ABSTRACT
ABSTRACT Objective: This study sought to determine serum sclerostin (SOST) expression in patients with osteoporotic thoracolumbar vertebral compression fractures before and after percutaneous kyphoplasty (PKP). Methods: Serum SOST levels were quantified with a sandwich enzyme-linked immunosorbent assay (ELISA) preoperatively and six months postoperatively. Anterior vertebral height, kyphotic angles, and Visual Analogue Scale (VAS) scores were also recorded. Results: Serum SOST was highly expressed in patients and remained negatively correlated with bone mineral density (BMD). Vertebral heights, local kyphotic angles, and VAS scores were all significantly improved after PKP. However, serum SOST was positively correlated with BMD six months after surgery. Conclusion: PKP was an effective treatment strategy for osteoporotic thoracolumbar vertebral compression fractures, improving BMD and decreasing serum SOST levels. Level of Evidence II, Prospective comparative study.
RESUMO Objetivo: Este estudo teve por objetivo determinar a expressão de esclerostina (SOST) em pacientes com fraturas vertebrais osteoporóticas por compressão na coluna toracolombar antes e depois da Cifoplastia Percutânea (PKP). Métodos: Os níveis de SOST no soro foram quantificados por meio de um Ensaio de Imunoadsorção Ligado à Enzima (ELISA) sanduíche, realizado no pré-operatório e aos seis meses pós-operatório. Foram também registrados a altura do corpo vertebral anterior, os ângulos cifóticos, e os valores obtidos na escala analógica visual (VAS). Resultados: O nível de SOST no soro foi altamente expresso nos pacientes, e permaneceu correlacionado negativamente com a densidade mineral óssea (DMO). As alturas vertebrais, os ângulos cifóticos locais, e as pontuações obtidas na escala VAS foram significativamente melhores após o PKP. No entanto, o SOST foi correlacionado positivamente com a DMO aos seis meses pós-operatório. Conclusão: O PKP foi uma estratégia eficaz para o tratamento de fraturas vertebrais osteoporóticas por compressão na coluna toracolombar, melhorando os níveis de DMO e diminuindo os níveis de SOST no soro. Nível de Evidência II, Estudo prospectivo comparativo.
ABSTRACT
Literature searches of the Cochrane Library, PubMed, EMBASE, Web of Science, LILACS, China National Knowledge Infrastructure, and Wanfang Data databases were performed from 1966 to September 2014. Only randomized and quasi-randomized controlled clinical trials comparing operative and nonoperative treatments for displaced midshaft clavicle fractures were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Thirteen studies were considered in the meta-analysis. Constant scores and the Disabilities of the Arm, Shoulder and Hand scores were improved in the operative fixation group at a follow up of one year or more. The nonunion and symptomatic malunion rates were significantly lower in the operative group. Additionally, the nonoperative group had a higher likelihood of neurological symptoms compared with the operative group. A significantly higher risk of complications was found in patients treated conservatively than in those who underwent operative fixation. However, when patients with nonunion and symptomatic malunion were excluded from the analysis, no significant differences in the complication rate were found. We concluded that based on the current clinical reports, operative treatment is superior to nonoperative treatment in the management of displaced midshaft clavicle fractures. However, we do not support the routine use of primary operative fixation for all displaced midshaft clavicle fractures in adults.