Analysis of related risk factors for the refracture of adjacent vertebral body after percutaneous kyphoplasty / 中国骨伤

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.

Clinical effect of posterior atlanto axial vertebra internal fixation for treatment of instability of occipitocervical / 中国骨伤

<p><b>OBJECTIVE</b>To explore radiographic results and clinical effects of posterior atlanto axial vertebra internal fixation in treating instability of occipitocervical.</p><p><b>METHODS</b>The clinical data of 155 patients with instability of occipitocervical treated by posterior atlanto axial vertebra internal fixation were respectively analyzed from September 2005 to January 2011. There were 68 males and 87 females, ranging in age from 6 to 75 years old with an average of 45.6 years old. Of them, 53 cases were fresh odontoid fractures(Aderson type II C), 30 cases were os odontoideum, 20 cases were old odontoid fractures, 18 cases were unstable atlas fractures, 12 cases were atlanto axial rotatory dislocation, 11 cases were atlanto axial dislocation after rheumatoid arthritis, and 11 cases were basilar invagination. Radiographic results were evaluated in terms of atlas pedicle screw fixation, bone healing and bone graft fusion. Clinical effect evaluation included relief of pain in the occipital-cervical region by VAS score and JOA score.</p><p><b>RESULTS</b>Totally 300 screws were set through atlas pedicle screw fixation in 150 patients. Five patients receivde hook fixation. Postoperative CT showed ideal nailing were 275 (91.7%),acceptable nailing were 14 (4.7%) and unacceptable nailing were 11 (3.6%). All patients were followed up, and the duration ranged from 16 to 40 months with an average of 25.4 months. The fresh fractures healed and 140 cases got bone graft fusion. Preoperative VAS and JOA score were respectively improved from (7.2 +/- 1.1), (7.3 +/- 2.4) to (3.2 +/- 1.1), (13.3 +/- 2.4) at the latest follow-up.</p><p><b>CONCLUSION</b>Posterior atlanto axial vertebra internal fixation in treating instability of occipitocervical can effectively recover physiological curvature of cervical, provide mechanical stability, and obtain good clinical effect. For the young patients who require further activity, posterior fixation and non-fusion technology is a good choose, which can avoid bone graft.</p>

Arthroscopic treatment of acute patellar dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate therapeutic effects of arthroscopic treatment for acute patellar dislocation.</p><p><b>METHODS</b>From May 2002 to March 2009, 36 patients with acute patellar dislocation were treated with arthroscopy, including taking out of the free cartilage chips, relaxing lateral retinaculum and tight suturing medial retinaculum. Among the patients, 6 patients were males and 30 patients were females, ranging in age from 12 to 30 years (averaged, 20.5 years). Fifteen patients had the dislocations on the left an 21 patients had the dislocations on the right. The development of condyles of femur and Q trianglel were detected by preoperative radiology. The Lysholm criteria system was used to evaluate the clinical effects.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 13 to 60 months (averaged, 42 months). All the patients had no complications such as infection, and the knee range of motion recovered to normal without pain. The Lysholm score improved from preoperative (28.9 +/- 2.5) to postoperative (95.1 +/- 8.4). All the patients had no redislocation.</p><p><b>CONCLUSION</b>Acute dislocation of the patella is an potential devastating injury. The arthroscopic treatment for acute patellar dislocation has advantages such as less trauma, faster recovery and more reliable.</p>