Clinical study of hydraulic perfusion pump and traditional water flushing for percutaneous endoscopic lumbar discectomy / 中国骨伤

OBJECTIVE@#To compare the clinical outcomes of hydraulic perfusion pump and traditional water fhushing in percutaneous endoscopic lumbar discectomy.@*METHODS@#From January 2016 to December 2018, 72 patients with lumbar disc herniation failed to conservative treatment were enrolled in this study. The patients were divided into hydraulic perfusion pump group and traditional water flushing group, 36 cases in each group. There were no significant differences in gender, age, prominent segment, clinical classification, preoperative visual analogue scale (VAS) and Japanese Orthopaedic Association(JOA) score between two groups (@*RESULTS@#All the patients were followed up for 12 to 24 (15.7±5.1) months. Compared with the traditional water flushing group, the operation time of the hydraulic perfusion pump group was shorter [(65.5±21.3) min vs (74.8±19.9) min, @*CONCLUSION@#Both hydraulic perfusion pump and traditional water flushing assisted percutaneous endoscopic lumbar disc herniation can achieve satisfactory clinical results, but the former has shorter operation time, clearer intraoperative vision, less bleeding, and fewer intraoperative and postoperative complications.

Risk factors of non-surgical vertebral fracture after percutaneous kyphoplasty of single segment thoracolumbar fracture / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the risk factors of non-surgical vertebral fracture after percutaneous kyphoplasty (PKP) in patients with single segment thoracolumbar osteoporotic vertebral compression fracture(OVCF).</p><p><b>METHODS</b>The clinical data of 219 patients with single segment thoracolumbar osteoporotic vertebral compression fracture underwent percutaneous kyphoplasty from January 2010 to December 2015 were retrospectively analyzed. There were 29 cases in non-surgical vertebral body fracture group with 7 males and 22 females aged (67.35±9.92) years. Bone mineral density was(-3.89±0.72)SD, fracture compressed degree was (0.57±0.35)%, bone cement injected volume was (4.53±1.64) ml, and vertebral height recovery was (0.49±0.86)% on average. Ten cases were with vertebral body space fracture, 7 cases with bone cement leakage to the intervertebral disc, 9 cases with bone cement leakage to the peripheral tissue and 14 cases were treated by systemic anti-osteoporosis treatment after operation. Other 190 cases in non-surgical vertebral body without fracture group, and there were 42 males and 148 females, aged (66.98±7.55) years. Bone mineral density was (-3.13±0.59) SD, fracture compressed degree was (0.39±0.60)%, bone cement injected volume was (4.72±1.28) ml, and vertebral height recovery was (0.46±0.94)% on average. Among them, 13 cases were with vertebral body space fracture, 5 cases with bone cement leakage to the intervertebral disc, 29 cases with bone cement leakage to the peripheral tissue and 129 cases were treated by systemic anti-osteoporosis treatment after operation. The factors of gender, age, fracture compressed degree, fractured type, bone mineral density, bone cement injected volume, bone cement leakage, vertebral height recovery, adjacent vertebral fractures, and systemic anti-osteoporosis treatment were studied in the two groups for single factor analysis. For the results with significant differences among above factors, the multivariate logistic regression analysis was used to research the non-surgical vertebral fracture risk factors.</p><p><b>RESULTS</b>Among the 219 patients with single thoracolumbar fractures, 29 cases occurred non-surgical vertebral fractures. The single factor analysis results showed that there was no significant correlation between non-surgical vertebral fracture occurrecne with age, sex, fracture compressed degree, bone cement injected volume, and vertebral height recovery(>0.05), but there was a significant correlation between non-surgical vertebral fracture occurrence with fractured type, bone cement leakage, systemic anti-osteoporosis treatment, and bone mineral density (<0.05). Multivariate logistic regression analysis showed that fractured type(OR=0.135), whether systemic anti-osteoporosis treatment (OR=3.793), bone cement leakage (OR=8.975), and bone density (OR=57.079) are risk factors for postoperative non-surgical vertebral fractures.</p><p><b>CONCLUSIONS</b>Improving the quality of the people, systemic preventing and treating the osteoporosis, improving the surgical skills and decreasing the bone cement leakage during operation are effective methods to prevent postoperative non-surgical vertebral fractures.</p>