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Objective@#To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF).@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015. There were 54 males and 82 females, aged 55 to 83 years old, with an average age of 68.3 years. All the enrolled patients had single segment vertebral compression fractures, whose compression degree was ≥1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies. Among them, 59 patients were treated with simulated optimal reduction combined with PVP (PVP group), and 77 patients were treated with PKP (PKP group). The operation time, intraoperative fluoroscopy time, incidence of bone cement leakage, hospitalization cost and length of stay were compared between the two groups. Postoperative X-ray and CT examination were performed to observe bone cement diffusion. Before surgery and after surgery (1 day, 1 week, 1 month, 6 months, 1 year, 2 years and 3 years), Visual analogue scale (VAS) score, Oswestry disability index (ODI) scores, Cobb's angle, ratio of anterior and middle height of the affected vertebrae, and the incidence of vertebral refractures within 3 years were compared between the two groups.@*Results@#All the patients were followed up for 29-43 months, averaging 36 months. One patient in the PVP group was lost to follow-up after one year. In the PKP group, two patients were lost to follow-up after one year and one patient was lost to follow-up after two years. In the PVP group, single vertebral body operation time [(28.9±5.7)seconds] and intraoperative fluoroscopy time [(54.0±13.4)seconds] were significantly less than those in the PKP group, with statistically significant differences (P<0.01). The incidence of bone cement leakage in the two groups was 8.5% and 7.8%, respectively, with no significant difference (P>0.05). The hospitalization cost in the PVP group [(9.7±3.2)thousand yuan] was lower than that in the PKP group [(22.35±16.2)thousand yuan](P<0.01). The diffusion coefficient in PVP group (2.40±0.27) was higher than that in the PKP group (2.29±0.19) (P<0.01). In both groups, the fractured vertebral anterior height ratio, fractured vertebral middle height ratio and Cobb's angle were significantly improved after operation (P<0.01), while there were no significant differences between the two groups (P>0.05). In both groups, the VAS and ODI were significant decreased after operation (P<0.01). Better results were obtained in PVP group than the PKP group concerning the VAS [(2.5±0.8)points vs. (2.6±0.9)points, (2.7±0.3) points vs. (2.8±0.5)points, (2.8±0.6) points vs. (2.9±0.7)points] and ODI [(25.3±4.0 vs. 25.5±3.9, 25.8±4.1 vs. 27.5±4.0, 26.0±2.9 vs. 28.6±3.9)] at postoperative 1, 2 and 3 years, and there were no significant difference between the two groups at postoperative 1 day, 1 week, 1 month and 6 months (P>0.05). The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in the PKP group (0 vs. 1.3%)(P<0.01).@*Conclusion@#For OVCF, the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP, but the recovery of height of diseased vertebra and correction of kyphosis are better, with lower re-fracture rate of adjacent vertebra in the later stage.
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Objective To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF).Methods A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015.There were 54 males and 82 females,aged 55 to 83 years old,with an average age of 68.3 years.All the enrolled patients had single segment vertebral compression fractures,whose compression degree was ≥ 1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies.Among them,59 patients were treated with simulated optimal reduction combined with PVP (PVP group),and 77 patients were treated with PKP (PKP group).The operation time,intraoperative fluoroscopy time,incidence of bone cement leakage,hospitalization cost and length of stay were compared between the two groups.Postoperative X-ray and CT examination were performed to observe bone cement diffusion.Before surgery and after surgery (1 day,1 week,1 month,6 months,1 year,2 years and 3 years),Visual analogue scale (VAS) score,Oswestry disability index (ODI) scores,Cobb's angle,ratio of anterior and middle height of the affected vertebrae,and the incidence of vertebral refractures within 3 years were compared between the two groups.Results All the patients were followed up for 29-43 months,averaging 36 months.One patient in the PVP group was lost to follow-up after one year.In the PKP group,two patients were lost to follow-up after one year and one patient was lost to follow-up after two years.In the PVP group,single vertebral body operation time [(28.9 ± 5.7) seconds] and intraoperative fluoroscopy time [(54.0 ± 13.4)seconds] were significantly less than those in the PKP group,with statistically significant differences (P ＜ 0.01).The incidence of bone cement leakage in the two groups was 8.5％ and 7.8％,respectively,with no significant difference (P ＞ 0.05).The hospitalization cost in the PVP group [(9.7 t3.2) thousand yuan] was lower than that in the PKP group [(22.35 ± 16.2) thousand yuan] (P ＜ 0.01).The diffusion coefficient in PVP group (2.40 ± 0.27) was higher than that in the PKP group (2.29 ± 0.19) (P ＜ 0.01).In both groups,the fractured vertebral anterior height ratio,fractured vertebral middle height ratio and Cobb's angle were significantly improved after operation (P ＜ 0.01),while there were no significant differences between the two groups (P ＞0.05).In both groups,the VAS and ODI were significant decreased after operation (P ＜ 0.01).Better results were obtained in PVP group than the PKP group concerning the VAS [(2.5 ± 0.8) points vs.(2.6 ± 0.9) points,(2.7 ± 0.3) points vs.(2.8 ± 0.5) points,(2.8 ± 0.6) points vs.(2.9 ±0.7)points] and ODI [(25.3 ±4.0 vs.25.5 ±3.9,25.8 ±4.1 vs.27.5 ±4.0,26.0 ±2.9 vs.28.6 ±3.9)] at postoperative 1,2 and 3 years,and there were no significant difference between the two groups at postoperative 1 day,1 week,1 month and 6 months (P ＞ 0.05).The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in thePKP group (0 vs.1.3％) (P ＜ 0.01).Conclusion For OVCF,the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP,but the recovery of height of diseased vertebra and correction of kyphosis are better,with lower re-fracture rate of adjacent vertebra in the later stage.
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Objective to investigate the clinical efficacy of decompression and pedicle screw fixation through posterior approach for complete thoracic spine fracture dislocation.Methods The clinical data of six patients with complete thoracic spine fracture and dislocation treated from September 2002 to June 2016 were analyzed retrospectively by case series study.There were five males and one female,aged 21-67 years old (mean,47.2 years).The injury segments were T3～4 dislocation in one case,T5～6 dislocation in two cases,T6 ～7 dislocation in two cases and T8 ～9 dislocation in one case.There was one case of ASIA grade E and five cases of Grade A,and all of six cases were associated with multiple rib fractures and hemopneumothorax.The companied status was one case of sternal fracture,one case of atlantoaxial complex fractures and three cases of pulmonary contusion.The posterior median incision decompression and pedicle screw system fixation were performed,and the intervertebral bone grafting was conducted after restoration.The surgery time,bleeding volume during surgery,fracture restoration,bone grafting fusion,failure of internal fixation and other complications were recorded.The Visual Analogue Scale (VAS) and American Spinal Injury Association (ASIA) classification were used to assess the pain and neurological function improvement between the preoperative visit and final follow-up visit.Results The surgery time was 150-240 minutes (mean,205 minutes).The bleeding volume during the surgery was 700-2 100 ml (mean,1167 ml).One case was died of pulmonary infection at one week after surgery,the others were followed up for 3-14 months (mean,7.4 months).After operation,five patients were satisfied with the reduction,and the lateral displacement was partially restored in one cases.Five cases of intervertebral bone grafting all had bone fusion.There was no fixation failure.The VAS was (7.4 ± 0.6) points before surgery,(4.5 ± 1.6) points at one week after surgery and (1.8 ± 0.3) points at final visit of follow-up,which had significant difference from the preoperative status (P ＜ 0.05).One case of ASIA grade E had no postoperative aggravation and four cases of grade A had no improvement.Conclusion Posterior decompression and pedicle screw fixation system is optimal choice of treatment for complete thoracic fractures and dislocations for it can attain reduction of fracture and dislocation as well as bone fusion,provide stability for spine and relieve pain.
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BACKGROUND:In recent years, with the development of minimaly invasive techniques, the application of percutaneous pedicle screw fixation techniques gradualy become widespread, but in the percutaneous pedicle screw fixation for thoracolumbar fractures, due to lack of reduction apparatus or power defect, the reduction of the injured vertebra is poor. In order to improve this deficiency, we design a percutaneous pedicle screwsystem in order to achieve the desired effect of reduction. OBJECTIVE:To investigate the two different effects for treating unstable thoracolumbar fractures by fixing RTS (rotation softened trauma fixation system) or SEXTANT screws under minimaly invasive technology. METHODS:From October 2011 to June 2013, 50 patients who suffered from single-segment thoracolumbar fractures without any nerve-injured symptoms were treated by using percutaneous pedicle screws. Among them, 25 cases used Sextant screws; the others used RTS screws. Data were compared between the two groups, including the height of injured vertebrae, Cobb’s angle, visual analogue scale scores and Oswestry disability index 1 week, 3 and 6 months postoperatively, and during final folow-up. RESULTS AND CONCLUSION:(1) Al patients were folowed upfor8-18 months. (2) The height of injured vertebrae and Cobb’s angle were restored in both groups, showing significant differences (P<0.01). The restoration of the height of injured vertebrae and Cobb’s angle was better in the RTS group than in the SEXTANT group after treatment (P< 0.05-0.01). (3) The visual analogue scale scores and Oswestry disability index were significantly better in the RTS group than in the SEXTANT group 6 months postoperatively and during final folow-up (P< 0.05). (4) These results suggest that both RTS and SEXTANT systems can effectively repair single-segment thoracolumbar fractures without any nerve-injured symptoms. However, it is clear that the recovery of the height ofthe vertebral body is more satisfied and the postoperative pain and dysfunctionweremore minor in the RTS group.
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Objective To analyze the epidemiologic features of traumatic spinal fracture so as to improve its prevention and treatment levels.Methods A total of 1393 patients with spinal fractures(955 males,438 females,at age range of 4-89 years,mean 45.5 years)treated between May 2001 and May 2011 were reviewed to statistically analyze their epidemiologic characteristics.Results The age of all the patients was mainly focused at 30-49 years,accounting for 49.7％(692/1393).Males exceeded females in number among the five age groups below 59 years old,but the opposite tendency appeared in the two age groups above 60 years old.Fall from height and traffic accidents were the main injury causes,which accounted for 59.4％(827/1393).Among 1963 injury segments,cervical vertebral injury,thoracic vertebral injury,lumbar vertebral injury,sacrum and coccyx injury accounted for 23.8％(468/1963),31.9％(627/1963),43.9％(861/1963)and 0.4％(7/1963)respectively.Spinal fractures occurred largely in thoracolumbar segment(T10-L2),which accounted for 55.4％(1087/1963),and L1,T12 and L2 occupied 22.5％(441/1963),5.4％(303/1963),11.1％(218/1963)respectively.The predilection sites of fractures in cervical vertebrae were C2(6.4％,123/1963),C5(5.3％,105/1963)and C6(4.0％,78/1963)respectively.Of the patients with multiple level spinal fractures,the injury resulted from fall from height and traffic accidents accounted for 35.9 ％(78/217)and 17.1％(37/217)respectively.Of the patients with combined injury,the injury caused by fall from height and traffic accidents occupied 48.1％(176/366)and 25.1％(92/366)respectively.According to the American Spinal Injury Association(ASIA)scale,the injury degree of all the patients was mainly grade E(52.6％,733/1393),D(21.0％,293/1393)and A(15.3％,213/1393).A total of 1038 patients had surgical treatment.Their spinal function was mainly graded as level E(48.0％,498/1038),D(22.2％,231/1038)and A(17.1％,177/1038)pre-operatively,but the rates of patients with level E spinal function increased to 56.6％(588/1038)three weeks post-operatively.Conclusions The epidemiologic survey reveals that fall from height and traffic accidents are the main factors for spinal fractures and can easily lead to multi-level spinal fractures and systematic complications.Thereby,prevention and treatment methods should be designed according to the injury characteristics.