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Objective:To retrospectively compare the clinical efficacy of percutaneous vertebroplasty and biopsy by unilateral and bilateral pedicle approaches for the treatment of vertebral metastasis.Methods:From June 2020 to July 2022, a total of 82 patients with vertebral metastasis underwent percutaneous vertebroplasty and biopsy treated in Linyi Cancer Hospital were enrolled, 39 patients with 57 vertebral bodies were performed by unilateral pedicle approach (unilateral group) and 43 patients with 52 vertebral bodies were performed by bilateral pedicle approaches (bilateral group), used bone cement filling vertebral bodies after biopsy. The clinical efficacy and the positive rate of biopsy were compared between the two groups.Results:Both groups experienced significant pain relief in the Visual Analog Scale (VAS) score and improvement in the Oswestry Disability Index (ODI) score after operation ( P<0.05), but there were no significant differences between the two groups ( P>0.05). The operative time for a single vertebra, volume of bone cement in unilateral group were less than those in the bilateral group:(44.81 ± 13.01) min vs. (31.84 ± 11.87) min, (4.87 ± 0.92) ml vs. (4.18 ± 0.90) ml, there were significant differences ( P<0.05). There were no significant differences in the incidence of bone cement leakage and the positive rate of biopsy between both groups ( P>0.05). Conclusions:Percutaneous vertebroplasty and biopsy by unilateral and bilateral pedicle approaches are significant improvement for symptoms and functions of patients with vertebral metastasis. The clinical efficacy and the positive rate of biopsy are similar. But the former has easier operation procedure, shorter operative time and less volume of bone cement.
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Objective:To evaluate the efficacy of percutaneous vertebroplasty (PVP) by percutaneous bi-level bilateral puncture in the treatment of type ⅡA acute symptomatic osteoporotic thoracolumbar fracture (ASOTLF) with dense bone bands.Methods:From March 2017 to March 2018, 65 patients (65 vertebrae) with type ⅡA ASOTLF with dense bone bands were treated at Department of Orthopaedic Trauma, Qingdao Central Hospital. They were 25 males and 40 females, with an age of (71.6±8.4) years. The time from injury to operation was (3.5±0.7) d. They were divided into 2 groups according to different treatments. In the observation group of 31 cases (31 vertebrae), PVP was conducted by percutaneous bi-level bilateral puncture; in the control group of 34 cases (34 vertebrae), PVP was conducted by percutaneous single-level bilateral puncture. The 2 groups were compared in terms of operation time, volume of polymethyl methacrylate injected, incidence of bone cement leakage, incidence of vertebral refracture, diffusive distribution of bone cement in the vertebral body, and visual analogue scale (VAS) and Oswestry dysfunction index (ODI) at postoperative 1 day and 6 months.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). Operations were completed uneventfully in all the 65 patients. All the 65 patients were followed up for (8.2±1.2) months. There was no significant difference between the 2 groups in operation time, incidence of bone cement leakage or incidence of vertebral refracture for each vertebral body injured ( P>0.05). The volume of polymethyl methacrylate injected [(6.64±0.93) mL] and the excellent and good rate of diffusive distribution of bone cement in the vertebral body [87.1% (27/31)] in the observation group were significantly larger than those in the control group [(4.36±0.79) mL and 64.7% (22/34)] ( P<0.05). The VAS scores at postoperative 1 day and 6 months [2 (1, 2) and 1 (1, 2)] and ODIs at postoperative 1 day and 6 months (23.7%±1.6% and 18.8%±1.4%) in the observation group were significantly lower than those in the control group [2 (2, 3) and 2 (2, 2); 26.9%±4.2% and 22.1%±3.3%] ( P<0.05). The VAS scores and ODIs at postoperative 1 day and 6 months in all patients were significantly lower than those before operation ( P<0.05). Compression symptoms of the spinal cord and nerve root were observed in none of the patients. Conclusion:In the treatment of type ⅡA ASOTLF with dense bone bands, PVP by percutaneous bi-level bilateral puncture is more effective than the traditional PVP by percutaneous single-level bilateral puncture, and will not increase bone cement leakage or vertebral refracture.
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Objective:To investigate the clinical efficacy of percutaneous kyphoplasty (PKP) through the transverse process-pedicle approach (TPPA) by comparing with PKP through the conventional transpedicle approach (CTA).Methods:A retrospective study was conducted to analyze the data of 101 patients with single-segment osteoporotic vertebral compression fracture (OVCF) who had been treated at Department of Spine Surgery, The Fourth Hospital of Wuhan from August 2020 to August 2021. There were 31 males and 70 females, with an age of (70.3±7.6) years. Their T values of bone mineral density averaged (-3.0±0.3). They were divided into a TPPA group of 52 cases in which PKP was performed through the TPPA and a CTA group of 49 cases in which PKP was performed through the CTA. The clinical efficacy was evaluated by comparing the 2 groups in terms of operation time, frequency of intraoperative fluoroscopy, excellent to good rate of bone cement distribution, rate of bone cement leakage, refractures, and visual analogue scale (VAS), Oswestry disability index (ODI) and Beck index at preoperation, 24 hours, 3 months and 6 months postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). All the patients were followed up for (9.8±1.5) months. Operations were completed successfully in all patients with no complications like nerve injury or pedicle fracture. There were no significant differences in operation time, frequency of intraoperative fluoroscopy or rate of bone cement leakage between the 2 groups ( P>0.05). In the TPPA group, the excellent to good rate of bone cement distribution [92.3% (48/52)] was significantly higher than that in the CTA group [61.2% (30/49)], the VAS score [3.0 (2.0, 4.0)] and ODI (57.2±4.6) at 24 hours postoperation were significantly lower than those in the CTA group [4.0 (3.0, 4.0) and 59.2±5.3] ( P<0.05). There were no significant differences in VAS or ODI between the 2 groups at preoperation, 3 months or 6 months postoperation ( P>0.05). The VAS and ODI improved steadily within each group, showing significant differences between every 2 time points ( P<0.05). The Beck indexes [0.81 (0.69, 0.86) and 0.76 (0.67, 0.81)] at 24 hours and 6 months postoperation in the TPPA group were significantly higher than those in the CTA group [0.75 (0.71, 0.79) and 0.72 (0.68, 0.77)] ( P<0.05). The Beck indexes at 24 hours and 6 months postoperation improved significantly in all patients compared with the preoperative values ( P<0.05). Conclusions:In the treatment of OVCF with PKP, the TPPA shows the same surgical safety as CTA does, but leads to better cement distribution, better pain relief at immediate postoperation and an advantage in restoring and maintaining the height of the injured vertebral body.
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Objective:To study the use of the Glissonean pedicle approach based on the triangular area among the right anterior pedicle, the right posterior pedicle and the right hepatic vein ( "APR triangle" ), followed by indocyanine green fluorescence negative staining in laparoscopic anatomical resection of right hepatic segments.Methods:The clinical data of 34 patients with liver tumors who underwent laparoscopic anatomical right hepatic segmentectomy at the Chinese Academy of Medical Sciences and Peking Union Medical College from September 2020 to September 2021 were analyzed retrospectively. Of the 34 patients, there were 24 males and 10 females, aged (58.3±10.3) years old. Data on completion of operation, operation time, intraoperative blood loss, intraoperative blood transfusion, postoperative complications and postoperative hospital stay were collected.Results:All the 34 patients had malignant liver tumors, and they were successfully operated using total laparoscopic surgery. There was no conversion to open surgery. Three patients underwent segment V resection, 3 patients segment VI resection, 5 patients segment VII resection, 2 patients segment V + segment VI resection, 9 patients segment VI + segment VII resection, 3 patients segment V + segment VII resection, 5 patients segment V dorsal segment + segment VI + segment VII resection, 3 patients right posterior section resection + anterior dorsal segment resection and 1 patient anterior dorsal section resection. The operation time was (275.58±82.28) min, the amount of intraoperative blood loss was 100(100, 300) ml, and there were no patients requiring blood transfusion during the operation. Liquid food was started on the first day after operation, and out-of bed activities were carried out on the second to third days after operation. The Clavien Dindo classification of postoperative complications was grade I in 32 patients and grade III in 2 patients. The postoperative hospital stay was (7.23±3.10) d. All tumor margins were negative for malignancy. All the 34 patients were followed-up for (8.94±2.94) months. By the end of follow-up, 34 patients had survived without tumor recurrence.Conclusion:The right Glisson pedicle approach based on the "APR triangle" and the anatomical resection of right hepatic segments with fluorescence negative staining were safe and feasible.
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BACKGROUND: Percutaneous kyphoplasty (PKP) is an effective method for treating osteoporotic vertebral compression fracture. Although satisfactory clinical outcomes can be achieved, bone cement leakage is still one of the main complications of PKP. Based on previous studies, there are many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphology of different vertebral bodies may be an important reason for bone cement leakage into spinal canal. OBJECTIVE: To investigate the effect of thoracic and lumbar vertebral posterior wall morphology in the patients with osteoporotic vertebral compression fracture on bone cement leakage into the spinal canal during the PKP. METHODS: The clinical data of osteoporotic vertebral compression fracture patients with PKP were selected. There were 98 osteoporotic vertebral compression fracture patients with CT scan and three-dimensional reconstruction image data from T6 to L5. The three-dimensional reconstruction of CT and multiplanar reconstruction were used to measure the depth of the concave vertebral posterior wall (OC) and the corresponding middle-sagittal diameter of the vertebra (PC) of the non-fractured vertebral body, the ratio of OC to PC was calculated. All subjects were divided into thoracic group (T6-T12) and lumbar group (L1-L5) based on the location of measured vertebral, and the differences of the OC between groups were compared. 357 patients (548 vertebrae) with osteoporotic vertebral compression fracture without CT three-dimensional reconstruction underwent PKP within the same period. They were also divided into thoracic vertebra and lumbar vertebra groups. The degree of bone cement leakage into the spinal canal was compared between thoracic and lumbar vertebra groups. RESULTS AND CONCLUSION: (1)The morphological parameters of posterior vertebral wall in 98 patients showed that the depth of the concave vertebral posterior wall gradually (OC) deepened from T6toT12, with an average of 4.6 mm. The depth became gradually shallow from L1 to L5, with an average of 0.6 mm. The ratio of the depth of the concave vertebral posterior wall to the corresponding middle-sagittal diameter of the vertebra was approximately 16% (1/6) from T6toT12. The average value of ratios from Li to U was 3%. The ratios in lumbar vertebra were significantly decreased compared with thoracic vertebra (16%, 1/6). (2) Results form 357 patients who underwent PKP at the same time showed that the rate of bone cement leakage into spinal canal was 10.2% (31/304) in the thoracic vertebra group during the PKP, and the rate of lumbar vertebra group was 3.7% (9/244). In the thoracic group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (3.1 ±0.2) mm, the average maximal area of the bone cement intruded spinal canal was (30.8±0.3) mm2, and the spinal canal encroachment rate was (22.5±0.2)%. In the lumbar group, the average maximal sagittal diameter of the bone cement intruded spinal canal was (1.4±0.1) mm, the average maximal area of the bone cement intruded spinal canal was (14.9±0.2) mm2, and the spinal canal encroachment rate was (11,4±0.3)%. There was significant difference between thoracic and lumbar groups (P<0.05). (3) The above results imply that due to the presence of OC structure in the middle and lower thoracic vertebra, it is possible to reduce the occurrence of bone cement leakage into spinal canal through avoiding bone cement distribution over the posterior 1/6 (16%) of vertebral body in PKP. The effect of the difference between thoracic and lumbar vertebral posterior wall morphology in osteoporotic vertebral compression fracture patients on bone cement leakage into the spinal canal during the PKP may be one of the reasons why the rate of bone cement leakage into spinal canal in thoracic vertebra significantly higher than that in lumbar vertebra. The study protocol was approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (approval No. K2018008).
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BACKGROUND: Percutaneous vertebroplasty is clinically performed mainly through unilateral and bilateral pedicle approaches and unilateral pedicle extrapedicle approach. However, there are still disputes on the clinical effect and complications of the three approaches. OBJECTIVE: To compare the clinical effect of percutaneous vertebroplasty in the treatment of thoracolumbar vertebral compression fractures among three approaches. METHODS: Seventy-eight patients with thoracolumbar vertebral compression fractures who received treatment in Hainan Provincial Hospital of Traditional Chinese Medicine, China between January 2016 and January 2018 were included in this study. These patients consisted of 30 males and 48 females and were aged 40-71 years. Twenty patients received bone cement perfusion through the unilateral pedicle approach (unilateral pedicle group), 35 patients received bone cement perfusion through the bilateral pedicle approach (bilateral pedicle group), and 23 patients received bone cement perfusion through the unilateral pedicle extrapedicle approach (unilateral pedicle extrapedicle group). Bone cement perfusion volume and cement leakage rate were recorded. All patients were followed up for 1 year. The Visual Analogue Scale score, Oswestry Disability Index, vertebral height reconstruction rate, Cobb angle improvement, patient satisfaction and complications were compared among the three groups. This study was approved by the Hospital Ethics Committee, Hainan Provincial Hospital of Traditional Chinese Medicine, China (approval No. HKL20151203). RESULTS AND CONCLUSION: (1) Bone cement perfusion volume in the bilateral pedicle group was significantly lower than that in the unilateral pedicle and unilateral pedicle extrapedicle groups (P 0.05). At 1 year after surgery, Visual Analogue Scale score and Oswestry Disability Index were significantly lower than those before surgery in each group (P < 0.05). (3) Cement leakage rate in the bilateral pedicle group was significantly lower than that in the unilateral pedicle and unilateral pedicle extrapedicle groups (P < 0.05). Cement leakage rate in the unilateral pedicle extrapedicle group was significantly lower than that in the unilateral pedicle group (P < 0.05). (4) The fracture rate of adjacent vertebral bodies in the bilateral pedicle group was significantly lower than that in the unilateral pedicle group (P < 0.05). (5) These results suggest that three approaches of vertebroplasty and bone cement injection for treatment of thoracolumbar vertebral compression fractures can achieve better clinical efficacy. Bilateral pedicle approach can significantly reduce the incidence of cement leakage and adjacent vertebral fractures compared with the unilateral pedicle approach and unilateral pedicle extrapedicle approach.
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Objective To investigate the lamina windowing small gap and the vertebrae pedicle bone graft in the treatment of thoracolumbar burst fractures of the curative effect.Methods 132 patients with thoracolumbar burst fracture of were selecteds, the average random divided into open the window and pedicle group, open a window line set of lamina windowing small gap vertebral body bone graft and pedicle group through pedicle vertebral body bone graft, through intraoperative records, hospital records and postoperative follow-up of collecting morphological index, operation index, JOA score and Frankel classification of spinal cord injury in order to evaluate the clinical curative effect of two kinds of operative methods.Results The operation time in the pedicle group was (103.58±14.37) min, which was more than that of the fenestration group [ (85.72±12.96) min], the incision drainage rate in the pedicle group [ (100.96±5.29) ml] was less than that in the fenestration group [ (178.52±12.41) ml], and the postoperative pain score in the pedicle group [ (15.37±2.86) ] was higher than that in the fenestration group [ (8.26±4.52) ], the healing time of fractures in the pedicle group [ (20.85±0.60) weeks ]was less than that of the fenestration group [ (24.29±1.06) weeks].The difference was all statistically significant (P＜0.05).After treatment, the intervertebral space height of the pedicle group [ (11.55±1.94) mm] was significantly higher than that of the fenestration group [ (9.53±1.92) mm], and the difference was statistically significant (P＜0.05).After treatment, the JOA scores of patients in the pedicle group[7.78±1.39, 4.93±0.92, 13.84±2.74] were significantly higher than those in the open window group[6.24±1.20, 4.50±0.83, 12.43±2.52] (P＜0.05).The difference between the composition of Frankel spinal cord injury in the pedicle group and the fenestration group was statistically significant (P＜0.05).Conclusion Compared with small fenestration through the intervertebral space, this surgical method can promote the fracture healing and improve the symptoms of patients more rapidly, and is more suitable for the surgical treatment of thoracolumbar burst fracture patients.