Résumé
Percutaneous vertebral augmentation is the most commonly used minimally invasive surgery in the treatment of osteoporotic vertebral compression fractures(OVCF).The efficacy and safety have been widely recognized,however,there are still some complications of percutaneous vertebral augmentation.And the most common complication is bone cement leakage,which can lead to nerve root and spinal cord injury,increase the risk of secondary fractures of adjacent vertebral,and even cause serious complications such as pulmonary embolism.The diagnosis,classification,hazard,influence factors and preventive measures of bone cement leakage in vertebral augmentation for OCVF are reviewed in this paper,which will provide reference for prevention and treatment of bone cement leakage in clinical practice.
Résumé
Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures.Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016.There were 9 males and 3 females,aged (42.7 ± 13.0) years (range,24-63 years).All patients received percutaneous minimally invasive pedicle screw fixation.The operation duration,intraoperative blood loss,length of incision,ambulation time,and time to basic life were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation.Postoperative complications and bone fracture union were observed during the followup period.Results All patients were followed up for average 22 months (range,14-36 months).All patients underwent successful surgery,with operation duration and intraoperative blood loss of (178.0 ± 60.2) min and (116.7 ± 44.2) ml respectively.No serious complications such as blood vessel or nerve injury occurred during the operation.The incision length was 1.2-1.5 cm.All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4 ± 7.3)days postoperatively.At 1,3,6 and 12 months after operation,VAS and ODI differed significantly from the preoperative detections (P ＜ 0.05).During the follow-up,bone fracture union was observed in all patients,with no nail breakage or nail loosening occurred after operation.Conclusion For AS combined with thoracolumbar fractures,minimally invasive fixation can attain satisfactory curative effect,with advantages of minor lesion,little bleeding,fast recovery and sound bone union.
Résumé
Fracture nonunion is the cessation of a normal reparative process of fracture healing. With an incidence of 2.5%-4.4%, it is one of difficult problem for orthopedics surgeons. Definition, classification, treatment and causes of fracture nonunion are reviewed in this article. The therapeutic principles and methods are introduced systematically combined with causes of fracture nonunion.