Résumé
Objective To evaluate the feasibility of percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral burst fractures (OVBF) without nerve injury, and observe the clinical therapeutic effect. Methods A total of 32 patients with primary OVBF without nerve injury were treated by PKP from January 2009 to January 2013. The volume of bone cement intraoperative injection and complications after operation were observed. The visual analog scale (VAS) and Oswesty disability index (ODI) before and after operation were metered to evaluate pain relief and improvement of life quality. The Beck index, Cobb angle and vertebral canal bones occupying rate were metered before and after operation to evaluate the recovery of vertebral body height, correction of kyphosis and change of intraspinal bone block position. Results There were no serious complication occurred. The operation time was (52.05± 7.60) min, the volume of bone cement intraoperative injection was (4.08 ± 1.50) ml. After operation for one day, the VAS decreased from (7.89±0.52) scores to (2.31±0.39) scores, the Cobb angle decreased from (19.15±3.20)°to (11.19±2.58)°, the Beck index increased from 0.46±0.06 to 0.61±0.07, there were significant differences (P<0.01 or<0.05). The rate of spinal bones occupying after operation for one day was not decreased obviously, but after operation for 3 months, it decreased from (17.89±5.03)%to (9.18±4.17)%, there was significant difference (P<0.05).The ODI before operation was (76.89± 6.72) scores, after operation for 3 months was (30.86± 7.25) scores, there was significant difference (P<0.01). Conclusions The pain could be relieved effectively, and the quality of life could be improved by the method of PKP in treating OVBF. Meanwhile, the vertebral body height and kyphosis could be corrected and the rate of spinal bones occupying could not be increased significantly.
Résumé
BACKGROUND:The ligamentum flavum is important to connect the rear of the spine. If the flexibility of the ligamentum flavum is decreased due to degeneration, in the role of various factors, it can reduce the effective space of the spinal canal to induce spinal cord and nerve root compression, thereby resulting in neurological symptoms, even paralysis or residual disease. OBJECTIVE:To study the mechanism of over-dose fluoride on the degeneration and ossification of the ligamentum flavum in rats. METHODS:Thirty male Sprague-Dawley rats were randomly divided into two groups: experimental group was given distiled water containing NaF (mass fraction 10-4) and control group was given the same amount of distiled water. After 3 and 6 months, the bone mineral density, Ca2+ and P3+ contents in serum and bone tissue and serum alkaline phosphatase activity were detected, respectively. Meanwhile, the ligamentum flavum specimens were taken for X-ray examination and histopathological observation. RESULTS AND CONCLUSION: In the experimental group, chalk stripes or spots occurred in the lower incisors of five rats at 3 months after treatment and dental fluorosis that was mostly in chalk color was found in al the rats at 6 months after treatment; moreover, the bone density of the lumbar spine significantly increased (P < 0.05). Compared with the control group, the contents of serum Ca2+ were significantly higher, while the contents of P3+were significantly lower in the experimental group at 3 and 6 months after treatment (P < 0.05); the serum alkaline phosphatase activity was also significantly higher in the experimental group than the control group at 3 and 6 months after treatment (P < 0.05). X-ray films, at 6 months after treatment, showed that the bone density of the lumbar vertebra was increased obviously; pathological observation showed that the number of elastic fibers in the ligamentum flavum was reduced further, a large amount of colagen fibers, fibroblasts and calcium deposition were found, and the ossification of the ligamentum flavum was visible at the lamina attachment site. These findings indicate that the over-dose fluorides can lead to the degeneration and ossification of the ligamentum flavum in Sprague-Dawley rats, which may plan an important role in the ossification of the ligamentum flavum.