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.

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.

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.

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.

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.

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.

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.

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.

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.

药物双磷酸盐的研究及其在OVCFs中的应用

双膦酸盐(BP)作为钙化和骨吸收抑制剂的生物学效应在20世纪60年代后期首次被描述。之后的50年里,BP已成为治疗以骨吸收增加为特征的骨骼疾病的主要药物,包括佩吉特骨病、骨转移、多发性骨髓瘤、骨质疏松症和几种儿童遗传性疾病。本文简要介绍了双磷酸盐的结构,对其药理学及应用进行了相关阐述,为国内此领域的药物应用人员提供了参考。

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.

PKP术后早期递进式有限活动结合唑来膦酸对OVCFs患者的影响

目的探讨经皮穿刺椎体后凸成形术(PKP)术后递进式有限活动结合唑来膦酸(ZOL)对骨质疏松性脊柱压缩性骨折(OVCFs)患者的影响。方法选取2018年1月至2020年12月在本院骨科接受PKP治疗的60例老年OVCFs患者随机分为递进式有限活动组(PLA+ZOL)、递进式有限活动结合唑来膦酸组(PLA+ZOL)和非有限活动组(ULA)。PLA组:术后第一周每天有限活动2 h,第二周每天有限活动3 h,第三周每天有限活动4 h。PLA+ZOL组术后第三天予静脉注射ZOL 5 mg,术后采取PLA组同样的递进式有限活动。ULA:术后第一天开始进行下床活动,在可承受范围内不受限制。在治疗的不同时期评估两组的疼痛评分(NRS)、正侧位X线片、MRI影像学改变、骨密度(BMD)。结果术后早期NRS评分PKP+ZOL组及PLA组低于ULA组,PKP+ZOL组低于PLA组,差异均有统计学意义(P<0.05)。术后12个月PLA+ZOL组椎体前、中柱高度高于PLA组,差异有统计学意义(P<0.05),PLA+ZOL组及PLA组高于ULA组,差异均有统计学意义(P<0.05)。MRI显示腰背部水肿PLA+ZOL组轻于PLA组及ULA组,新近的椎体骨折发生率PLA+ZOL组低于PLA组及ULA组(P<0.05)。骨密度T值PLA+ZOL、PLA组及ULA组,差异无统计学意义(P>0.05)。结论PKP术后早期采取递进式有限活动结合唑来膦酸可改善术后疼痛及维持椎体高度,降低新近的椎体骨折发生率。

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.

OVCF患者椎旁肌密度与椎体骨密度的相关性研究

目的探讨骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)患者腰骶区椎旁肌密度与椎体骨密度(vertebral bone mineral density,vBMD)之间的关系。方法回顾性分析了OVCF患者的前瞻性机构数据库(NCT05848167)。纳入2021年1月至2022年12月共167例患者资料,其中101例定量CT(quantitative computed tomography,QCT)检查资料可用的OVCF患者,女80例,男21例;女性中位年龄73(68.00,82.50)岁,男性中位年龄71(67.00,80.00)岁。在L_(3~5)椎体上终板水平进行椎旁肌密度和面积测量,并使用人工分割和定制编写的程序进行计算。利用QCT Pro软件在L_(1~2)水平进行vBMD测量和计算。按性别、年龄对所有分析进行分层分析。结果本研究发现男性患者的椎旁肌密度与vBMD有统计学相关。在调整年龄和性别后,L_(1~2)vBMD与L_(3)左侧多裂肌、L_(4)左侧竖脊肌、L_(4)右侧多裂肌、L_(5)左右双侧多裂肌密度之间存在统计学意义上的正相关,而在女性患者中未发现显著相关性。结论男性多裂肌密度和vBMD在不同的腰椎水平存在显著的正相关,这与年龄无关。在解释腰椎椎体和椎旁肌关联时,应考虑性别及区域性差异。

三种不同填充物在PVP入路治疗胸腰椎OVCF中的应用研究

目的探究不同填充物在经皮椎体成形术(PVP)入路治疗胸腰椎单节段骨质疏松性椎体压缩骨折(OVCF)的应用研究。方法前瞻性选取2022年6月至2023年5月在珠海市中西医结合医院接受PVP入路治疗的胸腰椎OVCF患者190例,根据信封法对患者进行分组:对照组(n=65)、研究1组(n=41)、研究2组(n=84)。对照组患者行双侧骨水泥注入,研究1组患者行一侧骨水泥,一侧骨粉注入,研究2组患者行双侧混合骨水泥与骨粉注入,对患者进行6个月的随访。记录患者术前、术后1 d、术后3个月、术后6个月的Oswestry功能障碍指数(ODI)评分、视觉模拟评分法(VAS)评分、Cobb角情况及术前、末次随访时的椎体后凸角度(KA)、椎体前缘高度(ABH)和椎体中间高度(MBH)、骨密度水平,记录患者随访期内并发症发生情况。结果术后1 d、3个月、6个月,3组患者的ODI评分比较,差异均有统计学意义(P<0.05),其中研究1组、研究2组患者的ODI评分均低于对照组,研究2组的ODI评分低于研究1组,差异均有统计学意义(P<0.05)。3组患者术后3、6个月的VAS评分比较,差异均无统计学意义(P>0.05);术后1 d,3组患者VAS评分比较,差异有统计学意义(P<0.05),其中研究1组、研究2组患者的VAS评分低于对照组,研究2组的VAS评分低于研究1组,差异均有统计学意义(P<0.05)。术后1 d、3个月、6个月,3组患者的Cobb角比较,差异均有统计学意义(P<0.05),其中研究1组、研究2组患者的Cobb角小于对照组,研究2组的Cobb角小于研究1组,差异均有统计学意义(P<0.05)。末次随访时,3组KA、ABH、MBH比较,差异均有统计学意义(P<0.05),其中研究1组、研究2组患者的KA低于对照组,ABH、MBH高于对照组,且研究2组的KA低于研究1组,ABH、MBH高于研究1组,差异均有统计学意义(P<0.05)。随访期间,研究2组患者总并发症发生率为3.57%,低于对照组(12.31%)、研究1组(24.39%),差异有统计学意义(P<0.05)。结论在PVP入路治疗胸腰椎OVCF中,相比于单独使用骨水泥和部分使用骨粉,混合骨水泥与骨粉方案能够获得更好的功能恢复和疼痛缓解效果,同时改善椎体角度和骨密度指标,并降低术后并发症和邻椎骨折的风险。

椎体高度丢失率与OVCF患者PKP术后邻近椎体骨折的相关性分析

目的 探讨椎体高度丢失率与骨质疏松性椎体压缩骨折(OVCF)患者行PKP术后邻近椎体骨折(AVF)的相关性。方法 选择2019年1月至2021年12月在该院接受PKP治疗的147例OVCF患者病历资料进行回顾性分析,根据患者术后是否发生AVF,将患者分为A组(AVF组,28例)和B组(非AVF组,119例),观察两组患者椎体高度丢失率(本文采取两种方式计算椎体高度丢失率,分别为VBHL1和VBHL2),剔除混杂因素后,分析VBHL1、VBHL2与AVF的关系。结果 术前A组VBHL1和VBHL2均高于B组,差异均有统计学意义(P<0.05);术后两组患者VBHL1和VBHL2均较术前显著下降,术后A组VBHL1和VBHL2均高于同期B组,VBHL1和VBHL2手术前后变化量均高于B组,差异均有统计学意义(P<0.05)。多因素Logistic分析显示,VBHL1术前≥61.3%或VBHL2≥术前62.1%是AVF的风险因素(P<0.05)。Spearman相关性分析显示,VBHL1与骨水泥体积、局部后凸角、楔形角及VBHL1变化量呈正相关(r=0.308、0.605、0.572、0.588,P均<0.05),VBHL2与骨水泥体积、局部后凸角、楔形角及VBHL2变化量呈正相关(r=0.337、0.677、0.593、0.601,P均<0.05)。结论 OVCF患者行PKP术后AVF的发生率较高,与椎体高度丢失率有明显相关性,临床中应针对性进行预防和干预。