scholarly journals Perioperative Hidden Blood Loss in Elderly Osteoporotic Vertebral Compression Fracture Patients With Percutaneous Vertebroplasty and Influencing Factors

2021 ◽  
Vol 12 ◽  
pp. 215145932199617
Author(s):  
Tongchuan Cai ◽  
Feng Wang ◽  
Liping Nan ◽  
Dong Chen ◽  
Shuguang Wang ◽  
...  

Introduction: To analyze perioperative hidden blood loss (HBL) and its influencing factors in elderly patients with osteoporotic vertebral compression fracture (OVCF) treated with percutaneous vertebroplasty (PVP). Materials and Methods: From January 2016 to December 2018, 103 elderly patients with OVCF (age > 85 years) treated with PVP were selected. The patient’s height, weight, duration of symptoms, previous medical history and other basic information were recorded. The hemoglobin (Hb) and hematocrit (Hct) immediately after admission and the next day postoperative were recorded. The operation time, surgical bleeding, Kummell’s disease, vertebral height preoperative and postoperative, and bone cement leakage was recorded. The total blood loss (TBL) was calculated according to Gross’s formula, and HBL was calculated based on the TBL and surgical bleeding. The influential factors were analyzed by multivariate linear regression analysis and single factor correlation analysis. Results: The mean surgical bleeding was 11.83 ± 5.37 mL, and HBL was 306.19 ± 185.92 mL, with a statistically significant difference (P = 0.000). According to the multiple linear regression analysis, the duration of symptoms (P = 0.030), number of fracture segments (P = 0.016), operation time (P = 0.004), loss of vertebral height (P = 0.026), recovery of vertebral height (P = 0.004), Kummell’s disease (P = 0.040) and cement leakage (P = 0.004) were correlated with an increased amount of HBL. Sex (P = 0.077), body mass index (BMI) (P = 0.486), hypertension (P = 0.734), diabetes (P = 0.769), fracture level (P = 0.518) and surgical bleeding (P = 0.821) had no correlation with the amount of HBL. Conclusions: There was obvious HBL during the perioperative period of PVP in elderly patients with OVCF. A fresh fracture, multi-segment vertebral fracture, longer operation time, presence of Kummell’s disease, loss of vertebral height, recovery of vertebral height and cement leakage the increased perioperative HBL during PVP.

2020 ◽  
Author(s):  
Jian-Zhong Chang ◽  
Ming-Jian Bei ◽  
Dong-Ping Shu ◽  
Cheng-Jun Sun ◽  
Ji-Bin Chen ◽  
...  

Abstract Background Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used in the treatment of Kümmell's disease. The purpose of this article is to investigate the clinical efficacy of PVP and PKP for Kümmell's disease. Methods The clinical data that 56 cases of OVCF treated with either PVP (28 cases) or PKP (28 cases) and met the selection criteria from December 2015 to December 2017 were prospectively analyzed. Gender, age, course of disease, injury segment, BMD, VAS, ODI, imaging measurement indexes before surgery between the two groups showed no significant difference (all P>0.05). The bone cement leakage rate, bone cement injection amount, operation time, VAS, ODI, the rate of vertebral compression, correction rate of kyphosis and refracture rate of adjacent vertebra in 2 years were compared between the two groups to calculate clinical efficacy. Results The two groups were followed up for 24-48 months. There was no significant difference in the follow-up time, amount of bone cement injected, incidence of bone cement leakage and refracture rate of adjacent vertebra between the two groups (all P > 0.05). The operation time, intraoperative blood loss and fluoroscopy times of the PVP group were significantly lower than those of the PKP group (all P = 0.000). VAS score and ODI of the two groups were significantly lower at 1 d, 1 year and 2 years after surgery than before surgery (all P <0.05), but there was not statistically significant difference between the two groups at each time point after surgery (all P> 0.05). The rate of vertebral compression and kyphosis correction in the two groups were significantly corrected (P <0.05, respectively) and decreased significantly with time (all P <0.05), But there was not significant difference between the two groups at any time point (all P> 0.05). Conclusion Both PVP and PKP can achieve similar effects in the treatment of Kümmell's disease. Because the cost, operation time, blood loss, radiation exposure and surgical procedure of PVP are less than those of PKP, PVP has more clinical priority value.


2021 ◽  
Vol 12 ◽  
pp. 215145932110021
Author(s):  
Tongchuan Cai ◽  
Dong Chen ◽  
Shuguang Wang ◽  
Pengzhi Shi ◽  
Junwu Wang ◽  
...  

Introduction: To analyze the perioperative hidden blood loss (HBL) and its influencing factors in elderly cervical spondylosis patients treated with anterior cervical discectomy fusion (ACDF). Materials and Methods: From January 2017 to December 2018, 128 elderly cervical spondylosis patients (age > 65 y) treated with ACDF were selected. The patients’ height, weight, duration of symptoms, previous medical history and other basic information were routinely recorded. The hemoglobin (Hb), hematocrit (Hct) and blood coagulation function preoperative and the next day postoperative were recorded. The operation time, surgical bleeding, ASA classification, fixation method, total drainage and the time for extraction of drainage tube were recorded. The total blood loss (TBL) was calculated according to the Gross’s formula, and HBL was calculated based on TBL, total drainage and surgical bleeding. The statistical analysis of HBL was performed, and then influential factors were further analyzed by multivariate linear regression analysis and t test. Results: The mean surgical bleeding was 102.70 ± 46.78 mL and HBL was 487.98 ± 255.96 mL. HBL accounted for 67.61 ± 5.20% of TBL. According to the multiple linear regression analysis, the gender (P = 0.047), operation time (P = 0.000), fixation method (P = 0.014) and international normalized ratio (INR) (P = 0.003) influenced the amount of HBL. Body mass index (BMI) (P = 0.624), hypertension (P = 0.977), diabetes (P = 0.528), blood type (P = 0.577), ASA classification (P = 0.711), duration of symptoms (P = 0.661), preoperative cobb angle (P = 0.152), number of surgical level (P = 0.709), intramedullary hyperintensity (P = 0.967), drainage time (P = 0.294), postoperative drainage volume (P = 0.599), prothrombin time (PT) (P = 0.674), activated partial thromboplastin time (APTT) (P = 0.544) and thrombin time (TT) (P = 0.680) had no correlation with the amount of HBL. Conclusions: There was obvious HBL during the perioperative period of ACDF in elderly cervical spondylosis patients. The male patients, longer operation time, fusion with titanium plate and cage and high INR were independent risk factors for HBL.


2020 ◽  
Author(s):  
Jian-Zhong Chang ◽  
Ming-Jian Bei ◽  
Dong-Ping Shu ◽  
Cheng-Jun Sun ◽  
Ji-Bin Chen ◽  
...  

Abstract Background Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used in the treatment of Kümmell's disease. The purpose of this article is to investigate the clinical efficacy of PVP and PKP for Kümmell's disease. Methods The clinical data that 56 cases of Kümmell's disease treated with either PVP (28 cases) or PKP (28 cases) from December 2015 to December 2017 were prospectively analyzed. Gender, age, course of disease, injury segment, bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), imaging measurement indexes before surgery between the two groups showed no significant difference (all P>0.05). The bone cement leakage rate, bone cement injection amount, operation time, VAS, ODI, the rate of vertebral compression, correction rate of kyphosis and refracture rate of adjacent vertebra in 2 years were compared between the two groups to calculate clinical efficacy. Results The two groups were followed up for 24-48 months. There was no significant difference in the follow-up time, amount of bone cement injected, incidence of bone cement leakage and refracture rate of adjacent vertebrae between the two groups (all P> 0.05). The operation time, intraoperative blood loss and fluoroscopy times of the PVP group were significantly lower than those of the PKP group (all P = 0.000). VAS score and ODI of the two groups were significantly lower at 1 day, 1 year and 2 years after surgery than before surgery (all P <0.05), but there was not statistically significant difference between the two groups at each time point after surgery (all P> 0.05). The rate of vertebral compression and kyphosis correction in the two groups were significantly corrected (P <0.05, respectively) and decreased significantly with time (all P <0.05), But there was not significant difference between the two groups at any time point (all P> 0.05). Conclusion Both PVP and PKP can achieve similar effects in the treatment of Kümmell's disease. Because the cost, operation time, blood loss, radiation exposure and surgical procedure of PVP are less than those of PKP, PVP has more clinical priority value.


2020 ◽  
Author(s):  
Dan Pan ◽  
Xiaojie Ouyang ◽  
Qinghua Huang ◽  
Dayong Chen

Abstract Background: Percutaneous kyphoplasty (PKP) is effective for the treatment of Kummell's disease. However, controversy remains regarding whether a unipedicular or bipedicular PKP is superior.Methods: A retrospective study was performed to review 40 patients with stage I and II Kummell's disease who underwent PKP in our hospital from January 2015 to June 2018. Based on the transpedicular approach of PKP, those patients were randomly divided into unipedicular group (n = 19) and bipedicular group (n = 21) . Operative time, bone cement injection volume and cement leakage rate were compared in the two groups. Pre- and post-operative visual analogue score (VAS), local kyphotic angle and average vertebral height were also evaluated.Results: All patients underwent surgery successfully. Compared with preoperative condition, VAS was significantly decreased at 1 day after operation and the last follow-up in both groups (P < 0.05) , and local kyphotic angle and average vertebral height were restored markedly (P < 0.05). Operative time of both groups had no significant difference (P > 0.05). Bone cement injection volume was larger in bipedicular group (P < 0.05). At 1 day after operation and the last follow-up , the local kyphotic angle and average vertebral height in bipedicular group were restored better than those in unipedicular group (P < 0.05). There were 4 cases of cement leakage in both groups, with leakage rates of 21.1% and 19.0%, respectively, and the difference was not significant (P > 0.05).Conclusion: Both unipedicular and bipedicular PKP are effective for treating patients with stage I and II Kummell's disease, while postoperative pain relief and imaging results in bipedicular group were better than those in unipedicular group.


2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Z.-K. Duan ◽  
J.-F. Zou ◽  
X.-L. He ◽  
C.-D. Huang ◽  
C.-J. He

Abstract Summary Kümmell’s disease (eponymous name for osteonecrosis and collapse of a vertebral body due to ischemia and non-union of anterior vertebral body wedge fractures after major trauma) cannot heal spontaneously. Bone-filling mesh container (BFMC) can significantly relieve pain, help the correction of kyphosis, and may prevent cement leakage. This pilot study may provide the basis for the design of future studies. Purpose To compare the effectiveness and safety of BFMC and percutaneous kyphoplasty (PKP) for treatment of Kümmell’s disease. Methods From August 2016 to May 2018, 40 patients with Kümmell’s disease were admitted to Guizhou Provincial People’s Hospital. Among them, 20 patients (20 vertebral bodies) received PKP (PKP group) and the other 20 received BFMC (BFMC group). Operation time, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Cobb’s angle changes, and related complications were recorded. Results All patients underwent operations successfully. VAS scores and ODI of both groups at each postoperative time point were lower than preoperatively, with statistically significant difference (p < 0.05). Postoperative Cobb’s angle of both groups postoperatively was lower than preoperatively (p < 0.05). Cement leakage occurred in eight vertebrae (8/20) in the PKP group and in one vertebra (1/20) in the BFMC group. No complications such as pulmonary embolism, paraplegia, or perioperative death occurred during operation in both groups. Adjacent vertebral refractures occurred in five patients (5/20) in the PKP group and in four patients (4/20) in the BFMC group, with no significant difference in the incidence rate of refractures in both groups but the material is too small to verify statistically. Conclusions Both PKP and BFMC technologies can significantly relieve pain and help the correction of kyphosis while treating Kümmell’s disease. Moreover, the BMFC may prevent cement leakage.


Author(s):  
Liang Zhang ◽  
Jingcheng Wang ◽  
Yongxiang Wang ◽  
Xinmin Feng

OBJECTIVE: To compare the clinical outcomes and cement leakage rate between high-viscosity and low-viscosity cement percutaneous vertebroplasty (PVP) with manipulative reduction in the treatment of Kümmell’s disease (KD). METHOD: PVP using high-viscosity cement (Group H) or low-viscosity cement (Group L) with manipulative reduction was compared in 86 KD patients. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), vertebral height, kyphosis angle and complications were evaluated and compared preoperative, one day postoperative, and at final follow-up. RESULTS: The VAS score, ODI score, mean anterior and middle vertebral height variation significantly improved in both groups postoperatively. However, there was no significant difference between the two groups considering the above results preoperative and postoperative. Significantly less cement leakage (13.6%) and shorter operative time (35.6 ± 5.1 min) were observed in Group H when compared with Group L (45.2% and 41.1 ± 5.3 min) (p< 0.05). CONCLUSION: The clinical outcomes and radiologic findings of PVP with manipulative reduction was not influenced by cement viscosity. However, high cement viscosity PVP was found to be significant less cement leakage and shorter operative time.


2020 ◽  
Author(s):  
Cheng-Liang Wang ◽  
Ji-Bin Chen ◽  
Te Li

Abstract Background The purpose of this study is to investigate and compare the therapeutic effect and distribution characteristics of bone cement in the PVP treatment for thoracolumbar Kümmell's diseases and OVCFs. Methods A prospective analysis of 35 patients with Kümmell ’s disease (K group) and 35 patients with OVCFs (O group) who underwent PVP treatment from February 2016 to February 2018 was conducted. The vertebral compression rate and degree of osteoporosis were more serious in the K group than in the O group ( P <0.05, respectively). Distribution pattern, volume and leakage rate of bone cement, operation time, VAS score, ODI, correction rates of vertebral compression and kyphosis, re-fracture rate of adjacent vertebrae in 2 years between the two groups were compared to assess clinical effect. Results The follow-up time of the two groups was 24-48 months. The amount of intraoperative bone cement injection was significantly higher in the K group than in the O group ( P =0.025). The cement distribution pattern of local solid lump was dominant in the K group (65.71%), while intercalation with trabeculae was dominant in the O group (74.29%) ( P <0.001). VAS score and ODI were significantly lower both in the two groups at 1 day, 1 year and 2 years after surgery than before surgery (all P <0.05), but significantly lower in the K group than in the O group at each time point after surgery (all P <0.05). The correction rates of kyphosis and vertebral compression in both groups was significantly corrected ( P <0.05, respectively) and gradually lost with time ( P <0.05, respectively). The correction rates of kyphosis and vertebral compression were significantly higher in the K group than in the O group at each time point after surgery (all P <0.05). Conclusions PVP has the advantages of simple operation, short operation time, small trauma and quick recovery in treating both Kümmell's disease and OVCFs. However, PVP can better restore partial vertebral height and correct kyphosis in the treatment of Kümmell's disease, while can better alleviate pain and improve ODI in the treatment of OVCFs.


2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hongyu Wei ◽  
Chunke Dong ◽  
Yuting Zhu ◽  
Haoning Ma

Abstract Background A systematic review and meta-analysis to assess the pros and cons of percutaneous vertebroplasty (PVP) versus kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) including all available evidence from controlled trials. Methods Databases including Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched to identify relevant studies comparing PVP and PKP for OVCFs with IVC. The outcomes mainly included visual analog scale (VAS), Oswestry Disability Index (ODI), local kyphotic angle (LKA), rate of vertebral height (VH%), and adverse events. Results Nine studies enrolling 688 patients were eligible for meta-analysis. The results indicated no significant differences between the two groups in the short-and long-term VAS, ODI, LKA, or VH% (P > 0.05). Compared with PVP, PKP was associated with significantly longer operation time (P < 0.05), higher cost (P > 0.05), and more injected cement volume (P < 0.05). In terms of adverse events, PKP has a lower risk of cement leakage (P < 0.05), while with no significant difference in adjacent-level fracture rates (P > 0.05). Conclusion The two procedures have similar short- and long-term pain relief, functional recovery, local kyphosis correction, and vertebral height maintenance in OVCFs with IVC. PKP is superior to PVP for the injected cement volume, and lower cement leakage rate, however, with longer operation time, more fluoroscopy times, and higher cost. Further randomized controlled trials (RCTs) should be conducted to confirm these results.


2015 ◽  
Vol 6;18 (6;11) ◽  
pp. E1021-E1028
Author(s):  
Yan Yang

Background: Percutaneous kyphoplasty (PKP) has been proven as an effective, minimally invasive procedure for the treatment of Kummell’s disease in the early stages. However, a risk of cement leakage and further neurological damage remains during and after PKP, especially in chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Objective: To evaluate the feasibility and efficacy of PKP for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Study Design: A retrospective evaluation of postoperative radiographs. Setting: Pain management clinic. Methods: A retrospective study was performed on 9 patients with 11 levels managed with PKP for chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Clinical and radiological outcomes were assessed. Results: Substantial pain relief was attained in all the patients. Both visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores improved significantly from pre- to post-operation (P < 0.05), and remained unchanged at every follow-up. No neurological deterioration was found. Postoperatively, the anterior and midline vertebral body heights were significantly corrected (P < 0.05), and were sustained at the final follow-up. Similar results were seen in the correction of kyphotic angle. Neither cement leakage into the spinal canal nor further dislodging of the posterior vertebral fragments occurred. Two cases experienced subsequent fractures with one having a second PKP and the other being treated conservatively. Limitations: Retrospective study of 9 cases with 11 levels due partly to the rarity of the disorder. Conclusions: PKP is an effective, minimally invasive procedure for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal stenosis, leading to a significant relief of symptoms and improvement of functional status. Institutional Review: This study was approved by the Institutional Review Board. Key words: Kummell’s disease, kyphoplasty, spine, osteoporosis, cement leakage, polymethylmethacrylate, neurological deficits, burst fractures


Author(s):  
Nikil Sanaba Paramesh ◽  
Usman Taufiq

<p class="abstract"><strong>Background:</strong> Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 60 years old.</p><p class="abstract"><strong>Methods:</strong> We searched PUBMED from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our control trial involved 132 patients (132 hips) who were eligible for the study. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; p = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; p&lt;0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; p&lt;0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; p&lt;0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.</p><p class="abstract"><strong>Conclusions:</strong> Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.</p>


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