[Comparison of the effects of injured vertebra pedicle fixation combined with vertebroplasty and vertebra pedicle screw fixation combined with vertebroplasty in the treatment of osteoporotic thoracolumbar burst fractures].

OBJECTIVE: To assess the curative effects of injured vertebra pedicle fixation combined with vertebroplasty and short-segment pedicle screw fixation combined with vertebroplasty in treatment of osteoporotic thoracolumbar burst fractures. METHODS: Seventy patients with osteoporotic thoracolumbar burst fractures who met the inclusion criteria were collected in the study from January 2015 to December 2017. Among them, 35 patients were treated with injured vertebra pedicle fixation combined with vertebroplasty (group A), including 20 males and 15 females, aged from 55 to 74 years with an average of (64.03± 7.82) years. Twenty-six cases were type A3 and 9 cases were type A4 according to the AO typing;another 35 patients were treated with short segment pedicle screw fixation combined with vertebroplasty (group B), including 18 males and 17 females, aged from 54 to 72 years with an average of (62.78±6.40) years. Twenty-eight cases were type A3 and 7 cases were type A4 according to AO typing. Operation length, intraoperative bleeding volume, complication, imaging parameters and clinical effects were compared between the two groups. RESULTS: All the patients were followed up for at least 12 months. There were no significant differences in gender, age, injury site, preoperative VAS, Cobb angle, and injured vertebral height before surgery. There were no significant differences in operation length, intraoperative bleeding volume between two groups. In terms of VAS scores before surgery, 1 week after surgery, and at the final follow up, group A was 5.5 ±2.5, 1.8 ±0.8, 0.9 ±0.4, group B was 5.4 ± 2.3, 1.7±0.6, 1.2±1.8, respectively;injured vertebral height was (40.4±8.8)%, (92.0±4.9)%, (87.1±3.8)% in group A, and (41.2±6.6)%, (93.2±4.6)%, (80.0±4.3)% in group B;Cobb angle was (18.4±6.9) °, (2.8±2.2) °, (4.2±2.6) ° in group A, and (16.8±7.2) °, (2.7±2.5) °, (6.0±2.4) ° in group B. There were significant differences in the 3 parameters above before the operation and at the final follow up in all groups (P<0.05). There were significant differences in the Cobb angle and injured vertebral height between 1 week after operation and at the final follow up (P<0.05). At the final follow up, injured vertebral height in group A was obviously better than that in group B (P<0.05). Internal fixation failure occurred in 2 cases from the group A, and occurred in 4 cases from the group B. There were no neurological complications in both groups. CONCLUSION: For osteoporotic thoracolumbar vertebral burst fractures, injured vertebra pedicle fixation combined with vertebroplasty and vertebra pedicle screw fixation combined with vertebroplasty can achieve good clinical effects. However, injured vertebra pedicle fixation combined with vertebroplasty is better at maintaining postoperative vertebral height and sagittal arrangement, and reducing internal fixation related complications. The treatment strategy is worthy of application and promotion.

[Diagnosis and clinical application of MRI for giant cell tumor of tendon sheath in lower extremity].

OBJECTIVE: To analyze the manifestation and investigate the value of MRI in the diagnosis of giant cell tumor of tendon sheath (GCTTS). METHODS: Twenty patients with GCTTS proved by operation and pathology were retrospectively analyzed. There were 8 males and 12 females. The average age was 35.5 years, range from 15 to 61 years. All the patients underwent MRI examination. RESULTS: Among the 20 cases, 16 patients had the tumor in knee joint, 2 patients had the tumor in interphalangeal articulation of foot and ankle joint respectively. Nineteen patients had limited tumor and 1 patient had diffuse tumor. The soft tissue mass localized beside lower extremity osteoarticulation was displayed on MRI images. On T1WI, the signal intensities of GCTTS almost equaled to those of skeletal muscle in 15 cases and were slightly lower than those of skeletal muscle in 5 cases. On T2WI, the signal intensities tended to range between those of skeletal muscle and fat in 4 cases, almost equaled to those of skeletal muscle in 13 cases, and were slightly lower than those of skeletal muscle in 3 cases. In the 16 patients with gadolinium-enhanced images on T1WI, 5 patients showed homogeneous enhancement and 11 patients showed inhomogeneous enhancement. Four patients had adjacent bone destruction. CONCLUSION: The location, shape and inner signal characteristic of GCTTS localized beside lower extremity osteoarticulation could be demonstrated clearly by MRI examination, which is valuable for clinical diagnosis, guiding treatment and follow-up visit.