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Objective:To compare effects of conservative treatment and percutaneous kyphoplasty on paravertebral muscle degeneration in patients with osteoporotic compression vertebral fractures.Methods:A retrospective case control analysis was conducted on 286 cases of osteoporotic compression vertebral fractures from January 2017 to December 2019. There were 54 males and 232 females, with a mean age of 67.7 (range, 52-90 years). According to the treatment, the patients were divided in to conservative treatment group (134 patients) and percutaneous kyphoplasty treatment group (152 patients). The pre-operation and post-operation of paravertebral muscle cross-sectional area (CSA) and fatty infiltration (FI% ) , bed rest time, visual analogue scale (VAS), Oswestry disability index (ODI), the sagittal view Cobb angle, and the anterior column height of fractured vertebra were compared between these two groups.Results:The two groups had no significant difference in CSA and FI% of paravertebral muscle in each plane of the intervertebral discs of the L 3-4、L 4-5 and L 5S 1. The CSA of multifidus in each plane of the intervertebral discs three months after operation were 6.56±1.26 cm 2, 6.87±1.31 cm 2, and 7.14±1.29 cm 2; the CSA of erector were 12.39±2.16 cm 2, 14.72±2.67 cm 2, and 16.45±3.09 cm 2; the CSA of psoas major were 7.05±1.52 cm 2, 8.12±1.75 cm 2, and 8.68±1.66 cm 2, which all were larger than those in conservative treatment group and showed significant difference between two groups ( P<0.05). However, the two groups had no significant difference in FI% of paravertebral muscle three months after operation. The CSA of multifidus in each plane of the intervertebral discs one year after operation were 6.43±1.23 cm 2, 6.62±1.42 cm 2, and 7.06±1.32 cm 2; the CSA of erector were 12.02±2.08 cm 2, 14.53±2.76 cm 2, and 16.39±2.84 cm 2; the CSA of psoas major were 6.98±1.47 cm 2, 8.01±1.59 cm 2, and 8.37±1.72 cm 2, which all were larger than those in conservative treatment group and showed significant difference between two groups ( P<0.05). The FI% of multifidus in each plane of the intervertebral discs one year after operation were 31.40%±5.84% , 32.54%±6.64% , and 33.26%±7.16% ; the FI% of erector were 22.64%±3.47% , 23.08%±3.72% , and 23.84%±3.99% ; the FI% of psoas major were 9.23%±2.20% , 9.72%±2.54% , and 10.98%±2.43% , which all were less than those in conservative treatment group and showed significant difference between two groups ( P<0.05). Two groups had significant difference in bed rest time as (9.21±2.52) d vs. (40.32±9.79) d ( t=37.79, P<0.001). The VAS, ODI score at the time of the first day after treatment and the last follow-up of the surgical treatment group were all significantly lower than those of conservative treatment group ( P<0.05). The operation could effectively improve the kyphosis deformity and reduce the loss the anterior column height of fractured vertebra compared with conservative treatment ( P<0.05). Conclusion:There exists paravertebral muscle degeneration of varying degrees during the course of the osteoporotic compression vertebral fractures. Compared to conservative treatment, percutaneous kyphoplasty treatment can not only significantly relieve pain in the short term, improve quality of patient's life, but also significantly delay the degeneration of paravertebral muscle.
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Objective@#To investigate the preventive effects of gelatin sponge debris pre-filling on bone cement leakage during percutaneous kyphoplasty (PKP) for vertebral osteoporotic fracture with cortical bone rupture.@*Methods@#The data of 256 cases (294 segments) of osteoporotic vertebral compression fracture (OVCF) treated with PKP from January 2014 to July 2016 were retrospectively analyzed. There were 106 segments in 92 males and 188 segments in 164 females. In 119 cases, a total of 132 segments were pre-filled with gelatin sponge debris before bone cement injection. The average age was 74.4±7.7 years. In 137 cases, 162 segments were not pre-filled with gelatin sponge debris, with average age of 73.3±6.4 years. The incidences of cement leakage, visual analogue scale (VAS), Oswestry disability index (ODI), the change of anterior vertebral height and kyphosis angle before and after operation were compared between the two groups.@*Results@#In gelatin sponge group, the incidence of cement leakage was 12.6% (15/119), including 3.4% (4/119), 0.8% (1/119), 1.7% (2/119), 5.0% (6/119) and 1.7% (2/119) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The incidence of cement leakage in non-gelatin sponge group was 23.4% (32/137), including 4.4% (6/137), 5.1% (7/137), 5.1% (7/137), 5.8% (8/137) and 2.9% (4/137) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The difference of total cement leakage rate between the two groups was significant (χ2=4.912, P=0.027). There was no significant difference in leakage rates among different types (P>0.05). Postoperative symptoms were improved in both groups. VAS score and ODI index were improved at 1, 3 and 6 months after operation (P<0.05). However, there was no significant difference in VAS score and ODI index at preoperative and post-operative follow-up between groups. There were no significant difference between the two groups in the height of the anterior edge of the injured vertebra before operation (17.3±3.2 mm, 17.5±5.4 mm), the kyphosis angle before operation (18.9°±2.0°, 18.7°±2.3°), the height of the anterior edge of the injured vertebra after operation (22.7±3.6 mm, 22.4±5.4 mm), and the kyphosis angle after operation (11.2°±1.4°, 11.9°±1.8°).@*Conclusion@#Gelatin sponge debris pre-filling can effectively reduce bone cement leakage after PKP in patients with vertebral cortical bone rupture. There was no significant effect on the improvement of symptoms after PKP.
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Objective To compare the clinical efficacy of unilateral and bilateral short segment fixation in treating thoracolumbar fractures combined with unilateral pedicle fractures.Methods A retrospective case control study was conducted on the clinical data of 43 patients with thoracolumbar fractures with unilateral pedicle fractures admitted from January 2012 to December 2016.There were 24 males and 19 females,with a mean age of 48 years (range,19-68 years).Fractured segments included T10 in 1 patient,T11 in 6,T12 in 11,L1 in 19,and L2 in 6.According to the fixation method,the patients were divided into unilateral transpedicular fixation group (unilateral group,15 patients) and bilateral transpedicular fixation group (bilateral group,28 patients).All patients were treated with fixation via injured vertebrae combined with short segment fixation.The operation time,intraoperative blood loss,X-ray frequency,fracture healing time,intemal fixation removal time,preoperative and postoperative anterior vertebral height ratio,sagittal Cobb angle recovery,spinal canal invasion rate,visual analogue score (VAS),Oswestry dysfunction index (ODI),Frankel classification of spinal cord injury,incidence of screw deviation,and spinal lateral angulation were compared between the two groups.Results All patients were followed up for 12-26 months,with an average of 18.5 months.The operation time in unilateral group and bilateral group were (82.3 ± 14.7) minutes and (120.9 ± 12.8) minutes,respectively.The intraoperative blood loss was (186.1 ± 20.4)ml in unilateral group and (231.2 ± 39.6) ml in bilateral group.The number of fluoroscopy was (6.6 ± 1.2) times in unilateral group and (13.3 ± 2.0) times in bilateral group respectively.The incidence of screw deviation was 13％ (2/15) in unilateral group and 46％ (26/56) in bilateral group (P ＜ 0.05).There were no significant differences between the two groups in anterior vertebral height ratio,sagittal Cobb angle,spinal canal invasion rate,VAS,ODI,Frankel grade and spinal lateral angulation (P ＞ 0.05).Conclusions For thoracolumbar fractures combined with unilateral pedicle fractures,unilateral and bilateral transpedicular short segment fixation has similar reduction and fixation effects.Unilateral transpedicular short segment fixation has the advantages of shorter operation time,less bleeding,fewer fluoroscopy times,and lower screw deviation rate.
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Objective To explore the role of regulatory T-lymphocytes(Treg) in the immune pathogenesis of suba-cute thyroiditis (SAT). Methods The proportion of Treg in CD4+T cells in peripheral blood of 46 SAT patients and15 controls was detected using flow cytometry. And the concentration of interleukin-10(IL-10), transforming growth factor-beta1(TGF-β1) and prostaglandin E2(PGE2) in serum of 46 SAT patients and 15 controls was measured with ELISA. In addition, the Forkhead box protein 3 (Foxp3) positive cells in thyroid tissue of 29 SAT patients and20 controls was detected by immunohistochemistry. Results The proportion of Treg in peripheral blood of SAT pa-tients was significantly lower than that of controls (P＜0.05). And the concentration of TGF-β1 in serum of SAT patients was apparently higher than that of controls(P＜0.05). Additionally, the positive rate of Foxp3 in thyroid tissue of SAT patients was markedly higher than that of controls(P＜0.05).Conclusions The decrease of Treg may play an important role in the immune pathogenesis of SAT.