BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral comp...BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.展开更多
Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation proced...Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation procedures that have been associated with increased risks of cement leakage, adjacent fractures and non-union. Objective: The aim of this study was to describe a novel approach for the union of osteoporotic vertebral compression fractures with minimally invasive open reduction and internal fixation. Patients and Methods: Seven consecutive patients with intractable back pain without neurological deficits due to osteoporotic vertebral compression fractures were treated using minimally invasive fixation with intra-vertebral expandable pillars and artificial bone substitute. The clinical symptoms and image findings were recorded. Results: All of the patients reported relief of back pain, and the height of the vertebral bodies was well restored. X-ray findings obtained 2 to 4 years after the procedures showed fracture healing and favorable formation of the callus confirmed in the anterior longitudinal ligament. Conclusion: This mini-open procedure with intravertebral devices is an effective and reliable technique for osteoporotic vertebral compression fractures and may avoid complications related to traditional open spinal instrumentation procedures and augmentation with bone cement.展开更多
Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have be...Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography(CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element(FE) simulation lets us know the biomechanical changes that take place after hipprostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints applied to the correction of deformities, providing the recovering force-displacement and angle-moment curves that characterize the mechanical behavior of the splint in the overall range of movement.展开更多
目的:探讨含重组人碱性成纤维细胞生长因子(recombinant human basic fibroblast growth factor,rhbFGF)和重组人骨形态发生蛋白-2(recombinant human bone morphogenetic protein-2,rhBMP-2)骨水泥在骨质疏松性腰椎压缩性骨折(osteopor...目的:探讨含重组人碱性成纤维细胞生长因子(recombinant human basic fibroblast growth factor,rhbFGF)和重组人骨形态发生蛋白-2(recombinant human bone morphogenetic protein-2,rhBMP-2)骨水泥在骨质疏松性腰椎压缩性骨折(osteoporotic vertebral compression fracture,OVCF)患者经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的应用价值。方法:回顾性分析2018年1月至2021年1月收治的103例行PKP手术治疗的OVCF患者,男40例,女63例;年龄61~78(65.72±3.29)岁。受伤原因:滑倒33例,跌倒42例,提重物受伤28例。根据填充骨水泥不同分为3组:磷酸钙组34例,男14例,女20例,年龄(65.1±3.3)岁,填充磷酸钙骨水泥;rhBMP-2组34例,男12例,女22例,年龄(64.8±3.2)岁,填充含rhBMP-2的骨水泥;rhbFGF+rhBMP-2组35例,男14例,女21例,年龄(65.1±3.6)岁,填充含rhbFGF和rhBMP-2的骨水泥。比较3组Oswestry功能障碍指数(Oswestry dysfunction index,ODI)、骨密度、椎体前缘丢失高度、伤椎前缘压缩率、疼痛视觉模拟评分(visual simulation score,VAS)及再骨折发生率。结果:所有患者获得12个月随访。3组术后ODI、VAS呈下降(P<0.001),骨密度增高(P<0.001),椎体前缘丢失高度、伤椎前缘压缩率呈先下降后缓慢上升趋势(P<0.001),rhbFGF+rhBMP-2组术后第1、6、12个月ODI、VAS均低于rhBMP-2组和磷酸钙组(P<0.05),术后第6、12个月骨密度大于rhBMP-2组和磷酸钙组(P<0.05)。rhbFGF+rhBMP-2组术后第6、12个月椎体前缘丢失高度、伤椎前缘压缩率均低于rhBMP-2组和磷酸钙组(P<0.05)。3组再骨折发生率比较差异无统计学意义(P>0.05)。结论:含rhbFGF和rhBMP-2骨水泥可更有效地增加OVCF患者骨密度,获得术后满意的临床和放射学效果,显著改善临床症状。展开更多
目的探讨骨质疏松性椎体压缩骨折(OVCF)合并胸腰筋膜损伤(TFI)患者在椎体强化术后的临床疗效。方法选取2022年11月至2023年8月川北医学院附属医院骨科收治的81例采用经皮椎体球囊后凸成形术(PKP)治疗的OVCF患者为研究对象,根据是否合并...目的探讨骨质疏松性椎体压缩骨折(OVCF)合并胸腰筋膜损伤(TFI)患者在椎体强化术后的临床疗效。方法选取2022年11月至2023年8月川北医学院附属医院骨科收治的81例采用经皮椎体球囊后凸成形术(PKP)治疗的OVCF患者为研究对象,根据是否合并TFI进行分组,将合并TFI的患者作为TFI组(n=36),未合并TFI患者作为NTFI组(n=45)。比较两组患者年龄、性别、住院时间、骨密度等一般资料;手术时间、术中出血量、伤椎节段(T10-L2、L3-I5)占比、单侧或双侧穿刺占比、骨水泥注射量等术中指标。分别采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估患者腰部疼痛程度和腰椎功能改善情况。结果两组患者伤椎节段占比、手术时间、术中出血量、单或双侧穿刺占比比较,差异均无统计学意义(P>0.05)。两组患者术前、术后3 d VAS、ODI评分比较,差异均无统计学意义(P>0.05)。TFI组患者术后1、3个月VAS、ODI评分均高于NTFI组患者(P<0.05)。结论TFI组患者在采用PKP治疗后3个月内,腰椎疼痛缓解程度和腰椎功能改善情况均较NTFI组患者差,TFI可作为OVCF合并TFI患者在椎体强化术后临床疗效观察的有效指标。展开更多
基金Supported by National Natural Science Foundation of China,No.81972108.
文摘BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.
文摘Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation procedures that have been associated with increased risks of cement leakage, adjacent fractures and non-union. Objective: The aim of this study was to describe a novel approach for the union of osteoporotic vertebral compression fractures with minimally invasive open reduction and internal fixation. Patients and Methods: Seven consecutive patients with intractable back pain without neurological deficits due to osteoporotic vertebral compression fractures were treated using minimally invasive fixation with intra-vertebral expandable pillars and artificial bone substitute. The clinical symptoms and image findings were recorded. Results: All of the patients reported relief of back pain, and the height of the vertebral bodies was well restored. X-ray findings obtained 2 to 4 years after the procedures showed fracture healing and favorable formation of the callus confirmed in the anterior longitudinal ligament. Conclusion: This mini-open procedure with intravertebral devices is an effective and reliable technique for osteoporotic vertebral compression fractures and may avoid complications related to traditional open spinal instrumentation procedures and augmentation with bone cement.
文摘Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography(CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element(FE) simulation lets us know the biomechanical changes that take place after hipprostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints applied to the correction of deformities, providing the recovering force-displacement and angle-moment curves that characterize the mechanical behavior of the splint in the overall range of movement.
文摘目的探讨骨质疏松性椎体压缩骨折(OVCF)合并胸腰筋膜损伤(TFI)患者在椎体强化术后的临床疗效。方法选取2022年11月至2023年8月川北医学院附属医院骨科收治的81例采用经皮椎体球囊后凸成形术(PKP)治疗的OVCF患者为研究对象,根据是否合并TFI进行分组,将合并TFI的患者作为TFI组(n=36),未合并TFI患者作为NTFI组(n=45)。比较两组患者年龄、性别、住院时间、骨密度等一般资料;手术时间、术中出血量、伤椎节段(T10-L2、L3-I5)占比、单侧或双侧穿刺占比、骨水泥注射量等术中指标。分别采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估患者腰部疼痛程度和腰椎功能改善情况。结果两组患者伤椎节段占比、手术时间、术中出血量、单或双侧穿刺占比比较,差异均无统计学意义(P>0.05)。两组患者术前、术后3 d VAS、ODI评分比较,差异均无统计学意义(P>0.05)。TFI组患者术后1、3个月VAS、ODI评分均高于NTFI组患者(P<0.05)。结论TFI组患者在采用PKP治疗后3个月内,腰椎疼痛缓解程度和腰椎功能改善情况均较NTFI组患者差,TFI可作为OVCF合并TFI患者在椎体强化术后临床疗效观察的有效指标。