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Objective To discuss the complications of percutaneous kyphoplasty (PKP) in treatment of osteoporotic compression fractures (OVCFs) of the thoracic and lumbar vertebrae,and to investigate their causes and prevention.Methods From Jan.2004 to Dec.2012,PKP or PKP combined with percutaneous vertebroplasty(PVP) was performed on 126 vertebrae in 112 thoracolumbar OVCFs patients.There were 21 males and 91 females.The average age was 69 years (ranging from 36 to 85).100 cases had single vertebra,10 cases had double vertebrae,and 2 cases had 3 vertebrae.The injured segments were identified by MRI before surgery,and the fractures of the vertebrae were observed clearly by X ray and CT scan.The causes of the complications were retrospective analyzed.Results Perioperative complication happened in 68 cases (54％).The leakage of the bone cement happened in 66 cases (52.4％):one of them had high fever after the leakage happened behind the post-wall of the vertebra body,and it disappeared after one week with the relevant treatment.There was no injury of the nerve.Most of the leakage happened in front of the vertebra body,few happened in the terminal plate,and few happened behind the vertebral plate.There was no pulmonary embolism.Toxic reaction of the bone cement wasn't found in this team.There was no artery or nerve injury.One temporary spinal cord injury happened,one case was punctured in a wrong vertebra,and balloon rupture happened in one case.One case didn't achieve pain release.No infection happened.Conclusion The bone cement leakage was the most common complication associated with PKP in treatment of OVCFs.The complication rate can be reduced if the operation indications are strict,the volume of the filling cementis is well controlled,and the operation is performed in experienced hands.
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Objective To discuss the methods and the effects of percutaneous kyphoplasty(PKP)in the treatment of thoracolumbar osteoporotic vertebral compression fractures ( OVCFs).Methods Retrospective analysis was made on 110 vertebrae in 96 thoracolumbar OVCFs patients undergoing transpedicular unilateral PKP or PKP combined with percutaneous vertebroplasty(PVP) from Jan.2004 to Nov.2011.We analyzed the change of the anterior heights of the vertebra,the clinical outcomes using VAS and Oswcstry bcforc and after the treatment,and the rate of cement leakage.Results 85 vertebrae were treated with the PKP sucessfully,and 25 vertebraewere treated with both PKP and PVP sucessfu]ly.All patients were satisfied with the diffusion of the cement.Theoperation time of each vertebra was about 20-40 minutes for one side.The injection volume of of each vertebrawas about 5.4 ml.According to VAS and Oswestry,the pain was alleviated obviously after the operation ( P ＜0.01) and the anterior heights of the vertebrae changed ( P ＜ 0.01).The leakage of the cement was the only complication in these patients and most of the leakage happened at the anterior of the vertebrae and the vein nearby.The overall rate of the leakage was 56.3％.For the 40 vertebrae of the 36 patients that were followed up,1patient had fracture in a neighbor vertebra and 1patient had subsidence in the upper anterior edge of the treated vertebra where there was no cement filled in,but the patient had no discomfort.Conclusion PKP or PKP combined with PVP are safe,convenient and effective methods in treating OVCFs.
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Objective To compare the biomechanical properties of mono-segTnent pedicle instru-mentation and its combination with bone cement fixation in treatment of thoracolumbar fractures. Meth-ods Eight fresh specimens of calf spines ( T11 -L3 ) were used for development of incomplete burst frac-ture models at the vertebral body of L1. Mono-segment pedicle instrumentation and its combination with vertebroplasty were respectively applied in each specimen subsequently to restore spinal stability. A cyclic loading with pure moment of 4 Nm was applied to specimens, with load frequency of 0.5 Hz for 2 000 cy-cles. Range of motion (ROM) at flexion/extension, left/right lateral bending and left/right axial rotation of the fixated segment at different status of intact, injury, fixation and cyclic loading was determined by spinal three-dimensional instability test system. Results ROM after treatment with two fixation tech-niques and that at different directions after cyclic loading were distinctly smaller than that of intact and fractured models (P <0.05 ). Under mono-segment pedicle instrumentation combined with bone cement fixation, ROM at flexion, extension, lateral bending and axial rotation was 0.40°, 0. 53°, 0.86° and 0.55° respectively and that after cyclic loading was 0.10°, 0.07°, 0.19° and 0.08°respectively, which were all lower than those of monosegmental fixation, especially at flexion and axial rotation, with statisti-cal difference (P <0.05 ). Conclusions Both fixation techniques can provide instant stabihty of the fractured spine and have good fatigue resistance effect. However, mono-segment pedicle instrumentation is inferior to mono-segment pedicle instrumentation plus bone cement fixation in treatment of fractured verte-bral body at flexion and axial rotation.
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BACKGROUND: In post-menopausal women, the reduction of estrogen level is followed by gradual increase of bone absorption, accompanied by increased cytokine synthesis and bone metabolism disorder. Observation of serum interleukin-6(IL-6), osteocalcin(OC), estradiol(E2)and urinary pyridinoline (PYD) in women with osteoporosis may help understand role of these factors in the onset and development of osteoporosis.OBJECTIVE: To investigate the relationship of serum IL-6, OC, E2, and urinary PYD levels with bone metabolism in women with osteoporosis, so as to identify the factors responsible for the occurrence and development of osteoporosis.DESIGN: A case-controlled clinical observation.SETTING: Central Laboratory of Orthopedics, Nanshan People's Hospital of Shenzhen City.PARTICIPANTS: Between January 1999 and December 2001, 25 post-menopausal women with osteoporosis aged 42 -69 years were selected from the Department of Orthopedics, Nanshan People' s Hospital of Shenzhen to constitute the experimental group, with 10 healthy women from the same hospital serving as control group.METHODS: Two milliliters of fasting venous blood and 2 mL urine samples were collected from women in both groups in the morning to determine the contents of IL-6, OC, PYD and E2, respectively.MAIN OUTCOME MEASURES: Serum IL-6, OC, E2 and urinary PYD levels in the subjects.RESULTS: In the experimental group, the IL-6 level was(201.0±79. 9) ng/L, OC(25.5 ± 16.2) μg/L, and PYD(41.3 ±9.7) nmol/mmol (creatinine), all significantly higher than those in control group( t = 2. 159 -2. 953, P < 0.05-0.01) . Serum E2 level in the experimental group (79. 8 ± 73.2) ng/L, however, was significantly lower than that in control group ( t = 2.071, P < 0.05).CONCLUSION: IL-6, OC, PYD and E2 may play important roles in the occurrence and development of osteoporosis, and adjustment of the levels of these factors can be necessary in the treatment of women with osteoporosis.
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Objective To assess the clinical outcome of retrograde intramedullary interlocking nail in the treatment of femoral suplracondylar or intercondylar fracture with femoral shaft fracture.Methods 3 cases of femoral supracondylar fracture with femoral shaft fracture and 6 cases of intercondylar femoral fracture with femoral shaft fracture experienced the fixation with retrograde intramedullary interlocking nail.Results The patients were followed up for 7～ 20 months,on an average of 10 months.All the patients recovered in an average time of 6 months,with excellent knee joint movement.Conclusion Retrograde intramedullary interlocking nail has obvious advantages in the treatment of femoral supracondylar or intercondylar fracture with femoral shaft fracture and the clinical outcome is satisfactory.