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BACKGROUND:Bone cement solidification can improve the stability, strength and mechanical support of fractured vertebrae. However, there are few studies on the effect of bone cement dispersion within the fracture line on percutaneous vertebroplasty. OBJECTIVE:To analyze the effect of bone cement dispersion within the fracture line of thoracolumbar osteoporotic vertebral compression fractures on percutaneous vertebroplasty. METHODS:Totaly 90 patients with thoracolumbar osteoporotic vertebral compression fractures were enroled, 53-80 years old, including 42 males and 48 females. Al these patients underwent percutaneous vertebroplasty with bone cement injection, and divided into two groups according to bone cement dispersion conditions: study group with good bone cement dispersion (n=60) and control group with poor bone cement dispersion (n=30). Visual analogue scale scores, Oswestry dysfunction index, Cobb's angle and adverse reactions were recordedbefore and after treatment. RESULTS AND CONCLUSION:There were no differences in the visual analogue scale score and Oswestry dysfunction index between the two groups before treatment (P > 0.05). The visual analogue scale scores were significantly lower in the study group than the control group at 3 days after treatment and at the last folow-up (P < 0.05); the Oswestry dysfunction index and Cobb's angle were also lower in the study group than the control group at 3 days after treatment (P < 0.05). However, no difference was found in the Oswestry dysfunction index, Cobb's angle and bone cement leakage between the two groups at the last folow-up. These findings indicate that the percutaneous vertebroplasty show better effects on pain relief in patients with good bone cement dispersion that those with poor bone cement dispersion, and the vertebral stability is better as wel as the short-term effect is more obvious.
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Objective To study the curative effect of prosthetic replacement for femoral neck frac-tures at the hemiplegic extremity in the elderly with previous stroke. Methods From May 1990 to May 2000, 189 elderly patients with femoral neck fractures were treated with prosthetic replacement. 29 cases were of previous stroke with femoral neck fractures (Garden type Ⅲ and type Ⅳ) at hemiplegic extremity. 30 non-hemiplegia cases were adopted randomly as control. Two group patients were subjected to a follow-up study for 2 years and 3 months to 8 years and 2 months(average 4 years and 11 months) to compare the differences of ages, hospitalization days, operation time, blood loss, blood transfusion, complications during perioperative period and short-term complications with each other as well as the results of femoral head re-placement versus total hip replacement in treatment of hemiplegia group. Results Two group patients sur-vived during perioperative period. The ages, hospitalization days, operation time, blood loss and blood trans-fusion were of no significant difference in two groups, while complications during perioperative period were of significant difference. 5 patients died in hemiplegia group and 2 patients died in non-hemiplegia group at 11 months to 5 years follow-up. Mortalities were 17.2% and 6.7% respectively. Short-term complication rate was of no significant difference in 2 groups. In hemiplegia group, short-term complication rate of femoral head replacement were significantly higher than that of total hip replacement. Conclusion Prosthetic re-placement is reliable to treat Garden type Ⅲ and type Ⅳ of femoral neck fractures of the hemiplegic ex-tremity in the elderly with previous stroke. Complications during perioperative period are more in hemiplegia group, but short-term complications are of no significant difference in 2 groups. Mortality of hemiplegia group is higher than in non-hemiplegia group in 5 years after operation. Total hip replacement should be in-dicated in treatment of Garden type Ⅲ and type Ⅳ of femoral neck fractures of the hemiplegic extremity in the elderly with previous stroke on condition that hip muscular strength is beyond Ⅳ degree.
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Objective To evaluate the life quality in the elderly who underwent internal fixation with cannulated screws and bipolar hemiarthroplasty for the displaced femoral neck fractures. MethodsA retrospective study was performed on 141 cases older than 60 years treated from 1993 to 2004. All cases were followed up for mean 40.2 months to evaluate the differences in regard of pain and daily living at one and three years. Results The daily living in hemiarthroplasty group possessed better outcome than that in internal fixation group at one year, with statistical difference but without statistical difference at three years. There was no statistical differences in postoperative pain relief between both groups. Conclusions Both internal fixation and hemiarthroplasty can relieve pain and revive the life quality of the elderly.