ABSTRACT
OBJECTIVE: It remains disputed whether percutaneous curved vertebroplasty and unilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture. This study systematically analyzed the efficacy and safety of percutaneous curved vertebroplasty and unilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture. METHODS: A computer-based online search of Wanfang, VIP, CNKI, PubMed, EMBASE, The Cochrane library, and CBM was performed to retrieve randomized controlled trial studies regarding percutaneous curved vertebroplasty and unilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture published before January 2020. Related papers were manually searched. After two evaluators independently selected literature, data were extracted and the quality of methodology included in the study was evaluated. Meta-analysis was carried out by using Stata/SE 12.0 software. RESULTS: (1) A total of eight randomized controlled trials were conducted, including 628 patients, of whom 394 were treated with percutaneous curved vertebroplasty and 404 with unilateral pedicle approach percutaneous vertebroplasty. (2) The meta-analysis results showed that visual analogue scale score [MD=-0.20, 95%CI(-0.28,-0.12), P < 0.05], the leakage rate of bone cement [RR=0.30, 95%CI(0.15, 0.58), P < 0.05], and the total distribution rate of bone cement in the center of vertebral body [RR=1.27, 95%CI(1.12, 1.45), P < 0.05] were better in the percutaneous curved vertebroplasty group than those in the unilateral pedicle approach percutaneous vertebroplasty group. (3) There was no significant difference in Oswestry disability index score [MD=-4.83, 95%CI (-9.71, 0.05), P=0.052], operation time [MD=-1.45, 95%CI(-5.91, 2.82), P=0.488]and X-ray exposure times [MD=-0.70, 95%CI(-2.11, 0.71), P=0.33] between the two methods. CONCLUSION: Percutaneous curved vertebroplasty exhibits significant advantages in analgesic effect, low leakage rate of bone cement and the high total distribution rate of bone cement in the center over unilateral pedicle approach percutaneous vertebroplasty. Therefore, a large number of high-quality multicenter randomized controlled trials are needed to provide more evidence.
ABSTRACT
BACKGROUND: With the aging of the society, the number of patients with osteoporotic vertebral fracture is increasing, mainly manifesting compression fracture of thoracolumbar body, which seriously affects the daily life of the elderly. Therefore, to study the relationship between the degree of external force and the performance of osteoporotic thoracolumbar body fracture on MRI STIR is to provide a better basis for clinical diagnosis and treatment. OBJECTIVE: To explore the relationship between the size of external force and a linear black signal area of STIR image in MRI of thoracic and lumbar osteoporosis vertebral compression fractures. METHODS: The hospitalized patients, who were diagnosed as thoracic and lumbar osteoporosis vertebral compression fractures, were retrospectively analyzed from September 2013 to September 2016 at the Department of Spine Surgery of The First Affiliated Hospital of Guangxi University of Chinese Medicine. All cases in the three groups were diagnosed as osteoporosis by quantitative CT (bone mineral density ≤80 mg/cm3). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into three groups according to the different trauma history: Non-obvious external force group (without apparent cause or external force), low energy group (sprains, bent down to lift heavy objects, and carrying heavy items), high energy group (flat road down hips touchdown, falls, and bruise). Gender, age, fracture site (thoracic lumbar segment and non-thoracic lumbar segment), the number of the vertebrae and the position where would they occur with a linear black signal area of STIR image in MRI were analyzed in each group. Age was analyzed by analysis of variance. Gender, fracture site and the number of the vertebrae and the position were analyzed by Pearson chi-square test. RESULTS AND CONCLUSION: (1) All the 782 cases were included in the three groups. There were 334 in the non-obvious external force group, which a linear black signal area of STIR image in MRI existed in 114 cases. There were 186 cases in low energy group, which a linear black signal area of STIR image in MRI existed in 124 cases. There were 262 cases in high energy group, which a linear black signal area of STIR image in MRI existed in 87 cases. (2) The age, gender, fracture site and the number of the vertebrae and the position in three groups were not statistically significantly different among the three groups (P > 0.05). (3) There were significant differences in a linear black signal area of STIR image in MRI among the three groups (P 0.017). (4) The occurrence rate of linear black signal area of STIR image in MRI was 66.7% and higher than other groups (43.1% and 33.2%). (5) In the history of trauma, low energy in external force has more opportunity to cause a linear black signal area of STIR image in MRI than non-obvious external force and high energy; and they often occur in thoracic and lumbar osteoporosis vertebrae.
ABSTRACT
BACKGROUND:At present, the internal fixation and fusion surgical treatment of lumbar degenerative disease tends to diversify, but posterior lumbar interbody fusion within a single bilateral pedicle screw fixation is stil common in clinical practice; the two ways after treatment can achieve satisfactory clinical efficacy, but which way has advantages is stil controversial. OBJECTIVE:To evaluate the efficacy and safety of unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the repair of lumbar degenerative disease by a meta-analysis system. METHODS: According to the Cochrane Colaboration search strategy, we searched MEDLINE, PubMed, EMBASE, CBMdisc, CNKI, VIP and WanFang Data. Randomized controled trials concerned unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the treatment of lumbar degenerative diseases. By two reviewers, in strict accordance with inclusion and exclusion criteria, literatures were screened, data were extracted, and the methodology quality of included trials was criticaly assessed. RevMan5.1 software was used for meta-analysis. RESULTS AND CONCLUSION: Six randomized controled trials involving 507 patients were included. The results of meta-analysis showed that fixed unilateral and bilateral pedicle screw between single lumbar fusion and surgery in the treatment of lumbar degenerative diseases, significant differences were detected in surgical time [WMD=-40.29, 95% CI (-43.79, -36.79)], intraoperative blood loss [WMD=-74.13, 95%CI (-86.13,-62.13)], length of hospital stay [WMD=-1.04, 95%CI (-1.30,-0.79)], final folow-up Visual Analogue Scale score [WMD=0.33, 95% CI (0.24, 0.42)], final folow-up Oswestry dysfunction index [WMD=-1.07, 95%CI(-1.57, -0.56)]; unilateral side was better than bilateral side (P < 0.000 1). There was no significant difference in complication rate [RR=0.54, 95% CI(0.25, 1.17)] and fusion rate [RR=0.53, 95%CI (0.22, 1.28)] (P=0.12 andP=0.16). These results suggested that unilateral and bilateral pedicle screw fixation and single lumbar fusion in the treatment of lumbar degenerative disease has achieved satisfactory results. Unilateral pedicle screw fixation can reduce operation time, intraoperative blood loss and length of stay. Visual Analogue Scale score and Oswestry dysfunction index improved significantly in a short period after treatment.
ABSTRACT
BACKGROUND:The correlation between blood stasis syndrome and non-blood stasis syndrome of lumbar intervertebral disc protrusion remains unclear. OBJECTIVE:To construct serum protein pattern model for diagnosing blood stasis syndrome of lumbar intervertebral disc protrusion. METHODS:A total of 180 cases were included in this study and divided into treatment group (120 patients with lumbar intervertebral disc protrusion) and control group (60 healthy cases from physical examination). Furthermore treatment group was equal y assigned into blood stasis syndrome subgroup and non-blood stasis syndrome subgroup, with 60 cases in each subgroup. The involved cases were wel matched in nations, genders and ages. Serum samples of peripheral blood from the 180 cases were col ected. Surface-enhanced laser desorption/inionation time of flight mass spectrometry and ProteinChip technology were employed to detect and plot protein mass spectrum. The protein peak values were identified using Biomarker Wizard software. Then serum diagnosis model of blood stasis syndrome of lumbar intervertebral disc protrusion was established. The obtained models were verified through double blind method. The differential proteins were searched by ExPASy data. RESULTS AND CONCLUSION:We detected that peak values of eleven proteins had statistical significance (P<0.05) from the involved 180 cases. Among them, two proteins were highly expressed while the other nine proteins were lowly expressed. Serum protein pattern model for diagnosing blood stasis syndrome of lumbar intervertebral disc protrusion was established through Biomarker Patterns software, and the sensibility was 86.667%, the specificity was 94.167%, the positive predictive value was 88.136%. There are a variety of abnormal y expressed proteins in the serum of the patients with blood stasis syndrome of lumbar intervertebral disc protrusion. The serum protein pattern model involved eleven different proteins can be used to diagnose blood stasis syndrome of lumbar intervertebral disc protrusion.
ABSTRACT
0.05),the symptoms and activities of daily living were improved significantly in three groups after treatment(P0.05),but the clinical effect had obvious difference between traditional Chinese medicine group and traditional Chinese medicine-western medicine group or western medicine group and traditional Chinese medicine-western medicine group(P