we retrieved from establishment of the electronic database to November 2017. Gray studies were found in the references of included literature reports. STATA version 11.0 (Stata Corporation, College Station, Texas) was used to analyze the pooled data.Fourteen studies involving 1910 patients, 395 of whom had fracture secondary to the surgery were included in this meta-analysis. The result of meta-analyses showed the risk factors of the secondary fractures for OVCFs after PVP was related to bone mineral density (BMD) [95%CI (-0.650, -0.164), SMD=-0.407, P=.001], cement leakage ((RR=0.596, 95%CI (0.444,0.798), P = .001)), and kyphosis after primary operation ((SMD=0.741, 95%CI (0.449,1.032), P = .000)), but not to gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.Bone mineral density, cement leakage, and kyphosis after primary operation are the risk factors closely correlative to the secondary fracture after PVP. There have not been enough evidences to support the association between the secondary fracture and gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.


Assuntos
Fraturas por Compressão/etiologia , Fraturas por Osteoporose/etiologia , Complicações Pós-Operatórias/etiologia , Fraturas da Coluna Vertebral/etiologia , Vertebroplastia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Cimentos para Ossos/efeitos adversos , Densidade Óssea , Ensaios Clínicos como Assunto , Feminino , Fraturas por Compressão/cirurgia , Humanos , Cifose/complicações , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/cirurgia , Fatores de Risco , Fraturas da Coluna Vertebral/cirurgia
3.
South Med J ; 114(4): 252-259, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33787941

RESUMO

OBJECTIVES: This study aimed to identify factors, including physical functions and activities that affect quality of life (QOL) at discharge among patients with osteoporotic vertebral fractures. METHODS: Patients with osteoporotic vertebral fractures were included in our prospective cohort study. Multiple regression analysis was performed to determine the predictors of QOL at discharge using two models: model 1, basic medical information and physical functions at admission, and model 2, basic medical information, physical function, and activity after 4 weeks of admission. RESULTS: Multiple regression analysis (standard partial regression coefficients) using model 1 identified L2 to L4 bone mineral density (-0.2), Visual Analog Scale for pain during activity at admission (-0.31), and Revised Hasegawa Dementia Scale (HDS-R) score at admission (0.64) as factors affecting QOL at discharge. Multiple regression analysis using model 2 identified HDS-R at admission (0.64), Pain Catastrophizing Scale score at 4 weeks (-0.34), and knee extension muscle strength at 4 weeks (0.28) as factors affecting QOL at discharge. CONCLUSIONS: Our results suggest that if patients have high bone mineral density, intense pain, and low cognitive function at admission, then low QOL at discharge will be predicted; however, improvement of pain catastrophizing and knee extension muscle strength during first the 4 weeks of admission may be able to improve QOL at discharge. Because patients in this study were Japanese only, it is important to exercise caution when applying our results to other populations.


Assuntos
Regras de Decisão Clínica , Fraturas por Osteoporose , Alta do Paciente , Qualidade de Vida , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Demência/diagnóstico , Feminino , Seguimentos , Fixação de Fratura , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/psicologia , Fraturas por Osteoporose/cirurgia , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/psicologia , Prognóstico , Estudos Prospectivos , Qualidade de Vida/psicologia , Recuperação de Função Fisiológica , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/psicologia , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral , Escala Visual Analógica
4.
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
5.
Medicine (Baltimore) ; 100(12): e25151, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761684

RESUMO

ABSTRACT: In 2014, the American College of Cardiology/American Heart Association (ACC/AHA) released guidelines for ordering pre-operative echocardiograms in patients undergoing non-cardiac surgery. The purpose of this study is to determine if pre-operative echocardiograms ordered prior to fragility hip fracture repair are ordered according to these guidelines, change anesthetic management or affect patient outcomes. In addition, we attempted to evaluate the efficacy of the ACC/AHA guidelines.We conducted a 4-year retrospective chart review of acute fragility hip fractures at a single institution. Charts were reviewed to determine which patients met criteria for a pre-operative echocardiogram. Within this group we then compared patients who received a pre-operative echocardiogram to those who did not. Comparisons were made with regard to time to surgery, changes from standard anesthetic management, major adverse cardiac events, length of hospital stay, and 1-year mortality. We also examined which patients received postoperative echocardiograms and the incidence of adverse cardiac events in this group.Of 402 patients, 87 (22%) had ACC/AHA indications for pre-operative echocardiogram, and 42 (48%) of them received one. The indication to order a pre-operative echocardiogram in stable heart failure or valve disease patients if their last echo was greater than 1 year was only followed 23% of the time. In the pre-operative echocardiogram group, anesthetic management was adjusted more frequently (P = .025), and average time to surgery was greater (P < .001). The incidence of a major adverse cardiac event was 10% in the ACC/AHA echocardiogram indicated group and 3% in the non-indicated echocardiogram group. An equal number of echocardiograms were completed postoperatively as were completed under ACC/AHA pre-operative guidelines. Sixty-seven percent of the postoperative echocardiograms did not have ACC/AHA pre-operative indications.Our data demonstrates that pre-operative echocardiograms for "stable heart failure and valvular disease with greater than 1 year from last echocardiogram" is infrequently performed without significant adverse cardiac outcomes. Pre-operative echocardiography was associated with more anesthetic adjustments and longer time to surgery. Postoperative echocardiograms were done for cardiopulmonary complications. Studies need to examine and refine clinical parameters that would improve the selection of patients who would benefit from pre-operative echocardiograms.


Assuntos
Ecocardiografia/normas , Cardiopatias/prevenção & controle , Fraturas do Quadril/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/normas , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Fraturas do Quadril/cirurgia , Humanos , Incidência , Masculino , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco
6.
Medicine (Baltimore) ; 100(7): e24596, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607792

RESUMO

PURPOSE: This study aimed to investigate the potential beneficial effects of periarticular injection (PAI) of multimodal drugs on the inflammatory response and joint function after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures. METHODS: Fifty six elderly patients with unilateral osteoporotic femoral neck fractures were randomly allocated to 2 groups: the PAI group, which received the multimodal drug PAI intraoperatively before incision closure, and the control group, which received an injection of saline at the same time as placebo. The C-reactive protein (CRP), interleukin-1ß (IL-1ß), and IL-6 levels as well as the erythrocyte sedimentation rate (ESR) in peripheral venous blood samples were measured, along with the Visual Analogue Scale (VAS) score with activity and Harris hip score preoperation at 1, 2, 4, 7, and 14 days as well as 1 and 3 months post-operation. RESULTS: The 2 groups were comparable in sex and age, and no significant differences were observed in the preoperative CRP, IL-1ß, and IL-6 levels, ESR, VAS score, or Harris hip score between the 2 groups (all P > .05). However, during the postoperative period, the PAI group exhibited significantly lower levels of CRP, IL-1ß, and IL-6 as well as a lower ERS and VAS score compared with the control group (P < .05), while the Harris hip score was significantly higher postoperatively in the PAI group (P < .05). CONCLUSION: Multimodal drug PAI can alleviate the inflammatory response and enhance hip function recovery after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral/cirurgia , Mediadores da Inflamação/sangue , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica , Idoso , Betametasona/administração & dosagem , Biomarcadores/sangue , Quimioterapia Combinada , Epinefrina/administração & dosagem , Feminino , Humanos , Injeções Intra-Articulares , Cuidados Intraoperatórios , Isoxazóis/administração & dosagem , Masculino , Morfina/administração & dosagem , Ropivacaina/administração & dosagem
7.
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
8.
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
9.
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
10.
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
11.
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
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
13.
Medicine (Baltimore) ; 99(31): e21276, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756106

RESUMO

To retrospectively evaluate the efficacy and safety of unilateral and bilateral percutaneous balloon kyphoplasty (PKP) in the treatment of osteoporotic thoracolumbar burst fractures.Retrospectively collected clinical data of 138 patients with osteoporotic thoracolumbar burst fractures who underwent unilateral (n = 70) and bilateral (n = 68) PKP in our hospital from March 2015 to December 2018. The general conditions, operation time, radiation exposure time, intraoperative blood loss, bone cement dosage, hospitalization expenses, and complications were collected from the two groups. Visual analog scale (VAS) values, Cobb's angle changes, average vertebral height changes, and Oswestry Dysfunction Index (ODI) values before treatment, 1 month, and 6 months after treatment were collected.There was no significant difference in gender (male: 28 vs 22; female 42 vs 46) and age (70.25 ±â€Š7.10 vs 69.82 ±â€Š8.20, P > .05) distribution between the two groups. The VAS score (7.38 ±â€Š1.34 vs 2.52 ±â€Š0.99, P < .05), ODI (77.24 ±â€Š6.98 vs 23.11 ±â€Š3.54, P < .05), vertebral mean height (16.71 ±â€Š2.18 vs 17.05 ±â€Š1.94, P < .05) and Cobb's angle (20.26 ±â€Š3.21 vs 11.58 ±â€Š3.20, P < .05) of the two groups were significantly improved after operation, but there was no significant difference between the two groups (P > .05). There was no significant difference in the rate of cement leakage (10.29% vs 11.42%, P > .05), incision swelling (30.88% vs 19.71%, P > .05) and incidence of adjacent vertebrae (4.41% vs 5.71%, P > .05) between the two groups. Compared with bilateral PKP group, operation time (50.88 ±â€Š7.38 vs 62.18 ±â€Š8.01), intraoperative blood loss (14.54 ±â€Š3.16 vs 22.03 ±â€Š5.92), radiation exposure time (23.74 ±â€Š3.41 vs 15.22 ±â€Š3.70), bone cement dosage (4.36 ±â€Š0.81 vs 5.16 ±â€Š0.77) and hospitalization costs (2.38 ±â€Š0.08 vs 2.74 ±â€Š0.07) were significantly lower in the unilateral PKP group (P < .05).Bilateral PKP and unilateral PKP have the same efficacy and safety in the treatment of osteoporotic thoracolumbar burst fractures. However, the unilateral PKP has the characteristics of short operation time, small trauma, low cost and short radiation exposure time, and has clinical application value.


Assuntos
Cifoplastia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
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): E967-E971, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675618

RESUMO

STUDY DESIGN: Technique note. OBJECTIVE: To evaluate the feasibility of endoscopy in various spinal pathologies. SUMMARY OF BACKGROUND DATA: Osteoporotic vertebral fractures are a common pathology in the elderly. These fractures are often accompanied by serious complications such as neurological deficits due to the compression of the spinal cord or nerve roots. METHODS: A 78-year-old female patient presented to our hospital with a severe pain in her left leg and back. Lumbar magnetic resonance imaging and computed tomography scan revealed an osteoporotic L3 burst fracture compressing the left L3 nerve root. A minimally invasive translaminar endoscopic approach was used to remove the fractured fragment and cement was injected into the L3 vertebra. The patient was mobilized the same evening and was relieved of her pain. CONCLUSION: Minimally invasive endoscopy is a safe and effective alternative to conventional major decompression with or without posterior stabilization, particularly in elderly patients with serious comorbidities. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Lombares/cirurgia , Neuroendoscopia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Cimentos para Ossos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem
16.
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
17.
Clin Orthop Surg ; 12(2): 194-199, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32489541

RESUMO

Background: Pedicle screw augmentation with bone cement has been experimentally demonstrated to increase the pullout strength. However, the mechanisms of screw loosening are complicated and interacting. Although vertebroplasty augmentation and fenestrated screw augmentation have been compared in many studies, there has been no comparative study on their clinical effects and complications in real clinical settings. We investigated clinical effects of bone cement augmentation of a pedicle screw and differences according to augmentation methods. Methods: Of the total 241 patients who had osteoporosis and underwent posterior pedicle screw fixation without anterior bone graft between January 2010 and December 2016, 132 patients with ≥2 years of radiological follow-up were included in this retrospective study. The patients were divided into group I (unaugmented) and group II (bone cement augmented). Group II was subdivided into II-S group (solid screw augmented) and II-F group (fenestrated screw augmented). The incidence of screw loosening was compared between groups I and II. Cement leakage, screw loosening, and screw fractures were investigated in the subgroups. Results: In total, 36 of 71 (52%, group I) unaugmented cases and 96 of 170 (56%, group II) augmented cases were followed up for ≥2 years. Of the total 78 solid screw augmented cases, 42 (56%) were in II-S group; 54 of the total 92 (59%) fenestrated screw augmented cases were in II-F group. Groups I and II were homogenous regarding demographic characteristics; II-S and II-F groups were also homogenous. The incidence of screw loosening was 50.0% (18/36) in group I and 7.3% (7/96) in group II (p < 0.001). Cement leakage developed in 2 of 42 (4.8%) cases in II-S group and in 5 of 54 (9.3%) cases in II-F group (p = 0.462). Screw loosening developed in 6 of 42 (14.3%) cases in II-S group and in 1 of 54 cases (1.9%) in II-F group (p = 0.041). Screw fracture developed in none of 42 cases in II-S group and in 3 of 54 cases (5.6%) in II-F group (p = 0.254). Conclusions: In osteoporotic patients, bone cement augmentation of a pedicle screw decreased the incidence of screw loosening, and fenestrated screw augmentation was more effective than vertebroplasty augmentation.


Assuntos
Cimentos para Ossos , Teste de Materiais , Parafusos Pediculares , Complicações Pós-Operatórias/etiologia , Vertebroplastia/métodos , Idoso , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Vértebras Torácicas/cirurgia
18.
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
19.
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
20.
Pain Res Manag ; 2020: 4145096, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566060

RESUMO

Purpose: We aimed to present our experience in anchoring technique and evaluate the efficacy and safety of unilateral percutaneous vertebroplasty in patients with neurologically intact Kümmell's disease. Methods: From January 2014 to December 2017, 29 patients (17 males and 12 females) with neurologically intact Kümmell's disease were operated on using anchoring technique in unilateral percutaneous vertebroplasty (PVP). Ages of the enrolled patients ranged from 67 to 81 years (mean 73.8 years). Clinical efficacy was evaluated by back pain visual analogue scale (BP-VAS) score, Oswestry disability index (ODI) score, as well as the height of anterior border and the kyphotic angle of the involved vertebral body on a standing lateral radiograph. The safety of PVP was assessed by surgical-related complications, including bone cement leakage and neurological deficit. Results: All 29 patients underwent the PVP procedure successfully. The mean operation time was 35 ± 12 min. And all patients were able to walk/ambulate with a thoracolumbar brace after 12 to 24 hours, staying in bed postoperatively. Significantly statistical differences were observed in both BP-VAS and ODI scores at each time point of follow-up when compared with the preoperative condition (P < 0.05). Besides, statistically significant improvement in radiographic measurements such as kyphotic angle and the height of the anterior border of the involved vertebral body between the preoperative and postoperative assessments was also observed (P < 0.05) and asymptomatic leakage of cement occurred in 7 of 29 cases (24.1%). Conclusions: We considered that the anchoring technique in unilateral PVP could provide an effective and safe alternative for neurologically intact Kümmell's disease.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Fraturas por Compressão/cirurgia , Humanos , Masculino , Fraturas da Coluna Vertebral/complicações
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