ABSTRACT
AIM: To explore the clinical efficacy of percutaneous vertebroplasty (PVP) combined with the polymethyl methacrylate - gelatin sponge (PMMA-GS) complex in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs) accompanied by superior endplate injuries. MATERIAL AND METHODS: A total of 77 OVCF patients with superior endplate injuries who were treated with PVP from January 2017 to December 2020 were retrospectively analyzed. The visual analogue scale (VAS) score, Oswestry disability index (ODI), and injured vertebral height ratio at one day (1d) before surgery, three days (3d) after surgery, and one year (1y) after surgery were compared between both groups. Besides, the surgical duration, PMMA(polymethyl methacrylate)injection volume, PMMA leakage rate, and adjacent vertebral fracture rate were compared between these two groups. RESULTS: Among these patients, there were 39 individuals treated with PVP combined with the PMMA-GS complex (the observation group) and 38 individuals treated with PVP (the control group). These patients in both groups completed the surgery successfully. There were no such complications as pulmonary embolism, hemopneumothorax, rib fracture, spinal cord nerve injuries, and vital organ injuries. In these two groups, the VAS score, ODI, and injured vertebral height ratio 1d before surgery were significantly different from those 3d and 1y after surgery (P 0.05). However, there was no significant difference in these indexes between both groups (P 0.05). There was no significant difference in the surgical duration and PMMA injection volume between both groups (P 0.05). However, the PMMA leakage rate and adjacent vertebral fracture rate in the observation group were significantly lower than those in the control group (P 0.05). CONCLUSION: Compared with traditional PVP, this therapy PVP combined with PMMA-GS complex in the treatment of OVCF patients with superior endplate injuries can effectively reduce the incidence of PMMA leakage and adjacent vertebral fracture rate.
ABSTRACT
AIM: To introduce, and to evaluate the efficacy of the trans-superior articular process (trans-SAP) approach utilizing visual trephine in percutaneous endoscopic transforaminal lumbar discectomy (PETLD) for migrated lumbar disc herniation. MATERIAL AND METHODS: This study included 98 patients, 50 patients were in trans-SAP PETLD group and 48 patients were in conventional PETLD group. Visual analogue scale (VAS), Oswestry disability index (ODI), gender, age, blood loss, operation time, the frequency of X-ray fluoroscopy and the percentage of highly migrated herniation were evaluated and compared between the trans-SAP PETLD and conventional PETLD group. RESULTS: In both trans-SAP PETLD and conventional PETLD group, VAS and ODI were decreased at postoperative 1 day and 3 months compared with preoperative (p < 0.001). What's more, the VAS and ODI of postoperative 3 months were lower than postoperative 1 day (p < 0.001). There was no difference in gender, age, blood loss after the operation, and VAS during operation between trans-SAP group and conventional group (p > 0.05). The blood loss during the operation of trans-SAP group was higher (p < 0.05), but the operation time and frequency of X-ray fluoroscopy were lower than conventional group (p < 0.001). Last, trans-SAP group had a higher percentage of highly migrated herniation (p < 0.001). CONCLUSION: Both the conventional way and trans-SAP approach can achieve excellent surgical results. But, in trans-SAP group, the operation time is shorter, and X-ray fluoroscopy is less. PETLD with visual trephine has more advantages in highly migrated herniation and maybe easier to be mastered by young surgeons.
