Factors influencing further vertebral height loss following percutaneous vertebroplasty in osteoporotic vertebral compression fractures:A 1-year follow-up study

BACKGROUND Osteoporotic vertebral compression fractures(OVCFs)contribute to back pain and functional limitations in older individuals,with percutaneous vertebroplasty(PVP)emerging as a minimally invasive treatment.However,further height loss post-PVP prompts investigation into contributing factors.AIM To investigate the factors associated with further height loss following PVP with cement augmentation in OVCF patients.METHODS A total of 200 OVCF patients who underwent successful PVP between January 2021 and December 2022 were included in this study.“Further height loss”during 1 year of follow-up in OVCF patients with bone edema was defined as a vertical height loss of≥4 mm.The study population was divided into two groups for analysis:The“No Further Height Loss group(n=179)”and the“Further Height Loss group(n=21).”RESULTS In comparing two distinct groups of patients,significant differences existed in bone mineral density(BMD),vertebral compression degree,prevalence of intravertebral cleft(IVF),type of bone cement used,and cement distribution patterns.Results from binary univariate regression analysis revealed that lower BMD,the presence of IVF,cleft distribution of bone cement,and higher vertebral compression degree were all significantly associated with further height loss.Notably,the use of mineralized collagen modified-poly(methyl methacrylate)bone cement was associated with a significant reduction in the risk of further height loss.In multivariate regression analysis,lower BMD and the presence of IVF remained significantly associated with further height loss.CONCLUSION Further height loss following PVP in OVCF patients is influenced by a complex interplay of factors,especially lower BMD and the presence of IVF.These findings underscore the importance of assessing and managing these factors when addressing height loss following PVP in OVCF patients.

The impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity during treatment of osteoporotic vertebral compression fractures with balloon kyphoplasty

This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who received balloon kyphoplasty. Patients were divided into four groups： Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale （VAS） and Oswestry disability index （ODI） scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture. Therefore, surgery should not only restore compressed vertebral body height and correct kyphosis, but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.

Managements of osteoporotic vertebral compression fractures:A narrative review

Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.

A Comparative Study of High-viscosity Cement Percutaneous Vertebroplasty vs. Low-viscosity Cement Percutaneous Kyphoplasty for Treatment of Osteoporotic Vertebral Compression Fractures

The clinical effects of two different methods–high-viscosity cement percutaneous vertebroplasty（PVP） and low-viscosity cement percutaneous kyphoplasty（PKP） in the treatment of osteoporotic vertebral compression fractures（OVCFs） were investigated. From June 2010 to August 2013, 98 cases of OVCFs were included in our study. Forty-six patients underwent high-viscosity PVP and 52 patients underwent low-viscosity PKP. The occurrence of cement leakage was observed. Pain relief and functional activity were evaluated using the Visual Analog Scale（VAS） and Oswestry Disability Index（ODI）, respectively. Restoration of the vertebral body height and angle of kyphosis were assessed by comparing preoperative and postoperative measurements of the anterior heights, middle heights and the kyphotic angle of the fractured vertebra. Nine out of the 54 vertebra bodies and 11 out of the 60 vertebra bodies were observed to have cement leakage in the high-viscosity PVP and low-viscosity PKP groups, respectively. The rate of cement leakage, correction of anterior vertebral height and kyphotic angles showed no significant differences between the two groups（P〉0.05）. Low-viscosity PKP had significant advantage in terms of the restoration of middle vertebral height as compared with the high-viscosity PVP（P〈0.05）. Both groups showed significant improvements in pain relief and functional capacity status after surgery（P〈0.05）. It was concluded that high-viscosity PVP and low-viscosity PKP have similar clinical effects in terms of the rate of cement leakage, restoration of the anterior vertebral body height, changes of kyphotic angles, functional activity, and pain relief. Low-viscosity PKP is better than high-viscosity PVP in restoring the height of the middle vertebra.

Full-endoscopic spine surgery treatment of lumbar foraminal stenosis after osteoporotic vertebral compression fractures:A case report

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.

Minimally Invasive Open Reduction and Internal Fixation for Osteoporotic Vertebral Compression Fractures: Technical Report and Mid-Term Outcomes

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.

Clinical Research of Pre-Hospital Emergency Care, Nursing, Infection Prevention and Control for Senile Osteoporotic Vertebral Compression Fracture during Epidemic Period

Background: Novel coronavirus pneumonia (NCP) and osteoporotic vertebral compression fractures (OVCF) are the high incidences of diseases in the elderly. During the epidemic period, if not treated in time, the complications are high and the mortality is high. If we do not pay attention to infection prevention and control in pre-hospital emergency care, it will lead to the first time infection of medical staff and in-hospital cross infection in emergency outpatient receiving area. The correct consideration of both and the establishment of perfect pre-hospital emergency treatment and infection prevention and control synchronous strategy is an important premise to ensure the stable, orderly and safe medical treatment. Objective: To explore the effect of synchronous implementation of pre-hospital emergency care, nursing and infection pre-vention and control for senile OVCF during the epidemic. In order to improve the efficiency of pre-hospital emergency care and prevent the spread of infection. Method: A total of 92 elderly patients with OVCF who received pre-hospital treatment in 18 hospitals in Zhangjiakou City during the epidemic prevention and control period from January 2020 to November 2022 and met the inclusion criteria were selected as research objects, including 24 males and 68 females, aged 65 - 82 (74.2 ± 2.2) years. All patients were associated with concomitant injuries and underlying diseases. All patients in this group underwent predictive pre-hospital rescue and infection prevention and control procedures. Results: All the 92 elderly patients with OVCF received timely pre-hospital treatment during the epidemic period, and no aggravation occurred of the 92 patients, 35 were in the high risk area, 10 were in the medium risk area, and 47 were in the low risk area. Exclude OVCF for NCP Patients were treated according to the conventional diagnosis and treatment principles. Suspected and confirmed cases are transferred to designated surgical hospitals for treatment. All patients were followed up 3 months, 6 months and 12 months after treatment. There was no death rate, high satisfaction of pre-hospital first aid, high diagnostic accuracy, and good curative effect. None of the rescue personnel had any infection rate, and no hospital infection transmission and nosocomial cross infection occurred. Conclusion: It is the first step to safely treat patients and prevent cross infection to establish a perfect synchronous strategy of pre-hospital first aid and infection prevention and control.

Diagnosis and Treatment and Infection Protection Strategy of Osteoporotic Vertebral Compression Fractures Minimally Invasive Percutaneous Kyphoplasty Surgery during the Prevention and Control of COVID-19

Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.

Meta-analysis of percutaneous kyphoplasty for elderly osteoporotic vertebral compression fractures

Objective:To evaluate the clinical efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF)in the elderly by meta-analysis,and to provide a basis for clinical application.Methods:CNKI,Wanfang,Weipu,CBM,PubMed,the Cochrane Library and EMbase were retrieved by computer from the date of establishment to January 2019.The literature on randomized controlled trials of PKP and conservative treatment of OVCF was collected and diagnosed as thoracolumbar vertebral compression fracture by X-ray,CT,and MRI.Osteoporosis of thoracolumbar vertebrae(T<2.5)was determined by bone mineral density measurements.Age(>50 years old)and course of the disease(<3 months).Postoperative outcome indicators included at least one of the following indicators:visual analogue scale.VAS and Oswestry Dysfunction Index(ODI),changes of Cobb angle of diseased vertebrae and height of the anterior edge of diseased vertebrae.The quality of the included literature was evaluated by referring to the evaluation criteria for randomized controlled trials provided in the Cochrane Systematic Evaluation Manual.Results:Six randomized controlled trials studies were included,all of which were Chinese literature.Five of them had 4 or more points in methodological quality evaluation and one had 3 points in methodology quality evaluation.There were 525 patients in the two groups,267 in the PKP group and 258 in the conservative treatment group.Meta-analysis showed that the pain visual analogue score in the PKP group was significantly higher than that in the conservative treatment group[MD=2.10,95%CI(-2.25,-1.95),P<0.00001].There were significant differences between the PKP group and the conservative treatment(CT)group[MD=8.90,95%CI(-9.86,-7.94),P<0.00001]in the changes of the Cobb angle of the diseased vertebrae after treatment.There were significant differences in the ODI and the height of the anterior edge of the diseased vertebrae(P<0.05).Conclusion:PKP treatment of OVCF can effectively reduce pain visual analogue score,improve dysfunction index(ODI)and improve the quality of life of patients.It can also effectively restore the height of vertebral loss,correct the Cobb angle of the diseased vertebrae,and reduce the risk of recurrent fracture of the adjacent vertebral body and serious complications.

Effect of Osteoporotic Vertebral Compression Fracture on Adjacent Intervertebral Disc Degeneration

Objective:The influence of vertebral compression fracture on the degeneration of adjacent disc was analyzed.Methods:88 patients with osteoporotic vertebral compression fractures admitted to the orthopedic pain department from July 2014 to July 2019 were selected as the research objects.According to the previous MRI and the improved MRI results of admission,the patients were converted into old fractures after conservative treatment.They were followed up in 3,6 and 12 months after discharge,and the VAS score at each time point(visual acuity score)was calculated We collected and analyzed the classifcation of intervertebral disc degeneration and MRI index.Results:The follow-up rate was 659%(58/88);There were 42 cases(72.4%)of degenerative disc adjacent to the diseased vertebra,and 16 cases(27.5%)of adjacent intervertebral disc did not degenerate;VAS scores were 1ower at 14 days,3 months,6 months and 12 months after admission;The number of grade 1 of disc degeneration was lower in 6 months and 12 months than that in admission(P<0.05),and the number of grade 2,3 and 4 was significantly higher than that in the follow-up in December(P<0.05).The difference between 6 and 12 months was not statistically significant(P>0.05);MRI index at 6 and 12 months follow-up was lower than that at admission(P<0.05).Conclusion:Through the research and analysis,we found that osteoporotic vertebral compression fracture will have a corresponding impact on the adjacent intervertebral disc,which can make the adjacent intervertebral disc degenerate.

Comparative Analysis and Exploration of Clinical Value of Kyphoplasty and Conservative Treatment for Osteoporotic Vertebral Compression Fractures

Objective:To explore the clinical value of kyphoplasty and conservative treatment for osteoporotic vertebral compression fractures.Methods:40 patients with Osteoporotic vertebral compression fracture from May 2019 to November 2021 were selected.The control group was treated with conservative treatment and the experimental group was treated with kyphoplasty.Results:Compared with the control group,the experimental group had higher total effective rate(95.00%),better recovery of Cobb Angle and vertebral height,and higher quality of life score.The data was more meaningful(P<0.05).Conclusion:For patients with osteoporotic vertebral compression fractures,the application of kyphoplasty can improve the treatment effect,accelerate the recovery of vertebral body function and enhance the quality of life,which is worthy of popularization.

Outcome analysis of surgical interventions for osteoporotic vertebral compression fractures

Objective To compare the clinical outcomes of 2 surgical interventions for osteoporotic vertebral compression fractures(OVCF).Methods Sixty-five patients with OVGF from March 2005 to March 2009 were included in this clinical study.They

The Clinical Effect of Zoledronic Acid Combined with Teriparatide in Perverting Recurrent Fracture of Osteoporotic Vertebral Compressive Fractures in the Elderly after Percutaneous Kyphoplasty

Background: Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. Purpose: To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). Method: A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (β-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. Results: After normalized treatment, the bone metabolism indexes of PINP and β-CTX were improved and BMD was increased in three groups. Adverse Reactions: There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). Conclusion: Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.

Pedicle Screw Fixation with Kyphoplasty Decreases the Fracture Risk of the Treated and Adjacent Non-treated Vertebral Bodies:a Finite Element Analysis

Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures（OVCFs） after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation（PSF） with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation（PSF）,two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.

Adjacent Level Vertebral Fractures in Patients Operated with Percutaneous Vertebroplasty

Percutaneous vertebroplasty is a minimally invasive procedure that involves filling of a fractured vertebral body with bone cement to relieve pain and to restore the vertebral height. It is a safe and effective treatment and is widely used for treating Osteoporotic Vertebral Compression Fracture. Despite of its beneficial advantages over primary conservative managements, adjacent level vertebral compression fracture remains the challenge for surgeons. Adjacent level vertebral compression fracture following percutaneous vertebroplasty using PMMA cement has been reported as a complication. Numerous risk factors have been reported for the occurrence of new adjacent VCFs after PVP. The multiple level osteoporotic vertebral compression fractures and the increasing age of the patients are directly proportional to the risk of developing new symptomatic adjacent vertebral compression fracture after PVP. Moreover, low BMD and cement leakage are other factors that directly affect the incidence of new symptomatic adjacent vertebral fractures. The aim of this review is to evaluate the adjacent level vertebral compression fracture following percutaneous vertebroplasty on the basis of radiographs, Kaplan-Meier Estimation index and also the factors that lead to adjacent level vertebral compression fractures.

骨质疏松性脊柱椎体压缩骨折经皮椎体成形后骨水泥外漏原因及治疗策略

背景:随着人口老龄化的加剧,骨质疏松症的发病率逐年上升,而骨质疏松性脊柱椎体压缩骨折作为其中的一种常见并发症,给患者带来了极大的痛苦和不便。经皮椎体成形术作为一种有效的治疗方法,在临床上得到了广泛应用。然而,骨水泥外漏作为该手术的一个潜在风险,一直是研究者们关注的重点。目的:探讨骨质疏松性椎体压缩骨折经皮椎体成形后骨水泥外漏的原因及处理策略。方法:选择2017年3月至2021年2月于北京市平谷区医院骨科行经皮椎体成形治疗的骨质疏松性椎体压缩骨折患者100例为研究对象,根据术后12个月随访结果分为骨水泥外漏组(n=27)和无骨水泥外漏组(n=73)。Cox比例风险回归分析筛选术后骨水泥外漏的影响因素,用以构建术后骨水泥外漏风险预测列线图模型,并对模型进行评价。行骨水泥外漏治疗后,观察术前、术后3 d、术后12个月时,27例患者的目测类比评分、Oswesry功能障碍指数。结果与结论:①27例骨水泥外漏患者中,24例均为椎间盘终板内渗漏,无明显症状及不适,无需特殊处理;1例发生肺栓塞,请呼吸科协助处理得以好转;2例有症状,行经皮椎间孔镜下骨水泥取出术;②CT值、骨折严重程度、骨水泥黏度、皮质断裂、骨水泥注入量是术后发生骨水泥外漏的独立影响因素(P<0.05);③列线图模型的校准度、区分度均较好,且具有很好的临床实用性;④对于27例术后骨水泥外漏患者,术后3 d、术后12个月时,目测类比评分均显著低于术前,差异有显著性意义(P<0.05);术后12个月的Oswesry功能障碍指数显著低于术后3 d,差异有显著性意义(P<0.05);⑤结果表明,骨水泥注入量、骨水泥黏度、皮质断裂、CT值、骨折严重程度是经皮椎体成形术后发生骨水泥外漏的危险因素。

局部麻醉下机器人辅助经皮椎体后凸成形伤椎注入骨水泥的患者体验分析

背景:局部麻醉下传统C臂辅助经皮椎体后凸成形手术需多次透视以调整穿刺方向,工作通道建立时间较长,患者术中疼痛刺激较大;而机器人辅助经皮椎体后凸成形手术可一次性精准穿刺成功,明显改善患者术中体验,同时减少骨水泥渗漏风险。目的:比较局部麻醉下机器人辅助和传统C臂辅助经皮椎体后凸成形手术的患者体验和其他疗效。方法:选择四川省医学科学院·四川省人民医院(电子科技大学附属医院)收治的单节段骨质疏松性椎体压缩骨折患者241例,其中132例在局部麻醉下进行机器人辅助经皮椎体后凸成形手术治疗(机器人辅助组),109例在局部麻醉下进行传统C臂辅助经皮椎体后凸成形手术治疗(传统透视组),记录患者术中体验评价、骨水泥注射量、手术时间、工作通道建立时间、住院费用及并发症,术后1 d通过影像学评估穿刺偏差与骨水泥渗漏。结果与结论:(1)机器人组59例患者术中体验评价为“非常好”,43例为“好”,16例为“一般”,10例为“差”,4例为“非常差”;传统透视组30例患者术中体验评价为“非常好”,44例为“好”,21例为“一般”,9例为“差”,5例为“非常差”,两组间术中体验评价比较差异有显著性意义(Z=-2.546,P=0.011);机器人组患者术中目测类比评分低于传统透视组(t=-9.513,P=0.000);机器人组、传统透视组愿意在必要时再次接受经皮椎体后凸成形手术的患者分别为84例和47例,组间比较差异有显著性意义(Z=-2.730,P=0.006);(2)机器人组患者手术时间、住院费用均多于传统透视组(t=2.860,P=0.003;t=36.522,P=0.000),工作通道建立时间短于传统透视组(t=-27.066,P=0.000),穿刺精度优于传统透视组(Z=-3.656,P=0.000),骨水泥渗漏率低于传统透视组(χ^(2)=7.284,P=0.007);(3)结果表明,局部麻醉后在机器人辅助行经皮椎体后凸成形手术患者的手术体验较好,具有穿刺精确、工作通道建立时间短、骨水泥渗漏率低的优势。

单侧经皮椎体成形骨水泥分布对椎体压缩性骨折修复疗效的影响

背景:虽然研究表明,骨水泥的对称分布可以减少术后椎体再次骨折并有助于改善预后,但是进行经皮椎体成形过程中获得更好的骨水泥分布仍然是外科医生面临的一个重要课题。目的:探讨骨水泥分布对单侧经皮椎体成形术后疗效的影响,以提供有效的预防和治疗措施,防止术后椎体再次骨折。方法:选择2018年1月至2022年12月在新疆医科大学第六附属医院行单侧经皮椎体成形治疗的193例患者,根据术后骨水泥分布分为Ⅰ组(骨水泥不接触上端和远端端板,n=59)、Ⅱ组(骨水泥只接触上端板或只接触下端板,n=80)和Ⅲ组(骨水泥同时接触上端和远端端板,n=54)。对比3组患者的基本资料,手术相关指标包括手术时间、总住院费用、术后住院时间、骨水泥注射量、腰痛目测类比评分及Oswestry功能障碍指数、术后椎体高度恢复率、椎体局部后凸角、损伤椎体及邻近椎体再骨折发生率等,记录所有患者的随访结果。结果与结论:(1)Ⅲ组患者术后1年腰痛目测类比评分和Oswestry功能障碍指数明显低于Ⅰ组和Ⅱ组,差异有显著性意义(P <0.05);(2)Ⅰ组和Ⅱ组损伤椎体再次骨折发生率、总椎体骨折发生率高于Ⅲ组,差异均有显著性意义(P <0.05);(3)3组患者其余指标,包括骨水泥渗漏、腰痛术后1周、术后1个月和末次Oswestry功能障碍指数及目测类比评分、术后椎体高度恢复率、椎体局部凸角、手术时间、总住院费用及术后住院时间等指标均无显著性差异(P> 0.05);(4)提示与骨水泥不接触上端和远端端板组和骨水泥只接触上端板或只接触下端板组相比,骨水泥同时接触上端和远端端板组患者可获得更好的长期预后,而且骨水泥同时接触上端和远端端板能够明显降低损伤椎体及总椎体骨折发生率,医生术中应充分掌握骨水泥的弥散情况,并制定有针对性的预防和治疗策略,从而有助于减少未来再发生骨折的风险。

经“O”点穿刺与传统单侧入路治疗L_(5)椎体骨质疏松性压缩性骨折

背景:单侧穿刺入路经皮穿刺球囊扩张椎体后凸成形治疗骨质疏松性椎体压缩骨折优于双侧穿刺入路,由于L_(5)特殊解剖形态和位置特殊,传统单侧穿刺入路治疗L_(5)椎体骨质疏松性椎体压缩骨折适用性差,因此提出“O”点穿刺入路来解决该问题。目的:比较经横突基底部-椎弓根后上部-关节突外侧交点(“O”点)入路与传统单侧入路经皮穿刺球囊扩张椎体后凸成形治疗L_(5)椎体骨质疏松性压缩骨折的疗效差异。方法:回顾性分析西南医科大学附属医院2020年1月至2022年12月收治的54例L_(5)椎体骨质疏松性压缩骨折行经“O”点入路或传统经皮穿刺球囊扩张椎体后凸成形治疗的患者,根据手术方式分为2组,“O”点入路组(A组)29例,传统入路组(B组)25例。术前在X射线正位片测量A组“O”点与髂棘位置及穿刺角度;比较两组术前与术后第2天、末次随访的局部Cobb角、椎体前缘、中部高度及骨水泥分布情况;术前、术后第2天及末次随访采用疼痛目测类比评分、Oswestry功能障碍指数评估患者疼痛缓解情况与日常生活能力,记录手术相关并发症。结果与结论:①A组手术时间、术中透视次数均少于B组,差异有显著性意义(P<0.05);两组术中出血量及骨水泥注射量差异无显著性意义;②两组患者术后第2天及末次随访疼痛目测类比评分、Oswestry功能障碍指数较术前明显降低,且A组降低比B组更明显(P<0.05);③“O”点位于双侧髂棘最高点连线之下平均距离1.23 cm;“O”点到髂棘平均横向距离2.89 cm;④两组患者末次随访Cobb角较术前明显改善(P<0.05),但两组间比较差异无显著性意义(P>0.05);⑤术后骨水泥分布,A组分布良好占97%(28/29),B组分布良好占88%(22/25),A组明显优于B组(P<0.05);⑥提示经“O”点穿刺入路与传统入路经皮穿刺球囊扩张椎体后凸成形治疗L_(5)椎体骨质疏松性压缩骨折疗效满意,但“O”点穿刺入路经皮穿刺球囊扩张椎体后凸成形治疗骨水泥分布更满意,还可避免高髂棘对L_(5)椎体穿刺入路的影响。

椎体骨皮质强化差异对骨质疏松性椎体压缩性骨折生物力学的影响

背景:骨质疏松性椎体压缩性骨折经皮椎体成形过程中骨水泥在椎体内的骨皮质强化区域对脊柱生物力学及临床疗效有重要影响,但以往研究大多局限于二维层面。目的:采用有限元分析法探讨经皮椎体成形过程中骨水泥在椎体三维层面内骨皮质强化差异对骨质疏松性椎体压缩性骨折椎体、邻近椎间盘及终板生物力学分布的影响,以评估其效果。方法:建立T12椎体骨质疏松性压缩性骨折行经皮椎体成形治疗的有限元模型,从横断面、矢状面、冠状面对骨水泥有无皮质强化情况进行分组分析,研究不同体位变化下,骨皮质强化对T12椎体松质骨、皮质骨、T11/T12椎间盘、T12/L1椎间盘、T11下终板、L1上终板生物力学的影响。结果与结论:(1)在垂直压缩力作用下,经皮椎体成形过程中有或无骨水泥皮质强化在不同体位变化下除伤椎皮质骨以外结构应力变化均不明显;(2)伤椎皮质骨Von Mises应力值在人体前屈、左/右侧弯和左/右轴向旋转时差异显著,同一平面内骨皮质完全强化组较无骨皮质强化组最大Von Mises应力值明显变小,随着骨皮质强化越广泛Von Mises应力值整体呈下降趋势;(3)提示行经皮椎体成形治疗时,横断面内骨水泥应尽量广泛对称水平分布于椎体骨皮质边缘,矢状面内骨水泥应广泛纵向分布且靠近上下终板及前后壁,冠状面内骨水泥应广泛分布于中线两侧同时对称接触上下终板及侧壁,可有效避免伤椎再骨折风险且不增加邻椎骨折、残留盘源性疼痛风险。