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Objective@#To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF).@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015. There were 54 males and 82 females, aged 55 to 83 years old, with an average age of 68.3 years. All the enrolled patients had single segment vertebral compression fractures, whose compression degree was ≥1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies. Among them, 59 patients were treated with simulated optimal reduction combined with PVP (PVP group), and 77 patients were treated with PKP (PKP group). The operation time, intraoperative fluoroscopy time, incidence of bone cement leakage, hospitalization cost and length of stay were compared between the two groups. Postoperative X-ray and CT examination were performed to observe bone cement diffusion. Before surgery and after surgery (1 day, 1 week, 1 month, 6 months, 1 year, 2 years and 3 years), Visual analogue scale (VAS) score, Oswestry disability index (ODI) scores, Cobb's angle, ratio of anterior and middle height of the affected vertebrae, and the incidence of vertebral refractures within 3 years were compared between the two groups.@*Results@#All the patients were followed up for 29-43 months, averaging 36 months. One patient in the PVP group was lost to follow-up after one year. In the PKP group, two patients were lost to follow-up after one year and one patient was lost to follow-up after two years. In the PVP group, single vertebral body operation time [(28.9±5.7)seconds] and intraoperative fluoroscopy time [(54.0±13.4)seconds] were significantly less than those in the PKP group, with statistically significant differences (P<0.01). The incidence of bone cement leakage in the two groups was 8.5% and 7.8%, respectively, with no significant difference (P>0.05). The hospitalization cost in the PVP group [(9.7±3.2)thousand yuan] was lower than that in the PKP group [(22.35±16.2)thousand yuan](P<0.01). The diffusion coefficient in PVP group (2.40±0.27) was higher than that in the PKP group (2.29±0.19) (P<0.01). In both groups, the fractured vertebral anterior height ratio, fractured vertebral middle height ratio and Cobb's angle were significantly improved after operation (P<0.01), while there were no significant differences between the two groups (P>0.05). In both groups, the VAS and ODI were significant decreased after operation (P<0.01). Better results were obtained in PVP group than the PKP group concerning the VAS [(2.5±0.8)points vs. (2.6±0.9)points, (2.7±0.3) points vs. (2.8±0.5)points, (2.8±0.6) points vs. (2.9±0.7)points] and ODI [(25.3±4.0 vs. 25.5±3.9, 25.8±4.1 vs. 27.5±4.0, 26.0±2.9 vs. 28.6±3.9)] at postoperative 1, 2 and 3 years, and there were no significant difference between the two groups at postoperative 1 day, 1 week, 1 month and 6 months (P>0.05). The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in the PKP group (0 vs. 1.3%)(P<0.01).@*Conclusion@#For OVCF, the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP, but the recovery of height of diseased vertebra and correction of kyphosis are better, with lower re-fracture rate of adjacent vertebra in the later stage.
ABSTRACT
Objective: To explore the practicability and safety of ultrasonic bone curette in the laminoplasty of spinal canal after resection of intraspinal tumors. Methods: The clinical data of 17 patients with thoracolumbar intraspinal tumors treated with ultrasonic bone curette after resection of intraspinal tumors between December 2015 and April 2017 were retrospectively analyzed. All patients were male, aged 42-73 years with an average of 57.4 years. The disease duration was 2-47 months with an average of 21.1 months. Among them, there were 4 cases of thoracic intrathoracic tumors (T 10 in 1, T 12 in 3) and 13 cases of lumbar intrathoracic tumors (L 1 in 5, L 2 in 4, L 3 in 2, and L 4 in 2). Postoperative pathological diagnosis showed that 8 cases were schwannoma, 4 cases were meningioma, 2 cases were neurofibroma, 2 cases were dermoid cyst, and 1 case was ependymoma. Spinal nerve function was evaluated preoperatively according to Frankel classification criteria, with 2 cases of grade B, 7 cases of grade C, and 8 cases of grade D. During the operation, the time of single segmental vertebral canal posterior wall incision, the overall operation time, intraoperative blood loss, intraoperative dural injury, and cerebrospinal fluid leakage, spinal cord and nerve root injury were recorded. At 3-6 months after operation, the tumor and bone healing were observed according to MRI and CT three-dimensional reconstruction, and the spinal nerve function was evaluated by Frankel classification. Results: The time of ultrasonic osteotomy for the posterior wall of a single segmental vertebral canal was 3.4-5.7 minutes, with an average of 4.1 minutes. The overall operation time was 135-182 minutes, with an average of 157.3 minutes. The intraoperative blood loss was 300-500 mL, with an average of 342.6 mL. There was no accidental dural injury, and cerebrospinal fluid leakage, nerve root injury, or spinal cord injury. The incision healed by first intention after operation. All the 17 patients were followed up 9-18 months, with an average of 12.7 months. MRI examination showed no tumor recurrence, and CT three-dimensional reconstruction showed good bone healing in all patients. During the follow-up, there was no loosening or rupture of the internal fixator and there was no re-compression of the spinal cord. At last follow-up, according to Frankel classification, there were 1 case as grade B, 5 cases as grade C, 7 cases as grade D, and 4 cases as grade E. Conclusion: The application of ultrasonic bone curette in laminoplasty of spinal canal after resection of intraspinal tumors can preserve the integrity of the bone ligament structure of posterior column, maintain the volume of vertebral canal, and has high safety, practicability, and good postoperative effectiveness.
ABSTRACT
Objective To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF).Methods A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015.There were 54 males and 82 females,aged 55 to 83 years old,with an average age of 68.3 years.All the enrolled patients had single segment vertebral compression fractures,whose compression degree was ≥ 1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies.Among them,59 patients were treated with simulated optimal reduction combined with PVP (PVP group),and 77 patients were treated with PKP (PKP group).The operation time,intraoperative fluoroscopy time,incidence of bone cement leakage,hospitalization cost and length of stay were compared between the two groups.Postoperative X-ray and CT examination were performed to observe bone cement diffusion.Before surgery and after surgery (1 day,1 week,1 month,6 months,1 year,2 years and 3 years),Visual analogue scale (VAS) score,Oswestry disability index (ODI) scores,Cobb's angle,ratio of anterior and middle height of the affected vertebrae,and the incidence of vertebral refractures within 3 years were compared between the two groups.Results All the patients were followed up for 29-43 months,averaging 36 months.One patient in the PVP group was lost to follow-up after one year.In the PKP group,two patients were lost to follow-up after one year and one patient was lost to follow-up after two years.In the PVP group,single vertebral body operation time [(28.9 ± 5.7) seconds] and intraoperative fluoroscopy time [(54.0 ± 13.4)seconds] were significantly less than those in the PKP group,with statistically significant differences (P ＜ 0.01).The incidence of bone cement leakage in the two groups was 8.5％ and 7.8％,respectively,with no significant difference (P ＞ 0.05).The hospitalization cost in the PVP group [(9.7 t3.2) thousand yuan] was lower than that in the PKP group [(22.35 ± 16.2) thousand yuan] (P ＜ 0.01).The diffusion coefficient in PVP group (2.40 ± 0.27) was higher than that in the PKP group (2.29 ± 0.19) (P ＜ 0.01).In both groups,the fractured vertebral anterior height ratio,fractured vertebral middle height ratio and Cobb's angle were significantly improved after operation (P ＜ 0.01),while there were no significant differences between the two groups (P ＞0.05).In both groups,the VAS and ODI were significant decreased after operation (P ＜ 0.01).Better results were obtained in PVP group than the PKP group concerning the VAS [(2.5 ± 0.8) points vs.(2.6 ± 0.9) points,(2.7 ± 0.3) points vs.(2.8 ± 0.5) points,(2.8 ± 0.6) points vs.(2.9 ±0.7)points] and ODI [(25.3 ±4.0 vs.25.5 ±3.9,25.8 ±4.1 vs.27.5 ±4.0,26.0 ±2.9 vs.28.6 ±3.9)] at postoperative 1,2 and 3 years,and there were no significant difference between the two groups at postoperative 1 day,1 week,1 month and 6 months (P ＞ 0.05).The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in thePKP group (0 vs.1.3％) (P ＜ 0.01).Conclusion For OVCF,the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP,but the recovery of height of diseased vertebra and correction of kyphosis are better,with lower re-fracture rate of adjacent vertebra in the later stage.