The distribution of bone cement in the vertebral body after percutaneous vertebral augmentation for osteoporotic vertebral compression fractures / 中华骨科杂志

Percutaneous vertebral augmentation, including percutaneous vertebroplasty and percutaneous kyphoplasty, has been considered as an effective and safe option in treating osteoporotic vertebral compression fractures. The fractured vertebrae were strengthened by the bone cement injected, thus reducing the symptoms related to fracture. Bone cement injected intraoperatively can be divided into extraspinal (leakage) and intraspinal part, depending on its final location. The former may lead to pulmonary embolism, spinal cord or nerve injury, or some other sequelae; the latter may closely relate to the clinical outcome, radiological outcomes, surgical complications and biomechanical properties. To date, there were a large number of studies on term of the distribution type of bone cement. However, the classification criteria varied and there was lack of literature review on this issue. According to the literature reviewed, the distribution type of bone cement was a critical parameter in percutaneous vertebral augmentation; most classification systems were based on the postoperative X-ray, some based on the postoperative CT, and only a few based on postoperative MRI; in different classification systems, criteria on bone cement morphology tends to be consistent, however, criteria on bone cement range tends to be inconsistent, consistency, similarity and controversy all exited among conclusions between various studies on the morphology and range of bone cement; any single classification system can not describe the distribution of bone cement thoroughly. In this study, classification systems were reviewed, clinical significance and biomechanical conclusions of different classification systems were documented, and the reliability and limitations of classification systems were summarized, hence providing an insight for further research on classifications of the bone cement distribution.

Risk factors for cement leakage in percutaneous vertebroplasty for Kümmell disease / 中华骨科杂志

Objective:To identify risk factors for cement leakage in percutaneous vertebroplasty (PVP) for Kümmell disease.Methods:A total of 309 patients (351 levels) with Kümmell disease who underwent PVP between November 2015 and June 2019 were retrospectively reviewed. Age, gender, time of symptom onset, staging of Kümmell disease, fracture site(thoracic, lumbar), cortical disruption, type of fracture (wedge, biconcave, crush), fracture severity (mild, moderate, severe), intrusion of posterior wall, basivertebral foramen, puncture approach (unilateral, bilateral), cement distribution pattern (lumped, spongy), cement volume, cement leakage (yes, no) and cement leakage type were recorded. Cement leakage was classified into three types: through the basivertebral vein, through the cortical defect, and through the segmental vein. The data was analyzed by univariate and multivariate analysis to determine related factors of cement leakage in general and each type.Results:The rate of overall leakage was 65.8% (231/351). The leakage rate of basivertebral vein type, cortical defect type, and segmental vein type was 21.4% (75/351), 37.6% (132/351) and 22.8% (80/351), respectively. Multivariate analysis showed that three significant factors related to leakage in general were cortical disruption, basivertebral foramen and cement distribution pattern. Significant factors related to basivertebral vein type leakage were basivertebral foramen and cement distribution pattern. Significant factors related to cortical defect type leakage were cortical disruption and cement distribution pattern. Significant factors related to segmental vein type leakage were basivertebral foramen, cement distribution pattern, cement volume and fracture site.Conclusion:Risk factors of cement leakage in PVP for Kümmell disease include cortical disruption, basivertebral foramen and cement distribution pattern.

Radiological characteristics and clinical manifestation of isolated lumbar foraminal stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss radiological characteristics and clinical manifestation of isolated lumbar foraminal stenosis.</p><p><b>METHODS</b>From March 2011 to March 2014, 21 patients with isolated degenerative lumbar foraminal stenosis accepted lumbar decompression and fusion in Beijing Luhe Hospital. Intervertebral disc space was evaluated by measuring the position of joint-body line on preoperative X-ray. Bilateral foraminal area of the corresponding segment in CT (sagittal view of 2D reconstruction) and MRI (T2W1 sagittal view) were measured by Surgimap software. For patients with unilateral symptoms, foraminal area of the affected side was compared with that of the contralateral side. Foraminal area of the same segment on CT was also compared with that on MRI. Preoperatively and at the final follow-up, visual analogue score (VAS) and Oswestry Disability Index (ODI) were used to evaluate clinical outcomes.</p><p><b>RESULTS</b>All patients had a follow-up over 6 months and the average follow-up was 16.8 months (7-42 months). Of the 21 patients (26 segments), 12 segments showed gross narrowing and 14 segments showed slight narrowing. After preoperative measurement on MRI, 6 patients had foraminal stenosis of grade 2, and 15 patients had foraminal stenosis of grade 3, showing no significant difference in clinical outcomes. Compared with the foraminal area of the unaffected side, the affected side showed a decrease of 16% on CT and 28% on MRI, and the difference was statistically significant (t = 3.453, P < 0.05). The foraminal area measured on CT was larger than that measured on MRI (P < 0.05). Compared with that preoperatively, VAS (back pain), VAS (leg pain) and ODI showed significant improvement at the final follow-up (P < 0.05).</p><p><b>CONCLUSIONS</b>Radiological examinations as X-ray, CT, MRI and intervertebral foramen block technique play an important role in the diagnosis of foraminal stenosis. Soft oppression caused by hyperplasia and hypertrophy of transforaminal ligment or joint capsule may be important promoters of degenerative lumbar foraminal stenosis. Lumbar foraminal decompression and interbody fusion can satisfactorily improve preoperative symptoms.</p>

Clinical observation of lumbar muscle strain treated by Biqi Capsule / 中华中医药杂志

Objective:To study curative effect of Biqi Capsule on lumbar muscle strain. Methods:120 patients who meet the full diagnostic criteria were grouped into the treatment group (66 patients) and the control group (54 patients) at random. The treatment group was treated with Biqi Capsule per os,while the control group was treated with western medicine Composite Chlorzozazone tablets per os.The comprehensive curative effects on the two groups were summarized.Results:The total effective rate of the treatment group and the control group were 92.4% and 79.6% respectively;No significant differences in two groups in statistics (P=0.06).The VAS score of the treatment group and the control group were (0.95?1.63) and (1.83?2.39) respectively.The curative effect was found to be better in the treatment group than that in the control group (P