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Objective To investigate the risk factors for re-fracture after percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic thoracolumbar compression fractures and to construct a line graph prediction model. Methods One hundred and eighty-two elderly patients with osteoporotic thoracolumbar compression fractures treated with PKP from January 2016 to November 2019 were selected for the study‚ and the patients were continuously followed up for 3 years after surgery. Clinical data were collected from both groups; Receiver operating characteristic (ROC) curve analysis was performed on the measures; Logistic regression analysis was performed to determine the independent risk factors affecting postoperative re-fracture in PKP; the R language software 4. 0 “rms” package was used to construct a predictive model for the line graph‚ and the calibration and decision curves were used to internally validate the predictive model for the line graph and for clinical evaluation of predictive performance. Results The differences between the two groups were statistically significant (P0. 22‚ which could provide a net clinical benefit‚ and the net clinical benefit was higher than the independent predictors. Conclusion BMD‚ number of injured vertebrae‚ single-segment cement injection‚ cement leakage‚ pre-and post-PKP vertebral height difference‚ and posterior convexity angle change are independent risk factors affecting the recurrent fracture after PKP in elderly patients with osteoporotic thoracolumbar compression fracture‚ and this study constructs a column line graph model to predict the recurrent fracture after PKP in elderly patients with osteoporotic thoracolumbar compression fracture as a predictor for clinical. This study provides an important reference for clinical prevention and treatment‚ and has clinical application value.
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Objective:To analyze the long-term efficacy of percutaneous kyphoplasty (PKP) assisted with vitamin D in the treatment of elderly thoracolumbar single vertebral osteoporotic vertebral compression fractures (OVCF) and its effect on transfected bone morphogenetic protein-Effects of 7 (BMP-7) /25-hydroxyvitamin D3 [ (25- (OH) -D3] levels.Methods:106 elderly patients with fresh OVCF of thoracic and lumbar vertebrae who were treated with PKP in Li Huili Hospital of Ningbo Medical Center from Jun. 2017 to Jun. 2021 were selected as the research object, and they were divided into two groups according to the random number table method (53 cases in each group) . Both groups were treated with PKP and received conventional anti-osteoporosis treatment and rehabilitation training. On this basis, patients in the treatment group were given vitamin D therapy. Before treatment and 1, 3, 6, and 12 months after treatment, the degree of pain improvement, Cobb angle improvement, bone mineral density, vertebral body compression rate, vertebral body function recovery and serum BMP-7, 25- (OH) -D3 level, and the cement leakage rate of all subjects within 1 year of follow-up was recorded.Results:Two patients in the observation group and 3 patients in the control group lost to follow-up. Comparing the results of before treatment and 12 months after treatment: the control group’s BMD increased from 0.585±0.042 to 0.755±0.0641; BMP-7 increased from 80.02±6.24 to 129.87±10.52;25- (OH) -D3 increased from 9.15±2.16 to 13.52±2.64;and the treatment group’s BMD increased from 0.576±0.039 to 0.868±0.079; BMP-7 increased from 78.36±6.20 to 153.41±12.70; 25- (OH) -D3 increased from 9.01±2.12 to 16.24±2.81; the treatment group had higher increase ( P<0.05) . Meanwhile the control group’s Cobb angle decreased from 13.54±1.81 to 8.05±1.05; vertebral body compression rate decreased from 28.41±3.47 to 19.86±2.29; ODI score decreased from 74.42±7.37 to 24.08±2.41; VAS score decreased from7.54±0.81 to 2.65±0.25,and the treatment group’s Cobb angle decreased from 13.70±1.89 to 7.42±0.97;vertebral body compression rate decreased from 28.97±3.62 to 18.86±2.02; ODI score decreased from75.78±7.43 to 21.39±2.08; VAS score decreased from7.70±0.891 to 2.32±0.20,while the treatment group decreased more ( P<0.05) . In addition, the vertebral refracture rate in the control group was 22.00% (11/50) , while the vertebral refracture rate in the treatment group was 5.88% (3/51) , and there was a significant difference between the groups ( χ 2=5.125, P=0.024) . Conclusion:PKP combined with vitamin D in the treatment of elderly thoracolumbar OVCF can significantly improve the levels of BMP-7 and 25- (OH) -D3, better restore bone mineral density, vertebral body function and correct kyphosis, with a more ideal long-term efficacy.
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BACKGROUND: With the aging of the society, the number of patients with osteoporotic vertebral fracture is increasing, mainly manifesting compression fracture of thoracolumbar body, which seriously affects the daily life of the elderly. Therefore, to study the relationship between the degree of external force and the performance of osteoporotic thoracolumbar body fracture on MRI STIR is to provide a better basis for clinical diagnosis and treatment. OBJECTIVE: To explore the relationship between the size of external force and a linear black signal area of STIR image in MRI of thoracic and lumbar osteoporosis vertebral compression fractures. METHODS: The hospitalized patients, who were diagnosed as thoracic and lumbar osteoporosis vertebral compression fractures, were retrospectively analyzed from September 2013 to September 2016 at the Department of Spine Surgery of The First Affiliated Hospital of Guangxi University of Chinese Medicine. All cases in the three groups were diagnosed as osteoporosis by quantitative CT (bone mineral density ≤80 mg/cm3). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into three groups according to the different trauma history: Non-obvious external force group (without apparent cause or external force), low energy group (sprains, bent down to lift heavy objects, and carrying heavy items), high energy group (flat road down hips touchdown, falls, and bruise). Gender, age, fracture site (thoracic lumbar segment and non-thoracic lumbar segment), the number of the vertebrae and the position where would they occur with a linear black signal area of STIR image in MRI were analyzed in each group. Age was analyzed by analysis of variance. Gender, fracture site and the number of the vertebrae and the position were analyzed by Pearson chi-square test. RESULTS AND CONCLUSION: (1) All the 782 cases were included in the three groups. There were 334 in the non-obvious external force group, which a linear black signal area of STIR image in MRI existed in 114 cases. There were 186 cases in low energy group, which a linear black signal area of STIR image in MRI existed in 124 cases. There were 262 cases in high energy group, which a linear black signal area of STIR image in MRI existed in 87 cases. (2) The age, gender, fracture site and the number of the vertebrae and the position in three groups were not statistically significantly different among the three groups (P > 0.05). (3) There were significant differences in a linear black signal area of STIR image in MRI among the three groups (P 0.017). (4) The occurrence rate of linear black signal area of STIR image in MRI was 66.7% and higher than other groups (43.1% and 33.2%). (5) In the history of trauma, low energy in external force has more opportunity to cause a linear black signal area of STIR image in MRI than non-obvious external force and high energy; and they often occur in thoracic and lumbar osteoporosis vertebrae.
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Objective To investigate the clinical effect of combination of compaction and psychological intervention on osteoporotic thoracolumbar compression fractures. Methods Two groups of patients with osteoporotic thoracolumbar compression fractures were treated with percutaneous kyphoplasty, and the control group was treated with dense and auxiliary treatment. The changes of NRS scale scores before and after treatment in two groups of osteoporotic thoracolumbar compression fractures were recorded. The data were input into SPSS software and analyzed and concluded. Results Two groups of osteoporotic thoracolumbar compression fracture patients before treatment NRS score had no significant difference between; NRS scores in study group is lower than before significantly better than the control group, comparing the data of P<0.05. Conclusion Osteoporotic thoracolumbar compression fractures underwent surgical treatment after Aclasta, combined with psychological intervention can significantly improve clinical efficacy, has positive significance to guarantee the quality of life of patients, life safety.
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PURPOSE: We are to find the method to objectify postoperative prognosis, analyzing the factors confluencing the result of kyphoplasty in osteoporotic vertebral compression fracture (OVCF). MATERIALS AND METHODS: Our study included 50 patients (55 vertebral bodies) who have undergone kyphoplasty from Sep. 2004 until Oct. 2005. We divided in the group according to bone mineral density (BMD), compression rate, recovery rate and cement leakage. We verified the significance of each group, using independent t-test, and ANOVA test among observers. RESULTS: We performed kyphoplasty on 55 vertebral bodies, 12 cases with more than 0.4 g/cm2 in BMD (mean: 0.53 g/cm2) and their mean preoperative compression rate (CR), immediate postoperative recovery rate (RR-IPO), and recovery rate after 6 months (RR-6M) was each 30.58%, 12.35%P, 9.93%P. 15 cases under 0.4 g/cm2 (mean 0.31 g/cm2), and their CR, RR-IPO and RR-6M was 26.73%, 11.77%P, 5.26%P respectively. The p-value was 0.004. Another studies according to CR, RR-IPO and leakage of cement revealed the better results in the cases of the lower CR, the smaller reduction and abscecnce of cement leakage, but statistically insignificant (p=0.309, 0.069, 0.356). CONCLUSION: Preoperative BMD was most important factor that confluencing postoperative radiological result in OVCF. Other factors were also thought to be confluencing factors, but statistically insignificant..
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Humanos , Densidade Óssea , Fraturas por Compressão , Cifoplastia , Métodos , Osteoporose , PrognósticoRESUMO
[Objective]To investigate the biomechanical properties of transpedicular impacted grafting(TPIG) after bone loss calculation in the treatment of thoracolumbar compression fracture.[Method]Six fresh human thoracolumbar spine(T12-L2) specimens were tested as 6 models: normal control(group A),compression fracture(group B),TPIG after bone loss calculation(group C),transpedicular grafting(TPG)(group D),TPIG after bone loss calculation + pedicle fixation(group E),TPG + pedicle fixation(group F).Biomechanical analysis was carried out to test the intensity,stiffness,stability and torsion properties between different groups.[Result]The intensity,stiffness and stability of vertebral body and intervertebral disc in group E were higher than those in group F,with significant difference(P
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PURPOSE: To evaluate whether progression of compression correlates with bone densiometry index in patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine. MATERIALS AND METHODS: Using the results of bone densiometry, 30 patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine between March 2002 to March 2005 were categorized into 4 groups; above 80%, 70 to 80%, 60 to 70%, and below 60%. We compared the measurements of sagittal index and anterior vertebral height from the plain radiographs taken at the time of injury and following three consecutive months after the injury. RESULTS: Patients with lower bone densiometry index had greater amount of compression at the time of injury and more rapid progression of compression. We also found that progression of compression was lowest during the first month after injury in all groups. CONCLUSION: Patients with low bone densiometry index in osteoporotic thoracolumbar compression fracture are susceptible to more rapid progression of compression and should have early brace application and longer duration of treatment for osteoporosis.
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Humanos , Densidade Óssea , Braquetes , Fraturas por Compressão , Osteoporose , Coluna VertebralRESUMO
Conventional radiographs and simple CT scans fail to provide accurate information about the structural integrity of a fracture site. In recent years, special 3-dimensional CT scanning has been progressively developed, and we applied this technique to thoracolumbar compression fractures. Posterolateral spinal fusion with iliac bone graft was attempted in all patients; Comparative pre- and post-operative change in these fractures was then an-alysed, using 3-dimensional CT. The results of this study suggest that this imaging is a useful non-invasive technique to assess compression fracture and determine prognosis.