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Objective:To investigate the risk factors of bone cement leakage after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).Methods:A multi-center, large-sample, case-control study was carried out to analyze the clinical data of 2 273 OVCF patients (2 689 vertebrae) undergone PVP at four hospitals between May 2018 and October 2021, including 994 males and 1 279 females, with the age of 52-91 years [(69.1±3.1)years]. Of all, 581 patients (604 vertebrae) were allocated to leakage group and 1 692 patients (2 085 vertebrae) to no leakage group according to the occurrence of bone cement leakage. The gender, age, fracture sites, vertebral compression degree, endplate integrity of fractured vertebrae, surgical segments, surgical approaches and bone cement injection volume were recorded. Univariate analysis was used to investigate the correlation between those indicators with bone cement leakage. Multivariate Logistic regression analysis was used to identify the independent risk factors for bone cement leakage.Results:Univariate analysis showed that gender, age, fracture sites, vertebral compression degree, bone cement injection volume were related to bone cement leakage after PVP ( P<0.05 or 0.01), but no correlation was found in the endplate integrity of fractured vertebrae, surgical segments and surgical approaches (all P>0.05). Multivariate Logistic regression analysis showed that fracture sites ( OR=1.68, 95% CI 1.11-2.55, P<0.05), vertebral compression degree more than 40% ( OR=1.98, 95% CI 1.29-3.02, P<0.01), bone cement injection volume greater than or equal to 5.5 ml ( OR=1.55, 95% CI 1.07-2.26, P<0.05) were significantly associated with bone cement leakage after PVP. Conclusion:Thoracic vertebral fracture, vertebral compression degree more than 40% and bone cement injection volume greater than or equal to 5.5 ml are independent risk factors for bone cement leakage after PVP in OVCF.
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Objective To evaluate the treatment of ilioinguinal approach surgery associated acute iatrogenic deep venous thrombosis (DVT).Methods The clinical data and treatment of 11 patients with ilioinguinal approach surgery associated acute iatrogenic DVT were analyzed.Results These 11 patients initially suffered from complicated acetabulum fracture,7 cases were treated by single ilioinguinal approach surgery and the other 4 cases were combined with Kocher-Langenbeck approach.In 3 days after surgery,DVTs were found by Doppler sonography,and all the DVTs were proved having closed relationships with ilioinguinal approach through digital subtraction angiography(DSA):iliac-femoral veins appeared stenosis at ilioinguinal segment in all the 11 cases,DVTs were found distal to the stenosis in 9 cases,both sides in 2 cases (1 case combined extensive iliac vein emphraxis and the other case combined extensive femoral vein emphraxis).After retrievable inferior vena cava filters were implanted,11 patients received catheter-directed thrombolysis for 5-12 days.Complete thrombolysis was achieved in 8 cases and thrombi residual left in 3 cases.The iliac-femoral veins were recanalized completely.After (10 ± 4) month fellow-up,no DVT recurred and no PTS appeared.Conclusions Ilioinguinal approach surgery seriously effects iliac-femoral veins,and is a important precipitating factor of DVT.Early catheter-directed thrombolysis under the protection of inferior vena cava filter is an effective treatment.
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In the past few years, many techniques were used to study brain perfusion imaging;each of them has its own advantages and disadvantages. The principle, specification, clinical application, contradistinction and the current research situation of these techniques were reviewed in this article.
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Objective To explore the value of imaging diagnosis of nerve-root-type cervical spondylosis(NRTCS)and to study the relative factors to the nerve root disturbance.Methods 188 cases of NRTCS clinically proved and with complete imaging data were retrospectively analyzed.The imaging characteristics of CR,CT and MRI of NRTCS were compared and the relative factors to the nerve root disturbance were analyzed in combination with the clinical characteristics.Results ①CR films in six-position could show the whole expression of the cervical spine.The anterior-posterior and functional position CR showed the physiological curvature change in 122(64.9%),narrowing of intervertebral space in 96(51.2%)and vertebral-body unstability or slide in 49(26.1%).The oblique CR showed the intervertebral-foramen lessening or narrowing in(26.1%)and Luschka-or intervertebral-joint osteophyte in 82(43.2%);②CT scans showed Luschka-or intervertebral-joint osteophyte in 76(40.4%),disc herniation and calcification of cartilage nodus in 80(42.6%)and hypertrophy or calcification of ligamenlum flavum in 66(39.8%);③MRI showed intervertebral-disk degeneration and protrusion in 105(55.8%),hypertrophy or calcification of ligamentum flavum in 51(27.1%),the nerve root and spinal cord compressed in 69(36.7%)and edema or degeneration of spinal cord in 23(12.2%).Conclusion The nerve root disturbance is closely correlated with the imaging appearances in NRTCS.It is of importance in early diagnosis and treatment for NRTCS to analyse synthetically the imaging data and clinical characteristics.
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Objective To study the diagnostic value of imageology(CR,CT and MRI) for sacraoiliac pathological changes(SIPC) in ankylosing spondylitis(AS).Methods A retrospective analysis was made on the manifestations of CR,CT and MRI of the sacraoiliac joints in 98 cases of clinically-proved AS,including the grading,site and number,calcification,joint-space and sub-articular-surface-bone changes.Results The characteristics of AS in sacraoiliac joint on CR were: joint-space narrowing(67),articular-surface sclerosis(22),cystic change(15) and joint stiffness(17) and calcification(38).CT features were:the lesions involving iliac-side synovium of the sacraoiliac joint mainly,chondral calcification(55),joint-space narrowing(42),cystic change(43) and sclerosis(65) of the articular surface and sub-surface bone structure,and calcification of sacraoiliac-ligament(52).MRI showed: articular-cartilage damage(40),edema around the lesion(57) and intrabony fat sedimentation(15).Conclusion For sacraoiliac joint in AS,CR examination is the basic imaging method,CT in grading lesions is more accurate,while SIPC in AS can be early diagnosed by MRI.