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OBJECTIVE: To compare the clinical and radiological outcomes of limited discectomy (LD) and aggressive discectomy (AD) performed via spinal endoscopy using the transforaminal approach in patients with lumbar disc herniation(LDH) METHODS: We conducted a retrospective review of patients who underwent percutaneous endoscopic transforaminal discectomy (PETD) at the L4-L5 lumbar spine segments in our department from January 2017 to December 2020. The follow-up period extended to 24 months postoperatively. Patients were categorized into the LD and AD groups based on the extent of intraoperative disc removal. We retrospectively collected and analyzed clinical and radiological data. RESULTS: The study followed 65 patients, with 36 in the LD group and 29 in the AD group. No statistically significant differences were noted in recurrence rates, the excellent and good Macnab rates, preoperative Disc Height Index (DHI), and preoperative Modic changes between the groups (P >0.05). However, significant differences were observed in operation duration, postoperative DHI and postoperative Modic change (P<0.05). No significant differences in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were detected between the groups preoperatively, or one and two years postoperatively (P>0.05). Nevertheless, notable differences in VAS and ODI scores were present one month postoperatively (P<0.05). CONCLUSION: As a conventional surgical method for treating LDH, PETD can achieve satisfactory clinical results in both LD and AD, with no significant variance in recurrence rates. However, AD is associated with longer operation times, and greater postoperative reductions in DHI and greater postoperative Modic changes compared to LD.
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Discotomia Percutânea , Endoscopia , Deslocamento do Disco Intervertebral , Vértebras Lombares , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Estudos Retrospectivos , Masculino , Feminino , Vértebras Lombares/cirurgia , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Adulto , Endoscopia/métodos , Resultado do Tratamento , Discotomia Percutânea/métodos , Seguimentos , RecidivaRESUMO
BACKGROUND: Currently, consensus is lacking on the necessity of internal fixation after reducing valgus-intercalated femoral neck fractures with abduction > 15°. This study employs finite element analysis to compare the biomechanical differences between the femoral neck dynamic cross nail system (FNS) and inverted cannulated screw (ICS), aiming to provide a foundation for clinical procedures. METHODS: Human femur CT scan data were processed using MimICS21.0 and Geomagic 2021 software, imported into Solidworks2021 to create fracture models, based on Garden I abduction and Valgus-intercalated femoral neck fractures. The internal fixation model was divided into two groups: A-Anatomic reduction group; B-Valgus-intercalated femoral neck fracture group. ANSYS software facilitated meshing, material assignment, and data calculation for stress and displacement comparisons when ICS and FNS were applied in reduction or non-reduction scenarios. RESULTS: Without internal fixation, peak femur stress in both groups was 142.93 MPa and 183.62 MPa. Post FNS fixation, peak stress was 254.11 MPa and 424.81 MPa; peak stresses for the two FNS models were 141.26 MPa and 248.33 MPa. Maximum displacements for the two FNS groups were 1.91 mm and 1.26 mm, with peak fracture-end stress at 50.751 MPa and 124.47 MPa. After ICS fixation, femur peak stress was 204.76 MPa and 274.08 MPa; maximum displacements were 1.53 mm and 1.15 mm. ICS peak stress was 123.88 MPa and 174.61 MPa; maximum displacements were 1.17 mm and 1.09 mm, with peak fracture-end stress at 61.732 MPa and 104.02 MPa, respectively. CONCLUSIONS: Our finite element study indicates superior mechanical stability with internal fixation after reducing valgus-intercalated femoral neck fractures (> 15°) compared to in situ fixation. Additionally, ICS biomechanical properties are more suitable for this fracture type than FNS.
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Fraturas do Colo Femoral , Humanos , Análise de Elementos Finitos , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/métodos , Fêmur , Colo do Fêmur , Fenômenos BiomecânicosRESUMO
BACKGROUND: Tranexamic acid (TXA) has long been the antifibrinolytic hemostatic drug of choice for orthopedic surgery. In recent years, the hemostatic effect of epsilon aminocaproic acid (EACA) has gradually been recognized by orthopedic surgeons and has begun to be used in hip and knee arthroplasty with little mention of the comparison of these two drugs; Therefore, this study compared the efficacy and safety of EACA and TXA in the perioperative period of elderly patients with trochanteric fractures to verify whether EAC could be a "qualified alternative" to TXA and to provide theoretical support for the clinical application of TXA. METHODS: Two hundred and forty-three patients who received proximal femoral nail antirotation (PFNA) for trochanteric fractures from January 2021 to March 2022 at our institution were included and divided into the EACA group (n = 146) and the TXA group. (n = 97) determined by the drugs used in the perioperative period The main observations were blood loss and blood transfusion.The second second outcome was blood routine, coagulation, Hospital complications and complications after discharge. RESULTS: The perioperative EACA patients had significantly lower significant blood loss (DBL) than the TXA group (p < 0.0001) and statistically significant lower C-reactive protein in the EACA group than in the TXA group on postoperative day 1 (p = 0.022). Patients on perioperative TXA had better postoperative day one (p = 0.002) and postoperative day five erythrocyte width than the EACA group (p = 0.004). However, there was no statistically significant difference between the two groups in the remaining indicators in both drugs: blood items, coagulation indicators, blood loss, blood transfusion, length of hospital(LOH), total hospital expense, and postoperative complications (p > 0.05). CONCLUSION: The hemostatic effects and safety of EACA and TXA in the perioperative application of trochanteric fractures in the elderly are essentially similar, and EACA can be considered for use as an alternative to TXA, increasing the flexibility of physicians to use it in the clinical setting. However, the limited sample size included necessitated a high-quality, large sample of clinical studies and long-term follow-up.
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Antifibrinolíticos , Fraturas do Quadril , Ácido Tranexâmico , Humanos , Idoso , Ácido Aminocaproico/efeitos adversos , Ácido Tranexâmico/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Perda Sanguínea Cirúrgica/prevenção & controle , Antifibrinolíticos/efeitos adversos , Período Pós-Operatório , Fraturas do Quadril/tratamento farmacológico , Fraturas do Quadril/cirurgia , Fraturas do Quadril/complicaçõesRESUMO
BACKGROUND: The ramifications of osteoporotic fractures and their subsequent complications are becoming progressively detrimental for the elderly population. This study evaluates the clinical ramifications of postoperative bone cement distribution in patients with osteoporotic vertebral compression fractures (OVCF) who underwent both bilateral and unilateral Percutaneous Vertebroplasty (PVP). OBJECTIVE: The research aims to discern the influence of bone cement distribution on the clinical outcomes of both bilateral and unilateral Percutaneous Vertebroplasty. The overarching intention is to foster efficacious preventive and therapeutic strategies to mitigate postoperative vertebral fractures and thereby enhance surgical outcomes. METHODS: A comprehensive evaluation was undertaken on 139 patients who received either bilateral or unilateral PVP in our institution between January 2018 and March 2022. These patients were systematically classified into three distinct groups: unilateral PVP (n = 87), bilateral PVP with a connected modality (n = 29), and bilateral PVP with a disconnected modality (n = 23). Several operational metrics were juxtaposed across these cohorts, encapsulating operative duration, aggregate hospital expenses, bone cement administration metrics, VAS (Visual Analogue Scale) scores, ODI (Oswestry Disability Index) scores relative to lumbar discomfort, postoperative vertebral height restitution rates, and the status of the traumatized and adjacent vertebral bodies. Preliminary findings indicated that the VAS scores for the January and December cohorts were considerably reduced compared to the unilateral PVP group (P = 0.015, 0.032). Furthermore, the recurrence of fractures in the affected and adjacent vertebral structures was more pronounced in the unilateral PVP cohort compared to the bilateral PVP cohorts. The duration of the procedure (P = 0.000) and the overall hospitalization expenses for the unilateral PVP group were markedly lesser than for both the connected and disconnected bilateral PVP groups, a difference that was statistically significant (P = 0.015, P = 0.024, respectively). Nevertheless, other parameters, such as the volume of cement infused, incidence of cement spillage, ODI scores for lumbar discomfort, post-surgical vertebral height restitution rate, localized vertebral kyphosis, and the alignment of cement and endplate, did not exhibit significant statistical deviations (P > 0.05). CONCLUSION: In juxtaposition with unilateral PVP, the employment of bilateral PVP exhibits enhanced long-term prognostic outcomes for patients afflicted with vertebral compression fractures. Notably, bilateral PVP significantly curtails the prevalence of subsequent vertebral injuries. Conversely, the unilateral PVP cohort is distinguished by its abbreviated operational duration, minimal invasiveness, and reduced overall hospitalization expenditures, conferring it with substantial clinical applicability and merit.
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Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Idoso , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Fraturas por Compressão/complicações , Cimentos Ósseos/uso terapêutico , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/etiologia , Resultado do Tratamento , Cifoplastia/métodos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Fraturas por Osteoporose/complicações , Estudos RetrospectivosRESUMO
OBJECTIVE: This study compares the efficacy and complications of endoscopic transforaminal lumbar fusion (Endo-TLIF) and minimally invasive transforaminal lumbar fusion (MIS-TLIF) in treating lumbar degenerative diseases. It aims to provide reference data for clinical decision-making. METHODS: We identified randomized controlled studies and non-randomized controlled studies on Endo-TLIF and MIS-TLIF for treating lumbar degenerative diseases based on specific inclusion and exclusion criteria. Data were managed with Endnote X9 software and meta-analyzed using Revman 5.3 software. Extracted outcomes included lower back VAS score, lower extremity pain VAS score, low back pain ODI score, complication rate, fusion rate, time to surgery, blood loss, and length of hospital stay. RESULTS: â Thirteen high-quality studies were included in this meta-analysis, totaling 1015 patients-493 in the Endo-TLIF group and 522 in the MIS-TLIF group. â¡ Meta-analysis results revealed no significant differences in preoperative, postoperative 6-month, and final follow-up waist VAS scores, lower limb pain VAS score, ODI index, complications, and fusion rate between the two groups (P > 0.05). The MIS-TLIF group had a shorter operative time (MD = 29.13, 95% CI 10.86, 47.39, P = 0.002) than the Endo-TLIF group. However, the Endo-TLIF group had less blood loss (MD = - 76.75, 95% CI - 111.59, - 41.90, P < 0.0001), a shorter hospital stay (MD = - 2.15, 95% CI - 2.95, - 1.34, P < 0.00001), and lower lumbar VAS scores both immediately postoperative (≤ 2 week) (MD = - 1.12, 95% CI - 1.53, - 0.71, P < 0.00001) compared to the MIS-TLIF group. CONCLUSION: Meta-analysis results indicated that Endo-TLIF is similar to MIS-TLIF in terms of long-term clinical outcomes, fusion rates, and complication rates. Although MIS-TLIF has a shorter operation time, Endo-TLIF can significantly reduce blood loss and hospital stay duration. Endo-TLIF offers the advantages of less surgical trauma, reduced blood loss, faster recovery, and early alleviation of postoperative back pain.
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Dor Lombar , Fusão Vertebral , Humanos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
Objective: This study aims to investigate the clinical efficacy of endoscopic spinal tuberculosis focus removal, posterior pedicle lesion removal, bone grafting, and internal fixation combined with drug chemotherapy in treating thoracolumbar tuberculosis. It also seeks to summarize strategies for preventing complications and provide a reference for clinical treatment. Methods: We retrospectively analyzed 105 patients with spinal tuberculosis treated in our hospital from January 2018 to December 2022. Patients were divided into two groups: Group A (n=38), who underwent endoscopic spinal tuberculosis focus removal, and Group B (n=67), who underwent posterior pedicle lesion removal, bone grafting, and internal fixation. All patients received preoperative quadruple anti-tuberculosis drug chemotherapy (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) for 2-4 weeks. We recorded and compared parameters such as operation time, intraoperative blood loss, postoperative drainage, recovery time, hospital stay, blood transfusion, and complications. We also compared pre- and postoperative lumbar VAS, ODI, erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, and Cobb angle to evaluate kyphotic deformity and correction. Results: Preoperative data including age, sex, body mass index, segment involvement, past medical history, smoking history, preoperative erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, lumbar VAS score, lumbar ODI score, and spinal Cobb's angle showed no significant difference between the groups (P>0.05). Main postoperative indicators revealed that Group A had significantly lower lumbar VAS scores, higher hemoglobin and total protein levels, and a lower recurrence rate than Group B at the last follow-up (P<0.05). Secondary postoperative indicators showed that Group A required significantly less blood transfusion, had shorter operative time, less intraoperative blood loss, shorter postoperative hospitalization time, and lower Cobb Angle than Group B (P<0.05). Conclusion: Endoscopic spinal tuberculosis focus removal can achieve comparable safety to posterior pedicle lesion removal, bone grafting, and internal fixation, with shorter operation time, less intraoperative bleeding, lower postoperative recurrence rate, and less postoperative drainage. This method can effectively improve blood sedimentation, lumbar function, restore Cobb angle, and reduce pain, making it worthy of promotion and application.
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Objective: This study analyzed the current research hotspots and future development trends of the therapeutic effects of microRNA on PNI axonal regeneration through bibliometric methods. Moreover, the current advantages and disadvantages of this field as well as future development prospects are discussed in depth. Methods: CiteSpace V and VOSviewer were used as bibliometric tools to complete the analysis of the research focus and direction of the published articles. To supplement, sort out, and summarize, we analyzed the research status of the study on the application of microRNAs for axonal regeneration after peripheral nerve injury from 2013 to 2023. Results: A total of 207 publications were retrieved from the Web of Science database. After exclusion and screening, a final selection of 174 articles that met the research criteria. These 174 articles were authored by a total of 846 individuals, representing 24 countries and 199 institutions. Additionally, this study presents information on the annual publication output, country distribution, top 5 contributing authors, top 5 most cited articles, and top 10 contributing institutions. Conclusion: As one of the hottest topics today, microRNAs have become the current research hotspot in neural inflammation, neural cell repair and regeneration, neural protection, and functional recovery. With more investment in research in this field, more high-quality articles will be published in both domestic and international outstanding journals, which will bring a new era for the treatment of peripheral nerve injury.
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Background: Low molecular heparin(LMWH) and sodium sulfadiazine heparin(FPX) are commonly used to prevent deep vein thrombosis(DVT) after total hip arthroplasty(THA). In this study, we compared the role of these drugs in preventing DVT after THA. Methods: Patients who underwent unilateral THA at the Sixth Affiliated Hospital of Xinjiang Medical University from April 2020 to December 2022 were retrospectively analyzed for inclusion in this study. According to the anticoagulant drugs used, the patients were divided into LMWH group (n=106) and FPX group (n=97). Changes in perioperative coagulation-related indices, hemoglobin, blood loss And the postoperative complications. Results: The preoperative indexes of the two groups of patients, the difference was not statistically significant (P>0.05); the indexes of Intraoperative blood loss, Visible blood loss, Hidden blood loss, and Total blood loss of the two groups of patients were compared, and the difference was not significant (P>0.05); PT activity and INR in the LMWH group were significantly lower than those in the FPX group on the 1st and 5th postoperative days, and the differences were significant (P<0.05); Platelets, Hemoglobin, Hematocrit, D-dimer, and Fibrinogen were compared between the two groups on the 1st and 5th postoperative days, and the differences were not significant (P<0.05). The differences were not significant (P>0.05). The differences in blood transfusion rate and blood volume between the two groups were not significant (P>0.05); the total hospitalization cost of the LMWH group was significantly lower than that of the FPX group, and the difference was significant (P<0.05); and the differences in the incidence of postoperative complications between the two groups were not significant (P>0.05). Conclusion: In this study, we found that the efficacy and safety of FPX and LMWH in preventing VTE after THA were basically the same, and the total cost of hospitalization in the LMWH group was significantly lower than that in the FPX group; however, due to the limited inclusion of the sample size, high-quality, large-sample, long-term follow-up clinical studies are necessary.
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OBJECTIVE:To compare the efficacy and safety of terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures through a Meta-analysis. METHODS:By searching PubMed,Cochrane Library,EMbase,CNKI,WanFang and VIP databases,18 randomized controlled studies on terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures were included according to inclusion and exclusion criteria.Endnote X9 software was used to manage the literature and Revman 5.3 software was used to perform a Meta-analysis on the extracted data.The incidences of vertebral fracture,non-vertebral fracture and adverse reaction in postmenopausal osteoporosis patients treated with terlipatide and bisphosphate were analyzed. RESULTS:A total of 18 randomized controlled studies were included,of which 10 were of medium and high quality and 8 were of low quality.Meta-analysis results showed that the fracture incidence in the teriparatide group[risk ratio(RR)=0.56,95%confidence interval(CI):0.48-0.66,P<0.000 01]was lower than that in the bisphosphonate group,and teriparatide was superior to alendronate in preventing fractures in postmenopausal women with osteoporosis(RR=0.50,95%CI:0.35-0.69,P<0.000 1)and other bisphosphonates(RR=0.58,95%CI:0.49-0.70,P<0.000 01).During the follow-up over 18 months,teriparatide was superior to bisphosphonates in preventing fractures in postmenopausal women with osteoporosis(RR=0.56,95%CI:0.48-0.69,P<0.000 01).In addition,we found that teriparatide was superior to bisphosphonates in preventing vertebral fractures(RR=0.48,95%CI:0.37-0.62,P<0.000 01)and non-vertebral fractures(RR=0.63,95%CI:0.51-0.78,P<0.000 1)in postmenopausal women with osteoporosis.Teriparatide was superior to bisphosphonates in increasing lumbar bone density[odds ratio=4.16,95%CI:2.96-5.36,P<0.000 1)and femoral neck bone density(odds ratio=1.02,95%CI:0.04-2.01,P=0.04).There was no significant difference in adverse reactions between teriparatide and bisphosphonates(RR=0.95,95%CI:0.85,1.06,P=0.37). CONCLUSION:Teriparatide is superior to bisphosphonates in preventing vertebral and non-vertebral fractures in postmenopausal women with osteoporosis,but the safety and adverse drug reactions of teriparatide and bisphosphonates are basically similar.Teriparatide is superior to bisphosphonate in preventing fracture and improving lumbar and femoral neck bone density regardless of short-term(<18 months)or long-term(≥18 months)use.
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BACKGROUND:Studies have shown that good bone cement distribution during percutaneous vertebroplasty reduces postoperative secondary vertebral fractures and helps improve prognosis.However,how to get a good distribution of bone cement is a problem for spine surgeons. OBJECTIVE:To analyze the correlation of bone cement distribution with surgical and adjacent vertebral refractures after percutaneous vertebroplasty. METHODS:A total of 193 patients with thoracolumbar compression fracture(≤2 fractured vertebrae)admitted to Xinjiang Uygur Autonomous Region Orthopedic Hospital from January 2018 to December 2022 were selected.They underwent percutaneous vertebroplasty via unilateral approach and were followed up after surgery.They were divided into fracture group(n=30)and non-fracture group(n=163)based on whether the surgical and adjacent vertebral fractures were observed during the follow-up period(more than 6 months).The basic data of the two groups were analyzed by univariate analysis.Statistically significant factors were replaced with binary logistic regression model to explore the correlation with recompression fracture of surgical and adjacent vertebrae after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis showed that there was no significant difference between the two groups in gender,body mass index,menopause age of female patients,bone cement dose,previous history,smoking history,drinking history,operation segment,operation time,and hospital stay(P>0.05).There were significant differences in age,bone mineral density T value,bone cement leakage,and bone cement distribution between the two groups(P<0.05).(2)Binary logistic regression analysis showed that age(95%CI:1.016-1.167,P=0.016),bone cement leakage(95%CI:0.080-0.582,P=0.002),bone mineral density T value(95%CI:1.214-22.602,P=0.026),and bone cement distribution(P=0.007)were risk factors for recurrent fractures after percutaneous vertebroplasty and adjacent vertebroplasty.Patients with type I bone cement distribution(which did not touch the upper and lower endplates of the vertebral body)had a higher risk of recurrent fractures of surgical and adjacent vertebrae after percutaneous vertebroplasty.(3)The results of this study show that refracture of surgical and adjacent vertebrae is caused by the interaction of various risk factors.Age,bone cement leakage,T value of bone mineral density and bone cement distribution are independent risk factors for surgical and adjacent vertebral refracture.Refracture of surgical and adjacent vertebrae can easily occur when bone cement is distributed type I.
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BACKGROUND:Studies have exhibited that symmetrical distribution and effective dose of bone cement can reduce postoperative vertebral refractures and help improve outcomes,but obtaining better distribution and dose of bone cement during percutaneous vertebroplasty remains an issue for surgeons. OBJECTIVE:To investigate the risk factors of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture,and to analyze the correlation between these factors and recurrent fractures of the operative vertebral body and adjacent vertebral bodies after percutaneous vertebroplasty. METHODS:111 patients who underwent unilateral approach percutaneous vertebroplasty in Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2021 were screened and divided into fracture group(n=17)and non-fracture group(n=94)according to whether refracture was observed during follow-up.The following variables were reviewed in both groups:Gender,age,body mass index,operation time,menopause age,bone cement distribution index,bone density T value,bone cement dose,location of bone cement distribution,percutaneous vertebroplasty stage,past history,adverse reactions and disc cement leakage of patients.These variables were analyzed by univariate analysis.The statistically significant factors were replaced by a binary Logistic regression model to analyze the correlation with vertebral refracture after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis demonstrated that after percutaneous vertebroplasty,vertebral refracture was associated with disc cement leakage(P=0.000),cement dose(P=0.049),and cement distribution location(P=0.017).(2)Binary Logistic regression revealed that bone cement leakage(P=0.000),cement dose(P=0.031),and location of cement distribution(P=0.015)were risk factors for recurrent fracture of the operative vertebral body and adjacent vertebral body after percutaneous vertebroplasty.Compared with cement distribution types I,II,and III,the risk of recurrent fracture in the operative and adjacent vertebrae was higher in cement distribution types IV and V(OR=36.340,P=0.016;OR=27.755,P=0.017).(3)It is concluded that recurrent fractures of the surgically operated vertebral body and adjacent vertebral bodies are caused by the interaction of multiple risk factors.Bone cement distribution and bone cement leakage were independent risk factors.Recurrent fractures of the operative vertebra and adjacent vertebrae are more likely when the cement is distributed in type IV and type V.Surgeons should fully assess these risk factors before surgery and develop targeted prevention and treatment strategies to help reduce the risk of future refractures.