ABSTRACT
Objective:To investigate the changes of perioperative serum osteosclerosis protein (SOST) and Dickkopf-3 (Dkk-3) in elderly patients with femoral intertrochanteric fracture.Methods:Thirty elderly patients who underwent reduction and fixation of femoral intertrochanteric fracture in Baoding Second Hospital from May 2017 to December 2017 were prospectively selected as the observation group; 30 healthy subjects in the same period were selected as the healthy control group. Enzyme linked immunosorbent assay (ELISA) was used to detect the expression of serum SOST and Dkk-3 at 1 d before operation and at 1, 3, 5 d after operation and compared with the same period of healthy physical examination(normal control group). Spearman rank correlation analysis was used to analyze the correlation between SOST and Dkk-3 and disease activity score (ASDAS) and spinal imaging evaluation score (mSASSS).Results:There was a positive correlation between Dkk-3 level and ASDAS score in the observation group ( r = 0.331, P = 0.012); the level of SOST was negatively correlated with the scores of ASDAS ( r = - 0.162, P = 0.017). The levels of serum SOST and Dkk-3 in the observation group were lower than those in the healthy control group: 1.29(1.00, 2.40) μg/L vs. 1.96(1.63, 2.65) μg/L, (6.11 ± 1.15) μg/L vs. (9.81 ± 1.76) μg/L, P<0.05. The levels of serum SOST and Dkk-3 in the observation group increased first and then decreased on the 1st, 3rd and 5th day after operation. The level of serum Dkk-3 increased to the highest level on the 3rd day after operation, and then decreased gradually, but it was still slightly higher than that before operation. The level of serum SOST in the observation group increased to the highest level 1st day after operation, and decreased at 3rd and 5th day after operation. The perioperative serum levels of SOST and Dkk-3 in the observation group were positively correlated, the correlation coefficient was the largest at 1 day after operation ( r = 0.571) and the lowest before operation ( r = 0.119). Conclusions:The perioperative serum levels of SOST and Dkk-3 in elderly patients with femoral intertrochanteric fracture increased first and then decreased. The change of serum SOST level is more sensitive and can be used as a sensitive index to reflect the change of osteogenic ability.
ABSTRACT
BACKGROUND:Spinal canal decompression is needed in posterior pedicle screw fixation surgery for thoracolumbar burst fractures combine with spinal cord injury. The structure of posterior spine is often damaged. The posterolateral bone fusion in al fixed segment is stil the main surgery. In order to further reduce fusion segment and maintain motor unit, it is necessary to perform selective segmental bone graft fusion during fixation and decompression. OBJECTIVE: To discuss the advantages of selective posterolateral vertebral fusion for thoracolumbar fracture with spinal injury through comparing with posterolateral vertebral fusion. METHODS: Data of 83 thoracolumbar burst fracture cases, who received posterior lumbar decompression and short segment fixation with pedicle screws and bone graft through injured vertebra from January 2006 to July 2013, were analyzed retrospectively. According to fusion segments, above patients were divided into selective posterolateral vertebral fusion group (n=42) and the whole posterolateral vertebral fusion group (n=41). Perioperative index, internal fixation, vertebral height loss rate, Cobb angle, spinal nerve recovery and Oswestry Disability Index were compared between the two groups. RESULTS AND CONCLUSION:(1) Al cases were folowed up for 25-32 months. (2) There was no statistical significance in operation time, intraoperative blood loss and ambulation time between the two groups (P > 0.05). Postoperative drainage volume was less in the selective posterolateral vertebral fusion group than in the whole posterolateral vertebral fusion group (P 0.05). (4) There was no significant difference in fusion rate at 6 months after treatment between the two groups (P > 0.05). Fusion was achieved in both groups before removal of the fixator. (5) Spinal nerve recovery was found after treatment in both groups. No significant difference in Oswestry Disability Index was detected in final folow-up (P > 0.05). (6) Results verified that compared with the whole posterolateral vertebral fusion, selective posterolateral vertebral fusion can obtain a good vertebral height and prevent Cobb angle loss again, reduce the internal fixation loosening and breakage. After removal of the fixator, selective posterolateral vertebral fusion can reduce spinal motion unit lost, and decrease the adjacent vertebral degeneration.
ABSTRACT
BACKGROUND:Intravertebral bone graft to rebuild anterior and middle column structure and to recover vertebral morphology has been re-understood, and a suitable bone graft material can promote bone healing and be conducive to rebuild the long-term stability of the spine. OBJECTIVE:To discuss the differences in clinical efficacy of three kinds of bone graft materials through unilateral pedicle to treat thoracolumbar burst fractures. METHODS:Total y 102 thoracolumbar burst fracture patients were randomized into three groups:autologous bone, autologous bone combined with al ogeneic bone and al ogeneic bone were implanted via the unilateral pedicle, respectively, in the three groups. We measured the percentage of height of the anterior edge of vertebral body and Cobb angle by X-Ray before and after bone grafting, and used CT to observe bone graft healing, and used Mimics to measure the defect area of vertebral body at the last fol ow-up. RESULTS AND CONCLUSION:Al the 102 patients were fol owed-up for 24-36 months. The percentage of height of the anterior edge of vertebral body and Cobb angle of three groups were restored after bone grafting (P<0.05), but there was no difference in the percentage of height of the anterior edge of vertebral body of three groups at different time point after bone grafting. The Cobb angle in the al ogeneic bone group was bigger than that in the autologous bone group and autologous bone combined with al ogeneic bone group at 9, 12 and 24 months after bone grafting (P<0.05). The fracture healing rate of the al ogeneic bone group at different time points was lower than that of the autologous bone group and autologous bone combined with al ogeneic bone group (P<0.05), and the area of bone defect was bigger than that in the autologous bone group and autologous bone combined with al ogeneic bone group (P<0.05). These findings indicate that these three bone graft materials can rebuild the vertebral body via the unilateral pedicle to treat thoracolumbar burst fracture, reduce the loss of vertebral height and Cobb angle, and decrease defect area of the vertebral body. The clinical efficacy of autologous bone combined with al ogeneic bone to heal bone graft and reduce bone defect is similar to autologous bone, both of which are better than al ogeneic bone alone.