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.

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.

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.

老年女性骨质疏松性骨折相邻椎体再骨折的影响因素及列线图预测模型构建

背景:有关老年女性骨质疏松性椎体压缩性骨折患者相邻椎体再骨折的研究较多,但其相关危险因素仍在争论中,如何将其风险直观地呈现以便于临床应用的研究较少。目的:分析影响老年女性骨质疏松性椎体压缩性骨折患者相邻椎体再骨折的危险因素并构建列线图(Nomogram)预测模型。方法:选择2018年1月至2022年11月赣州市人民医院收治的268例老年女性骨质疏松性椎体压缩性骨折患者,经皮穿刺椎体成形术后3个月根据是否发生相邻椎体再骨折分为研究组(发生相邻椎体再骨折,n=31)和对照组(未发生相邻椎体再骨折,n=237)。比较两组患者一般临床资料,采用多因素Logistic回归分析影响老年女性骨质疏松性椎体压缩性骨折患者相邻椎体再骨折的独立风险因素,利用R软件“rms”包构建Nomogram预测模型。结果与结论:①两组患者的年龄、绝经年龄、体质量指数、骨折病史、术前骨折椎体数、骨水泥渗漏、骨密度、术后后凸畸形角度、术前Oswestry功能障碍指数比较差异均有显著性意义(P<0.05);②多因素Logistic回归分析结果显示,年龄(>69岁)、绝经年龄(≤51岁)、体质量指数(>24.7 kg/m^(2))、骨折病史(有)、术前骨折椎体数(≥2)、术后后凸畸形角度(>13°)是影响老年女性骨质疏松性椎体压缩性骨折患者相邻椎体再骨折的独立危险因素(P<0.05);③Nomogram预测模型决策曲线结果显示,当风险阈值>0.09时,此预测模型可以提供显著额外的临床净收益;④结果表明,年龄较大、绝经年龄较低、体质量指数较高、有骨折病史、术前骨折椎体数较多、术后后凸畸形角度较大是老年女性骨质疏松性椎体压缩性骨折患者相邻椎体再骨折的独立影响因素,基于此构建的Nomogram预测模型可为此类患者相邻椎体再骨折的防治提供重要的策略指导。

Volume viewer椎体容积测量在胸腰椎骨折伤椎椎体内植骨中的应用

目的探讨Volume viewer椎体容积测量在胸腰椎骨折伤椎椎体内植骨中的应用效果。方法收集2015—2021年收治的单节段胸腰椎骨折患者的临床资料,采用AW Siever 3.2后处理工作站Volume viewer对患者术前伤椎椎体CT扫描数据进行分析,精确计算术前伤椎椎体容积。将伤椎丢失容积<50%患者归为低丢失组,伤椎丢失容积≥50%者归为高丢失组,比较2组术后伤椎高度变化及再压缩发生率。结果共纳入70例患者,其中低丢失组37例,高丢失组33例。高丢失组患者术前伤椎容积和椎体前缘高度低于低丢失组(P<0.05)。高丢失组术后即刻及末次随访时椎体前缘高度恢复低于低丢失组(P<0.05)。高丢失组术后伤椎再压缩发生率高于低丢失组(48.5%比10.8%,P<0.05)。低丢失组中植骨患者术后再压缩发生率均与未植骨患者比较,差异无统计学意义(25.0%比9.1%,P=0.380);高丢失组中植骨患者术后再压缩发生率与未植骨患者比较差异无统计学意义(30.0%比56.5%,P=0.260)。结论术前伤椎椎体容积丢失≥50%的单节段胸腰椎骨折患者,其术后伤椎再压缩发生率高,而伤椎椎体植骨有降低术后再压缩发生率的可能。

老年胸腰椎压缩性骨折治疗方案及可行性分析

目的探讨不同治疗方案对老年胸腰椎压缩性骨折患者腰椎功能、疼痛程度、椎体前缘高度的影响。方法回顾性分析完成1年随访的102例老年胸腰椎压缩性骨折患者的临床资料,依据治疗方案的不同分为保守组(32例)、经皮球囊扩张椎体后凸成形术(PKP)组(35例)、经皮椎体成形术(PVP)组(35例),治疗1年后评估3组临床疗效和并发症发生情况,比较3组治疗前和治疗1年后视觉模拟评分法(VAS)评分、日本骨科学会(JOA)评分、Cobb角、椎体前缘高度。结果PKP组、PVP组治疗优良率高于保守组,差异有统计学意义(P<0.05);PKP组与PVP组治疗优良率比较,差异无统计学意义(P>0.05)。3组并发症发生率比较,差异无统计学意义(P>0.05)。治疗1年,3组VAS评分低于治疗前,JOA评分高于治疗前,且PKP组、PVP组VAS评分低于保守组,JOA评分高于保守组,差异有统计学意义(P<0.05);PKP组VAS评分低于PVP组,JOA评分高于PVP组,差异有统计学意义(P<0.05)。治疗1年,3组Cobb角小于治疗前,椎体前缘高度高于治疗前,其中PKP组、PVP组Cobb角小于保守组,椎体前缘高度高于保守组,差异有统计学意义(P<0.05);PKP组Cobb角小于PVP组,椎体前缘高度高于PVP组,椎体前缘高度差值大于PVP组,差异有统计学意义(P<0.05)。结论与保守治疗相比,手术可提高老年胸腰椎压缩性骨折患者的临床疗效。PKP在减轻患者疼痛程度、提高腰椎功能、改善Cobb角、椎体前缘高度方面优于PVP,且安全性较好。

椎体强化术后恢复高度对邻近椎体的影响:一项有限元分析

背景:椎体压缩骨折是当前骨科领域中常见的疾病,椎体强化术后邻近椎体发生再骨折是一个不可忽视的问题,这对患者的正常生活产生了严重的影响。目的:旨在利用CT图像,建立不同恢复高度的椎体强化后模型。采用有限元分析的方法得出不同恢复高度下邻近椎体的应力情况,并进一步探讨椎体强化术后伤椎高度恢复的重要性。方法:建立并验证了胸腰椎(T_(11)-L3)有限元模型,并在此基础上构建了4种不同恢复高度(100%,80%,60%,40%)的L1术后有限元模型,其中骨水泥容量随着恢复高度的变化而变化。具体模型如下:Model 1为正常恢复高度的术后模型,骨水泥容量为8.3 mL;Model 2为L1前部高度切除20%,后凸角变为10.41°的术后模型,骨水泥容量为6.9 mL;Model 3为L1前部高度切除40%,后凸角变为20.17°的术后模型,骨水泥容量为4.7 mL;Model 4为L1前部高度切除60%,后凸角变为28.85°的术后模型,骨水泥容量为3.6 mL。对术后模型进行评估时,施加了7Nm的力矩和500N的轴向力,记录并分析L2上终板和T12下终板的峰值应力,以及L2和T12松质骨的峰值应力。结果与结论:①L2上终板、T12下终板、L2松质骨、T12松质骨各工况的最高峰值应力都出现在Model 1和Model 4,特别是T12下终板(除后伸工况外),前屈、左右侧弯和左右旋转工况都在Model 4达到了最高峰值应力,应力分别为50.3,33.1,44.9,34.3,31.9 MPa;②根据邻近椎体终板和松质骨的峰值应力,排除Model 1和Model 4两个模型后,大部分工况的最小峰值应力都是出现在Model 2模型上,且Model 2模型出现最小峰值应力的情况占据了66.6%,尤其是在L2的上终板和松质骨(除后伸工况外),最小峰值应力都是出现在了Mode 2上;③因此将恢复高度控制在原高度的100%和40%左右是比较危险的恢复高度,对邻近椎体的影响较大;将恢复高度控制在原高度的80%左右可能是一个较为理想的选择;恢复高度在原高度的80%左右,邻近椎体所承受的应力较小,从而减小了患者发生邻近椎体再骨折的风险。

胸腰椎骨质疏松性压缩骨折患者经皮椎体后凸成形术后残留腰背部疼痛的影响因素分析

目的分析胸腰椎骨质疏松性压缩骨折(OVCF)患者经皮椎体后凸成形术(PKP)后残留腰背部疼痛的影响因素。方法选取2019年1月至2022年12月在我院择期行PKP的胸腰椎OVCF患者97例,术后随访1个月,根据是否存在残留腰背部疼痛[视觉模拟评分(VAS)>4分]分为疼痛组(n=15)和无痛组(n=82)。比较两组手术前后VAS评分,收集患者临床资料,分析胸腰椎OVCF患者行PKP后残留腰背部疼痛的影响因素。结果末次随访时97例患者VAS>4分有15例(15.46%),VAS≤4分有82例(84.54%)。术后12 h、1周和1个月两组VAS评分较术前均降低(P<0.05),且术后1周、1个月疼痛组VAS评分显著高于无痛组(P<0.05)。单因素Logistic回归分析显示,体质量指数、筋膜损伤、手术入路方式、单个椎体骨水泥注入量、骨水泥渗漏情况、术后椎体高度恢复率和术前骨密度等均为影响胸腰椎OVCF患者行PKP后残留腰背部疼痛的影响因素(P<0.05);多因素Logistic回归分析显示,有筋膜损伤、有骨水泥渗漏和术前骨密度<-3.10均为影响胸腰椎OVCF患者行PKP后残留腰背部疼痛的独立危险因素(P<0.05)。结论PKP治疗胸腰椎OVCF仍有部分患者存在残留腰背部疼痛,与筋膜损伤、骨水泥渗漏和术前骨密度<-3.10有关,临床应采取积极有效的针对性措施来降低残留腰背部疼痛发生率,改善预后。

预防性骨水泥灌注强化对胸腰段骨质疏松性VCFs的疗效

目的:探讨预防性骨水泥灌注强化对胸腰段骨质疏松性椎体压缩性骨折(VCFs)的疗效。方法:选取2021年9月-2023年1月昆山市第三人民医院收治的100例胸腰段骨质疏松性VCFs患者,随机分为对照组和观察组,各50例。对照组采用经皮椎体(或后凸)成形术(PVP/PKP)治疗,观察组在对照组基础上对相邻正常椎体进行预防性骨水泥灌注强化。比较两组术前、术后视觉模拟评分法(VAS)评分、伤椎高度、Cobb角、生活质量及随访过程中邻椎再骨折发生率。结果:术前,两组VAS评分、伤椎高度、Cobb角、生活质量量表(SF-36)评分比较,差异无统计学意义(P>0.05)。术后3个月、6个月,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05);术后3个月、6个月,观察组伤椎高度高于对照组,Cobb角低于对照组,差异有统计学意义(P<0.05);术后3个月、6个月,观察组SF-36各项评分均高于对照组,差异有统计学意义(P<0.05)。观察组邻椎再骨折发生率为0,低于对照组的12.00%(6/50),差异有统计学意义(χ^(2)=4.433,P=0.035)。结论:预防性骨水泥灌注强化能有效改善胸腰段骨质疏松性VCFs患者椎体功能,在提升患者近远期生活质量的同时,还能降低远期临椎再骨折的发生率。