Treatment Of Compression Fractures Research Articles

Percutaneous kyphoplasty for treatment of osteoporotic vertebral body compression fractures in the elderly

Objectives To study the clinical effects of percutaneous kyphoplasty on senile osteoporotic vertebral body compression fractures. Methods The 87 elderly patients with osteoporotic vertebral body compression fractures were randomly grouped into control group (n=42) treated with percutaneous vertebroplasty and observation group (n=45) treated with percutaneous kyphoplasty in our hospital from June 2013-March 2016.And the clinical curative effect before and after treatment was compared and analyzed. Results The visual analog scale (VAS) pain score in observation group versus control group was (8.49±2.86) vs.(8.56±2.98), (t=0.11, P>0.05) before treatment, and[(2.58±1.34) vs.(3.34±2.01), t=2.09, P< 0.05], [(2.06±0.97) vs (3.87±1.96), t=5.51, P<0.05]and[(1.09±0.89) vs (2.37±1.29)], t=5.42, P<0.05]at 1 week, 4 weeks, and 12 weeks after treatment respectively, showing statistically significant improvement after treatment.The data of kyphosis angle by using Cobb angle, Oswestry lumbar dysfunction index (ODI), mean time of postoperative ambulation, and mean postoperative hospital stay were similar to that of the visual analog scale (VAS) pain score, showing statistically significant improvement after treatment (all P<0.05). The incidence[cases (%)]of bone cement leakage was lower in observation group[3(6.7)]than in control[9(21.4)](χ2=3.98, P<0.05). Conclusions Clinical treatment effects of percutaneous kyphoplasty on the elderly patients with osteoporotic vertebral body compression fractures are superior to that of percutaneous vertebroplasty.Percutaneous kyphoplasty can effectively relieve pain, and improve body function disorders and the quality of life. Key words: Percutaneous kyphoplasty; Osteoporosis in the elderly; Compressive fractures

Percutaneous pedicle screw insertion for treatment of lumbar spine compression fractures via intersection of facet and center line of transverse process

Objective To compare the clinical effect of percutaneous pedicle screw insertion via intersection of facet and center line of transverse process and traditional percutaneous placement method in treatment of lumbar spine compression fractures. Methods A prospective study was performed on 56 patients with lumbar spine compression fractures without neurologic deficits admitted from January to May in 2014. There were 26 males and 30 females, aged from 20 to 47 years (mean, 37.1 years). Adjacent vertebrae above and below the fractured vertebra were instrumented, and each pair of pedicle screws of every instrumented vertebra were instrumented via traditional entry point (Group A) or via intersection of facet and center line of transverse process (Group B) according to the random number table. Preoperative and postoperative anterior vertebral height and Cobb angle were measured, and every pedicle screw was graded according to facet violation grading system. Intraoperative data were compared between the two groups, including time of determining entry point, frequency of fluorescence to determine entry point, patient radiation exposure, doctor radiation exposure and screw length. Visual analogue scale (VAS) and Oswestry disability index (ODI) were documented at postoperative 3 days, 1 month, 3 months, 6 months and 1 year. Patients with persistent back pain were managed by facet block according to the tenderness point, and the rate of persistent back pain and remission rate were compared between the two groups. Results Anterior vertebral height and Cobb angle were significantly improved after operation (P 0.05). Group B presented more level 0 violation and less level 1 and level 2 violation compared to Group A (P 0.05). VAS and ODI at postoperative 3 months were significantly lower than the preoperative indicators (P<0.01). Rate of persistent back pain and remission rate in Group A (47.3%, 79.2%) differed significantly from those in Group B (24.1%, 25.9%)(P<0.05). Conclusions Percutaneous pedicle screw instrumentation is effective in treatment of lumbar spine compression fractures. Choosing the entry point of intersection of facet and center line of transverse process, far away from facet joint, can bring less facet violation and less postoperative back pain. Key words: Lumbar vertebrae; Fracture fixation, internal; Percutaneous pedicle screw

Experimental ex-vivo validation of PMMA-based bone cements loaded with magnetic nanoparticles enabling hyperthermia of metastatic bone tumors

Percutaneous vertebroplasty comprises the injection of Polymethylmethacrylate (PMMA) bone cement into vertebrae and can be used for the treatment of compression fractures of vertebrae. Metastatic bone tumors can cause such compression fractures but are not treated when injecting PMMA-based bone cement. Hyperthermia of tumors can on the other hand be attained by placing magnetic nanoparticles (MNPs) in an alternating magnetic field (AMF). Loading the PMMA-based bone cement with MNPs could both serve vertebra stabilization and metastatic bone tumor hyperthermia when subjecting this PMMA-MNP to an AMF. A dedicated pancake coil is designed with a self-inductance of 10 μH in series with a capacitance of 0.1 μF that acts as resonant inductor-capacitor circuit to generate the AMF. The thermal rise is appraised in beef vertebra placed at 10 cm from the AMF generating circuit using optical temperatures sensors, i.e. in the center of the PMMA-MNP bone cement, which is located in the vicinity of metastatic bone tumors in clinical applications; and in the spine, which needs to be safeguarded to high temperature exposures. Results show a temperature rise of about 7 °C in PMMA-MNP whereas the temperature rise in the spine remains limited to 1 °C. Moreover, multicycles heating of PMMA-MNP is experimentally verified, validating the technical feasibility of having PMMA-MNP as basic component for percutaneous vertebroplasty combined with hyperthermia treatment of metastatic bone tumors.

EARLY ORTHOTICS IN COMPLEX TREATMENT OF CHILDREN WITH VERTEBRAL COMPRESSION FRACTURES OF THE THORACIC AND LUMBAR SPINE

Objective. To compare the results of treatment of compression fractures of the thoracic and lumbar vertebrae in children by classical functional extension and by early orthotics with hyperextension braces. Material and Methods . The study included 175 children aged 3 to 18 years with vertebral compression fractures of the thoracic and lumbar spine. In the study group (32 patients), early orthotics with a rigid hyperextension brace was used, in the control group (143 patients) - a standard Gorinevskaya - Dreving’s technique followed by wearing a semi-rigid brace. Results . In the study group, the average vertebral compression ratio was 63 %, WI - 0.6-0.8, and vertebral body height restoration was observed in 90.5 % of cases. In the control group, the average compression ratio was 75 %, WI - 0.75-0.9, and abnormal wedging of vertebral bodies after the treatment was observed in 48.0 % of patients. In the study group, the length of hospital stay was reduced, the mode of physical activity in the early stages was increased with better and faster restoration of vertebral bodies in comparison with the control group. Conclusion . Application of hyperextension braces shortens hospital stay, contributes to the complete restoration of the height and shape of the damaged vertebral body, and allows for more early returning the children to the familiar social environment.

Effect of percutaneous vertebroplasty with high-viscosity bone cement in treatment of severe osteoporotic vertebral compression fractures

Objective To evaluate the clinical effects of percutaneous vertebroplasty (PVP) with high-viscosity bone cement in treatment of severe osteoporotic vertebral compression fracture (OVCF). Methods This study involved 176 patients with severe OVCF treated by PVP with high-viscosity bone cement between January 2013 and January 2015. There were 61 male and 115 female patients, aged 58-78 years (mean, 67.7 years). Ninety-four patients were injured in a fall, 31 patients in a bumping condition, and 61 patients with no obvious causes. A total of 204 vertebrae were involved, including 23 T10, 22 T11, 49 T12, 43 L1 and 29 L2. Thirty patients suffered vertebral posterior wall damage. All the vertebral bodies were compressed more than 2/3. Vertebral height, kyphotic Cobb angle, visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded. Bone cement filling and leakage were detected. Results Bone cement leakage was detected in 64 patients, with a leakage rate of 36.3%.Seven patients were found with cement leakage in paravertebral veins, 38 patients in intervertebral spaces, and 19 patients in prevertebral soft tissues. Five patients with back pain got partial remission. Four patients experienced burning sensation in the lower extremity 5 minutes after bone cement filling and were relieved 10 minutes later. No severe adverse events were observed, including spinal cord compression, epidural hematoma, pulmonary infection, pulmonary embolism, bedsores, and cerebrovascular accident. After operation, improvements were observed in ODI [(31.73±7.98)% vs. (75.40±8.17)%] and VAS [(2.33±0.91)points vs. (7.23 ±0.88) points] (P<0.05). Conclusion PVP with high-viscosity bone cement can significantly relieve pain and improve motor function and hence is effective in the treatment of patients with severe OVCF. Key words: Osteoporotic fractures; Vertebroplasty; Complications

Research progress in kyphoplasty and vertebroplasty for treatment of thoracolumbar osteoporotic compression fracture

Research progress in kyphoplasty and vertebroplasty for treatment of thoracolumbar osteoporotic compression fracture

Influencing factors of recurrence of fracture after percutaneous vertebral augmentation

Objective To evaluate the influencing factors of recurrence of fracture after percutaneous vertebral augmentation. Methods From January 2007 to December 2013, 256 cases patients with percutaneous vertebral augmentation in treatment of osteoporotic vertebral compression fractures in the Central Hospital of Chaoyang were retrospectively reviewed.After operation, the patients were divided into recurrent fracture group(59 cases) and no recurrence group(197 cases) according to whether postoperative recurrence of vertebral fracture.The age, sex, body mass index(BMI), bone mineral density, operation mode, bone cement injection volume, the existence of bone cement leakage and vertebral body height recovery rate were compared between the two groups respectively.Multi factor Logistic regression analysis was performed to analyze the correlation between the factors and the recurrence of vertebral body fractures. Results The age((75.9±4.6) years old vs. (69.9±5.0) years old), BMI((23.5±0.6) kg/m2 vs. (25.4±0.7) kg/m2), bone mineral density((-3.67±0.68) vs. (-2.75 ±0.98)), the existence of bone cement leakage rate(22.0% vs. 5.1%) and vertebral body height recovery rate((24.1±2.9)% vs. (14.9±3.0)%) between recurrent fracture group and no recurrence group had statistically significant differences(P=0.046, 0.047, 0.046, 0.026, 0.023). Multi factor Logistic regression analysis showed that age, BMI were not related to postoperative recurrence of fracture(P=0.140, 0.137), and bone density, bone cement leakage and vertebral body height recovery rate were related to recurrence of fracture(P=0.018, 0.000, 0.000). Conclusion Low bone mineral density, existence of bone cement leakage and high body height recovery rate are the risk factors of recurrence of fracture after percutaneous vertebral augmentation. Key words: Thoracic and lumbar vertebrae fracture; Percutaneous vertebral angioplasty; Percutaneous kypho-plasty; Recurrence of vertebral fracture; Bone mineral density; Bone cement leakage; Vertebral body height recovery rate

Efficacy of percutaneous kyphoplasty for osteoporosis vertebral compression fractures

Objective To conclude the technology and clinical outcomes of percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Methods From June 2011 to June 2014, 29 cases of osteoporoticthoracic and lumbar vertebral compression fractures patients, who were diagnosed by ultrasonic bone mineral density measurement. X-ray, CT and MRI were treated with percutaneous kyphoplasty in Beijing 401 Hospital of China Nuclear Industry. Observed and recorded the degree of pain, patient's activity and the recovery of vertebral height in patients with 24 hours, 3 months and 6 months after operation. The index data were analyzed by SPSS17.0 statistical software, and the measurement data were analyzed by paired t test. Results Twenty-nine patients were operated successfully, 17 cases (58.62%)of back pain disappeared and 12 cases (41.38%) of back pain significantly reduced. Twenty-seven cases (93.1%) were allowed to get off bed after 24 hours of operation and 2 cases (6.9%) after 3 days. Three cases (10.34%) occurred PMMA leakage. After 24 hours, 3 months and 6 months VAS and vertebral height of the original vertebral height percentages are much better than before surgery (P 0.05). Compared after surgery 3-month and 6-month with after surgery 24 hours, the vertebral height have lost, but the lost height of the vertebral was no statistical significance (P>0.05). No infection, hematoma, spinal nerve injury and PMMA poisoning complications occurred. Conclusions Percutaneous kyphoplasty can relieve the pain and restore part of the vertebral height satisfactory with better outcomes. Key words: Percutaneous kyphoplasty; Fractures, compression; Osteoporosis; Lumbar vertebrae

Clinical efficacy of improved percutaneous kyphoplasty in treatment of osteoporotic vertebral compression fracture

Objective To compare the curative effect of improved percutaneous kyphoplasty (IPKP) with conventional PKP in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods A retrospective analysis was made on 103 senile patients with OVCF undergone IPKP (57 cases, 72 vertebras) or PKP (46 cases, 58 vertebras) between September 2009 and September 2014. Preoperative vertebral compression, vertebral height restoration, height loss, bone cement leakage and adjacent vertebral refracture were compared between the two groups. Curative effect was evaluated using the visual analogue score (VAS) and Oswestry disability index (ODI). Results Duration of follow-up was 6-38 months (mean, 16 months). Between-group differences were insignificant with respect to the rate of preoperative vertebral compression, rate of postoperative height restoration and height loss rate at the final follow-up (P>0.05). PKP versus IPKP was associated with a higher rate of cement leakage (14% vs. 8%) (P>0.05) and refracture (20% vs. 5%) (P 0.05). VAS and ODI within the group showed significant differences after operation and at the final follow-up compared to these before operation (P 0.05). Conclusions Both procedures can restore vertebral height, alleviate pain and improve mobility. By contrast, IPKP provides long-term benefits in vertebral height loss and refracture rate. Key words: Vertebroplasty; Thoracic vertebrae; Lumbar vertebrae; Osteoporotic fractures

Cognizance on the re-fracture of the operated vertebra with cemented augmentation in osteoporotic vertebral compression fractures

One option with minimally invasive surgery for treatment of painful osteoporotic vertebral compression fracture is percutaneous vertebroplasty or percutaneous kyphoplasty via an inflatable balloon tamp followed by stabilization with polymethylmethacrylate cement. The vertebral height is restored and the decreased loading ability of the fractured vertebral body is restrengthened with pain relief. The effect of the method is widely demonstrated in those conditions. At the same time, the relative problems, such as the complications are being lucubrated and discussed. The reports on the re-fracture or height loss of the operated vertebrae with cemented augmentation are becoming more. By now, there are some unclear aspects on the problem: the definition of the re-fracture of the augmented vertebra is still unclear and not ascertained and the clinical manifestations are various. The mechanisms and correlative factors are still not clear-cut either. The rate of subsequent re-fractures after cemented augmentation from literature is fargoing, with a rate of 0% to 63%. The correlative factors on the re-fracture of the operated vertebrae chiefly include: osteoporosis, bone necrosis caused by the heat injury from cement solidification, failure to achieve endplate-to-endplate cement augmentation, intravertebral cleft or avascular bone necrosis, premature mobilization or excessive movement, overfull reduction of the vertebral height, the biological character of the spine column, and so on. Great controversy still exists on the correlation between those possible factors and the re-fractures. More attention should be paid to this problem to explore the true risk factors and mechanism, decrease the re-fracutre rate, and elevate the clinical outcome in osteoporotic compression fractures.

Percutaneous vertebroplasty in treatment of upper thoracic osteoporotic compression fracture

Objective To evaluate the feasibility, safety and efficacy of percutaneous vertebroplasty (PVP) for osteoporotic compression fracture of the upper thoracic spine. Methods The study enrolled 20 patients with osteoporotic compression fracture in 25 upper thoracic segments. The subjects (5 males and 15 females) aged at (71.0±10.8) years (range, 57-89 years). Fracture occurred in 2 T1, 3 T2, 5 T3 and 15 T4 segments. The subjects were submitted to puncture process via unilateral extrapedicular approach. Operation time, volume of infused bone cement, X-ray images and CT scan were recorded after operation. Visual analogue score (VAS), mobility score and Oswestry disability index (ODI) were assessed after operation. Results The procedure was successfully accomplished in all patients. Mean operation time was (39.7±10.6)min. Infusion volume of bone cement was 2.0-6.0 ml [(3.3±1.5)ml]. Eighteen patients were available to the follow-up of 5.5-18 months [(7.6±2.7)months]. Three patients (15%) were associated with cement leakage into the epidural (n=1), paravertebral soft tissues (n=1) and disc (n=1) but remained asymptomatic. One patient (5%) had new fracture at the non-adjacent and non-operative segments within 15 days, and had no recurrence after PVP. No other serious complications such as rib fracture, pneumothorax, pulmonary embolism, vascular injury, spinal injury and infection were found. VAS, mobility score and ODI improved at 3 d, 1 month, 3 months and final follow-up compared to those at 1 d pre-operation (P<0.01). Conclusions PVP is a safe and effective treatment for upper thoracic osteoporotic compression fracture, which is associated with few complications, reduced pain and improved mobility as well as quality of life. Rational surgical position and puncture approach are beneficial to a successful surgery. Key words: Thoracic vertebrae; Percutaneous vertebroplasty; Vertebral compression fractures

Percutaneous kyphoplasty via the uni-extrapedicular approach for treatment of lower osteoporotic vertebral compression fractures

Objective To investigate the clinical efficacy and safety of the uni-extrapedicular percutaneous kyphoplasty (PKP) versus the unipedicular PKP in the treatment of lower osteoporotic vertebral compression fractures (OVCF). Methods From January 2011 to January 2013, 47 patients with lower OVCF were treated at our department. The uni-extrapedicular PKP was conducted for 25 of them (28 compressed vertebrae, group A) while the unipedicular PKP for the other 22 (24 compressed vertebrae, group B). The 2 groups were compatible, showing no significant differences in preoperative clinical data (P>0.05). The 2 groups were compared in terms of operation time, fluoroscopy frequency, volume of injected cement, cement leakage, and cobb angle, anterior vertebral height, visual analogue scale (VAS) score, Oswestry disability index (ODI), SF-36 score, and cement filling preoperatively, 3 days and one year postoperatively. Results All the patients had an uneventful operation and were followed up for at least one year. Compared with group B, group A reported significantly shorter operation time, lower fluoroscopy frequency, less cement leakage, better cement filling, and a lower rate of fracture of adjacent vertebra (all P 0.05). Conclusion Both of the 2 methods are safe and effective treatments of OVCF, but the uni-extrapedicular PKP may be more advantageous because it leads to shorter operation time and lower fluoroscopy frequency. Key words: Thoracic vertebrae; Fractures, bone; Osteoporosis; Vertebroplasty; Cement

Clinical efficacy of percutaneous kyphoplasty in management of osteoporotic thoracolumbar vertebral compression fracture in the elderly

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in surgical treatment of osteoporotic thoracolumbar vertebral compression fracture in the elderly. Methods From March 2007 to February 2013, 210 cases (100 males and 110 females; 55-91 years of age, mean 72.5 years) of osteoporotic vertebral compression fracture were treated with PKP. Single-segment fracture was observed in 180 cases, two-segment fracture in 20 cases and three-segment fracture in 10 cases. Lesion involved in 250 vertebrae located in the T6-L5 segment. Bone cement injected into each vertebra was 3-5 ml (mean, 4 ml). Treatment effects were assessed with vertebral height, Cobb angle and visual analogue score (VAS). Results At the follow-up of 6-15 months (mean 11 months), thoracic back pain significantly alleviated or disappeared. After operation, improvements were observed in VAS[(8.7±1.2) points vs (2.6±0.7) points], anterior vertebral height loss [(11.0±3.2) mm vs(5.5±0.8) mm], central vertebral height loss [(8.6±1.1) mm vs (3.3±1.0) mm], and Cobb angle [(29.8±4. 5)° vs (16.7±3.4)°] (P <0.01). Four patients appeared no pain or numbness in lower limbs although cement leak into disc. Whereas two patients had lower extremity nerve irritation because of cement leak into the spinal canal and recovered after symptomatic treatment. Conclusion PKP is an effective method for treatment of osteoporotic vertebral compression fracture in the elderly, for it can rebuild vertebral height, increase vertebral rigidity as well as stability and relieve thoracic back pain. Key words: Spinal fractures; Osteoporosis; Percutaneous kyphoplasty

A prospective multicentric observational study on the use of intravertebral implants for traumatic vertebral compression fracture treatment – 12 months follow up

MIS-surgery and intravertebral implants for treatment of Vertebral Compression Fractures could be a solution for an anatomically correct fracture reduction and decrease of complications related to more invasive surgery.

Cascading Adjacent Level Vertebral Compression Fractures Necessitating a Series of Eleven Kyphoplasties.

Vertebral kyphoplasty is a procedure used for the treatment of compression fractures. While early randomized-controlled trials were equivocal regarding its benefits, more recent RCTs have shown favorable results for kyphoplasty with regard to pain relief, functional recovery, and health-care related quality of life compared to control patients. Risks of kyphoplasty include but are not limited to cement extrusion, infection, hematoma, and vertebral body fracture of adjacent levels. We describe a case of a 66-year-old male attorney who underwent eleven kyphoplasties in an approximately one-year period, the majority of which were for fractures of vertebrae adjacent to those previously treated with kyphoplasty. Information on treatment was gathered from the patient's hospital chart and outpatient office notes. Following the last of the eleven kyphoplasties (two at T8, one each at all vertebrae from T9 to L5), the patient was able to function without pain and return to work. His physiologic thoracic kyphosis of 40 degrees prior to the first procedure was maintained, as were his lung and abdominal volumes. We conclude that kyphoplasty is an appropriate procedure for the treatment of vertebral compression fractures and can be used repeatedly to address fractures of levels adjacent to a previous kyphoplasty.

Clinical Outcome after the Use of a New Craniocaudal Expandable Implant for Vertebral Compression Fracture Treatment: One Year Results from a Prospective Multicentric Study

The purpose of this prospective multicentric observational study was to confirm the safety and clinical performance of a craniocaudal expandable implant used in combination with high viscosity PMMA bone cement for the treatment of vertebral compression fractures. Thirty-nine VCFs in 32 patients were treated using the SpineJack minimally invasive surgery protocol. Outcome was determined by using the Visual Analogue Scale for measuring pain, the Oswestry Disability Index for scoring functional capacity, and the self-reporting European Quality of Life scores for the quality of life. Safety was evaluated by reporting all adverse events. The occurrence of cement leakages was assessed by either radiographs or CT scan or both. Statistically significant improvements were found regarding pain, function, and quality of life. The global pain score reduction at 1 year was 80.9% compared to the preoperative situation and the result of the Oswestry Disability Index showed a decrease from 65.0% at baseline to 10.5% at 12 months postoperatively. The cement leakage rate was 30.8%. No device- or surgery-related complications were found. This observational study demonstrates promising and persistent results consisting of immediate and sustained pain relief and durable clinical improvement after the procedure and throughout the 1-year follow-up period.

Surgical treatment of acetabulum top compression fracture with sea gull sign

Objective To investigate the surgical method and clinical curative results of acetabulum top compression fractures with sea gull sign. Methods Data of 14 patients who had acetabulum top compression fractures with sea gull sign were retrospectively analyzed and were accepted surgical therapy and followed up. There were 5 females and 9 males, aged from 28 to 71 years （average, 49.9 years）. The pre-operative time was from 4 to 14 days （average, 9 days）. Letournel-Judet fracture classifica-tion：eight cases for the anterior column＋posterior semi-transverse, six cases for a simple anterior column. Three patients with lum-bar compression fracture, two patients with tibial plateau fracture, one patient with multiple rib fractures. All patients were accept-ed open reduction and bone graft and internal fixation through ilioinguinal approach or ilioinguinal approach＋Kocher-Langenbeck approach. The quality of fracture reduction was assessed according to the Matta reduction criterion after operation. The hip func-tion was evaluated according to Matta. Results 14 patients were followed up from 6 to 60 months （average, 36 months）. All pa-tients reached bone healing;healing time was from 3 months to 4 months （average, 3.4 months）. According to the Matta reset stan-dard after operation, there were 6 excellent cases, 5 good cases, 2 fair cases, 1 poor case, the excellent and good rate was 78.5%（11/14）. The Matta was from 10 to 18 scores （average, 16.4 scores）, 5 excellent cases, 5 good cases, 3 fair cases, 1 poor case, the ex-cellent and good rate was 71.4%（10/14）. Traumatic arthritis occurred in 3 patients. Pain was serious in two patients and disap-peared after total hip joint replacement. Pain was mild for one patient and disappeared after accepted non steroidal painkiller. One patient had heterotopic ossification after operation, which was not treatmented because of no obvious symptom. Conclusion The appropriate operation time of acetabular roof compression fracture with sea gull sign was from 5 to 10 days after fracture, which was no more than two weeks had best. Through ilioinguinal approach or ilioinguinal approach＋Kocher-Langenbeck approach, the articular surface could be reduced excellent and got sufficient bone graft. The clinical efficacy was satisfactory after operation. Key words: Acetabulum Fractures; compression Bone transplantation Fracture fixation; internal

Clinical study of percutaneous kyphoplasty in treatment of vertebral compression fracture in elderly patients

Objective To explore the clinical application of PKP in treatment of VCF in elderly patients. Methods 77 elderly patients with VCF were divided randomly into PVP group unilateral PKP group and bilateral PKP group by method of random number table. Preoperative and postoperative VAS scores, vertebral height, Cobb＇s angles, operative duration and incidence of bone cement leakage were observed and compared before and after opera- tions in different groups. Results VAS score after 6 days and 6 weeks after operation decreased significantly in all patients. In PVP group, VAS improved form （8.47 ± 1.42） to （2.15 ± 0.83 ） at 6 days after treatment （ t = 5.24） and to （2.89 ±O. 82） at 6 weeks after treatment（t =4.82） ;In unilateral PKP group,VAS improved form （8.52 ± 1.20） to （2.11 ±0.78） at 6 days after treatment（t =5.93） and to （2.04 ±0.75） at 6 weeks after treatment （t = 2.05 ） ; In bilateral PKP group, VAS improved form ± 8.44 ± 1.24） to （2.14 ± 0.82） at 6 days after treatment （ t = 6.29 ） and to （ 2.02 ± 0.71 ） at 6 weeks after treatment （ t = 3.14）, （ all P 〈 0.05 ） ; VAS seore after 6 weeks in PVP group was significantly higher than that in other two groups （ tunilateral PKP = 5. 19, tbilateral PKP = 6.82, P 〈 0.05 ） ;vertebral height and Cobb＇s angle were improved significantly after operations in all patients, In PVP group, vertebral leading edge height improved from （ 18.19 ± 1.32 ） mm to （ 20.17 ± 1.66 ） mm （ t = 7.53 ）, vertebral back edge height improved from （ 23.62 ± 0.71 ） mm to （ 24.07 ± 0.60 ） mm （ t = 6.18 ） , Cobb＇ s angle improved from （ 10.26 ± 1.60） degrees to （5.40 ± 0.92） degrees （ t = 4.92 ） （ all P 〈 0.05 ） ; In unilateral PKP group, vertebral leading edge height improved from （ 19.17 ± 1.12） mm to （21.60 ± 1.02 ） mm （ t = 5.51 ）, vertebral back edge height improved from （22.31 s0.92）ram to（2d. 98 s0.30） mm（t =6.25） ,Cobb＇s angle improved from （ 10.55 ± 1.48） degrees to（5.28 ± 0.43 ）degrees（ t = 5.44）（ all P 〈 0.05 ） ;In bilateral PKP group, vertebral leading edge height im- proved from （18.63 ± 1.24）mm to （20.46 ± 1. 11 ）mm（t =4.28）,vertebral back edge height improved from （24. 61 ± 0.40）mm to （25.09 ± 0.43 ）mm （ t = 9.62）, Cobb＇s angle improved from （ 10.72 ± 1.52 ） degrees to （55.32 ± 0.48 ） degrees （ t = 8.36） （ all P 〈 0.05 ）. Operative duration was significantly longer in bilateral PKP group which was （57.54 ± 12.75 ） min than that in PVP group which was （40.39 ± 1 l. 40 ） min （ t = 7.10 ）, or unilateral group which was （38.18 ± 15.31 ） min （t = 5.42, all P 〈 0.05 ） ;incidence of bone cement leakage was significantly higher in PVP group（64.00% ） than in bilateral（ 19.23%, X2 = 10.59）/unilateral groups（23.08%, X2 = 8.66）（ all P 〈 0.05）. Conclusion Unilateral PKP is a proper method in treatment of VCF in elderly patients. Key words: Percutaneous kyphoplasty; Percuteneous vertebroplasty; Spinal fractures ; Aged

Comparison of unipedicular versus bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Objective To compare the clinical efficacy and safety of unipedicular versus bipedicular percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures.Methods Enrolled for this study were 101 patients with osteoporotic vertebral compression fracture who had been treated by PVP in our department from January 2009 to January 2012 and followed up for at least one year.They were divided into 2 groups according to the approaches they used.In the unilateral group,there were 45 patients,11 males and 34 women,with a mean age of 69.4 ± 10.4 years; in the bilateral group,there were 56 patients,6 males and 50 women,with a mean age of 69.7 ± 9.7 years.The 2 groups were compared in terms of operation time,bone cement volume injected,cement leakage,vertebral height restoration,kyphosis correction and visual analogue scale (VAS) score.Results The unipedicular group incurred significantly shorter operation time (36.4±6.0 min) and significantly less bone cement volume injected (3.72 ± 1.09 mL) than the bipedicular group (52.9 ± 6.8 min and 4.29 ± 1.12 mL respectively) (P ＜ 0.05).There were no significant differences between the 2 groups in anterior vertebral height restoration,middle vertebral height restoration or kyphosis correction (P ＞ 0.05).The VAS scores at 24 hours,3 and 12 months postoperation were significantly lower than preoperation in both groups (P ＜ 0.05),but there were no such significant differences between the 2 groups (P ＞ 0.05).The cement leakage rate for the unipedicular group [28.9％ (13/45)]was insignificantly lower than that for the bipedicular group [46.4％ (26/56)] (P ＞ 0.05).Conclusions Both unipedicular and bipedicular PVP can obtain satisfactory analgesia for the treatment of osteoporotic vertebral compression fractures but the former may have advantages of less invasion and shorter operation time. Key words: Spinal fractures; Osteoporosis; Fractures, compression; Vertebroplasty

Bone filling mesh container repairs vertebral compression fractures: biomechanical changes

AbstractBACKGROUND:Percutaneous vertebroplasty and percutaneous kyphoplasty have become the mainstream clinical methods for the treatment of vertebral compression fractures. However, both of them have several shortcomings such as bone cement leakage, spinal stenosis, nerve compression, pulmonary emb