BACKGROUND Osteoporotic vertebral compression fractures(OVCFs)contribute to back pain and functional limitations in older individuals,with percutaneous vertebroplasty(PVP)emerging as a minimally invasive treatment.How...BACKGROUND Osteoporotic vertebral compression fractures(OVCFs)contribute to back pain and functional limitations in older individuals,with percutaneous vertebroplasty(PVP)emerging as a minimally invasive treatment.However,further height loss post-PVP prompts investigation into contributing factors.AIM To investigate the factors associated with further height loss following PVP with cement augmentation in OVCF patients.METHODS A total of 200 OVCF patients who underwent successful PVP between January 2021 and December 2022 were included in this study.“Further height loss”during 1 year of follow-up in OVCF patients with bone edema was defined as a vertical height loss of≥4 mm.The study population was divided into two groups for analysis:The“No Further Height Loss group(n=179)”and the“Further Height Loss group(n=21).”RESULTS In comparing two distinct groups of patients,significant differences existed in bone mineral density(BMD),vertebral compression degree,prevalence of intravertebral cleft(IVF),type of bone cement used,and cement distribution patterns.Results from binary univariate regression analysis revealed that lower BMD,the presence of IVF,cleft distribution of bone cement,and higher vertebral compression degree were all significantly associated with further height loss.Notably,the use of mineralized collagen modified-poly(methyl methacrylate)bone cement was associated with a significant reduction in the risk of further height loss.In multivariate regression analysis,lower BMD and the presence of IVF remained significantly associated with further height loss.CONCLUSION Further height loss following PVP in OVCF patients is influenced by a complex interplay of factors,especially lower BMD and the presence of IVF.These findings underscore the importance of assessing and managing these factors when addressing height loss following PVP in OVCF patients.展开更多
Objective:To explore the construction and application effect of a postoperative nursing intervention program for osteoporotic vertebral compression fractures.Methods:A total of 68 cases of osteoporotic vertebral compr...Objective:To explore the construction and application effect of a postoperative nursing intervention program for osteoporotic vertebral compression fractures.Methods:A total of 68 cases of osteoporotic vertebral compression fractures treated with vertebroplasty in our hospital from March 2023 to April 2024 were selected and randomly divided into the control group and the constructed program group,with 34 cases in each group.The control group received routine postoperative nursing after vertebroplasty,while the constructed program group was provided with a targeted postoperative nursing intervention program based on the control group,which was implemented postoperatively.The postoperative outcomes and thoracolumbar dysfunction of the two groups were compared.Results:The total postoperative efficacy rate in the constructed program group(97.06%,33/34)was significantly higher than that in the control group(76.47%,26/34)(P<0.05).The thoracolumbar dysfunction score in the constructed program group(15.02±1.36)was significantly lower than that in the control group(22.56±2.41)(P<0.05).Conclusion:Constructing a targeted nursing intervention program based on the postoperative nursing requirements for osteoporotic vertebral compression fractures and individual patient characteristics can effectively improve thoracolumbar dysfunction and enhance the postoperative surgical outcome.The clinical application of this program is reliable.展开更多
This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who receiv...This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who received balloon kyphoplasty. Patients were divided into four groups： Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale （VAS） and Oswestry disability index （ODI） scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture. Therefore, surgery should not only restore compressed vertebral body height and correct kyphosis, but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.展开更多
To address the issue of extensive deformation in the Tabaiyi Tunnel caused by the fault zone,nuclear magnetic resonance(NMR)technology was employed to analyze the physical and mechanical properties of waterabsorbing m...To address the issue of extensive deformation in the Tabaiyi Tunnel caused by the fault zone,nuclear magnetic resonance(NMR)technology was employed to analyze the physical and mechanical properties of waterabsorbing mudstone.This analysis aimed to understand the mechanism behind the significant deformations.Drawing from the principle of excavation stress compensation,a support scheme featuring NPR anchorcables and an asymmetric truss support system was devised.To validate the scheme,numerical analysis using a combination of the Discrete Element Method(DEM)-Finite Element Method(FEM)was conducted.Additionally,similar material model tests and engineering measurements were carried out.Field experiments were also performed to evaluate the NPR anchor-cable and truss support system,focusing on anchor cable forces,pressures between the truss and surrounding rock,pressures between the initial support and secondary lining,as well as the magnitude of settlement and convergence deformation in the surrounding rock.The results indicate that the waterinduced expansion of clay minerals,resulting from damage caused by fissure water,accelerated the softening of the mudstone's internal structure,leading to significant deformations in the Tabaiyi Tunnel under high tectonic stress.The original support design fell short as the length of the anchor rods was smaller than the expansion depth of the plastic zone.As a result,the initial support structure bore the entire load from the surrounding rock,and a non-coupled deformation contact was observed between the double-arch truss and the surrounding rock.The adoption of NPR asymmetric anchor-cable support effectively restrained the expansion and asymmetric distribution characteristics of the plastic zone.Considering the mechanical degradation caused by water absorption in mudstone,the rigid constraint provided by the truss proved crucial for controlling the stability of the surrounding rock.These research findings hold significant implications for managing large deformations in soft rock tunnels situated within fractured zones under high tectonic stress conditions.展开更多
Grouting has been the most effective approach to mitigate water inrush disasters in underground engineering due to its ability to plug groundwater and enhance rock strength.Nevertheless,there is a lack of potent numer...Grouting has been the most effective approach to mitigate water inrush disasters in underground engineering due to its ability to plug groundwater and enhance rock strength.Nevertheless,there is a lack of potent numerical tools for assessing the grouting effectiveness in water-rich fractured strata.In this study,the hydro-mechanical coupled discontinuous deformation analysis(HM-DDA)is inaugurally extended to simulate the grouting process in a water-rich discrete fracture network(DFN),including the slurry migration,fracture dilation,water plugging in a seepage field,and joint reinforcement after coagulation.To validate the capabilities of the developed method,several numerical examples are conducted incorporating the Newtonian fluid and Bingham slurry.The simulation results closely align with the analytical solutions.Additionally,a set of compression tests is conducted on the fresh and grouted rock specimens to verify the reinforcement method and calibrate the rational properties of reinforced joints.An engineering-scale model based on a real water inrush case of the Yonglian tunnel in a water-rich fractured zone has been established.The model demonstrates the effectiveness of grouting reinforcement in mitigating water inrush disaster.The results indicate that increased grouting pressure greatly affects the regulation of water outflow from the tunnel face and the prevention of rock detachment face after excavation.展开更多
This paper addresses the common orthopedic trauma of spinal vertebral fractures and aims to enhance doctors’diagnostic efficiency.Therefore,a deep-learning-based automated diagnostic systemwithmulti-label segmentatio...This paper addresses the common orthopedic trauma of spinal vertebral fractures and aims to enhance doctors’diagnostic efficiency.Therefore,a deep-learning-based automated diagnostic systemwithmulti-label segmentation is proposed to recognize the condition of vertebral fractures.The whole spine Computed Tomography(CT)image is segmented into the fracture,normal,and background using U-Net,and the fracture degree of each vertebra is evaluated(Genant semi-qualitative evaluation).The main work of this paper includes:First,based on the spatial configuration network(SCN)structure,U-Net is used instead of the SCN feature extraction network.The attention mechanismandthe residual connectionbetweenthe convolutional layers are added in the local network(LN)stage.Multiple filtering is added in the global network(GN)stage,and each layer of the LN decoder feature map is filtered separately using dot product,and the filtered features are re-convolved to obtain the GN output heatmap.Second,a network model with improved SCN(M-SCN)helps automatically localize the center-of-mass position of each vertebra,and the voxels around each localized vertebra were clipped,eliminating a large amount of redundant information(e.g.,background and other interfering vertebrae)and keeping the vertebrae to be segmented in the center of the image.Multilabel segmentation of the clipped portion was subsequently performed using U-Net.This paper uses VerSe’19,VerSe’20(using only data containing vertebral fractures),and private data(provided by Guizhou Orthopedic Hospital)for model training and evaluation.Compared with the original SCN network,the M-SCN reduced the prediction error rate by 1.09%and demonstrated the effectiveness of the improvement in ablation experiments.In the vertebral segmentation experiment,the Dice Similarity Coefficient(DSC)index reached 93.50%and the Maximum Symmetry Surface Distance(MSSD)index was 4.962 mm,with accuracy and recall of 95.82%and 91.73%,respectively.Fractured vertebrae were also marked as red and normal vertebrae were marked as white in the experiment,and the semi-qualitative assessment results of Genant were provided,as well as the results of spinal localization visualization and 3D reconstructed views of the spine to analyze the actual predictive ability of the model.It provides a promising tool for vertebral fracture detection.展开更多
BACKGROUND Osteoporosis is the leading cause of vertebral fractures.Dual-energy X-ray absor-ptiometry(DXA)and radiographs are traditionally used to detect osteoporosis and vertebral fractures/deformities.Magnetic reso...BACKGROUND Osteoporosis is the leading cause of vertebral fractures.Dual-energy X-ray absor-ptiometry(DXA)and radiographs are traditionally used to detect osteoporosis and vertebral fractures/deformities.Magnetic resonance imaging(MRI)can be utilized to detect the relative severity of vertebral deformities using three-dimen-sional information not available in traditional DXA and lateral two-dimensional radiography imaging techniques.AIM To generate normative vertebral parameters in women using MRI and DXA scans,determine the correlations between MRI-calculated vertebral deformities and age,DXA T-scores,and DXA Z-scores,and compare MRI vertebral deformity values with radiography values previously published in the literature.METHODS This study is a retrospective vertebral morphometric analysis conducted at our institution.The patient sample included MR images from 1638 female patients who underwent both MR and DXA imaging between 2005 and 2014.Biconcavity,wedge,crush,anterior height(Ha)/posterior height(Hp),and middle height(Hm)/posterior height values were calculated from the MR images of the patient’s vertebrae.Associations between vertebral deformity values,patient age,and DXA T-scores were analyzed using Spearman correlation.The MRI-derived measure-ments were compared with radiograph-based calculations from population-based data compiled from multiple studies.RESULTS Age was positively correlated with lumbar Hm/Hp(P=0.04)and thoracic wedge(P=0.03)and biconcavity(P=0.001)and negatively correlated with thoracic Ha/Hp(P=0.002)and Hm/Hp(P=0.001)values.DXA T-scores correlated positively with lumbar Hm/Hp(P<0.0001)and negatively with lumbar wedge(P=0.046),biconcavity(P<0.0001),and Ha/Hp(P=0.046)values.Qualitative analysis revealed that Ha/Hp differed between MRI and radiography population-based data by no more than 0.3 and Hm/Hp by a maximum of 1.2.CONCLUSION Compared with traditional imaging techniques,MRI detects vertebral deformities with high accuracy and re-liability.It may be a sensitive,ionizing,radiation-free tool for use in clinical settings.展开更多
Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review ...Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.展开更多
Lumbar vertebral body(VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone minera...Lumbar vertebral body(VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone mineral density(BMD), which may be applied in order to predict VB failure load and fracture risk. The most representative models are those that take account of normal spinal kinetics and assess the contribution of the cortical shell to vertebral strength. Overall, predictive models for VB fracture risk should encompass a range of important parameters including BMD, geometric measures and patient-specific factors. As interventions like vertebroplasty increase in popularity for VB fracture treatment and prevention, such models are likely to play a significant role in the clinical decision-making process. More biomechanical research is required, however, to reduce the risks of post-operative adjacent VB fractures.展开更多
The clinical effects of two different methods–high-viscosity cement percutaneous vertebroplasty（PVP） and low-viscosity cement percutaneous kyphoplasty（PKP） in the treatment of osteoporotic vertebral compression f...The clinical effects of two different methods–high-viscosity cement percutaneous vertebroplasty（PVP） and low-viscosity cement percutaneous kyphoplasty（PKP） in the treatment of osteoporotic vertebral compression fractures（OVCFs） were investigated. From June 2010 to August 2013, 98 cases of OVCFs were included in our study. Forty-six patients underwent high-viscosity PVP and 52 patients underwent low-viscosity PKP. The occurrence of cement leakage was observed. Pain relief and functional activity were evaluated using the Visual Analog Scale（VAS） and Oswestry Disability Index（ODI）, respectively. Restoration of the vertebral body height and angle of kyphosis were assessed by comparing preoperative and postoperative measurements of the anterior heights, middle heights and the kyphotic angle of the fractured vertebra. Nine out of the 54 vertebra bodies and 11 out of the 60 vertebra bodies were observed to have cement leakage in the high-viscosity PVP and low-viscosity PKP groups, respectively. The rate of cement leakage, correction of anterior vertebral height and kyphotic angles showed no significant differences between the two groups（P〉0.05）. Low-viscosity PKP had significant advantage in terms of the restoration of middle vertebral height as compared with the high-viscosity PVP（P〈0.05）. Both groups showed significant improvements in pain relief and functional capacity status after surgery（P〈0.05）. It was concluded that high-viscosity PVP and low-viscosity PKP have similar clinical effects in terms of the rate of cement leakage, restoration of the anterior vertebral body height, changes of kyphotic angles, functional activity, and pain relief. Low-viscosity PKP is better than high-viscosity PVP in restoring the height of the middle vertebra.展开更多
BACKGROUND Osteoporosis with vertebral compression fractures is increasingly common in the elderly population.Cement augmentation is one of the effective surgical treatments for these patients.Currently,there are seve...BACKGROUND Osteoporosis with vertebral compression fractures is increasingly common in the elderly population.Cement augmentation is one of the effective surgical treatments for these patients.Currently,there are several different types of cement augmentation treatments.No studies have compared the safety and efficacy of different cement augmentation types for the treatment of such fractures;thus,we retrospectively compared vertebroplasty,balloon kyphoplasty,and kyphoplasty with SpineJack or an intravertebral expandable pillar.AIM To compare the postoperative safety and efficacy of each surgical intervention in treating vertebral compression fractures.METHODS We retrospectively analyzed 354 patients with acute vertebral compression fractures,defined as signal changes in the T1 weighted magnetic resonance imaging,and randomly divided the patients into five groups.Their visual analog scale scores for pain,kyphotic angle,average body height,rate of cement leakage,and occurrence of adjacent vertebral compression fractures were followed for 1 year.One-way analysis of variance,the post hoc Bonferroni test,and Fisher exact probability test were used for statistical analyses.RESULTS All pain scores significantly improved 12 mo postoperatively;however,there was no significant difference between the groups(P=0.325).Kyphoplasty with SpineJack significantly reduced the kyphotic angle(P=0.028)and restored the height of the vertebral body(P=0.02).The rate of adjacent compression fractures was the highest in the vertebroplasty group,with a statistically significant difference according to the Fisher exact probability test(P=0.02).The treatment with the lowest cement leakage rate cannot be identified because of the small sample size;however,kyphoplasty with SpineJack,an IVEP,and vesselplasty resulted in lower rates of cement leakage than balloon kyphoplasty and vertebroplasty.CONCLUSION Kyphoplasty with SpineJack has good outcomes in kyphotic angle reduction and body height restoration.Vertebroplasty has the highest cement leakage rate and adjacent compression fracture occurrence.展开更多
Purpose: The Investigational Vertebroplasty Efficacy and Safety Trial (INVEST), a randomized blinded controlled study of Vertebroplasty, demonstrated similar improvements in pain between blinded Vertebroplasty and sha...Purpose: The Investigational Vertebroplasty Efficacy and Safety Trial (INVEST), a randomized blinded controlled study of Vertebroplasty, demonstrated similar improvements in pain between blinded Vertebroplasty and sham-Vertebroplasty groups. The result from the RCT study suggested that the observed efficacy of the Vertebroplasty procedure, instead of representing the cement-mediated reduction in pain, may relate to the vertebral bone drilling per se. The aim of this study was to demonstrate the effectiveness of pain relief of vertebral bone drilling at the site of painful osteoporotic vertebral compression fractures in the acute phase. Materials and Methods: Twenty-six patients with painful osteoporotic compression fractures underwent the vertebral bone drilling. We assessed primary outcome measures in the NRS pain score and RDQ score at day 0 and 3 following the drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and RDQ score, and the mean NRS and RDQ score at day 3 were 7.3 ± 1.2, 15.7 ± 4.2, 4.6 ± 1.4, 7.3 ± 2.2, respectively. Among the patients, we detected significant improvements in NRS pain score and RDQ score at day 3 following the drilling compared with day 0 (P < 0.001). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic vertebral compression fractures.展开更多
AIM:To evaluate the relationship between a vertebral fracture and a hip fracture in Saudi Arabians with osteoporosis.METHODS:In this retrospective study,154 Saudi Arabian patients with osteoporosis-related hip fractur...AIM:To evaluate the relationship between a vertebral fracture and a hip fracture in Saudi Arabians with osteoporosis.METHODS:In this retrospective study,154 Saudi Arabian patients with osteoporosis-related hip fractures were analyzed for the presence of a vertebral fracture.Radiographs were retrieved from the IPAC(Image Picture Archiving and Computing)System,an imaging retrieval system,and were reviewed independently by two of the authors,Abid Hussain Gullenpet,and Mir Sadat-Ali,and later reviewed jointly.Patients admitted with proximal hip fracture who were≥50 years and had undergone Thoraco-lumber imaging and a dual energy X-ray absorptiometry(DEXA)scan were included in the study.Patients with a history of significant trauma to the spine and those with a malignancy or connective tissue disorder were excluded from the analysis.RESULTS:Out of 154 patients with hip fractures,78had a fracture of the femoral neck while 76 had an intertrochanteric hip fracture.Of the 111 patients whowere finally included in the study,after applying inclusion and exclusion criteria,76 patients with an average age of 67.28±12 years had no fractures of the spine.Thirty-five patients with an average age of 76.9±14.5years(31.53%)had a total of 49 vertebral fractures.Patients with vertebral fractures were significantly older than those without fractures P<0.001.Overall,24.7%of these patients had an asymptomatic vertebral fracture.Further analysis showed that 11 males(18.96%)and 24 females(45.28%)had suffered a previous asymptomatic vertebral fracture.Interestingly,all women who participated in this study and who presented with a femoral neck fracture had experienced a prior asymptomatic vertebral fracture.CONCLUSION:We recommend that all elderly patients who go to the radiology department for a chest X-ray also have a DEXA scan and a lateral thoracic spine radiograph.展开更多
BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral comp...BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.展开更多
Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation proced...Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation procedures that have been associated with increased risks of cement leakage, adjacent fractures and non-union. Objective: The aim of this study was to describe a novel approach for the union of osteoporotic vertebral compression fractures with minimally invasive open reduction and internal fixation. Patients and Methods: Seven consecutive patients with intractable back pain without neurological deficits due to osteoporotic vertebral compression fractures were treated using minimally invasive fixation with intra-vertebral expandable pillars and artificial bone substitute. The clinical symptoms and image findings were recorded. Results: All of the patients reported relief of back pain, and the height of the vertebral bodies was well restored. X-ray findings obtained 2 to 4 years after the procedures showed fracture healing and favorable formation of the callus confirmed in the anterior longitudinal ligament. Conclusion: This mini-open procedure with intravertebral devices is an effective and reliable technique for osteoporotic vertebral compression fractures and may avoid complications related to traditional open spinal instrumentation procedures and augmentation with bone cement.展开更多
Percutaneous vertebroplasty is a minimally invasive procedure that involves filling of a fractured vertebral body with bone cement to relieve pain and to restore the vertebral height. It is a safe and effective treatm...Percutaneous vertebroplasty is a minimally invasive procedure that involves filling of a fractured vertebral body with bone cement to relieve pain and to restore the vertebral height. It is a safe and effective treatment and is widely used for treating Osteoporotic Vertebral Compression Fracture. Despite of its beneficial advantages over primary conservative managements, adjacent level vertebral compression fracture remains the challenge for surgeons. Adjacent level vertebral compression fracture following percutaneous vertebroplasty using PMMA cement has been reported as a complication. Numerous risk factors have been reported for the occurrence of new adjacent VCFs after PVP. The multiple level osteoporotic vertebral compression fractures and the increasing age of the patients are directly proportional to the risk of developing new symptomatic adjacent vertebral compression fracture after PVP. Moreover, low BMD and cement leakage are other factors that directly affect the incidence of new symptomatic adjacent vertebral fractures. The aim of this review is to evaluate the adjacent level vertebral compression fracture following percutaneous vertebroplasty on the basis of radiographs, Kaplan-Meier Estimation index and also the factors that lead to adjacent level vertebral compression fractures.展开更多
Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat...Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.展开更多
<strong>Background:</strong> Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy o...<strong>Background:</strong> Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. <strong>Purpose:</strong> To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). <strong>Method:</strong> A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (<em>β</em>-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. <strong>Results:</strong> After normalized treatment, the bone metabolism indexes of PINP and <em>β</em>-CTX were improved and BMD was increased in three groups. <strong>Adverse Reactions:</strong> There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). <strong>Conclusion:</strong> Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.展开更多
Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the...Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We evaluated the effects of vertebral bone drilling for the pain due to occults VFs. Materials and Methods: Eighteen patients with painful osteoporotic occult VFs underwent the vertebral bone drilling. We evaluated the clinical outcome by comparing numerical rating scale (NRS) and activity of daily life (ADL) values between before and after the vertebral bone drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and ADL score, and the mean NRS and ALD score after the bone drilling were 8.4 ± 0.8, 2.2 ± 0.6, 2.4 ± 1.0, 4.6 ± 0.5, respectively. Among the patients, we detected significant improvements in NRS pain score and ADL score after the drilling compared with baseline score (p < 0.0002). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic occult VFs.展开更多
Objective:To evaluate the clinical efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF)in the elderly by meta-analysis,and to provide a basis for clinical app...Objective:To evaluate the clinical efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF)in the elderly by meta-analysis,and to provide a basis for clinical application.Methods:CNKI,Wanfang,Weipu,CBM,PubMed,the Cochrane Library and EMbase were retrieved by computer from the date of establishment to January 2019.The literature on randomized controlled trials of PKP and conservative treatment of OVCF was collected and diagnosed as thoracolumbar vertebral compression fracture by X-ray,CT,and MRI.Osteoporosis of thoracolumbar vertebrae(T<2.5)was determined by bone mineral density measurements.Age(>50 years old)and course of the disease(<3 months).Postoperative outcome indicators included at least one of the following indicators:visual analogue scale.VAS and Oswestry Dysfunction Index(ODI),changes of Cobb angle of diseased vertebrae and height of the anterior edge of diseased vertebrae.The quality of the included literature was evaluated by referring to the evaluation criteria for randomized controlled trials provided in the Cochrane Systematic Evaluation Manual.Results:Six randomized controlled trials studies were included,all of which were Chinese literature.Five of them had 4 or more points in methodological quality evaluation and one had 3 points in methodology quality evaluation.There were 525 patients in the two groups,267 in the PKP group and 258 in the conservative treatment group.Meta-analysis showed that the pain visual analogue score in the PKP group was significantly higher than that in the conservative treatment group[MD=2.10,95%CI(-2.25,-1.95),P<0.00001].There were significant differences between the PKP group and the conservative treatment(CT)group[MD=8.90,95%CI(-9.86,-7.94),P<0.00001]in the changes of the Cobb angle of the diseased vertebrae after treatment.There were significant differences in the ODI and the height of the anterior edge of the diseased vertebrae(P<0.05).Conclusion:PKP treatment of OVCF can effectively reduce pain visual analogue score,improve dysfunction index(ODI)and improve the quality of life of patients.It can also effectively restore the height of vertebral loss,correct the Cobb angle of the diseased vertebrae,and reduce the risk of recurrent fracture of the adjacent vertebral body and serious complications.展开更多
基金the 2022 Panzhihua City Science and Technology Guidance Plan Project,No.2022ZD-S-35.
文摘BACKGROUND Osteoporotic vertebral compression fractures(OVCFs)contribute to back pain and functional limitations in older individuals,with percutaneous vertebroplasty(PVP)emerging as a minimally invasive treatment.However,further height loss post-PVP prompts investigation into contributing factors.AIM To investigate the factors associated with further height loss following PVP with cement augmentation in OVCF patients.METHODS A total of 200 OVCF patients who underwent successful PVP between January 2021 and December 2022 were included in this study.“Further height loss”during 1 year of follow-up in OVCF patients with bone edema was defined as a vertical height loss of≥4 mm.The study population was divided into two groups for analysis:The“No Further Height Loss group(n=179)”and the“Further Height Loss group(n=21).”RESULTS In comparing two distinct groups of patients,significant differences existed in bone mineral density(BMD),vertebral compression degree,prevalence of intravertebral cleft(IVF),type of bone cement used,and cement distribution patterns.Results from binary univariate regression analysis revealed that lower BMD,the presence of IVF,cleft distribution of bone cement,and higher vertebral compression degree were all significantly associated with further height loss.Notably,the use of mineralized collagen modified-poly(methyl methacrylate)bone cement was associated with a significant reduction in the risk of further height loss.In multivariate regression analysis,lower BMD and the presence of IVF remained significantly associated with further height loss.CONCLUSION Further height loss following PVP in OVCF patients is influenced by a complex interplay of factors,especially lower BMD and the presence of IVF.These findings underscore the importance of assessing and managing these factors when addressing height loss following PVP in OVCF patients.
文摘Objective:To explore the construction and application effect of a postoperative nursing intervention program for osteoporotic vertebral compression fractures.Methods:A total of 68 cases of osteoporotic vertebral compression fractures treated with vertebroplasty in our hospital from March 2023 to April 2024 were selected and randomly divided into the control group and the constructed program group,with 34 cases in each group.The control group received routine postoperative nursing after vertebroplasty,while the constructed program group was provided with a targeted postoperative nursing intervention program based on the control group,which was implemented postoperatively.The postoperative outcomes and thoracolumbar dysfunction of the two groups were compared.Results:The total postoperative efficacy rate in the constructed program group(97.06%,33/34)was significantly higher than that in the control group(76.47%,26/34)(P<0.05).The thoracolumbar dysfunction score in the constructed program group(15.02±1.36)was significantly lower than that in the control group(22.56±2.41)(P<0.05).Conclusion:Constructing a targeted nursing intervention program based on the postoperative nursing requirements for osteoporotic vertebral compression fractures and individual patient characteristics can effectively improve thoracolumbar dysfunction and enhance the postoperative surgical outcome.The clinical application of this program is reliable.
基金supported by National Natural and Science Foundation(81271988)Jiangsu Natural and Science Foundation (BK2012876)
文摘This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who received balloon kyphoplasty. Patients were divided into four groups： Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale （VAS） and Oswestry disability index （ODI） scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture. Therefore, surgery should not only restore compressed vertebral body height and correct kyphosis, but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.
基金financially supported by the Innovation Fund Research Project of State Key Laboratory for Geomechanics and Deep Underground Engineering,China University of Mining and Technology(Grant No.SKLGDUEK202201)。
文摘To address the issue of extensive deformation in the Tabaiyi Tunnel caused by the fault zone,nuclear magnetic resonance(NMR)technology was employed to analyze the physical and mechanical properties of waterabsorbing mudstone.This analysis aimed to understand the mechanism behind the significant deformations.Drawing from the principle of excavation stress compensation,a support scheme featuring NPR anchorcables and an asymmetric truss support system was devised.To validate the scheme,numerical analysis using a combination of the Discrete Element Method(DEM)-Finite Element Method(FEM)was conducted.Additionally,similar material model tests and engineering measurements were carried out.Field experiments were also performed to evaluate the NPR anchor-cable and truss support system,focusing on anchor cable forces,pressures between the truss and surrounding rock,pressures between the initial support and secondary lining,as well as the magnitude of settlement and convergence deformation in the surrounding rock.The results indicate that the waterinduced expansion of clay minerals,resulting from damage caused by fissure water,accelerated the softening of the mudstone's internal structure,leading to significant deformations in the Tabaiyi Tunnel under high tectonic stress.The original support design fell short as the length of the anchor rods was smaller than the expansion depth of the plastic zone.As a result,the initial support structure bore the entire load from the surrounding rock,and a non-coupled deformation contact was observed between the double-arch truss and the surrounding rock.The adoption of NPR asymmetric anchor-cable support effectively restrained the expansion and asymmetric distribution characteristics of the plastic zone.Considering the mechanical degradation caused by water absorption in mudstone,the rigid constraint provided by the truss proved crucial for controlling the stability of the surrounding rock.These research findings hold significant implications for managing large deformations in soft rock tunnels situated within fractured zones under high tectonic stress conditions.
基金supported by the China Scholarship Council(CSC,Grant No.202108050072)JSPS KAKENHI(Grant No.JP19KK0121)。
文摘Grouting has been the most effective approach to mitigate water inrush disasters in underground engineering due to its ability to plug groundwater and enhance rock strength.Nevertheless,there is a lack of potent numerical tools for assessing the grouting effectiveness in water-rich fractured strata.In this study,the hydro-mechanical coupled discontinuous deformation analysis(HM-DDA)is inaugurally extended to simulate the grouting process in a water-rich discrete fracture network(DFN),including the slurry migration,fracture dilation,water plugging in a seepage field,and joint reinforcement after coagulation.To validate the capabilities of the developed method,several numerical examples are conducted incorporating the Newtonian fluid and Bingham slurry.The simulation results closely align with the analytical solutions.Additionally,a set of compression tests is conducted on the fresh and grouted rock specimens to verify the reinforcement method and calibrate the rational properties of reinforced joints.An engineering-scale model based on a real water inrush case of the Yonglian tunnel in a water-rich fractured zone has been established.The model demonstrates the effectiveness of grouting reinforcement in mitigating water inrush disaster.The results indicate that increased grouting pressure greatly affects the regulation of water outflow from the tunnel face and the prevention of rock detachment face after excavation.
文摘This paper addresses the common orthopedic trauma of spinal vertebral fractures and aims to enhance doctors’diagnostic efficiency.Therefore,a deep-learning-based automated diagnostic systemwithmulti-label segmentation is proposed to recognize the condition of vertebral fractures.The whole spine Computed Tomography(CT)image is segmented into the fracture,normal,and background using U-Net,and the fracture degree of each vertebra is evaluated(Genant semi-qualitative evaluation).The main work of this paper includes:First,based on the spatial configuration network(SCN)structure,U-Net is used instead of the SCN feature extraction network.The attention mechanismandthe residual connectionbetweenthe convolutional layers are added in the local network(LN)stage.Multiple filtering is added in the global network(GN)stage,and each layer of the LN decoder feature map is filtered separately using dot product,and the filtered features are re-convolved to obtain the GN output heatmap.Second,a network model with improved SCN(M-SCN)helps automatically localize the center-of-mass position of each vertebra,and the voxels around each localized vertebra were clipped,eliminating a large amount of redundant information(e.g.,background and other interfering vertebrae)and keeping the vertebrae to be segmented in the center of the image.Multilabel segmentation of the clipped portion was subsequently performed using U-Net.This paper uses VerSe’19,VerSe’20(using only data containing vertebral fractures),and private data(provided by Guizhou Orthopedic Hospital)for model training and evaluation.Compared with the original SCN network,the M-SCN reduced the prediction error rate by 1.09%and demonstrated the effectiveness of the improvement in ablation experiments.In the vertebral segmentation experiment,the Dice Similarity Coefficient(DSC)index reached 93.50%and the Maximum Symmetry Surface Distance(MSSD)index was 4.962 mm,with accuracy and recall of 95.82%and 91.73%,respectively.Fractured vertebrae were also marked as red and normal vertebrae were marked as white in the experiment,and the semi-qualitative assessment results of Genant were provided,as well as the results of spinal localization visualization and 3D reconstructed views of the spine to analyze the actual predictive ability of the model.It provides a promising tool for vertebral fracture detection.
基金the Institutional Review Board at the University of Pennsylvania (Approval No.824040).
文摘BACKGROUND Osteoporosis is the leading cause of vertebral fractures.Dual-energy X-ray absor-ptiometry(DXA)and radiographs are traditionally used to detect osteoporosis and vertebral fractures/deformities.Magnetic resonance imaging(MRI)can be utilized to detect the relative severity of vertebral deformities using three-dimen-sional information not available in traditional DXA and lateral two-dimensional radiography imaging techniques.AIM To generate normative vertebral parameters in women using MRI and DXA scans,determine the correlations between MRI-calculated vertebral deformities and age,DXA T-scores,and DXA Z-scores,and compare MRI vertebral deformity values with radiography values previously published in the literature.METHODS This study is a retrospective vertebral morphometric analysis conducted at our institution.The patient sample included MR images from 1638 female patients who underwent both MR and DXA imaging between 2005 and 2014.Biconcavity,wedge,crush,anterior height(Ha)/posterior height(Hp),and middle height(Hm)/posterior height values were calculated from the MR images of the patient’s vertebrae.Associations between vertebral deformity values,patient age,and DXA T-scores were analyzed using Spearman correlation.The MRI-derived measure-ments were compared with radiograph-based calculations from population-based data compiled from multiple studies.RESULTS Age was positively correlated with lumbar Hm/Hp(P=0.04)and thoracic wedge(P=0.03)and biconcavity(P=0.001)and negatively correlated with thoracic Ha/Hp(P=0.002)and Hm/Hp(P=0.001)values.DXA T-scores correlated positively with lumbar Hm/Hp(P<0.0001)and negatively with lumbar wedge(P=0.046),biconcavity(P<0.0001),and Ha/Hp(P=0.046)values.Qualitative analysis revealed that Ha/Hp differed between MRI and radiography population-based data by no more than 0.3 and Hm/Hp by a maximum of 1.2.CONCLUSION Compared with traditional imaging techniques,MRI detects vertebral deformities with high accuracy and re-liability.It may be a sensitive,ionizing,radiation-free tool for use in clinical settings.
文摘Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.
文摘Lumbar vertebral body(VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone mineral density(BMD), which may be applied in order to predict VB failure load and fracture risk. The most representative models are those that take account of normal spinal kinetics and assess the contribution of the cortical shell to vertebral strength. Overall, predictive models for VB fracture risk should encompass a range of important parameters including BMD, geometric measures and patient-specific factors. As interventions like vertebroplasty increase in popularity for VB fracture treatment and prevention, such models are likely to play a significant role in the clinical decision-making process. More biomechanical research is required, however, to reduce the risks of post-operative adjacent VB fractures.
基金supported by Development Center for Medical Science and Technology,National Health and Family Planning Commission of China(No.W2012ZT15)
文摘The clinical effects of two different methods–high-viscosity cement percutaneous vertebroplasty（PVP） and low-viscosity cement percutaneous kyphoplasty（PKP） in the treatment of osteoporotic vertebral compression fractures（OVCFs） were investigated. From June 2010 to August 2013, 98 cases of OVCFs were included in our study. Forty-six patients underwent high-viscosity PVP and 52 patients underwent low-viscosity PKP. The occurrence of cement leakage was observed. Pain relief and functional activity were evaluated using the Visual Analog Scale（VAS） and Oswestry Disability Index（ODI）, respectively. Restoration of the vertebral body height and angle of kyphosis were assessed by comparing preoperative and postoperative measurements of the anterior heights, middle heights and the kyphotic angle of the fractured vertebra. Nine out of the 54 vertebra bodies and 11 out of the 60 vertebra bodies were observed to have cement leakage in the high-viscosity PVP and low-viscosity PKP groups, respectively. The rate of cement leakage, correction of anterior vertebral height and kyphotic angles showed no significant differences between the two groups（P〉0.05）. Low-viscosity PKP had significant advantage in terms of the restoration of middle vertebral height as compared with the high-viscosity PVP（P〈0.05）. Both groups showed significant improvements in pain relief and functional capacity status after surgery（P〈0.05）. It was concluded that high-viscosity PVP and low-viscosity PKP have similar clinical effects in terms of the rate of cement leakage, restoration of the anterior vertebral body height, changes of kyphotic angles, functional activity, and pain relief. Low-viscosity PKP is better than high-viscosity PVP in restoring the height of the middle vertebra.
文摘BACKGROUND Osteoporosis with vertebral compression fractures is increasingly common in the elderly population.Cement augmentation is one of the effective surgical treatments for these patients.Currently,there are several different types of cement augmentation treatments.No studies have compared the safety and efficacy of different cement augmentation types for the treatment of such fractures;thus,we retrospectively compared vertebroplasty,balloon kyphoplasty,and kyphoplasty with SpineJack or an intravertebral expandable pillar.AIM To compare the postoperative safety and efficacy of each surgical intervention in treating vertebral compression fractures.METHODS We retrospectively analyzed 354 patients with acute vertebral compression fractures,defined as signal changes in the T1 weighted magnetic resonance imaging,and randomly divided the patients into five groups.Their visual analog scale scores for pain,kyphotic angle,average body height,rate of cement leakage,and occurrence of adjacent vertebral compression fractures were followed for 1 year.One-way analysis of variance,the post hoc Bonferroni test,and Fisher exact probability test were used for statistical analyses.RESULTS All pain scores significantly improved 12 mo postoperatively;however,there was no significant difference between the groups(P=0.325).Kyphoplasty with SpineJack significantly reduced the kyphotic angle(P=0.028)and restored the height of the vertebral body(P=0.02).The rate of adjacent compression fractures was the highest in the vertebroplasty group,with a statistically significant difference according to the Fisher exact probability test(P=0.02).The treatment with the lowest cement leakage rate cannot be identified because of the small sample size;however,kyphoplasty with SpineJack,an IVEP,and vesselplasty resulted in lower rates of cement leakage than balloon kyphoplasty and vertebroplasty.CONCLUSION Kyphoplasty with SpineJack has good outcomes in kyphotic angle reduction and body height restoration.Vertebroplasty has the highest cement leakage rate and adjacent compression fracture occurrence.
文摘Purpose: The Investigational Vertebroplasty Efficacy and Safety Trial (INVEST), a randomized blinded controlled study of Vertebroplasty, demonstrated similar improvements in pain between blinded Vertebroplasty and sham-Vertebroplasty groups. The result from the RCT study suggested that the observed efficacy of the Vertebroplasty procedure, instead of representing the cement-mediated reduction in pain, may relate to the vertebral bone drilling per se. The aim of this study was to demonstrate the effectiveness of pain relief of vertebral bone drilling at the site of painful osteoporotic vertebral compression fractures in the acute phase. Materials and Methods: Twenty-six patients with painful osteoporotic compression fractures underwent the vertebral bone drilling. We assessed primary outcome measures in the NRS pain score and RDQ score at day 0 and 3 following the drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and RDQ score, and the mean NRS and RDQ score at day 3 were 7.3 ± 1.2, 15.7 ± 4.2, 4.6 ± 1.4, 7.3 ± 2.2, respectively. Among the patients, we detected significant improvements in NRS pain score and RDQ score at day 3 following the drilling compared with day 0 (P < 0.001). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic vertebral compression fractures.
文摘AIM:To evaluate the relationship between a vertebral fracture and a hip fracture in Saudi Arabians with osteoporosis.METHODS:In this retrospective study,154 Saudi Arabian patients with osteoporosis-related hip fractures were analyzed for the presence of a vertebral fracture.Radiographs were retrieved from the IPAC(Image Picture Archiving and Computing)System,an imaging retrieval system,and were reviewed independently by two of the authors,Abid Hussain Gullenpet,and Mir Sadat-Ali,and later reviewed jointly.Patients admitted with proximal hip fracture who were≥50 years and had undergone Thoraco-lumber imaging and a dual energy X-ray absorptiometry(DEXA)scan were included in the study.Patients with a history of significant trauma to the spine and those with a malignancy or connective tissue disorder were excluded from the analysis.RESULTS:Out of 154 patients with hip fractures,78had a fracture of the femoral neck while 76 had an intertrochanteric hip fracture.Of the 111 patients whowere finally included in the study,after applying inclusion and exclusion criteria,76 patients with an average age of 67.28±12 years had no fractures of the spine.Thirty-five patients with an average age of 76.9±14.5years(31.53%)had a total of 49 vertebral fractures.Patients with vertebral fractures were significantly older than those without fractures P<0.001.Overall,24.7%of these patients had an asymptomatic vertebral fracture.Further analysis showed that 11 males(18.96%)and 24 females(45.28%)had suffered a previous asymptomatic vertebral fracture.Interestingly,all women who participated in this study and who presented with a femoral neck fracture had experienced a prior asymptomatic vertebral fracture.CONCLUSION:We recommend that all elderly patients who go to the radiology department for a chest X-ray also have a DEXA scan and a lateral thoracic spine radiograph.
基金Supported by National Natural Science Foundation of China,No.81972108.
文摘BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.
文摘Background: Traditional open instrumentation may cause surgical complications due to fragile bones and induce medical comorbidities in senile patients. Vertebroplasty and kyphoplasty are palliative augmentation procedures that have been associated with increased risks of cement leakage, adjacent fractures and non-union. Objective: The aim of this study was to describe a novel approach for the union of osteoporotic vertebral compression fractures with minimally invasive open reduction and internal fixation. Patients and Methods: Seven consecutive patients with intractable back pain without neurological deficits due to osteoporotic vertebral compression fractures were treated using minimally invasive fixation with intra-vertebral expandable pillars and artificial bone substitute. The clinical symptoms and image findings were recorded. Results: All of the patients reported relief of back pain, and the height of the vertebral bodies was well restored. X-ray findings obtained 2 to 4 years after the procedures showed fracture healing and favorable formation of the callus confirmed in the anterior longitudinal ligament. Conclusion: This mini-open procedure with intravertebral devices is an effective and reliable technique for osteoporotic vertebral compression fractures and may avoid complications related to traditional open spinal instrumentation procedures and augmentation with bone cement.
文摘Percutaneous vertebroplasty is a minimally invasive procedure that involves filling of a fractured vertebral body with bone cement to relieve pain and to restore the vertebral height. It is a safe and effective treatment and is widely used for treating Osteoporotic Vertebral Compression Fracture. Despite of its beneficial advantages over primary conservative managements, adjacent level vertebral compression fracture remains the challenge for surgeons. Adjacent level vertebral compression fracture following percutaneous vertebroplasty using PMMA cement has been reported as a complication. Numerous risk factors have been reported for the occurrence of new adjacent VCFs after PVP. The multiple level osteoporotic vertebral compression fractures and the increasing age of the patients are directly proportional to the risk of developing new symptomatic adjacent vertebral compression fracture after PVP. Moreover, low BMD and cement leakage are other factors that directly affect the incidence of new symptomatic adjacent vertebral fractures. The aim of this review is to evaluate the adjacent level vertebral compression fracture following percutaneous vertebroplasty on the basis of radiographs, Kaplan-Meier Estimation index and also the factors that lead to adjacent level vertebral compression fractures.
文摘Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.
文摘<strong>Background:</strong> Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. <strong>Purpose:</strong> To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). <strong>Method:</strong> A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (<em>β</em>-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. <strong>Results:</strong> After normalized treatment, the bone metabolism indexes of PINP and <em>β</em>-CTX were improved and BMD was increased in three groups. <strong>Adverse Reactions:</strong> There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). <strong>Conclusion:</strong> Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.
文摘Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We evaluated the effects of vertebral bone drilling for the pain due to occults VFs. Materials and Methods: Eighteen patients with painful osteoporotic occult VFs underwent the vertebral bone drilling. We evaluated the clinical outcome by comparing numerical rating scale (NRS) and activity of daily life (ADL) values between before and after the vertebral bone drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and ADL score, and the mean NRS and ALD score after the bone drilling were 8.4 ± 0.8, 2.2 ± 0.6, 2.4 ± 1.0, 4.6 ± 0.5, respectively. Among the patients, we detected significant improvements in NRS pain score and ADL score after the drilling compared with baseline score (p < 0.0002). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic occult VFs.
基金National Natural Science Foundation of China(81674005)Fundamental Research Funds for the Central public welfare research institutes(ZZ10-015)Capital Health Research and Development of Special(2018-2-4162).
文摘Objective:To evaluate the clinical efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF)in the elderly by meta-analysis,and to provide a basis for clinical application.Methods:CNKI,Wanfang,Weipu,CBM,PubMed,the Cochrane Library and EMbase were retrieved by computer from the date of establishment to January 2019.The literature on randomized controlled trials of PKP and conservative treatment of OVCF was collected and diagnosed as thoracolumbar vertebral compression fracture by X-ray,CT,and MRI.Osteoporosis of thoracolumbar vertebrae(T<2.5)was determined by bone mineral density measurements.Age(>50 years old)and course of the disease(<3 months).Postoperative outcome indicators included at least one of the following indicators:visual analogue scale.VAS and Oswestry Dysfunction Index(ODI),changes of Cobb angle of diseased vertebrae and height of the anterior edge of diseased vertebrae.The quality of the included literature was evaluated by referring to the evaluation criteria for randomized controlled trials provided in the Cochrane Systematic Evaluation Manual.Results:Six randomized controlled trials studies were included,all of which were Chinese literature.Five of them had 4 or more points in methodological quality evaluation and one had 3 points in methodology quality evaluation.There were 525 patients in the two groups,267 in the PKP group and 258 in the conservative treatment group.Meta-analysis showed that the pain visual analogue score in the PKP group was significantly higher than that in the conservative treatment group[MD=2.10,95%CI(-2.25,-1.95),P<0.00001].There were significant differences between the PKP group and the conservative treatment(CT)group[MD=8.90,95%CI(-9.86,-7.94),P<0.00001]in the changes of the Cobb angle of the diseased vertebrae after treatment.There were significant differences in the ODI and the height of the anterior edge of the diseased vertebrae(P<0.05).Conclusion:PKP treatment of OVCF can effectively reduce pain visual analogue score,improve dysfunction index(ODI)and improve the quality of life of patients.It can also effectively restore the height of vertebral loss,correct the Cobb angle of the diseased vertebrae,and reduce the risk of recurrent fracture of the adjacent vertebral body and serious complications.
