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Objective:To investigate the therapeutic effect and prognosis of percutaneous balloon kyphoplasty (PKP) for diabetic patients with osteoporotic thoracolumbar compression fractures.Methods:A total of 105 patients with diabetes mellitus complicated with osteoporotic thoracolumbar compression fractures who received diagnosis and treatment in our hospital from May. 2017 to Feb. 2020, who were followed up to Mar. 2022 were selected as the research subjects, and all were treated with PKP. Time, intraoperative blood loss, hospital stay, incidence of secondary vertebral fracture, anterior height of injured vertebral body, Sagittal kyphosis Cobb angle, VAS score, and ODI index were investigated. The patients were divided into good prognosis group ( n=82) and poor prognosis group ( n=23) according to the presence or absence of secondary vertebral fractures during the follow-up period. Binary Logistic regression model was used to analyze the risk factors affecting the prognosis. Results:After PKP treatment, the efficiency of all 105 patients was 87.62% and the incidence of secondary vertebral fracture was 21.90%. The operative time was (83.52±16.85) min, the intraoperative blood loss was (32.11±1.52) ml, and the length of hospital stay was (10.62±1.65) d. The height of the anterior edge of the injured vertebra was (24.62±5.16) mm and (24.67±5.03) mm at the last follow-up and 3 months after surgery, respectively, higher than that before surgery ( t=15.21, 15.63, P=0.000). The Cobb angle of sagittal kyphosis was (10.03±1.27) ° and (10.10±1.25) °, respectively, and the VAS score was (3.11±0.52) and (1.00±0.11) points, respectively, 3 months after surgery and at the last follow-up. The ODI indexes were (11.25±2.85) % and (5.32±1.01) %, respectively, lower than those before surgery ( t3 months after surgery=28.84, 18.17, 29.21, tlast follow-up=25.68, 27.49, 42.78, P=0.000). There were significant differences in age, BMD, bone cement leakage, bone cement distribution and use of anti-osteoporosis drugs between the good prognosis group and the poor prognosis group ( t=4.03, 5.22, χ2=12.50, 22.694, 26.22, P=0.000). Logistic regression analysis showed that age ( OR=1.309, 95%CI=1.134-1.511, P=0.000), BMD ( OR=126.660, 95%CI=13.376-1199.376, P=0.000), bone cement leakage ( OR=4.698, 95%CI=1.306-16.902, P=0.018), dense distribution of bone cement ( OR=9.697, 95%CI=2.679-34.869, P=0.001), no use of anti-osteoporosis drugs ( OR=7.586, 95%CI=2.197-26.193, P=0.001) was an independent risk factor for the prognosis of patients with diabetes complicated with osteoporotic thoracolumbar compression fracture. Conclusion:PKP has a high rate of excellence in the treatment of diabetes mellitus complicated with osteoporotic thoracolumbar compression fractures, but factors such as age, BMD, bone cement leakage, bone cement dense distribution, and no postoperative use of anti-osteoporotic drugs will increase risks of secondary fractures, which in turn affects their prognosis.
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Objective To investigate the causes and managements of recent postoperative complications of degenerative scoliosis (DS) treated with long-segment internal fixation and fusion.Methods The clinical data of 89 patients with DS treated with long-segment internal fixation and fusion were retrospectively analyzed.Results There were 16 patients suffered from the recent operative complications and the incidence rate was 17.98％(16/89).There were 3 patients with superficial incision infection,1 patient with leakage of cerebrospinal fluid,1 patient with cardiac inadequacy,1 patient with urinary system infection,9 patients with lower limb numb or pain,1 patient with lower limb sensation and motor function decreased (severe nerve injury).According to the causes of complications,anti-infection,specific treatment,nerve nourishment,adjusting the screw in operation were treated.Infection,leakage of cerebrospinal fluid,cardiac inadequacy and urinary system infection were all cured.The symptom of lower limb numb or pain improved after treatment for 3 months,the symptom disappeared after treatment for 6 months.The nerve function of the patient with severe nerve injury improved after treatment for 3 months,and the nerve function was normal basaly after treatment for 6 months.Conclusions The incidence rate of postoperative complications of DS treated with long-segment internal fixation and fusion is higher.The patients are older and with more preoperative complications,so to decrease the incidence rate of complications,on the basement of symptom relieve,decreasing the trauma of operation,matching with the sufficient preoperative ready,correct operative manipulation and closely postoperative monitoring and nursing should be adopted.
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BACKGROUND:Spine is relatively complex in structure, shape, material properties, and load bearing. The traditional biomechanical method cannot solve these problems. OBJECTIVE:To investigate the stress distribution of intervertebral disc, zygapophysial joints and vertebral body of degenerative scoliosis, and to provide accordance to the biomechanical mechanism of degenerative scoliosis occurrence and development. METHODS:Based on the successive CT images of spinal column from T12 to superior segment of S1 of degenerative scoliosis patients, the special material properties were attributed to the model to form the integrated and effective three-dimensional finite element model of degenerative scoliosis. The model was loaded on the anteflexion, extension, left lateral bending, right lateral bending, left rotation and right rotation conditons. Then the spinal activity and the stress distribution of intervertebral disc, vertebral body and articular cartilage of zygapophysial joints were calculated and analyzed. RESULTS AND CONCLUSION:The spinal activities of degenerative scoliosis finite element model were less than those of common lumbar spine. The stress distribution of intervertebral disc was inclined to the verge of it and the greatest stress was appeared on the extension motion. The apex of scoliosis was the place of stress concentration and the obvious stress concentration of articular cartilage of zygapophysial joints was appeared on the rotation motion, then fol owed by the extension motion, especial y that of articular cartilage of zygapophysial joints on the apex of scoliosis. Stress concentration is easily appeared on the apex of scoliosis, and the extension and rotation motion can aggravate the development of degenerative scoliosis.
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Objective To observe the operative effect of selective decompressive laminectomy and long segment pedical screw internal fixation for degenerative scohosis beyond 3 segments. Methods During January 2003 to July 2009, 52 cases with degenerative scoliosis beyond 3 segments were treated by posterior selective decompressive laminectomy, intervertebral implanted bone fusion and long segment pedical screw internal fixation, vetebral plate fusion seperately, and all the cases were followed up. Results All the patients were followed up for 12-60 months after operation. The status of back leg pain relief were evaluated through Oswestry score system. The Oswestry score of 1 week,3 months and 12 months after operation were (25.91 ± 9.05), (26.75 ± 8.37), (26.90 ± 8.45) scores respectively and there was statistical significance compared to the preoperative [(46.35± 8.12) scorns] (P ＜0.05). The average coronal Cobb angle was corrected from 15.23°± 3.35° to 10.02°± 3.26° 1 week after operation (P ＜ 0.05). All the internal implant didn't appear loosing or fracture confirmed by X-ray at 3,6,12 months after operation. The intervertebral implanted bone fusion and vetebral plate fusion all got well in 18-24 months after operation. Conclusion Selective decompressive laminectomy and long segment pedical screw internal fixation for the degenerative scoliosis can get better operative effect.
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Objective To investigate the surgical treatment of spondylolisthesis combined with symptomatic intervertebral disk herniation of close together segments and evaluate the operative effect. Method From January 2001 to January 2009, 60 cases of spondylolisthesis combined with symptomatic intervertebral disk herniation of consecutive segments treated by posterior vertebral body reposition, excision of intervertebral disk herniation, interverbral implanted bone fusion and pedicle screw internal fixation, evaluated and compared the preoperative and postoperative effects. Results In 3 days postoperative, 55 cases had hemilateral or contralateral neuropathic pain or numbness, 9 cases had hemilateral or contralateral neuropathic pain or numbness 3 months postoperative, 2 cases had hemilateral neuropathic pain 1.5 years postoperative. Nobody had neuropathic pain after 2 years postoperative,but 7 cases had low back pain sometimes. The surface of the osteotomy infused after 1.5 years. There wasn't interplantation's clinch and breakage. Oswestry score 1 year postoperative average (26.07 ± 9.36) scores,preoperative average(55.34 ± 11.05) scores, there was statistical significance between them (P < 0.05). Conclusion Posterior vertebral body reposition, excision of intervertebral disk hermina, interverbral implanted bone fusion and pedicle screw internal fixation is an effective surgical method to treat spondylolisthesis combined with symptomatic intervertebral disk herniation of consecutive segments, it has satisfied clinical effect.
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[Objective]To evaluate the surgical results and value of posterior lumbar decompression and intervertebral bone fusion with pedicle screw interval fixation in degenerative sympotomatic lumbar scoliosis.[Method]From Jan.1999 to Apr.2006,37 cases with degenerative sympotomatic lumbar scoliosis underwent posterior lumbar decompression and intervertebral bone fusion with pedicle screw interval fixation,including 21 male and 16 female patients,aged 62.6 years old averagely.All the patients were assessed by routine X-ray and Bending X-ray.CT and MRI were performed necessarily.According to patients ' symptom,total or semi-laminectomy,intervertebral bone fusion with pedicle screw interval fixation were performed.[Result]The fellow-up period varied from 1 year to 6 years(averaged,2 years and 7 months),clinical symptoms were effectively relieved after operation in all cases.Neurological functions were evaluated using JOA system,the clinical success rate in all 37 patients was 91.9%.The corrective rate was 54.8%.The average solid arthrodsis time was 11.6 weeks.The height of intervertebral disc and corrective rate had no loss.All patients X-ray of the third month and the first year didn 't show the interplantation 's clinch and breakage.[Conclusion]In the treatment of the elderly patients with degenerative sympotomatic lumbar scoliosis,first of all,the particular principle of surgical operation should be applied,the old age and long course of disease are not absolute contraindication.In addition,The technique of posterior lumbar decompression and intervertebral bone fusion with pedicle screw interval fixation can be safely performed in the elderly patients with degenerative sympotomatic lumbar scoliosis.