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Objective:To investigate the effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture.Methods:One hundred cases of thoracolumbar fracture patients admitted to Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province from March 2019 to June 2021 were selected. Prospective randomized controlled study method was used and random number table method was used to divide them into three groups: incomplete expansion group (33 cases), moderate expansion group (33 cases) and complete expansion group (34 cases). All the 3 groups were treated with balloon dilation combined with prying reduction and bone graft fixation. The pressure of balloon dilation in incomplete dilation group, moderate dilation group and complete dilation group was 100 psi, 150 psi and no more than 200 psi respectively, and the volume of balloon dilation was 0.5∶1, 1∶1 and 1.5∶1 respectively. The operation time, intraoperative bleeding volume, postoperative drainage volume, vertebral anterior margin recovery rate and hospital stay, as well as local Cobb angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores before and after operation were compared among the three groups. According to the follow-up of whether there is re-fracture after surgery, the clinical data of the re-fracture group and the non re-fracture group were compared, and the risk factors of the re-fracture after surgery were analyzed. The measurement data with normal distribution was expressed as: independent sample t-test was used for comparison between two groups, one-way ANOVA or repeated measurement ANOVA was used for comparison between three groups, and SNK-q test was used for comparison between two groups. Counting data were expressed in cases or cases (%), and compared between groups by χ 2 Inspection. Logistic regression was used to analyze the risk factors of refracture after thoracolumbar fracture. Results:There was no significant difference in operation time, intraoperative blood loss and postoperative drainage volume among the three groups ( P=0.096, 0.328 and 0.344, respectively). The recovery rate of vertebral anterior edge height in moderate expansion group was higher than that in incomplete expansion group and complete expansion group ((84.15±4.21)% vs (70.18±7.44)%, (75.94±6.56)%), and the hospitalization time was shorter than that in incomplete expansion group and complete expansion group ((10.38±2.35) d vs (15.18±3.44), (14.59±2.48) d) (all P<0.001). Before treatment, there was no significant difference in Cobb angle, VAS and ODI scores among the three groups (all P>0.05). After treatment, the Cobb angle, VAS and ODI scores of patients in the three groups were lower than those before treatment, and the moderate expansion group were lower than those in the incomplete expansion group and the complete expansion group ((14.08±2.15) ° vs (16.48±4.85) °, (15.06±3.45) °, (1.81±0.53)% vs (2.25±0.41), (2.31±0.42), (18.16±2.18)% vs (20.48±4.85), (20.01±4.45) points) (all P<0.001). 100 patients were followed up until the fracture was healed. They were divided into re-fracture group (15 cases) and non re-fracture group (85 cases) according to whether there was re-fracture after operation. The results of multifactor logistic regression analysis showed that body mass index and bone mineral density were protective factors for patients with thoracolumbar fracture after operation (odds ratio was 0.66 and 0.15 respectively, 95% confidence interval: 0.51~0.86, 0.05~0.42, P values were 0.006 and <0.001 respectively), The old wedge-shaped change of the vertebral body and the abnormal structure of the lumbar spine are the risk factors for postoperative re-fracture (odds ratio 4.22 and 6.36, 95% confidence interval 1.14-15.56 and 1.43-28.21, respectively, P values were 0.027 and 0.015). Conclusions:In the treatment of thoracolumbar fracture with prying reduction and bone grafting fixation, the effect of balloon expansion pressure of 150 psi is better. Body mass index (BMI) and bone mineral density (BMD) were protective factors for postoperative re-fracture of patients with thoracolumbar fracture. Old wedge-shaped change of vertebral body and abnormal lumbar structure are risk factors for postoperative re-fracture.
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Resumen: Introducción: a medida que se invierte la pirámide poblacional vamos a ver más pacientes que sufren fracturas por mecanismos de bajo impacto y no todos los hospitales cuentan con un densitómetro para hacer el diagnóstico definitivo. Sin embargo, se cuenta con herramientas clínicas que nos apoyan para iniciar con un tratamiento oportuno. Objetivo: reconocer el riesgo de refractura que existe en pacientes mayores de 50 años dentro de nuestra población. Material y métodos: se incluyeron a pacientes > 50 años que sufrieron de una fractura de bajo impacto en el Hospital Ángeles Mocel. Usando el FRAX score México para medir el riesgo de sufrir una fractura. Se dividió la muestra en dos grupos, utilizando una p < 0.05 para considerar estadísticamente significativa con un IC de 95%. Resultados: se incluyeron 69 pacientes, 47.8% ya habían sufrido de alguna fractura previa, 10% de ellos tienen tratamiento para la osteopenia. El riesgo de sufrir una fractura mayor osteoporótica en 10 años se observó en 50.7% de los pacientes. El riesgo de sufrir una fractura de cadera en 10 años se encontró en 75% de los pacientes. A ningún paciente se le dio tratamiento, ya sea modificadores del estilo de vida o tratamiento farmacológico para osteopenia/osteoporosis a su egreso hospitalario. Conclusión: hay una deficiencia en el manejo inmediato de los cirujanos ortopedistas para prevenir en pacientes futuras refracturas de bajo impacto.
Abstract: Introduction: as the population pyramid inverts, we'll see more old patients suffering a fracture secondary to a low impact mechanism and not all hospitals have a densitometer to make a definitive diagnosis. Nevertheless, we have clinical tools that can help us to start an early treatment. Objective: to recognize the risk of re-fracture of patients older than 50 years in our population. Material and methods: we included all patients older than 50 that suffered a low impact fracture in the Ángeles Mocel Hospital. We used Mexico FRAX score tool to determine de risk of suffering a fracture. The sample was divided in two groups. Utilizing p < 0.05 and a CI of 95%. Results: 69 patients where included. 47.8% had past fractures and only 10% of those had preventive osteoporotic treatment. 50.7% of the patients have a high risk of suffering a mayor osteoporotic fracture in 10 years and 75% of suffering a hip fracture in 10 years. None of the patients received a treatment, either lifestyle modifiers or specific osteoporosis pharmacotherapy at hospital discharge. Conclusion: there is a deficiency in the early preventive management of osteoporosis in patients suffering a low impact fracture by orthopedic surgeons.
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Re-fracture of the injured vertebrae is a serious complication after vertebral augmentation for osteoporotic thoracolumbar fractures (OTLF), manifested by recurrent lower back pain, limitation of spinal motion and increased retroflexion deformity. The clinical treatment of re-fracture of the injured vertebrae is difficult, and some patients even need spinal function reconstruction to stabilize the fractured vertebrae, which has a serious impact on their postoperative rehabilitation, quality of life and economic burdens. Re-fracture of the injured vertebrae after vertebral augmentation for OTLF is closely related to patient factors, bone cement factors and perioperative factors. To this end, the authors discuss the risk factors for re-fracture of the injured vertebrae after vertebral augmentation for OTLF and propose corresponding management methods to provide a reference for understanding the risk of re-fracture of the injured vertebrae and improving the clinical treatment.
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Objective:To investigate the risk factors of refracture of the injured vertebrae after percutaneous vertebral augmentation for acute symptomatic thoracolumbar osteoporotic compression fractures (ASTOCFs).Methods:A case-control study was conducted to analyze the clinical data of 2 237 ASTOCFs patients admitted to three hospitals from January 2010 to January 2019. There were 569 males and 1 668 females, with age range of 50-85 years [(66.7±4.8)years]. The patients underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). According to the radiographic outcomes, the patients were divided into refracture group ( n=315) and non-refracture group ( n=1 922). Data were recorded for the two groups, including basic demographics (gender, age, height and weight), personal habits (smoking and alcohol consumption), basic diseases (diabetes, hypertension, coronary heart disease and chronic obstructive pulmonary disease), preoperative bone mineral density, fracture segment, number of injured vertebrae, surgical method (PVP or PKP), surgical approach, bone cement viscosity, distance from cement to the upper and lower endplate, cement volume in injured vertebrae, cement leakage, postoperative exercise, and postoperative anti-osteoporosis treatment. The above data were analyzed to identify their correlation with postoperative refracture of the injured vertebrae by univariate analysis. The independent risk factors for postoperative refracture of the injured vertebrae were determined by multivariate Logistic regression analysis. Results:Univariate analysis showed that refracture of injured vertebrae was correlated with gender, age, diabetes, fracture segment, surgical method, distance from cement to the upper and lower endplate, postoperative exercise, and postoperative anti-osteoporosis treatment ( P<0.05 or 0.01), but there was no correlation with height, weight, smoking, alcohol consumption, hypertension, coronary heart disease, chronic obstructive pulmonary disease, preoperative bone mineral density, number of fractured vertebrae, surgical approach, bone cement viscosity, cement volume in injured vertebrae or cement leakage (all P>0.05). Multivariate Logistic regression analysis showed that female ( OR=1.92, 95% CI 1.34-2.64, P<0.01), age ≥80 years ( OR=1.21, 95%CI 1.17-1.25, P<0.01), diabetes ( OR=1.92, 95% CI 0.44-2.55, P<0.01), thoracolumbar fracture ( OR=1.46, 95% CI 1.82-7.51, P<0.05), PKP ( OR=4.56, 95% CI 0.86-1.44, P<0.05), no postoperative exercise ( OR=2.14,95% CI 0.27-0.38, P<0.01), and no postoperative anti-osteoporosis treatment ( OR=2.36,95% CI 0.13-0.47, P<0.05) were positively correlated with refracture of injured vertebrae. Conclusion:Female, age ≥80 years, diabetes, thoracolumbar fracture, PKP, no postoperative exercise, and no postoperative anti-osteoporosis treatment are independent risk factors for refracture of injured vertebrae after percutaneous vertebral augmentation for ASTOCFs.
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OBJECTIVE@#To investigate the incidence and related risk factors of healthy side fracture after hip fracture surgery in the elderly, so as to provide basis for the prevention of re-fracture.@*METHODS@#The data of 452 patients over 65 years old with femoral neck fracture or intertrochanteric fracture treated with hip arthroplasty or proximal femoral intramedullary nailing from June 2012 to June 2017 were analyzed, including 168 males and 284 females, the age ranged from 65 to 97(75.5±7.5) years. There were 191 cases of femoral neck fracture and 261 cases of femoral intertrochanteric fracture. According to whether there was a fracture in the healthy hip after operation, the patients were divided into fracture group and no fracture group. The gender, age, body mass index, fracture type, initial treatment method, bone mineral density, bed time, medical compliance, postoperative short-term delirium, whether there were medical diseases before injury and Harris score of hip joint in the final follow-up were recorded. Univariate Logistic regression analysis was used to screen out the risk factors of healthy side fracture after operation, and then statistically significant risk factors were included in multi factor Logistic regression analysis to screen out the independent risk factors of healthy side fracture after operation of hip fracture in the elderly.@*RESULTS@#Among them, 42 of the 452 patients had hip fractures on the healthy side with an incidence of 9.3%. The average interval between the two fractures was (2.9±2.1) years. Univariate Logistic regression analysis showed that there were significant differences in age, bone mineral density, medical compliance, short-term postoperative deliriun, pre-injury complicated with medical diseases and Harris score of hip joint in the final follow-up (P<0.05). Multivariate Logistic analysis showed that age(OR=4.227), bone mineral density(OR=4.313), combined with medical diseases (OR=5.616) and low hip Harris score at the final follow-up (OR=3.891) were independent risk factors for healthy side fractures after hip fracture surgery in elderly(P<0.05).@*CONCLUSION@#The age, bone mineral density, combined with medical diseases and low Harris score of hip joint in the final follow-up are the main risk factors of healthy side fracture after hip fracture in the elderly. It is necessary to strengthen the treatment of medical diseases, anti osteoporosis and improve hip joint function within 3 years after operation, so as to prevent the occurrence of healthy side hip fracture.
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Aged , Aged, 80 and over , Female , Humans , Male , Bone Density , Femoral Fractures , Femoral Neck Fractures/surgery , Femur , Hip Fractures/surgery , Risk FactorsABSTRACT
OBJECTIVE@#To investigate the risk factors of vertebral refracture after percutaneous kyphoplasty (PKP) for osteoprotic vertebral compression fractures (OVCFs), and to provide reference for clinical prevention.@*METHODS@#A retrospective analysis of 228 OVCFs patients who met the inclusion criteria admitted from November 6, 2013 to December 14, 2018. There were 35 males and 193 females, with a male-to-female ratio of 3∶20, and aged 58 to 91 years with an average of (69.70±7.03) years. All patients were treated with PKP and had complete clinical data. According to whether refracture occurred after operation, they were divided into refracture group (24 cases) and non refracture group (204 cases). Factors that may be related to refracture (including gender, age, surgical segment, number of vertebral bodies in the surgical segment, whether combined with degenerative scoliosis, whether anti-osteoporosis treatment) were included in the univariate analyses, and the single factor analysis of statistically significant risk factors was carried out with multiple Logistic regression analysis to further clarify the independent risk factors for vertebral body refracture after PKP. Survival analysis was performed using the time of vertebral refracture after PKP as the end time of follow up, the occurrence of refracture after PKP as the endpoint event, and the presence or absence of degenerative lateral curvature as a variable factor.@*RESULTS@#All 228 patients were followed up for 1.8 to 63.6 months with an average of (28.8±15.6) months, and the refracture rate was 10.5%(24/228). There were statistically significant differences between two groups in age, number of operative vertebral bodies, whether combinedwith degenerative scoliosis and whether anti osteoporosis treatment (@*CONCLUSION@#Combined scoliosis is an independent risk factor for refracture after OVCFs vertebroplasty, and it is also a possible high-risk factor for refracture after surgery.
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Female , Humans , Male , Fractures, Compression/surgery , Kyphoplasty/adverse effects , Osteoporotic Fractures , Retrospective Studies , Risk Factors , Spinal Fractures/surgery , Vertebral BodyABSTRACT
Objective: To compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF). Methods: The clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups ( P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients' symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded. Results: The injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups ( t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups ( χ2=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation ( P0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups ( P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant ( χ2=4.105, P=0.043; χ2=4.661, P=0.031). Conclusion: Bone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.
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BACKGROUND: The purpose of this study was to investigate the incidence and characteristics of osteoporotic refractures after proximal humerus fracture in Korean adults aged above 50 years. METHODS: Patients aged 50 years or older with initial proximal humerus fractures reported in 2012 were enrolled and followed up until 2016 using the Korean National Health Insurance data. Based on the last claim date, the refractures were classified as osteoporotic fractures including spine, hip, distal radius, and humerus 6 months after the index fracture involving the proximal humerus. Each osteoprotic fracture was identified using specific International Classification of Diseases, 10th Revision codes and site-specific physician claims for procedures. RESULTS: A total of 5,587 first-time fractures involving proximal humerus were reported in 2012. Among them, a total of 1,018 osteoporotic refractures occured between 2012 and 2016. The total cumulative incidence of osteoporotic refractures was 4.85% (271/5,587) at 1 year, 9.61% (537/5,587) at 2 years, 14.21% (794/5,587) at 3 years, and 18.22% (1,018/5,587) at 4 years. In terms of site by year, the incidence of associated refractures was as follows: spine, 48.62% (495/1,018); hip, 25.83% (263/1,018); wrist 18.57% (189/1,018); and humerus 6.97% (71/1,018) during all the follow-up periods. CONCLUSIONS: Our study showed that the cumulative incidence of osteoporotic refractures following proximal humerus fractures in the elderly population has been increasing over the years. Given that osteoporotic refractures are associated with an increased mortality risk, a public health strategy to prevent the refracture after proximal humerus fracture in the elderly is imperative.
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Adult , Aged , Humans , Follow-Up Studies , Hip , Humeral Fractures , Humerus , Incidence , International Classification of Diseases , Korea , Mortality , National Health Programs , Osteoporotic Fractures , Public Health , Radius , Spine , WristABSTRACT
PURPOSE: Studies on the incidence and mortality of refractures after primary osteoporotic fracture are limited by the relatively rare incidence of such refractures and small sample sizes. The objectives of this research were: 1) to determine the incidence of osteoporotic refractures and fracture locations and 2) to assess mortality rates associated with osteoporotic refracture over a median follow up of 3 years using nationwide claim database. MATERIALS AND METHODS: Patients over 50 years of age who had an osteoporotic fracture that was confirmed operationally were enrolled. Refracture was defined as that after 6 months of an untreated period. Mortality rate was calculated using the Charlson comorbidity index and was analyzed using Cox proportional hazards regression analysis. RESULTS: A total of 18956 first-time instances of osteoporotic fracture were reported between 2007 and 2012 after a median follow up of 3.1 years (range, 1 to 7 years). Among 18956 patients, 2941 (15.50%) experienced refracture. After follow up for 1 year, cumulative mortality rates for re-fracture and non-refracture groups were 9.1% and 7.2%, respectively. After adjusting for covriates, mortality rate was 1.2 times greater in patients with re-fracture than in patients without re-fracture over a median follow up of 3 years (hazard ratio: 1.20, 95% confidence interval: 1.08–1.34, p<0.001). CONCLUSION: The incidence of osteoporotic re-fracture in this nationwide study was 15.5%, and the mortality rate of re-fracture patients was 1.2 times higher than that of non-refracture patients over a median follow up of 3 years.
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Humans , Comorbidity , Follow-Up Studies , Incidence , Korea , Mortality , Osteoporotic Fractures , Sample SizeABSTRACT
Osteoporosis is a metabolic bone disease characterized by decreased bone mass and degenerative changes in the microstructure of bone tissue, leading to increased bone brittleness and fracture risk. Bone fracture after osteoporosis is the most common and serious complication, which often leads to serious consequences in cases of inadequate prevention and late diagnosis. Therefore, more attention should be paid to prevention of osteoporosis and risk assessment of fracture and refracture after osteoporosis. This paper reviews the research progress in risk assessment of fracture and refracture after osteoporosis from the aspects of imaging, clinical manifestations and laboratory examination indexes. In recent years, the imaging methods have developed from dual-energy X-ray absorption, trabecular bone scoring and CT to high resolution peripheral quantitative CT; concern for their clinical manifestations has developed from independent risk factors to fracture risk assessment tools; the laboratory tests have developed from bone turnover markers and serotonin to microRNA. Although these developments have consistently increased the sensitivity of risk assessment for fracture and refracture after osteoporosis, problems still exist and need to be resolved.
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Osteoporosis is a metabolic bone disease characterized by decreased bone mass and degenerative changes in the microstructure of bone tissue,leading to increased bone brittleness and fracture risk.Bone fracture after osteoporosis is the most common and serious complication,which often leads to serious consequences in cases of inadequate prevention and late diagnosis.Therefore,more attention should be paid to prevention of osteoporosis and risk assessment of fracture and refracture after osteoporosis.This paper reviews the research progress in risk assessment of fracture and refracture after osteoporosis from the aspects of imaging,clinical manifestations and laboratory examination indexes.In recent years,the imaging methods have developed from dual-energy X-ray absorption,trabecular bone scoring and CT to high resolution peripheral quantitative CT;concern for their clinical manifestations has developed from independent risk factors to fracture risk assessment tools;the laboratory tests have developed from bone turnover markers and serotonin to microRNA.Although these developments have consistently increased the sensitivity of risk assessment for fracture and refracture after osteoporosis,problems still exist and need to be resolved.
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OBJECTIVES: Hip fracture is the most serious consequence of falling in elderly with osteoporosis. Patients with hip fractures suffer functional deterioration and increased morbidity especially during the first year after fracture. Rapid increase in the proportion of the elderly increases the prevalence of hip fractures in Thailand, leading to major problem for public health. There is substantial variation in the incidence of hip fracture in different regions of Thailand. Demographic data are required to improve management and prevention. This study was aimed to describe the demographic data and to determine the incidence of fragility hip fractures in Nan, Thailand. METHODS: A retrospective, cohort study had been conducted in Nan and Pua hospital. Patients with hip fractures were sorted by International Classification of Diseases 10th Revision (S72.0–S72.2) from September 1, 2014 to December 31, 2017. Statistical analyses were conducted using descriptive analysis and 95% confidence interval. RESULTS: The incidence of hip fractures in Nan province in 2015–2017 were 211.6, 214.9 and 238.5 per 100,000 person-years, respectively. There were 876 patients in this study. Higher incidence was found in female (ratio, 2.5:1). About 87.2% of the fracture occurred inside the house. There were 5.9% who had refracture. The median for refracture time was 143 weeks. CONCLUSIONS: The incidence of hip fractures in Nan province was classified as moderate severity and was increasing between 2015 and 2017. A coordinated, multidisciplinary approach in homecare management especially in fall prevention are important factors to reduce incidence of fragility hip fracture.
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Aged , Female , Humans , Accidental Falls , Cohort Studies , Epidemiology , Hip Fractures , Hip , Incidence , International Classification of Diseases , Osteoporosis , Prevalence , Public Health , Retrospective Studies , ThailandABSTRACT
Objective To investigate the clinical therapeutic effects of bone cement-augmented pedicle screw fixation for cement vertebrae refractures with lower limb neurological symptoms after percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic thoracolumbar compression fractures.Methods A total of 123 elderly patients with osteoporotic thoracolumbar compression fractures underwent PKP from December 2013 to December 2016 were retrospectively analyzed by case series study.Twelve patients had vertebral refracture with compression of the spinal cord or cauda equina which resulted in lumbosacral and leg pain,numbness and disability of ambulation and there were five males and seven females,with age of (69.2 ± 7.1) years.Injured vertebrae was located at T12 in five cases,at L1 in five and at L2 in two.Bone cement-augmented pedicle screw fixation through a standard posterior approach was utilized to treat all the 12 patients.Visual analogue scale (VAS),Oswestry disability index (ODI),anterior vertebral height compression ratio,and kyphotic angle at the preoperative time,one week postoperatively and last follow-up were recorded and compared.Intraoperative and postoperative complications were also recorded.Results The mean duration of follow-up in all the patients was 26.7 months (range,12-36 months).Intraoperative nerve injury,dural tear,leakage of bone cement,bone cement toxicity reaction,and pulmonary embolism were not observed during the surgery.The postoperative radiographs for all the 12 patients showed that the bone cement was distributed in cancellous bone and around the screw appropriately where there was no cement leakage out of the vertebral body or pedicle.Compared with preoperative scores,the average low back pain VAS,leg pain VAS and ODI at postoperative one week were improved by (2.2 ± 0.7) points,(2.2 ± 0.4) points and (33.2 ± 8.9) points,respectively (P ＜ 0.01).Anterior vertebral height compression ratio was decreased from preoperative (71.5 ± 11.7) ％ to (18.7 ± 10.3) ％ at postoperative one week (P ＜ 0.01).The mean kyphotic angle was corrected from preoperative (28.3 ± 7.6) ° to (7.1 ± 2.3) ° at postoperative one week (P ＜ 0.01).The symptoms of lumbar pain,and numbness and weakness of lower limbs were improved significantly.There was no statistically significant difference of all the parameters between the last follow-up evaluation and one week post-operatively (P ＞ 0.05).Conclusion For elderly patients with spinal cord or cauda equina nerve compression symptoms after PKP for osteoporotic thoracolumbar compression fractures,the usage of posterior approach bone cement-augmented pedicle screw fixation can effectively correct kyphosis,relieve neurological symptoms and restore spinal stability.
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Objective To investigate the refracture and risk factors after percutaneous vertebroplasty (PVP) in the patients with hormone induced osteoporotic thoracolumbar vertebral fracture.Methods A total of 646 patients with osteoporotic thoracolumbar vertebral fractures in 425 Central Hospital of PLA from April 2010 to July 2015 were selected and divided into the primary osteoporotic thoracolumbar vertebral fractures(n=542) and hormone-induced osteoporotic thoracolumbar vertebral fractures(n=104) according to the fracture types.The incidence rate of refracture was compared between the two types of patients.The patients with hormone induced osteoporotic thoracolumbar fractures were divided into the fracture group and non-fracture group according to the refracture occurrence situation.The clinical data of the two groups were performed the univariate and multivariate Logistic regression analysis.Results There were 542 cases of primary osteoporosis,102 cases had refracture with the incidence rate of 18.82％,104 cases had hormone induced osteoporosis and 53 cases had refracture with the incidence rate of 50.96％.BMI,bone mineral density,bone cement leakage,preoperative vertebral fissure change and proportion of unreceiving anti-osteoporosis treatment had statistical difference between the fracture group and non-fracture group (P＜0.05).Bone mineral density,bone cement leakage,preoperative vertebral fissure change and no anti-osteoporosis treatment were the independent risk factors for refracture after PVP operation in the patients with steroid-induced thoracolumbar vertebral fracture (P＜0.05).Conclusion The patients with hormone induced osteoporotic thoracolumbar vertebral fracture have higher risk of refracture.Bone mineral density,bone cement leakage,preoperative vertebral fissure change,whether accepting anti-osteoporosis treatment are the major risk factors of refracture.
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Objective To investigate the refracture and risk factors after percutaneous vertebroplasty (PVP) in the patients with hormone induced osteoporotic thoracolumbar vertebral fracture.Methods A total of 646 patients with osteoporotic thoracolumbar vertebral fractures in 425 Central Hospital of PLA from April 2010 to July 2015 were selected and divided into the primary osteoporotic thoracolumbar vertebral fractures(n=542) and hormone-induced osteoporotic thoracolumbar vertebral fractures(n=104) according to the fracture types.The incidence rate of refracture was compared between the two types of patients.The patients with hormone induced osteoporotic thoracolumbar fractures were divided into the fracture group and non-fracture group according to the refracture occurrence situation.The clinical data of the two groups were performed the univariate and multivariate Logistic regression analysis.Results There were 542 cases of primary osteoporosis,102 cases had refracture with the incidence rate of 18.82％,104 cases had hormone induced osteoporosis and 53 cases had refracture with the incidence rate of 50.96％.BMI,bone mineral density,bone cement leakage,preoperative vertebral fissure change and proportion of unreceiving anti-osteoporosis treatment had statistical difference between the fracture group and non-fracture group (P＜0.05).Bone mineral density,bone cement leakage,preoperative vertebral fissure change and no anti-osteoporosis treatment were the independent risk factors for refracture after PVP operation in the patients with steroid-induced thoracolumbar vertebral fracture (P＜0.05).Conclusion The patients with hormone induced osteoporotic thoracolumbar vertebral fracture have higher risk of refracture.Bone mineral density,bone cement leakage,preoperative vertebral fissure change,whether accepting anti-osteoporosis treatment are the major risk factors of refracture.
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Objective To investigate and analyze risk factors of re-fracture after operation of osteoporotic hip fracture.Methods Two hundred forty-seven patients receiving operation of osteoporotic hip fracture were retrospectively studied and followed up,and all patients were divided into re-fracture group (54 patients) and no-re-fracture group (193 patients).The related factors such as sex,age,body mass index (BMI),affected side,initial fracture site,operation type,perioperative blood loss,postoperative delirium,postoperative bedridden time,medical complications,Charlson comorbidity index,antiostoporosis therapy,hip function scores with Harris and functional independence measurement (FIM) scores were compared by single factor analysis and multivariate Logistic regression analysis.Results Single factor analysis and multivariate Logistic regression analysis both showed that the risk factors of re-fracture after operation of osteoporotic hip fracture included age,postoperative delirium,hypertension,diabetes mellitus,cerebrovascular disease,antiostoporosis therapy,hip function scores with Harris and FIM scores (P ＜ 0.05 or ＜ 0.01).Conclusions Risk factors of re-fracture after operation of osteoporotic hip fracture include passive factors of age,postoperative delirium and medical complications,and subjective factors of antiostoporosis therapy,hip function scores with Harris and FIM scores.Patients should receive medical treatment positively,enhance antiostoporosis therapy and rehabilitation training of hip function to prevent re-fracture.
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<p><b>OBJECTIVE</b>To evaluate the outcome of Titanium Elastic intramedullary nailing(TEN) for the treatment of refracture of clavicle.</p><p><b>METHODS</b>From March 2010 to March 2016, 9 cases of clavicle fracture, postoperative re-fracture (plate broken before fracture healing, plate and screw pull out or refracture after fracture union and internal fixation removal) included 6 males and 3 females with a mean age of 38.6 years old ranging from 20 to 62 years old; 3 cases were sports injury, 5 cases were traffic injury, 1 case was severe injury. All cases were closed fractures, and 2 cases were multiple fractures. According to OTA(Orthopaedic Trauma Association classification), 2 cases were 06-A1, 1 case was 06-A2, 1 case was 06-A3, 2 cases were 06-B1, 2 cases were 06-B2, and 1 case was 06-B3. Among them, 4 cases were treated with AO titanium elastic intramedullary nail (TEN), and 5 cases of early internal fixation failure of clavicle fracture were treated with plate and screw internal fixation plus bone graft. The time of bone union, VAS score and Constant Shoulder Score were observed and recorded.</p><p><b>RESULTS</b>All incisions healed at stage I without infection. All 9 patients were followed up for a period of 14 months. All patients' implants were removed at 12 months after the second operation without refractures. The Constant score of shoulder joint was from 64 to 94 at 4 weeks after the second operation, 91 to 100 at 4 weeks after implants removal. The average bone healing time was 4.3 months from 3 to 6 months. The pain VAS score decreased significantly and the pain was relieved significantly.</p><p><b>CONCLUSIONS</b>Titanium elastic intramedullary nail (TEN) for the treatment of clavicle fracture after internal fixation of refracture patients can be achieved better outcomes, less trauma, good fracture healing, good postoperative recovery of shoulder joint function, but need to pay attention to the reasonable selection of patients.</p>
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Objective To investigate the treatment of perinail refracture after surgery of proximal femoral fracture.Methods From January 2010 to January 2015,we treated perinail fractures in 31 patients who had undergone surgery for proximal femoral fracture.They were 11 men and 20 women,with an average age of 75.6 years (range,from 24 to 87 years).On average,their refracture occurred 9.4 months after primary fixation (range,from 3 to 60 months).With reference to the Vancouver classification of peri-prosthestic refractures in the proximal femur and the position and bone quality of perinail refractures,we tried to classify the perinail fractures and chose different treatment protocols accordingly.In our cohort,6 were type A,5 type B,15 type C,and 5 type D.Type A cases were treated conservatively,and types B and C cases with locking compression plate or less invasive stabilization system.In one case of type D,dynamic hip screws were implanted to fixate the femoral neck fracture after removal of the original intramedullary nail,and hip replacement was conducted in the other 4 after removal of the original intramedullary nail.Results The operation time averaged 2.1 hours (range,from 1.6 to 3.0 hours) and intraoperative bleeding 600 mL (range,from 150 to 800 mL) in this cohort.Of them,27 were followed up for an average of 15 months (range,from 12 to 24 months),giving a follow-up rate of 87.1％ (27/31).Six type A fractures obtained bone union after protected weight-bearing walking for 12 weeks.All the 16 fractures of types B and C healed after an average period of 4.2 months (range,from 3 to 6 months).Of the 5 type D fractures,one obtained bone union 12 weeks after change into dynamic hip screwing and 4 had fine functional recovery after hip replacement.No infection,nonunion,or implants failure occurred.Conclusions We have set an exploratory classification system for the perinail refractures at the proximal femur with reference to the Vancouver classification of peri-prosthestic refractures.Our classification can provide effective guidance for the treatment of perinail refracture after surgery of proximal femoral fracture.
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Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the 1st and 4th (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.
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Female , Humans , Flank Pain , Fractures, Compression , Lumbar Vertebrae , Polymethyl Methacrylate , Spine , VertebroplastyABSTRACT
OBJECTIVE: To identify risk factors for developing a vertebral refracture after percutaneous vertebroplasty. METHOD: A retrospective analysis of 60 patients who had undergone percutaneous vertebroplasty between January 2008 and April 2010 was conducted. All patients were observed for a 1 year follow-up period, and fracture was defined when it was both clinically reported and radiographically confirmed. Twenty-seven patients with a refractured vertebra and 33 patients without a refracture were included. Of the 60 patients, 20 presented with a refracture from a cemented vertebra, whereas the remaining 40 patients did not. Clinical, imaging and procedure-related factors for each group were analyzed by the Fisher's exact, chi-square, and the Mann-Whitney U-tests. RESULTS: Local kyphotic angle and sagittal index were significant as a result of researching various risk factors related to vertebral refracture (p<0.001, p<0.001, respectively) and refracture from a cemented vertebra itself (p=0.004, p<0.001, respectively). Other factors were not significant. CONCLUSION: Patients who had a high preoperative local kyphotic angle and a high sagittal index required a close follow-up and attention.