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Objective:To compare postural reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCFs).Methods:From January 2019 to January 2020,68 patients with OVCFs who met the inclusion and exclusion criteria in the Second Hospital of Tangshan Hebei Province were included in the observation study. A prospective randomized controlled study was used. The matched groups were divided into PVP combined group (adjust the overextension of the operating table by 20°-30°, if the posture reduction fails, pry the puncture needle on both sides in reverse according to the compression degree of the end plate before operation, and inject bone cement) and PKP group (do not adjust the operating table before operation, insert a balloon and expand on both sides after operation, and inject bone cement), with 34 cases in each group. The Cobb angle of the injured vertebrae was measured by taking the anterior and lateral X-ray film of the patient's lumbar spine before operation. The degree of pain and low back function were evaluated by visual analogue scale (VAS) and Oswetry disability index (ODI). The operation time and fluoroscopy times were recorded during the operation. On the second day after operation, the anterior and lateral X-ray of lumbar spine were taken to measure the Cobb angle of injured vertebrae. All patients were underwent computed tomography (CT) check the bone cement for leakage, record the VAS score, and record the ODI 3 months after operation to evaluate the patient's function. Follow up at the end of 12 months after operation to count the treatment cost and re-fracture of the patient. The data analysis and measurement data were compared by independent sample t-test between the two groups, paired sample t-test was used for intra-group comparison before and after operation. χ 2 test was used for counting data comparison between two groups. Results:All patients were followed up for 12 months. The operation time ((42.7±5.9) min), fluoroscopy times ((20.0±3.6) times) and treatment cost ((19 153±601) yuan) in the PVP combined group were better than those in the PKP Group ((67.4±7.3) min, (30.1±5.9) times, (27 496±669) yuan), and the difference was statistically significant ( t values were 15.39, 8.46, 54.12; all P<0.001). Cobb angle: Postoperative Cobb angle of injured vertebrae in the two groups (PVP combined group (10.7±4.5)°) and (PKP group (13.4±3.8)°) decreased compared with preoperative (PVP combined group (17.0±5.1)°) and (PKP group (16.7±5.1)°) ( t values were 10.61, 5.61; all P=0.001), and PVP combined group recovered better than PKP group, with statistically significant difference ( t=2.70, P=0.009). VAS score: Postoperative (PVP combined group (3.9±1.5) points) and (PKP group (4.1±1.6) points) was lower than preoperative the scores of (PVP combined group (6.9±1.1) points) and (PKP group (7.1±0.9) points), and the difference was statistically significant ( t values were 8.63, 8.88; all P=0.001). There was no significant difference in VAS scores between the two groups ( t=0.48, P=0.630). ODI scores: The scores of (PVP combined group (0.315±0.068)) and (PKP group (0.319±0.077)) after operation were lower than preoperative (PVP combined group (0.574±0.066), (PKP group (0.553±0.075)), and the difference was statistically significant ( t values were 18.54, 14.16, all P=0.001). There was no significant difference in ODI between the two groups ( t=0.25, P=0.803). There was no statistical significance in the two groups of postoperative bone cement leakage (χ 2=0.22, P=0.642). In PVP combined group, 1 case was re-fractured due to trauma, and there was no re-fracture in PKP group. Conclusion:Postural reduction combined with percutaneous needle prying reduction of PVP and PKP can alleviate the pain, improve the postoperative function and restore kyphosis in patients with OVCFs. Postural reduction combined with needle prying reduction of PVP has more advantages in operation time, radiation injury to doctors and patients, treatment cost, and the effect of correcting deformity is more significant.
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Objective To observe the effect of perioperative rehabilitation on anterior spinal cord syndrome caused by cervical hyper-flexion injury. Methods Sixty-nine inpatients with anterior spinal cord syndrome after cervical hyperflexion injury from January, 2012 to De-cember, 2014 were reviewed. 32 cases (group A) accepted systematic rehabilitations and other 37 cases (group B) did not. They were as-sessed with Japanese Orthopaedic Association (JOA) scores preoperatively and 1-year follow-up. Results All the patients succeeded in the operation. The JOA score improved more 1 year follow-up in group A than group B (t=2.538, P=0.044). Conclusion Systematic rehabilita-tion may work in the management of anterior spinal cord syndrome after cervical hyperflexion injury.
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Objective To study the mechanism, pathology, diagnosis and manage strategy of cervical fracture dislocation combined with anterior spinal cord syndrome (ASCS). Methods 32 cases of cervical fracture dislocation combined with ASCS from January 2012 to Sep-tember 2014 were summarized. The mechanisms of injury and pathological characteristics were analyzed. All of them received surgical treat-ment. Anterior approach or anterior approach combined with posterior approach was chosen according to the characteristics of injury. Re-sults All surgical treatments were successfully performed. There were 22 cases (68.75%) with hyperflexion, 5 cases (15.62%) with vertical hit, 1 case (3.12%) with hyperextension and 4 cases (12.5%) with multiple reasons. There were 4 cases (12.5%) with simple anterior disloca-tion, 28 cases (87.5%) with fracture combined with anterior dislocation. Only 8 cases were successfully diagnosed as ASCS, and the others (24 cases) were generally defined as spinal cord injury. Conclusion ASCS is not so rare. Hyperflexion injury is the most common mecha-nism. Anterior dislocation and fracture combined with anterior dislocation are the general types of pathology. Conscientious physical exami-nation with CT and MRI can facilitate the diagnosis. Anterior approach or combined with posterior approach could be selected according to injury mechanism.
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@#Objective To study the mechanism, pathology, diagnosis and manage strategy of cervical fracture dislocation combined with anterior spinal cord syndrome (ASCS). Methods 32 cases of cervical fracture dislocation combined with ASCS from January 2012 to September 2014 were summarized. The mechanisms of injury and pathological characteristics were analyzed. All of them received surgical treatment. Anterior approach or anterior approach combined with posterior approach was chosen according to the characteristics of injury. Results All surgical treatments were successfully performed. There were 22 cases (68.75%) with hyperflexion, 5 cases (15.62%) with vertical hit, 1 case (3.12%) with hyperextension and 4 cases (12.5%) with multiple reasons. There were 4 cases (12.5%) with simple anterior dislocation, 28 cases (87.5%) with fracture combined with anterior dislocation. Only 8 cases were successfully diagnosed as ASCS, and the others (24 cases) were generally defined as spinal cord injury. Conclusion ASCS is not so rare. Hyperflexion injury is the most common mechanism. Anterior dislocation and fracture combined with anterior dislocation are the general types of pathology. Conscientious physical examination with CT and MRI can facilitate the diagnosis. Anterior approach or combined with posterior approach could be selected according to injury mechanism.
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@#Objective To investigate the effect of comprehensive rehabilitation direction on functional ankle instability (FAI). Methods 32 consecutive patients with FAI were divided into 2 groups. The rehabilitation group (n=16) finished their rehabilitation program under the instruction of physiotherapists in the hospital, and the control group (n=16) exercised at home by written instruction. All the patients were tested with One Leg Standing Test (OLST) and Foot and Ankle Disability Index (FADI) for the injured ankle before and 4 weeks after training.Results The scores of both OLST and FADI improved after training in the rehabilitation group (P<0.01), but did not in the control group (P>0.05); and improved more in the rehabilitation group than in the control group (P<0.05). Conclusion The comprehensive rehabilitation direction is effctive on FAI.
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@#Objective To investigate the effect of rehabilitation on cervical fracture-dislocation following spinal cord injury.Methods126 patients with cervical fracture-dislocation following spinal cord injury from August, 2002 to March, 2009 in our hospital had undergone cervical anterior surgical treatment. 22 cases were picked up as control group, who missed rehabilitation after surgery. 22 cases were chosen randomly from the rest of 104 cases as rehabilitation group, who had undergone rehabilitation. Prognosis was evaluated by Japanese Orthopaedic Association Scores score(JOA).ResultsFollow-up time was 8-32 months，mean time 18 months. The limb function of rehabilitation group improved significantly. JOA score and quality of life were much higher in rehabilitation group than in control group.ConclusionRehabilitation is very beneficial to improve the quality of life and prognosis, and reduce complications of patients with cervical fracture-dislocation following spinal cord injury at the early stage.