RESUMO
Objective To explore the clinical characteristics of the distant pain associated with osteoporotic vertebral compression fracture (OVCF) and the effect of percutaneous kyphoplasty (PKP) on the distant pain. Methods Ninety-eight patients with OVCF were treated with PKP at our department from June 2013 to October 2016. They were divided into 2 groups according the their pain associated with OVCF. There were 34 patients in the distant pain group and 64 ones in the non-distant pain group. The sites of distant pain were recorded. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess the pain and disability severities preoperatively and postoperatively. Results The incidence of distant pain was 34.7% (34/98). The distant pain was located at the lumbosacral area in 24 cases, at the hip in 14 cases, at the iliac crest in 14 cases, at the thigh in 14 cases, and at the calf in 2 cases. The distant pain group had a significantly longer course of preoperative disease (15.3 ± 12.9 d) than the non-distant pain group (10.3 ± 7.0 d) (P <0.05). The postoperative VAS and ODI were significantly improved after surgery in both groups (P <0.05). There were no significant differences between the 2 groups in preoperative or postoperative VAS or ODI (P > 0.05). Conclusions The incidence of distant pain may be high in OVCF patients. The most common sites for distant pain are the lumbosacral area, hip, iliac crest and thigh. PKP can effectively relieve the distant pain associated with OVCF.
RESUMO
Objective To evaluate surgical treatment of chronic tibial osteomyelitis of Cierny-Mader type Ⅳ with Ilizarov technique and lesion osteotomy. Methods From January 2010 to May 2016, 39 patients with chronic tibial osteomyelitis of Cierny-Mader type Ⅳ were treated at our center. They were 33 males and 6 females, 8 to 54 years of age (average, 33.8 years). After debridement and lesion osteotomy, the tibia was fixated with Ilizarov external fixator. Bone was transported to the bone defect after corticotomy was performed on the proximal and/or distal tibial metaphyses simultaneously. Bifocal corticotomy was per-formed in 11 cases, proximal corticotomy in 21 cases, and distal corticotomy in 7 cases. The transport began 3 to 5 days after operation at a speed of 0.5 to 1.0 mm/d initially. The speed was lowered according to the bone healing and pain. Radiographic examination was done every 2 weeks to observe transporting deviation and osteogenesis in the transporting area. The transporting was adjusted whenever any abnormality was observed. The bone transporting lasted for 50 to 130 days (average, 62.4 days). Results The patients were fol-lowed up for 11 to 49 months (average, 21 months). All the soft tissue wounds healed uneventfully and there was no relapse of osteomyelitis. The bone defects in the 32 cases were reconstructed primarily. Nonunion of fracture ends happened in 5 cases and nonunion of the bone lengthening zone in 2 cases. The 7 cases of nonunion were healed after secondary bone grafting. Malalignment happened in 5 cases, 4 of which responded to timely adjustment of the external fixation and one of which had to receive secondary bone grafting after failure in adjustment of the external fixation. Ankle joint dysfunction occurred in 7 cases, 5 of which re-sponded to functional exercise and 2 of which accepted joint dysfunction because they refused surgery after unsatisfactory functional exercise. Pin tract infection of different severities occurred in 9 cases, one of which was treated by replacement of the K-wires under local anesthesia and the other 8 of which responded to rein-forced dressing change. Conclusions Chronic tibial osteomyelitis of Cierny-Mader typeⅣcan be treated by Ilizarov technique and lesion osteotomy. However, the Ilizarov technique should be improved because of the risks of multiple complications which can be reduced significantly by strengthening postoperative instruction, nursing, and regular follow-up.