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BACKGROUND: After the treatment of osteoporotic vertebral compression fractures with bone cement implantation,deteriorative osteoporosis and the distance augment between bone cement and bones result in a decrease in bone cement-bone interface compression strength and torsion strength, and then the bone cement tends to displace, which is easy to cause a secondary vertebral fracture.OBJECTIVE: To investigate the clinical efficacy of bone cement implantation via three approaches on osteoporotic vertebral compression fractures.METHODS: Sixty patients with single osteoporotic vertebral compression fracture were treated with vertebroplasty,percutaneous kyphoplasty or fraction cement vertebroplasty. All data were collected to analyze the correlation between the bone cement morphology and treatment method, and to detect the visual analogue scale, Oswestry disability index,Cobb angle and incidence of secondary vertebral fractures.RESULTS AND CONCLUSION: The visual analogue scale scores, Oswestry disability index, and Cobb angle in thethree groups were significantly improved after treatment (P < 0.05). All above indicators showed no significant difference among groups at each time point after treatment, suggesting that these three kinds of treatments exert the same effects on pain relief, functional recovery, preventing the vertebral height loss and maintaining spinal mechanical properties.Bone cement displacement and secondary vertebral fracture occurred after clotted cement implantation. Therefore,mixed and trabecular-shaped grafts are preferred, aiming to achieve good long-term treatment outcomes in osteoporotic vertebral compression fractures.
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BACKGROUND: Iliac bones are common habitant parts in metastatic tumor of bone, and the affiliate cortex is easy to be penetrated into soft tissue blots. The irregular iliac shape and its complex surrounding tissues create the difficulties in puncture operations and cement perfusion.OBJECTIVE: To investigate the clinical outcomes of CT-guided versus DSA-guided puncture combined with bone cement perfusion for metastatic tumor to the ilium.METHODS: Sixty-four patients with metastatic tumor to the ilium udergoing bone cement perfusion were enrolled, and then divided into control and experimental groups (n=32 per group), followed by treated with DSA-guided percutaneous injection of bone cement, and CT-guided puncture, respectively. Subsequently, the diffuse distribution of bone cement was observed using CT. The success rate, leakage rate, Visual Analogue Scale scores and Oswestry Disability Index were compared between two groups.RESULTS AND CONCLUSION: (1) All patients received the surgery successfully, and bone cement leakage happened in two cases of control group and one case of experimental group. (1) The Visual Analog Scale and Oswestry Disability Index scores in the two groups were significantly better than those before treatment (P 0.05). (3) No difference was found in the pain relief and functional recovery between two groups. (4) To conclude, CT-guided treatment can achieve satisfactory outcomes for metastatic tumor to the ilium by bone cement infusion in appropriate time.
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BACKGROUND:By using the bone filing mesh container, a smal amount of bone cement can be penetrated to the trabecular space to form a microscopic twist, thereby strengthening the vertebral body. But there is no report about bone filing mesh container for treatment of osteoporotic vertebral compression fractures. OBJECTIVE:To compare the vertebral uplift and cement leakage of bone filing mesh container, percutaneous vertebroplasty and percutaneous kyphoplasty for the treatment of wedge-shaped osteoporotic vertebral compression fractures. METHODS:Ninety patients with wedge-shaped osteoporotic vertebral compression fractures were randomly divided into three groups. Polymethylmethyl acrylic bone cement type II was perfused into these three groups by bone filing mesh container, percutaneous vertebroplasty and percutaneous kyphoplasty, respectively. Bone cement type, vertebral uplift, leakage rate, visual analogue scale score, Oswestry disability index and Cobb’s angle were calculated and compared among the three groups. RESULTS AND CONCLUSION:The operation was successful in al patients. The success rate of puncture was 100%. There were 2 cases of bone cement leakage for percutaneous vertebroplasty and one case for percutaneous kyphoplasty. The vertebral uplift, visual analog scale score, Oswestry disability index and Cobb’s angle were improved significantly in the three groups after treatment (P 0.05). No difference in pain relief and action recovery was found among the three groups. These findings demonstrate that the bone filing mesh container with polymethylmethyl acrylic bone cement for treatment of osteoporotic vertebral compression fractures can have a promising result in relieving the pain, lifting the injured vertebral height, and the correction of kyphosis, which can also reduce the leakage rate of bone cement.
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Objective To investigate the clinical features of children with systemic lupus erythematosus (SLE).Methods Ninety-five patients hospitalized in Wuxi Children's Hospital from Jan.2003 to Dec.2013 were analyzed retrospectively.They were diagnosed as SLE for the first time.The clinical features of SLE between boys and girls were compared.Chi-square test was used for statistical analysis.Results Of the 95 cases with SLE,12 were boys and 83 were girls.Clinical manifestations showed 69 cases with facial rash (72.6％),43 cases with fever (45.3％),31 cases with arthritis (32.6％),24 cases with serositis (25.3％),23 cases with oralulcer (24.2％),13 cases with allergy to sunlight (13.7％),11 cases with nervous system damage (11.6％).Laboratory examination:94 cases (98.9％) with anti-nuclear antibody positive,91 cases (95.6％) with decreased C3 complement,71 cases (74.7 ％) with anti-dsDNA antibody positive,71 cases(74.7％) with decreased C4 complement,69 cases(72.6％) with anti-SSA antibody positive,62 cases (65.3％) with anti-Sm antibody positive,52 cases (54.7％) wiht proteinuria,anti-SSB antibody positive 49 cases(51.6％),46 cases (48.4％) with decreased leukocyte,38 cases(40.0％) with anti-nucleosome antibody,38 cases (40.0％) with anemia,26 cases(27.4％) with hematuresis,14 cases(14.7％) with decreased platelet,6 cases(6.3％) with injury of renal function.Renal injury,anti-Sm antibody and anti-nucleosome antibody of male children with SLE were significantly higher than those of female children(x2 =9.989,4.224,4.070,all P ＜ 0.05).The positive rate of anti-SSB antibody in female children with SLE was significantly higher than that of male children(x2 =3.885,P ＜ 0.05).Conclusions Male childre with SLE are easy to appear the renal injury,proteinuria is the most common.Anti-Sm antibody is a risk factor for the high incidence of renal injury in male children with SLE.Anti-nucleosome antibody is a risk factor for the high incidence of SLE disease activity in male children than that of female children.The risk of future Sjogren's syndrome in female children with SLE is higher than that of male children.
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BACKGROUND:Vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures can result in many complications, such as bone cement leakage and adjacent-level fractures. OBJECTIVE:To verify the possibility of biodegradable mesh-like microporous polymer bal oon for the treatment of osteoporotic vertebral compression fractures. METHODS:Biodegradable mesh-like microporous P(DLLA-CL) bal oons were fabricated by electrospinning technique. Coated bal oons with the same specification was fabricated by coating P(DLLA-CL) onto the same mould. Morphology of the bal oons was observed by scanning electron microscopy. The bal oon leakage was observed by eyes after the injection of water or cement. The initial strength and stiffness were measured by a universal testing machine. The proliferation of MC3T3-E1 cel s on the bal oons was determined by laser confocal microscope and cel counting kit-8 assays. The biodegradation of bal oons in simulated body fluid, porcine pancreatic lipase, and fresh human serum was studied by residual weighing and scanning electron microscopy observation. Burst pressure of bal oons was measured after the bal oon was placed into a hole in the vertebral bone. For the in vitro calcium release tests, the bal oons were fil ed with calcium cement, tied, placed into 6atm ultrapure water, and then the calcium concentration was regularly determined. RESULTS AND CONCLUSION:Mesh-like microporous bal oons presented with good fiber morphology, thickness distribution, and the presence of pores;on the coated bal oon surface, there was absence of specific morphology and porosity. Compared with the coated bal oon, the mesh-like microporous bal oon showed better mechanical properties, liquid permeability and burst pressure, to prevent leakage of bone cement and promote osteoblast adhesion and proliferation. In addition, the degradation of the mesh-like microporous bal oons was more uniform and stable than the coated bal oons, which may increase the calcium concentration in the injured vertebrae and wil be beneficial to the new bone growth and fracture healing.
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BACKGROUND:In vitro experiments have demonstrated that the biodegradable mesh-like microporous baloon made of macromolecular materials has obvious advantage of anti-leakage, which is capable of maintaining calcium homeostasis, has no inhibitory effects on cel growth and on microscopic interdigitation formation between new bone and bone cement. OBJECTIVE:To evaluate the therapeutic effects of biodegradable mesh-like microporous baloon with calcium bone cement on vertebral fractures based on animal experiments. METHODS:The fracture model was established in 48 New Zealand rabbits, in which a bone dril was introduced after successful puncture at sites near left low extremity of the femur. These rabbit models were randomized into two groups: experimental group with calcium phosphate bone cement and biodegradable mesh-like microporous baloon and control group only with calcium phosphate bone cement. Clinical parameters such as blood cel count, biochemistry, and CT/X ray were examined at 1, 3 and 6 months after implantation of the baloon and bone cement. After that, the specimens were fixed for pathological analysis. RESULTS AND CONCLUSION:The operation was performed under general anesthesia with no eventful infusion of bone cement. The expansion of baloon was satisfactory without definite extravasation of bone cement in the experimental group. In the control group, cement diffusion was found with pulmonary embolism occurring in three New Zealand rabbits. No statistical significance for blood cel counts and biochemistry was found between pre- and postoperation or between two groups. The materials in the two groups had favorable biocompatibility with injured bones without obvious immunological response. In the experimental group, the baloon wal was thinned and partial bone tissues grew into the cement at 1 month; at 3 months, a large amount of bone tissues grew into the cement and cement volume diminished; at 6 months, the baloon disappeared and only a smal amount of cement left in the bone tissues. In the control group, it was difficult to determine when the cement degraded. The biodegradable mesh-like microporous baloon combined with calcium bone cement is superior to bone cement alone in the management of vertebral fractures.
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Objective Biodegradable is validated by the New Zealand rabbit femoral puncture mesh porous seepage prevention performance of the balloon.Methods The experiment was divided into the experimental group and control group, by piercing the New Zealand rabbit left leg near the femur, establish channel introduced after bone drill, fracture model is established, degradable mesh implant microporous balloon and/or bone cement.Observe and record the operation process of each New Zealand rabbit blood oxygen saturation change and cases of bone cement occur breakup and shortness of breath and groupings.Results Surgery under general anesthesia, bone cement injection process smoothly, balloon group of intraoperative breathing smooth, blood oxygen saturation has no obvious change; CPC group of blood oxygen saturation in the cement perfusion and perfusion after 81.63 +/-32.02, 32.02 +/-32.26, respectively, compared with perfusion 96.67 +/-1.71 in front of the difference is statistically significant, of which 3 cases died in 5 cases, shortness of breath, direct infusion of bone cement is more likely to lead to pulmonary embolism.Conclusions Further confirmed that the degradable mesh porous balloon seepage prevention of CPC and the breakup of the effect is obvious, comply with the design requirements.
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BACKGROUND:Percutaneous vertebroplasty and percutaneous kyphoplasty have become the mainstream clinical methods for the treatment of vertebral compression fractures. However, both of them have several shortcomings such as bone cement leakage, spinal stenosis, nerve compression, pulmonary embolism and other issues. OBJECTIVE:To verify the possibility of bone filing mesh container prepared by polyethylene terephthalate for the treatment of vertebral compression fractures. METHODS:The biological properties of bone filing mesh container were examined according to GB/T16886. After sample aging test, the tensile properties of the aged samples and the fresh prepared samples were compared. The expansion and bone cement leakage were evaluated by injecting bone cement into the bone filing mesh container and measuring the pressure. The initial strength and stiffness of the fresh pig vertebrae with calcium phosphate cement injection or with bone filing mesh container filed with calcium phosphate cement were compared. The in vivo bone tissue growth was periodicaly observed after the lumbar vertebra of 4-month-old pigs was implanted with the bone filing mesh container that was then ful of bone cement. RESULTS AND CONCLUSION: The bone filing mesh container had good biocompatibility. Bone filing mesh containers after 2-year storage had the same tensile strength to the fresh bone filing mesh containers. At ambient conditions, after bone cement injection, bone filing mesh containers could be expanded at 5-10 atm and therefore could play the role of uplift; at 7-10 atm, bone cement could leak out from the bone filing mesh container and enter into the interspace between surrounding bone tissues, thus playing the role of adhesion and fixation. The vertebrae after bone cement injection with or without bone filing mesh containers had the same initial strength and stiffness and exhibited bigger initial strength and stiffness than untreated vertebrae. Thein vivo animal experiments proved that bone filing mesh container had no obvious effect on the vertebrae. These findings indicate that the bone filing mesh container can be used to restore the height and strength of the fractured vertebrae. Moreover, it may eliminate bone cement leakage and therefore increase the surgery safety.
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BACKGROUND:It has become a focus to look for new vertebral body fil ing materials which have the biomechanical property, biological activity and low cement leakage rate. OBJECTIVE:To investigate the biomechanical characters and cement leakage rate of the vertebral bodies implanted with biodegradable reticulated bal oon and calcium phosphate. METHODS:Thirty-two vertebral bodies from pigs were randomly divided to four groups. For A group, 2.5-3.0 mL polymethacrylate cement was injected into the body through a unilateral thoracic pedicle pathway;for B group, 2.5-3.0 mL calcium phosphate cement were injected by the same protocol;for C group, the biodegradable reticulated bal oons fil ed with 2.5-3.0 mL calcium phosphate cement were implanted;D group, including normal vertebral bodies, was designed as controls. Leakage of bone cement was observed in each group. The load-shift curves were recorded by an electronic universal testing machine (SCHENCK RSA-250). RESULTS AND CONCLUSION:The stiffness and strength of A group were significantly higher than those of D group (P0.05). Cement leakage rate of C group was lower than that of A or B group (P<0.05). Vertebral bodies implanted with biodegradable reticulated bal oons may lead to similar biomechanical characters as the normal vertebral bodies and reduce the cement leakage rate.
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Objective To investigate the features of intravertebral vacuum phenomenon (IVP)in vertebral compression fractures (VCFs). Methods Two hundred and nine patients with VCFs underwent percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). The biopsies and the images of X-ray, CT, MRI of VCFs were obtained. The consistency between IVP and osteonecrosis on histology and the positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and Youden index of IVP for diagnosing local osteonecrosis in VCFs were analyzed. Fisher exact probability test was used to analyze the coherence between IVP and osteonecrosis. Results Histological examination revealed 146(69.9%) osteoporoses, 10 (4.8%) osteonecroses with osteoporoses, 53 (25.4%) neoplasms. Prior to surgery,10 cases of IVP were found. Plain radiograph showed horizontally oriented lucent cleft in the vertebral body;CT further confirmed the location of gas;T_1-weighted MR image appeared hypointensity,while the signal intensity of T_2-weighted MR image differed, depending on the duration of recumbency. Nine of 10 patients with IVP showed osteonecrosis on histology, while 9 of 10 patients with osteonecrosis contained IVP. The association of osteonecrosis on histology and the IVP was statistically significant(P <0.01). The PPV, NPV, sensitivity, specificity, and Youden index for diagnosing local osteonecrosis was 90% (9/10), 99.5% (198/199), 90.0% (9/10), 99.5% (198/199), and 0.9, respectively. Conclusion The IVP is stongly suggestive of local osteonecrosis in vertebral compression fracture.
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Objective To explore the safety and effectiveness of percutaneous vertebrophasty(PVP)in the treatment of the metastatic tumor involved axis.Methods Ten patients(8 male,2 female)with osteolytic metastases involved axis were treated with PVPs.The anterolateral approach with fluoroscopy guidance was selected in 9 cases,while the posterolateral approach with CT guidance was selected in 1 case.Results Successful unilateral-paracentesis for PVP were achieved in all patients without intervention related complications such as bleeding and symptomatic polymethylmethacrylate(PMMA)leakage.CT scan taken following PVP showed that over 70% of the osteolytic metastatic area was well filled with PMMA in all cases.Varying degrees of pain relief were observed(CR in 7 cases,PR in 3 cases)within 7 days.All patients could support their heads without brackets.During a 3 to 24 months follow up after the procedures,No aggravated pain was found in the group.Two patients died in 4 months,3 Patients died in 8 to 11 months 4 patients died in 13 to 15 months,and 1 patient still was alive after 24 months.Conclusion Anterolateral or posterolateral approach to Aixs in PVP is safe and effective in treating osteolytic metastatic tumors.
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BACKGROUND: In kyphoplasty procedure, two balloons are inserted into the vertebral body and inflated simultaneously for height symmetric restoration of the vertebral body. However, the expensive cost of balloon of kyphoplasty limits the extensive development of this procedure in developing countries. In this study, we try to inflate single balloon with bilateral transpedicular routes alternatively to achieve vertebral body height balanced restoration and reduce operation expenditure. But biocompatibility of bone cement and effect of kyphoplasty still need further observation.OBJECTIVE: To investigate the biocompatibility of bone cement and the clinical efficacy of bipedicular kyphoplasty for osteoporotic vertebral compression fractures by inserting single inflatable balloon into injured vertebral body and filling bone cement in the cavity caused by inflating balloon via bipedicular approach.DESIGN: Controlled observation.SETTING: Department of Medical Imaging, General Hospital of Jinan Military Area Command of Chinese PLA.PARTICIPANTS: Twenty-two patients (31 vertebral bodies) undergoing kyphoplasty with single balloon in Department of Medical Imaging, General Hospital of Ji'nan Military Area Command of Chinese PLA from May 2004 to May 2005 were selected, including 5 males and 17 females aged 68-85 years. Patients with painful compression fractures caused by osteoporosis were enrolled, and confirmed by CT and MRI with complete vertebral posterior wall but no spine deformity. The informed consent was obtained from all subjects, and the experiment and treatment were approved by Ethics Committee. METHODS: The especial instrument for kyphoplasty including puncturing device and balloon were provided by Shandong Guanlong Medical Utensils Co., Ltd. [LDAI (T) 2004 No. 2150017]; bone cement (Polymethymethacrylate) was made in China [MAIT 2005(T) No. 3650267]. Under X-ray fluoroscopy monitoring, single inflatable balloon was inserted into fractured vertebral body by puncturing needle and inflated via bipedicular approach to restore vertebral height. MAIN OUTCOME MEASURES: ①Bone cement biocompatibility during and after surgery; ②pain relief within 72 hours after surgery, restoration of vertebral height and correction of kyphotic deformity.RESULTS: ①Bone cement biocompatibility: Little cement leakage was observed at one intervertebral space of one patient by X-ray film, but no clinical symptoms, inflammatory reaction or rejection were found. ②Obvious pain relief was found in 22 cases with within 72 hours after kyphoplasty. ③The height loss of the anterior and middle vertebral body reduced from (14.70±4.21) mm and (10.62±4.11) mm preoperatively to (10.38±4.23) mm and (6.45±4.04) mm postoperatively after single balloon inflation and cement filling. Cobb angle was corrected averagely from (21.15±6.33)° preoperatively to (11.64±4.33)° postoperatively. CONCLUSION:Biocompatibility of bone cement is good, and no specific adverse effects are found in despite of cement leakage. Bipedicular kyphoplasty with single balloon for painful osteoporotic vertebral compression fractures effectively restores vertebral heights and relieves pain.
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Objective To evaluate the clinical efficacy and safety of kyphoplasty with single balloon cross-midline expansion using unipedicular approach for osteoporotic vertebral body compressive fracture (OVCF).Methods Thirty six cases of painful OVCF were included in the study,with 61 vertebrae involved.Under X-ray fluoroscopy monitoring,kyphoplasty was performed using a unilateral,single,balloon via a unilateral transpedicular approach.A final balloon position was in the midline of the vertebral body with the balloon cross-midline expansions and bone cement filled. Clinical outcomes were determined by comparison of preoperative and postoperative VAS and ODI scores.Radiographic assessment included vertebral height restoration and correction of kyphosis.Follow-up was conducted for 6.0-12.0 months(mean 9.2 months).Results Thirty-six consecutive patients with 61 vertebrae were successfully operated with an operative time of(37.4±9.6)rain per vertebra.All patients had significant pain relief and functional recovery within 96 h after the procedure with no surgery-and device-related complications.VAS score improved from(7.3±1.0)preoperatively to(2.7±0.8)postoperatively(t=19.53,P＜0.01).ODI score was decreased from(71.1±10.9)%preoperatively to(26.6±6.4)%postoperatively(t=18.54,P＜0.01).The average anterior body height loss was(14.3±2.8)mm before procedure and(10.0±1.8)mm after procedure(t=14.68,P＜0.01).The average middle body height loss was(10.2±2.7)mm before procedure and(5.9±1.8)mm after procedure(t=16.44,P＜0.01).The Cobb's angle was corrected from 23.4°±5.0° to 16.2°±2.8°(t=15.60,P＜0.01).Some leakages of cement around the anterior margin of vertebra and inter-vertebral space were found in 2 patients,but there were no clinical symptoms.X-ray examination indicated there were no cement leakages in other vertebra.The pain relief and functional recovery were substantial and maintained to the last follow up without any re-collapse or adjacent level fracture.Conclusions A single-balloon cross-midline expansion using unipedicular approach in kyphoplasty for OVCF is effective and safety,less operation time,less radiation exposure compared to the conventional kyphoplasty technique.