Tandem Mass Tag-Based Proteomic Analysis of Normal and Degenerated Human Intervertebral Discs.

Background: Intervertebral disc degeneration (IVDD) is the main cause of low back pain (LBP), but the specific regulatory factors, pathways and specific molecular mechanisms remain unclear. Methods: We identified and quantitatively analyzed Pfirrmann Grade II (n=3) and Pfirrmann Grade IV (n=3) pulposus samples via MRI. The differential abundance of proteins in the samples was determined and quantitatively analyzed by relative and absolute quantitative analysis of the isotope marker levels combined with the liquid chromatography-tandem mass spectrometry (LC‒MSMS/MS). Results: A total of 70 proteins (30 significantly increased proteins (> 1.2-fold change) and 40 significantly decreased proteins (< 0.8-fold change)) showed different levels among the groups. Kyoto Encyclopedia of Genes and Genomes and Gene Ontology (GO) enrichment analyses and Western blot analysis showed that CYCS, RAC1, and PSMD14 may play important roles in IVDD and that Epstein‒Barr virus infection, viral myocarditis, colorectal cancer, nonalcoholic fatty liver disease (NAFLD) and amyotrophic lateral sclerosis (ALS) are the main pathways involved in IVDD. Conclusion: CYCS, RAC1 and PSMD14 may play important roles in IVDD, and Epstein‒Barr virus infection, viral myocarditis, colorectal cancer, NAFLD and ALS may be the main pathways involved in IVDD.

Analgesic effect and safety of a half-dose transdermal buprenorphine patch after arthroscopic rotator cuff repair.

Objective: To retrospectively explore the effect of a half-dose buprenorphine transdermal patch for analgesia after arthroscopic rotator cuff repair (ARCR). Methods: This analysis was performed with clinical data from patients who received unilateral ARCR in our hospital between October 2017 and December 2020. The patients were divided into three groups (30 cases each). In group A (control group), 100 mg flurbiprofen axetil (FA) was administered twice a day for 5 days after surgery. In group B (experimental group), 100 mg FA was administered twice a day for 5 days and half (2.5 mg) of a buprenorphine transdermal patch was applied after surgery; an additional half (2.5 mg) patch was applied 3 days later. In group C (condition control group), 100 mg FA was administered twice a day for 5 days and a 5-mg patch was applied directly after surgery. The visual analog scale (VAS) was administered repeatedly 1 day before surgery and 1, 2, 3, 5, and 14 days after surgery in each group. The simple shoulder test (SST) score, range of shoulder forward elevation (FE), and external rotation (ER) were recorded preoperatively and 12 weeks postoperatively. Results: VAS scores on postoperative days 3 and 5 were significantly lower in groups B and C than in group A (p < 0.05). The VAS score on postoperative day 14 was significantly lower in group C than in group A (p < 0.05). The difference in VAS score between groups B and C was not significant (p > 0.05). All patients had significantly improved VAS scores, SST scores, FE, and ER at 12 weeks postoperatively. Conclusion: The half-dose buprenorphine transdermal patch had a good analgesic effect with minimal side effects after ARCR and did not delay the recovery of shoulder joint function.

The effect of the Ankle Pump Exercise (APE) counter system assisted ankle pump motion in patients after femoral neck fracture.

OBJECTIVE: To explore the effect of the Ankle Pump Exercise (APE) counter system on moderate to high-risk Venous thromboembolism (VTE) after femoral neck fracture surgery. METHODS: From June 2021 to June 2022, a total of 140 patients with moderate and high-risk VTE after femoral neck fracture surgery treated at the Department of Orthopedics of a tertiary hospital in Zhejiang were included and divided into observation (70 cases) and control (70 cases) groups according to whether APE counter system was used or not. The control group was given routine oral propaganda, and the observation group was given a comprehensive nursing intervention with APE counter system on the basis of the control group's treatment. The compliance rates of the two groups on the postoperative 3st, 5rd, and 7th days were compared. Moreover, the General self-efficacy scale (GSES) was used to evaluate self-efficacy before and after exercise. RESULTS: The compliance rates of the control group and the observation group on the postoperative 3st, 5rd, and 7th days were 74.3% vs. 85.7%, 67.1% vs. 85.7%, and 61.4% vs. 82.9%. On the 5rd and 7th days, the compliance of the observation group was obviously higher than that of the control group. Moreover, the mean postoperative GSES score was also significantly higher than that in the control group (23.20 ± 3.516 vs. 25.31 ± 4.583, P < 0.05, values are expressed in mean ± standard). CONCLUSION: APE counter system can significantly improve the compliance and self-efficacy of patients with moderate and high-risk VTE after lower limb fracture surgery.

[Effect of acrylic bone cement mixed with calcium sulfate combined with percutaneous kyphoplasty in the treatment of osteoporotic fractures].

OBJECTIVE: To investigate the clinical efficacy of acrylic cement (PMMA) mixed with calcium sulfate combined with percutaneous kyphoplasty (PKP) in the treatment of osteoporotic fracture (OVCF). METHODS: The clinical data of 191 patients with OVCF treated with PKP from January 2020 to March 2021 were retrospectively analyzed. Among them, 82 patients with 94 vertebral bodies were treated with PMMA mixed with calcium sulfate as the observation group, and 109 patients with 125 vertebral bodies were treated with pure PMMA as the control group. Among the 82 patients in the observation group, there were 16 males and 66 females, with a mean age of (75.35±11.22) years old, including 36 thoracic vertebrae and 58 lumbar vertebrae. In the control group, there were 109 patients, 22 males and 87 females, with an average age of (74.51±9.21) years old, including 63 thoracic vertebrae and 62 lumbar vertebrae. The visual analog scale (VAS) before operation and 1 day, 3 months and 1 year after operation were calculated. The Oswestry disability index (ODI), Cobb's angle, vertebral body height and the probability of postoperative bone cement leakage were used to analyze the efficacy of the two groups. RESULTS: All the patients were followed up for more than one year. Compared with the control group, there was no significant difference in operation time, bleeding volume and bone cement injection volume between the two groups(P>0.05), while the leakage rate of bone cement was significantly lower in the observation group (P<0.05). In addition, there was no significant difference in VAS, ODI, Cobb angle, and vertebral body height between the two groups before operation, and 1 day, 3 months, and 1 year after operation (P>0.05), but each index was improved compared with that before operation (P<0.05). CONCLUSION: PMMA mixed with calcium sulfate has equivalent efficacy in treating OVCF than PMMA alone, but can effectively reduce the probability of cement leakage.

[Clinical study of double plate system in the treatment of complex proximal humeral fractures in the elderly].

OBJECTIVE: To explore the clinical outcomes of anteromedial combined with lateral locking plate for complex proximal humeral fractures in the eldery. METHODS: From June 2018 to October 2020, 30 patients who underwent surgical treatment for Neer grade 3 to 4 proximal humeral fractures, including 8 males and 22 females, aged from 51 to 78 years old with an average of (61.5±7.5) years old. Of them, 15 patients had fractures fixed with anteromedial combined with lateral locking plate(ALLP group), whereas 15 received internal fixation with proximal humerus locking plate only(PHLP group). The clinical data, simple shoulder test (SST), humeral head height loss, varus angle and shoulder range of motion were compared between the two groups. RESULTS: All fractures were healed. The follow-up time ranged from 12 to 24 months, with an average of(14.3±2.9) months. The operation time of ALLP group was longer than that of PHLP group (P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). There was no significant difference in SST score between the two groups at 1, 3 and 12 months after operation (P>0.05). In terms of radiographic measurement, there was no significant difference in humeral head height loss and varus angle between the two groups at 1 and 3 months after operation (P>0.05). At 12 months after operation, the height loss and varus angle of humeral head in ALLP group were lower than those in PHLP group (P<0.05). In shoulder range of motion, the range of forward elevation in ALLP group was larger than that in PHLP group 1 year after operation(P<0.05). There was no significant difference in external rotation between the two groups. CONCLUSION: Anteromedial combined with lateral locking plate in the treatment of complex proximal humeral fractures in the elderly can increase the stability of the medial column and obtain a good fracture prognosis. But there are also disadvantages such as longer operation time, so it should be individualized according to the fracture type of the patient.

Dual role of injectable curcumin-loaded microgels for efficient repair of osteoarthritic cartilage injury.

Curcumin has been widely used for the treatment of age-associated diseases, and showed chondroprotective potential for post-traumatic osteoarthritis (OA). However, due to the irregular-shaped and large-sized defects on joint cartilage in degenerated OA, the in vivo delivery and therapeutic effect of curcumin for effective repair remain challenging. In this study, we first present a PEG-GelMA [Poly(Ethylene Glycol) Dimethacrylate-Gelatin Methacrylate, PGMs] hydrogel microgel-based curcumin delivery system for both improved anti-inflammatory and pro-regenerative effects in treatment for cartilage defects. The curcumin-loaded PGMs were produced by a microfluidic system based on light-induced gelation of gelatin methacrylate (GelMA). This PGMs embedding curcumin at a relative low dosage were demonstrated to promote the proliferation and chondrogenic differentiation of mesenchymal stem cells in vitro. More importantly, the PGMs were shown to attenuate the inflammatory response of chondrocytes under IL-1ß stimulation. Lastly, the in vivo application of the injectable PGMs significantly promoted the repair of large-sized cartilage injury. These results confirmed that curcumin-loaded PGMs can not only enhance the chondroprotective efficacy under inflammatory conditions but also induce efficient cartilage regeneration. This study provides an advanced strategy with anti-inflammatory and pro-regenerative dual-role therapeutic for treatment of extensive cartilage injuries.

Analysis of Chronic Low Back Pain Caused by Lumbar Microinstability After Percutaneous Endoscopic Transforaminal Discectomy: A Retrospective Study.

Objective: Chronic low back pain (CLBP) after percutaneous endoscopic transforaminal discectomy (PTED) surgery may be caused by preoperative lumbar microinstability (MI). However, there is a paucity of research on the relationship between lumbar microinstability and chronic low back pain. The purpose of this article is to assess the preoperative radiographic characteristics of patients and evaluate the effects of lumbar microinstability on patient-reported outcomes among single-level lumbar disc herniation (LDH) patients who underwent PTED. Methods: This study retrospectively reviewed the radiographic characteristics of a consecutive series of 127 patients with low back pain and leg pain caused by single-level LDH underwent PTED from August 2018 to March 2021. They were divided into three groups according to the radiographic parameters: the stable group (Group S), the dysfunctional group (Group D), and the microinstability group (Group M). The visual analogue scale (VAS) scores for leg and low back pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Logistic regression analysis was used to identify independent risk factors for CLBP. Results: Compared with Group D and Group S, Group M had the highest ODI scores (P < 0.01) and VAS scores (low back pain) (P < 0.01) after 1 year, while there were no significant differences in the VAS scores for leg pain at different time points after surgery (P > 0.05). In addition, the logistic regression analysis results regarding CLBP revealed that muscle fatty degeneration on MRI (95% CI, 1.20-8.51, P = 0.02), and facet tropism (95% CI, 1.39 -11.37, P = 0.01) may be independent risk factors. Conclusion: Patients with lumbar microinstability may have CLBP after PTED, so patients with lumbar microinstability may need to take internal fixation surgery to solve their symptoms.

Variation in Global Spinal Sagittal Parameters in Asymptomatic Adults with 11 Thoracic Vertebrae, four Lumbar Vertebrae, and six Lumbar Vertebrae.

OBJECTIVE: To investigate the prevalence of 11 thoracic vertebrae (TVs), four lumbar vertebrae (LVs) and six LVs among asymptomatic Chinese volunteers, and the influence of spine variations on the global spinal sagittal parameters. METHODS: A total of 389 asymptomatic Chinese volunteers were recruited. Each subject underwent a full-spine X-ray examination with measurement of global spinal sagittal parameters. The radiographs were examined by a spine surgeon and a radiologist to determine the variation in the number of vertebrae. These parameters were used to compare individuals with five LVs to those with 11 TVs, four LVs, and six LVs. RESULTS: The study population included 12 individuals (3.1%) with seven cervical vertebrae (C) + 11 thoracic vertebrae (T) + five lumbar vertebrae (L), 8 (2.1%) with 7C + 11T + 6L, 8 (2.1%) with 7C + 12T + 4L, and 15 (3.9%) with 7C + 12T + 6L. Compared to the 7C + 12T + 5L individuals, those with 7C + 11T + 5L had significantly lower C6 -T5 Cobb values (P < 0.05); 7C + 12T + 4L individuals had significantly greater thoracic inlet angles (P < 0.05) and significantly lower pelvic tilt (P < 0.05); individuals with 7C + 12T + 6L had significantly greater sacral slope, pelvic tilt, pelvic incidence, and L1-5 Cobb values (all P < 0.05), but significantly lower thoracic inlet angle (P < 0.05). There were no significant differences in any of the parameters examined between the 7C + 11T + 6L group and the 7C + 12T + 5L group. CONCLUSIONS: Asymptomatic adults with 7C + 12T + 6L, 7C + 12T + 4L, and 7C + 11T + 5L presented with different spinal sagittal alignment compared to those with 7C + 12T + 5L. Compared to variation in the number of LVs, the variation in the number of TVs had less effect on global spinal sagittal parameters. Spinal surgeons and researchers should be aware of the effects of variation in numbers of TVs and LVs on global spinal parameters and sagittal balance.

Fraxin Prevents Knee Osteoarthritis through Inhibiting Chondrocyte Apoptosis in an Experimental Rat Osteoarthritis Model.

BACKGROUND: Current treatments of osteoarthritis are unsatisfied, a new approach towards the treatment of osteoarthritis is urged considering the state at present. OBJECTIVE: The objective of this study is to investigate the effect of fraxin on knee OA in a rat model and probe into the possible molecular mechanism. METHODS: Primary Murine Chondrocytes were isolated and cell apoptosis analyses were performed. Rat OA models were established using meniscectomy method and allocated into three groups. Knee joint specimens were collected for qRT-PCR, western blotting and histological analysis. Statistical analyses were processed by using a SPSS. RESULTS: The apoptosis rate of fraxin group is significantly reduced compared with the OA group or the control group. Fraxin remarkably down-regulated the expression of cleaved-Caspase-3 while significantly up-regulated the expression of Bcl-2, both on mRNA and protein levels. Toluidine blue stain results show relatively lighter articular cartilage damage compared with OA group. CONCLUSION: Fraxin prevents knee osteoarthritis by inhibiting chondrocyte apoptosis, which makes it a potential candidate as an anti-OA drug for clinical use.

[Analysis on risk factors of functional recovery after intramedullary nail fixation for femoral intertrochanteric fractures in elderly patients].

OBJECTIVE: To investigate the risk factors of functional recovery after intramedullary nail fixation for femoral intertrochanteric fracture in elderly patients, and to propose corresponding measures to promote postoperative hip function recovery. METHODS: From June 2012 to June 2015, 74 patients after intramedullary nail fixation surgery were analyzed, including 33 males and 41 females, with an average age of(75.07±7.89) years old, and divided into well-function group(55 patients) and bad-function group(19 patients) according to Sanders function criterion. Age, gender, bone density, fracture type, systemic disease, complication, rehabilitation exercises with therapist or not, nourishment state, anesthesia method, fracture reduction condition, ASA classification, tip apex distance were reviewed and analyzed by t test, non-parametric test, χ² test and Logistic analysis. RESULTS: Univariate analysis showed that age, bone density, nourishment state, ASA classification, anesthesia method, fracture reduction condition, rehabilitation exercises with therapist, and tip apex distance were the risk factors for the recovery of hip function. Logistic analysis showed that bone density(P=0.006, OR=0.077), rehabilitation exercises with therapist(P=0.006, OR=0.070), ASA classification(P<0.001, OR=0.049), nourishment state (P=0.046, OR=0.188) were the risk factors for the functional recovery. CONCLUSIONS: Bone density, rehabilitation exercises with therapist, ASA classification, nourishment state were the risk factors for the functional recovery of intramedullary nail fixation for intertrochanteric fracture in elderly patients. Multidisciplinary cooperation and fast track surgery system should be set up to promoting the hip functional recovery.

[Mid-term follow-up and clinical efficacy of total knee arthroplasty for osteoarthritis patients with Parkinson's disease].

OBJECTIVE: To investigate clinical efficacy and experience of total knee arthroplasty in treating knee osteoarthritis patients with Parkinson's disease. METHODS: From January 2011 to January 2014, 19 knee osteoarthritis patients with Parkinson's disease treated with total knee arthroplasty were collected. Among them, including 9 males and 10 females aged from 61 to 83 years old with an average of 71.3 years old. Radiology results were checked before and after operation. VAS score and KSS score were applied to evaluate clinical effects. Patients were classified according to HoehnYahr grade, 3 cases in grade 1, 4 cases in grade 1.5, 2 cases in grade 2, 4 cases in grade 2.5, 2 cases in grade 3 and 1 case in grade 4. RESULTS: Nineteen patients were followed up from 3 to 7 years with an average of 4.3 years. The pain of patients was significantly reduced or disappeared. All incisions were healed at stage I. At the latest follow-up, 3 patients had knee pain, and mild pain in 1 patient, moderate in 1 patient without severe pain. VAS score was reduced from preoperative 8.4±1.3 to the latest follow-up 3.1±1.2, the difference was statistically significant (P<0.05). KSS score improved from 43.6±7.3 before operation to 91.8±10.6 after operation. The condition of Parkinson's were controlled by medicine. No loosening and subsidence of prosthesis by X-ray examination. CONCLUSIONS: Total knee arthroplasty is a safe and effective method for the treatment of Parkinson's disease and has satisfactory mid-term clinical effect.

[Efficacy analysis on hip replacement for hip-joint diseases with Parkinson disease].

OBJECTIVE: To explore clinical efficacy of hip replacement for hip-joint diseases with Parkinson disease. METHODS: From December 2011 to December 2016, 18 patients with hip-joint diseases with Parkinson disease treated by hip replacement, including 8 males and 10 females aged from 59 to 87 years old with an average of 71 years old. Among them, 3 cases were developmental dysplasia of hip, 3 cases were femoral head necrosis and 12 cases were femoral neck fracture. All patients manifested with obvious pain and limitation of stepping ability. Postoperative complications were observed and Harris score were used to compare hip joint function after operation. RESULTS: The incision were healed well, and pain were alleviated or disappeared, and hip joint function were improved. Eighteen patients were followed up from 1 to 3 years with an average of 2.3 years. At the latest follow up, 14 cases recovered freedom-walk, 2 cases could walk with walking stick, 1 case could walk with walking aid and 1 case was died. Among 18 patients, 2 cases were occurred dislocation, and 1 case were died for cardiac disease at 3 months after operation. Four patients were occurred slight pain. There were significant differences in Harris scores among preoperative (41.7±1.4), 6 months after operation(80.1±5.4) and the final follow-up (83.4±2.1), and 10 cases got excellent result, 4 good, 1 fair and 2 poor. CONCLUSIONS: Application of hip replacement for hip-joint diseases with Parkinson disease is a safe and effective clinical therapy, and has advantages of less complications and rapid recovery of hip joint function.

[Mid-term follow-up and coping strategies of bone cement leakage after percutaneous kyphoplasty].

OBJECTIVE: To retrospectively analyze the clinical data of 17 patients with bone cement leakage after percutaneous kyphoplasty and explore the leakage type and mid-term clinical effects. METHODS: The clinical data of 17 patients with osteoporotic vertebral compression fractures occurred bone cement leakage after percutaneous kyphoplasty from October 2011 to October 2016 were collected. There were 7 males and 10 females, aged from 68 to 87 years old with an average of 78 years. All the patients had the history of low emergy trauma who had normal activity and full self-care for living before trauma, and complained with the lower back pain without signs and symptoms of nerve root injury after trauma. According to the anatomical location by images, the bone cement leakage pathways was confirmed, the preoperative and postoperative vertebral body height and Cobb angle were measured, the improvement of spinal stenosis were recorded. Preoperative and postoperative visual analogue scale (VAS) and Oswestry Disability Index(ODI) were used to evaluate pain and daily activities. RESULTS: All the patients were followed up for 4 to 7 years with an average of 5.1 years. According to anatomical location by images, we found the bone cement leakage pathways of vertebral side type in 6 cases, intervertebral disc type in 3 cases, spinal canal type in 2 cases, vertebral pedicle type in 5 cases and mixed type in 1 case. Vertebral body height from preoperative(27.7±3.5)% restored to (56.4±2.5)% at final follow-up, and the kyphosis was corrected with Cobb angle from preoperative(45.3±4.2)° corrected to(18.3±3.1)° at final follow-up. VAS score decreased from preoperative 7.9±1.5 to 2.1±0.5 at final follow-up. ODI obviously restored from preoperative(49.1±7.5)% to (23.5±3.7)% at final follow-up. The nerve symptoms in lower limbs occurred in 2 cases, and the neurological symptom was disappeared after urgent symptomatic treatment and anaphase trophic nerve treating. Lower back pain occurred in 3 cases, including one case of unbearable pain, and the pain disappeared after symptomatic treatment. CONCLUSIONS: Although the rate of bone cement leakage during percutaneous vertebral kyphoplasty is not low, the bone cement leakage has little influence on PKP surgery. Even if a little leakage occurred within the spinal canal during the surgery, spinal canal decompression will not be needed urgently. The significant clinical symptoms caused by leakage can basically disappear after treatment in mid-term follow-up.

[Mid-term follow-up study of hip arthroplasty for internal fixation failure of femoral intertrochanteric fractures in the elderly].

OBJECTIVE: To retrospective analysis the mid-term follow-up effect of hip joint replacement in elderly patients with failure of intertrochanteric fractures of the hip joint internal fixation. METHODS: From December 2008 to December 2011, 32 elderly patients underwent arthroplasty after intertrochanteric fracture fixation failure, of which, 4 death cases were excluded from the study, and the remaining 28 cases were in the study group. The age of patients ranged from 69 to 83 years old with a mean of 75 years old. The time from the internal fixation to the hip replacement were 8 to 72 months. Among them, 6 patients were Evans I type, 11 patients were Evans II type, 9 patients were Evans III type, and 2 patients were Evans IV type. Nine cases showed fracture of the lateral plate before operation, while 15 cases were femoral head screw cut-out and 4 cases were screw loosening. Harris score was used to compare the changes of hip function before operation with the final follow-up. Imaging results(X-ray) and erythrocyte sedimentation rate(ESR) were performed during the follow-up. RESULTS: All patients were followed up from 4 to 7 years with an average of 5.3 years. Pain was significantly reduced or disappeared in patients compared with pre-operation. And hip function was significantly improved. Two cases had moderate pain after the physical activity and 4 cases had mild pain after the physical activity. At the final follow-up, 19 patients resumed free walking, 8 patients required walking with walking sticks, and 1 patient needed walking aid. The Harris scores improved from preoperative 34.9±2.4 to 83.4±5.7 at the final follow-up, among them, 15 cases were classified as excellent, 10 as good, 2 as fair, and 1 as poor. X-ray examination showed no prosthesis loosening and sinking fracture. CONCLUSIONS: Salvage THA surgery could improve the hip function and the quality of life for old patients with intertrochanteric fracture fixation failure, and the middle-term follow-up results support that.

[Analysis of perioperative complications of percutaneous kyphoplasty for osteoporotic vertebral compression fracture].

OBJECTIVE: To analyze the perioperative complications of percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture. METHODS: From June 2009 to December 2011, 63 patients with osteoporotic vertebral compression fracture underwent PKP, there were 18 males and 45 females with an average age of 75.3 years ( ranged, 62 to 91). All patients with severe back pain and without neurological symptoms and signs, which were confirmed by X-ray and MRI. Among them,there were 63 cases with severe osteoporosis, 37 cases with hypertension, 10 with coronary artery disease, 29 with anemia, 26 with diabetes, 11 with chronic obstructive pulmonary diseases and 8 with gastritis and peptic ulcer. The common perioperative complications were retropectively reviewed. RESULTS: Preoperative complications occured in 9 cases (14.3%), including hypostatic pneumonia (1 case), electrolyte disturbances (2 cases), urinary tract infection (2 cases), moderate anemia(2 cases),electrolyte disturbances combined with moderate anemia (1 case), hypostatic pneumonia combined with delirium (1 case). Intraoperative and postoperative. complications occurred in 17 cases (26.9%), there were bone cement correlated complications in 9 cases (14.3%), in which 2 cases of toxic reaction of bone cement and 7 cases of leakage (2 cases had clinical symptoms); there were non-bone cement correlated complications in 3 cases (4.8%), in which 1 case of focal hematoma caused by paracentesis, 1 case of transient nerve injury, 1 case of left intercostal neuralgia;there were transient hyperpathia in 5 cases after operation. All complications result in no severe consequence after treatment. CONCLUSION: Perioperative complications of percutaneous kyphoplasty are not uncommon,however,these complications may not cause serious consequence after active treatment,so prevention and treatment are important for it.

[Treatment of senile osteoporotic vertebral compression fractures with percutaneous kyphoplasty under local anesthesia].

OBJECTIVE: To evaluate the clinical outcomes of percutaneous kyphoplasty (PKP) in treating senile osteoporotic vertebral compression fractures under local anesthesia. METHODS: From May 2007 to May 2010,129 patients with osteoporotic vertebral compression fractures were treated with PKP under local anesthesia. There were 47 males and 82 females, ranging in age from 61 to 92 years old,with an average of 73.7 years old,including 88 segments of thoracic vertebrae and 101 segments of lumbar vertebrae. Visual analogue scale (VAS),height of vertebral body,Cobb's angle were evaluated before and after operation. RESULTS: Operations were performed successfully in all patients and these patients were followed up from 24 to 60 months with an average of 34.2 months. Preoperative,postoperative two weeks and at final follow-up,VAS score was 7.9+/-2.5,2.8+/-1.8,3.0+/-2.2,respectively;Cobb angle was (28.3+/-13.7)degree, (16.2+/-9.8)degree, (19.1+/-10.3)degree, respectively. There was significant difference between postoperative and preoperative, and between at final follow up and preoperative (P<0.05). The height of vertebral body obtained partial recovery. Bone cement leakage occurred in 23 vertebrae (with proportion of 17.8%) during operation,among one patient with temporary clinical symptom of radiculalgia. All lumbago obtained obviously anesis after operation, 1 case complicated with respiratory depression and recovered after resuscitation; 1 case complicated with intestinal obstruction and improved after treatment, 1 case complicated with fracture separation of vertebral body by bone cement, and 4 cases complicated with fracture of adjacent vertebral body. CONCLUSION: Percutaneous vertebral kyphoplasty is an effective method for treatment of senile osteoporotic vertebral compression fractures,which can expeditiously relieve pain and effectively recovery height of vertebral body and Cobb angle,it has advantages of minimal invasive. The results of short and mid-term follow-up were satisfactory, long-term follow-up is still needed. Correctly choosing the operative indication and improving surgical technique may avoid complications, especially bone cement leakage which is the most frequent complication.