ABSTRACT
Objective To compare the effects of different types of bone cement augmentation of pedicle screws on the prognosis of osteo -porotic thoracolumbar fractures in elderly patients.Methods From August 2013 to November 2016,184 elderly patients with osteoporotic thoracolumbar fractures in our hospital were selected as the research object,all the patients were randomly divided into observation group and control group,94 cases in each group.Two groups were treated with pedicle screw fixation,the control group received conventional pedicle screw combined with PMMA bone cement augmentation,and the observation group were treated by cannulated pedicle screws combined with PMMA bone cement augmentation,the prognosis of the two groups were recorded.Results All patients were successfully completed the oper-ation without serious complications occurred.There was no significant difference in operation time,intraoperative blood loss,the amount of sin-gle vertebral bone cement,hospitalization time between the two groups(P>0.05).The postoperative 1 month incidence rate of cerebrospinal fluid leakage,bone cement leakage,wound infection,loosening of internal fixation was 4.3% in the observation group,which was lower than 21.3%in the control group,the difference was significant(P<0.05).The postoperative 1 month of vertebral height in the observation group and the control group were respectively(4.53 ±1.11)mm and(5.09 ±1.42)mm that were lower than the preoperative(6.41 ±1.39)mm and(6.38 ±1.31)mm(P<0.05),meanwhile the vertebral height at postoperative 1 month of the observation group was lower than that of the control group,the differences were significant(P<0.05).There were 0 case of Frankle grade A,0 case of grade B,10 cases of grade C, 18 cases of grade D,66 cases of grade E in the observation group at postoperative 1 month,and there were 6 cases,14 cases,20 cases,20 ca-ses and 34 cases of corresponding Frankle grade in the control group,the observation group was significantly better than the control group,the differences were significant(P<0.05).Conclusion The application of cannulated pedicle screw combined with PMMA bone cement in the osteoporotic thoracolumbar fractures does not increase the difficulty of operation,and it can reduce the complications and reduce vertebral height,which is conducive to the recovery of nerve function.
ABSTRACT
<p><b>OBJECTIVE</b>To analyze the clinical effects of percutaneous endoscopic technique via three different approaches for highly migrated lumbar disc herniation.</p><p><b>METHODS</b>The clinical data of 68 patients underwent percutaneous endoscopic technique from June 2011 to June 2014 were retrospectively analyzed. There were 43 males and 25 females, aged from 11 to 77 years old with an average of (42.29±15.92) years. The patients were divided into three groups according to different operative approaches, of them, 45 cases were by transforaminal approach (group A), 15 cases by translaminar approach (group B), and 8 cases by transpedicular approach (group C). There was 1 case in level L₂,₃, 12 cases in L₃,₄, 36 cases in L₄,₅, 19 cases in L₅S₁. The herniated disc was migrated superiorly in 23 patients, inferiorly in 45 patients. MRI were available to confirm migrated disc pre-and post-operatively. Operation time, loss blood volume, intraoperative and postoperative complications, time of back to work (postoperative recovery time) were recorded. Preoperative and postoperative VAS were used to evaluate low back pain and sciatica and JOA and MacNab criteria were used to evaluate functional recovery.</p><p><b>RESULTS</b>All the operations were successful and all the patients were followed up from 12 to 40 months with an average of (18.0±15.9) months. Seven patients(3 cases in group A, 3 cases in group B, 1 case in group C) complicated with transient paraesthesia (hyperalgesia or hypesthesia), and the symptoms relieved after symptomatic treatment with neurotrophic medicine, at final follow-up, no symptoms were left. One case in group B complicated with dura mater tearing during operation and it was untreated, there was no resulted complications such as headache and sinus tract of skin. In group A, B, C, the mean VAS score of sciatica improved from preoperative 6.93±1.34, 6.33±1.23, 6.13±1.73 to 0.80±0.87, 0.73±0.70, 0.38±0.52 at final follow-up; and JOA score improved from preoperative 9.09±2.62, 9.80±2.31, 10.50±2.93 to 26.82±1.53, 25.93±1.58, 26.50±1.51 at final follow-up, respectively(<0.05). There was no significant difference among three groups(>0.05). There was no significant difference in loss blood volume, postoperative recovery time among three groups. But operation time of group B was shorter than other two groups. According to MacNab criterion to assess the clinical effects, 42 cases got excellent results, 21 good, 5 fair.</p><p><b>CONCLUSIONS</b>Percutaneous endoscopic technique is a safe and effective method for surgical treatment of highly migrated herniation. The decision of operative approach should be made by characters of anatomy. By tanspedicular approach the lesion could be found directly. However, it depends on good skill and equipment.</p>