Clinical study of unilateral Percutaneous vertebra plasty(PVP) in the treatment of Osteoporotic vertebral compression fractures(OVCF) in the elderly

Objective To study the clinical effect of unilateral percutaneous vertebra plasty (PVP) in the treatment of osteoporotic lumbar compression fracture (OVCF) in the elderly. Methods 84 elderly patients with OVCF who were treated in our hospital from January 2017 to December 2020 were included and divided into unilateral group (n=42) and bilateral group (n=42) according to the random number table method. Unilateral PVP treatment was performed in the unilateral group, and bilateral PVP treatment was performed in the bilateral group. Observed two groups of X-ray machine, bone cement dosage irradiation time and operation time indicators such as surgery, preoperative and postoperative and postoperative convex Cobb Angle, after 1 years of vertebral body lesions vertebral body height and body function, preoperative and postoperative 7d and postoperative pain degree and 1 year serum Norepinephrine (NE) and Serotonin (5-HT) and Substance P (SP) and so on pain factor levels, postoperative complications and other indicators; Results the time of X-ray machine irradiation, amount of bone cement and operation time in theunilateral group were all lower than those in the bilateral group (P<0.05). After surgery and 1 year after surgery, there was no difference in Cobb Angle of kyphotic vertebra, height of diseased vertebra and limb function between the two groups (P>0.05).There was no difference in VAS scores and 5-ht, SP and NE levels between the two groups after and 1 year after surgery(P>0.05).The incidence of postoperative complications in the unilateral group (19.05%) was lower than that in the bilateral group (47.62%) (P<0.05). Conclusion unilateral PVP can achieve the same effect as bilateral PVP in the treatment of elderly OVCF. Small trauma, easy to operate, can effectively relieve patients' pain, safe and reliable, worthy of clinical recommendation.

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Comparison of a flexible versus rigid bone cement injection system in unilateral percutaneous vertebroplasty.

10.21203/rs.3.rs-16060/v1 ◽

2020 ◽

Author(s):

yuwei li ◽

wei cui ◽

peng zhou ◽

cheng li ◽

yan wen ◽

...

Keyword(s):

Vertebral Fracture ◽

Radiation Exposure ◽

Bone Cement ◽

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Operation Time ◽

Cement Leakage ◽

X Ray ◽

Cement Injection ◽

Significant Difference

Abstract Background: Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of acute osteoporotic vertebral fracture (AOVF). However, bilateral puncture takes more time to accept more X-ray irradiation; some scholars apply unilateral puncture PVP, but the cement cannot be symmetrically distributed in the vertebral body, so we use a flexible cement injector that undergoes PVP through the unilateral pedicle puncture. This research aims to compare the clinical results of PVP for AOVF with unilateral pedicle puncture using a straight bone cement injector and a bendable cement injector, determine the value of a bendable cement injector.Methods: We undertook a retrospective analysis of patients with thoracic and lumbar compression fracture treated with unilateral pedicle puncture Percutaneous vertebroplasty from our institution from June 2013 to July 2015. Operation time, radiation exposure, bone cement injection amount, and the incidence of bone cement leakage were recorded on presentation, the cement leakage was measured by x-ray and computed tomography scan. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiological outcomes.Results: There was no significant difference in the operation time, radiation exposure time and incidence of bone cement leakage between the two groups. There was significant difference in the amount of bone cement injection and the difference between the two groups. there were no significant differences in VAS and the relative height of the vertebral body and local Cobb angle and QUALEFFO between 2 groups at 1 week after PVP, only significant difference was observed between 12 months after operation.Conclusions: Application of flexible cement injector is safe and feasible,Compared with the application of straight bone cement injector, without prolonging the operative time, radiation exposure time and the incidence of bone cement leakage, it has the advantages of good long-term effect and low incidence of vertebral fracture recurrence.

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Comparison of a flexible versus rigid bone cement injection system in unilateral percutaneous vertebroplasty

10.21203/rs.3.rs-21372/v1 ◽

2020 ◽

Author(s):

yuwei li ◽

wei cui ◽

peng zhou ◽

cheng li ◽

yan wen ◽

...

Keyword(s):

Vertebral Fracture ◽

Radiation Exposure ◽

Bone Cement ◽

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Operation Time ◽

Cement Leakage ◽

X Ray ◽

Cement Injection ◽

Significant Difference

Abstract Background: Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of acute osteoporotic vertebral fracture (AOVF). However, bilateral puncture takes more time to accept more X-ray irradiation; some scholars apply unilateral puncture PVP, but the cement cannot be symmetrically distributed in the vertebral body, so we use a flexible cement injector that undergoes PVP through the unilateral pedicle puncture. This research aims to compare the clinical results of PVP for AOVF with unilateral pedicle puncture using a straight bone cement injector and a bendable cement injector, determine the value of a bendable cement injector. Methods: We undertook a retrospective analysis of patients with thoracic and lumbar compression fracture treated with unilateral pedicle puncture Percutaneous vertebroplasty from our institution from June 2013 to July 2015. Operation time, radiation exposure, bone cement injection amount, and the incidence of bone cement leakage were recorded on presentation, the cement leakage was measured by x-ray and computed tomography scan. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiological outcomes. Results: There was no significant difference in the operation time, radiation exposure time and incidence of bone cement leakage between the two groups. There was significant difference in the amount of bone cement injection and the difference between the two groups. there were no significant differences in VAS and the relative height of the vertebral body and local Cobb angle and QUALEFFO between 2 groups at 1 week after PVP, only significant difference was observed between 12 months after operation. Conclusions: Application of flexible cement injector is safe and feasible,Compared with the application of straight bone cement injector, without prolonging the operative time, radiation exposure time and the incidence of bone cement leakage, it has the advantages of good long-term effect and low incidence of vertebral fracture recurrence.

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Long-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell diseaseLong-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease

10.21203/rs.2.22708/v1 ◽

2020 ◽

Author(s):

Guo-ye Mo ◽

Teng-peng Zhou ◽

Yong-xian Li ◽

Hui-zhi Guo ◽

Dan-qing Guo ◽

...

Keyword(s):

Cobb Angle ◽

Bone Cement ◽

Pedicle Screw ◽

Screw Fixation ◽

Operation Time ◽

Pedicle Screw Fixation ◽

Stage Iii ◽

Efficacy And Safety ◽

Sagittal Vertical Axis ◽

Term Efficacy

Abstract Purpose This study aimed to evaluate the efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease. Methods Twenty-five patients with stage III Kümmell disease who received bone cement-augmented pedicle screw fixation at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between June 2009 and December 2015 were enrolled. All patients were females with a history of osteoporosis. The vertebral Cobb angle (V-Cobb angle), the fixed segment Cobb Angle (S-Cobb angle), pelvic parameters, visual Analogue Scale (VAS) score, and Oswestry Disability Index (ODI) were assessed preoperatively, postoperatively and at the final follow-up. Complications, loosening rate, operation time, and intraoperative bleeding were recorded. Results The average lumbar vertebral density T-value was -3.68 ± 0.71 SD, and the average age was 71.84 ± 5.39. The V-Cobb angle, S-Cobb angle, and Sagittal Vertical Axis（SVA） were significantly smaller postoperatively compared to the preoperative values. The VAS and ODI at 1 month after surgery were 3.60 ± 1.00 and 36.04 ± 6.12%, respectively, which were both significantly lower than before surgery (VAS: 8.56±1.04, ODI: 77.80 ± 6.57%). Conclusion Bone cement-augmented pedicle screw fixation is a safe and effective treatment for stage III Kümmell disease. It can effectively correct kyphosis, restore and maintain sagittal balance, and maintain spinal stability.

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Influence of the distribution of bone cement along the fracture line on the curative effect of vertebral augmentation

Journal of International Medical Research ◽

10.1177/0300060519864183 ◽

2019 ◽

Vol 47 (9) ◽

pp. 4505-4513 ◽

Cited By ~ 3

Author(s):

Kai Xu ◽

Ya-Ling Li ◽

Fei Song ◽

Hua-Wei Liu ◽

Hua-Dong Yang ◽

...

Keyword(s):

Pain Relief ◽

Bone Cement ◽

Compression Fracture ◽

Cement Leakage ◽

Fracture Line ◽

Vertebral Augmentation ◽

Bilateral Group ◽

Significant Difference ◽

Cement Distribution ◽

Unilateral Group

Objective The present study was performed to evaluate the effect of different bone cement distributions along the fracture line on clinical and imaging outcomes of vertebral augmentation. Methods In total, 84 patients who underwent vertebral augmentation for a single osteoporotic vertebral compression fracture from January 2016 to August 2018 were retrospectively reviewed. These patients were divided into two groups according to the relationship between the bone cement distribution and the fracture line: the unilateral group (n = 23) and the bilateral group (n = 61). Postoperative clinical and imaging parameters were compared between the two groups. Results Statistical analyses showed no significant difference in postoperative pain relief, bone cement leakage, nerve injury, or new vertebral fracture between the two groups. Significant recovery from vertebral compression was observed in the bilateral group after surgery, but there was no significant difference in vertebral compression after surgery in the unilateral group. Conclusions Pain relief was similar for different types of cement distributions along the fracture line, but a bilateral cement distribution exhibited better recovery from vertebral compression and did not increase bone cement leakage in the vertebral augmentation procedure.

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A comparative study of the fracture union between long and short proximal femoral intramedullary nails antirotation in the treatment of intertrochanteric femur fractures in the elderly: a multicentric analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190793 ◽

2019 ◽

Vol 5 (2) ◽

pp. 288

Author(s):

B. Hari Krishnan ◽

S. K. Rai ◽

Rohit Vikas ◽

Manoj Kashid ◽

Pramod Mahender

Keyword(s):

Postoperative Complications ◽

Blood Transfusion ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Operation Time ◽

The Elderly ◽

Intertrochanteric Fractures ◽

Intraoperative Blood Loss ◽

Fracture Union ◽

Femur Fractures

Background: The objective of the study was to compare the fracture union of long vs. short proximal femoral intramedullary nail antirotation (PFNA) in the treatment of intertrochanteric fractures in elderly patients who was more than 60 years old.Methods: A retrospective analysis of 170 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted. There were 64 males (37.6%) and 106 females (62.3%) with the age of 60–90 (mean age 75) years. The general demographic data of patients, operation time, intraoperative blood loss, length of hospital stay, blood transfusion rate, anterior thigh pain, postoperative complications like periprosthetic fractures, infections were recorded.Results: The short nail group also had a significantly shorter operation time (41.5±15.3 minutes vs. 62.5±25.3 minutes, p=0.002) and lower rate of postoperative transfusion (31.3% vs. 58.7%, p=0.041). However the length of hospital stay showed no significant differences. After surgery in short group there were 03 cases of periprosthetic fracture with a total incidence of 03%, however there were none in long nail group. At the end of the follow-up, all patients achieved bony union. The average fracture union time of the long nail group was (8.5±3.2) months, and the short nail group was (7.8±4.7) months, revealing no significant differences (p=0.09).Conclusions: Both the proximal femoral intramedullary long and short nail fixation has a good result in the form of fracture union in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of fracture union, hospital stay, and postoperative complications. The incidence of periprosthetic fractures and anterior thigh pain was slightly high in short nail group. In short intramedullary nailing group there was obvious decrease in the intraoperative blood loss, operation time and postoperative blood transfusion.

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Unilateral Transforaminal Approach (UTFA) in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Novel Puncture Technique

10.21203/rs.3.rs-154379/v1 ◽

2021 ◽

Author(s):

wang yefeng ◽

Li suoyuan ◽

Cai xiaoqiang ◽

Shen jun ◽

Zou tianming

Keyword(s):

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Operation Time ◽

Vertebral Compression Fractures ◽

X Rays ◽

Osteoporotic Vertebral Compression Fractures ◽

Invasive Treatment ◽

X Ray ◽

Compression Fractures ◽

Transforaminal Approach

Abstract Background: Percutaneous vertebroplasty (PVP) via various puncture approaches was an effective minimally invasive treatment for osteoporotic vertebral compression fractures (OVCFs). In recent years, unilateral puncture techniques had been increasingly used with advantages of shorter operation time, lower X-ray exposure. The aim of this study was to explore the safety and efficacy of the unilateral transforaminal approach (UTFA) in PVP for the treatment of OVCFs. Methods: A retrospective study was designed to review 155 cases of single-level OVCFs from July 2018 to December 2019. We treated 77 patients with PVP via the UTFA and 78 via the bilateral transpedicular approach (BTPA). Operation time, number of intraoperative fluoroscopic X-rays, volume of bone cement injection and distribution of bone cement were recorded. We used Visual Analog Scale (VAS) score and Oswestry disability index (ODI) presurgery and at 1 day, 3 months and last follow-up after surgery to assess clinical outcomes. Results: The operation was successfully completed in both groups, with no complications of neurovascular injuries or bone cement embolism. UTFA group had significantly shorter operation time and less-frequent fluoroscopy than BTPA group (P < 0.05). There were no significant differences between the two groups in volume or distribution of injected bone cement (P > 0.05). Postoperative VAS scores and ODI of the two groups were significantly improved over their presurgical values (P < 0.05), but there were no significant differences in VAS or ODI at each time point between the two groups (P > 0.05). Conclusions: Both unilateral transforaminal PVP and bilateral transpedicular PVP were safe and effective treatments for OVCFs, but the former approach had the advantages of shorter operation time and less X-ray radiation exposure and therefore is worthy of greater clinical application.

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Vesselplasty for the treatment of osteoporotic vertebral compression fractures with peripheral wall damage: A retrospective study

10.21203/rs.3.rs-107453/v1 ◽

2020 ◽

Author(s):

Chongqing Xu ◽

Mengchen Yin ◽

Wen Mo

Keyword(s):

Cobb Angle ◽

Bone Cement ◽

Vertebral Body ◽

Body Height ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Vertebral Body Height ◽

Compression Fractures ◽

Time Points ◽

Postoperative Time

Abstract Background The clinical efficacy of vertebroplasty and kyphoplasty treating osteoporotic vertebral compression fractures (OVCF) has been widely recognized in recent years. However, there are also disadvantages of bone cement leakage (BCL), limited correction of kyphosis and recovery of vertebral height. Nowadays, in view of these shortcomings, vesselplasty has been widely used in clinical practice. The objective of this study is to assess its clinical effect and application value for the treatment of OVCF with peripheral wall damage. Methods/Design: All 62 patients (70 vertebrae) treated for OVCF with peripheral wall damage using vesselplasty were involved and retrospectively analyzed. The data collection included operation time, volume of bone cement, relevant surgical complications, visual analog scale (VAS), Oswestry disability index (ODI), vertebral body height and kyphosis Cobb angle. Results The time of operation was 20–65 (34.5 ± 10.5) minutes. The volume of bone cement was 3–8 (5.3 ± 1.3) ml. VAS and ODI at different time points after operation were decreased compared with before operation (all P < 0.05). There were no statistical differences between VAS or ODI at different postoperative time points (P > 0.05). Vertebral body height and Cobb angle at different time points after operation were improved compared with before operation (all P < 0.05). There were no statistical differences between vertebral body height or Cobb angle at different postoperative time points (all P > 0.05). Conclusion Vesselplasty can reduce the risk of BCL and better control the dispersion of bone cement in the treatment of OVCF. It has a definite effect in relieving pain, restoring the vertebral body height and correcting the kyphosis caused by injured vertebrae, especially in OVCF with peripheral wall damage. Therefore, vesselplasty is safe and worthy of clinical application.

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Long-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease

Scientific Reports ◽

10.1038/s41598-021-93013-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Guo-ye Mo ◽

Teng-peng Zhou ◽

Hui-zhi Guo ◽

Yong-xian Li ◽

Yong-chao Tang ◽

...

Keyword(s):

Cobb Angle ◽

Bone Cement ◽

Pedicle Screw ◽

Screw Fixation ◽

Operation Time ◽

Vertical Axis ◽

Pedicle Screw Fixation ◽

Stage Iii ◽

Efficacy And Safety ◽

Sagittal Vertical Axis

AbstractThis study aimed to evaluate the efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease. Twenty-five patients with stage III Kümmell disease who received bone cement-augmented pedicle screw fixation at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between June 2009 and December 2015 were enrolled. All patients were females with a history of osteoporosis. The vertebral Cobb angle (V-Cobb angle), the fixed segment Cobb Angle (S-Cobb angle), pelvic parameters, visual Analogue Scale (VAS) score, and Oswestry Disability Index (ODI) were assessed preoperatively, postoperatively and at the final follow-up. Complications, loosening rate, operation time, and intraoperative bleeding were recorded. The average lumbar vertebral density T-value was − 3.68 ± 0.71 SD, and the average age was 71.84 ± 5.39. The V-Cobb angle, S-Cobb angle, and Sagittal Vertical Axis (SVA) were significantly smaller postoperatively compared to the preoperative values. The VAS and ODI at 1 month after surgery were 3.60 ± 1.00 and 36.04 ± 6.12%, respectively, which were both significantly lower than before surgery (VAS: 8.56 ± 1.04, ODI: 77.80 ± 6.57%). Bone cement-augmented pedicle screw fixation is a safe and effective treatment for stage III Kümmell disease. It can effectively correct kyphosis, restore and maintain sagittal balance, and maintain spinal stability.

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A novel bone cement screw system combined with vertebroplasty for the treatment of Kummell disease with bone deficiency at vertebral anterior border: minimum 3-year follow-up study

10.21203/rs.3.rs-18781/v1 ◽

2020 ◽

Author(s):

Biao Wang ◽

Xinliang Zhang ◽

Lingbo Kong ◽

Li Yuan ◽

Simin He ◽

...

Keyword(s):

Bone Cement ◽

Vertebral Body ◽

Operation Time ◽

Anterior Border ◽

Body Angle ◽

Follow Up Study ◽

Bone Deficiency ◽

Sf 36 ◽

Significant Difference

Abstract Background: When vertebroplasty is used to treat Kummell disease with bone deficiency at vertebral anterior border, bone cement displacement often occurs intraoperative or postoperative. We designed and used a new bone cement screw system to avoid the serious complication. The purpose of this study is to evaluate the safety and effectiveness of this novel operation method through more than 3 years of follow-up. Methods: From January 2012 to August 2016, 27 patients suffering from single-segment Kummell disease with bone deficiency at vertebral anterior border were treated by vertebroplasty combined with novel bone cement screw. Bone cement is released into the diseased vertebrae through screw to fully fill the intravertebral vacuum cleft. Screw fixation of bone cement can avoid intraoperative or postoperative displacement. All patients were operated by unilateral technique, only one screw was implanted for each patient. The clinical efficacy was evaluated using Odom’s criteria and statistical analysis based on the results of vertebral body index (VBI), vertebral body angle (VBA), bisegmental Cobb angle (BCA), visual analogue scale (VAS), oswestry disability index (ODI), and the MOS 36-item short from health survey (SF-36). Results: The operation was completed successfully in 27 cases. The average operation time was 49.63±10.82 min, and the average volume of cement injected was 4.70±0.87 ml. The patients’ preoperative VBI, VBA, BCA, VAS and ODI scores were 43.11±5.94, 21.04±2.55, 45.00±6.26, 7.59±0.84, and 79.85±7.58, respectively. The postoperative measurements were 78.70±2.55, 12.70±2.11, 26.11±4.73, 3.22±0.93 and 50.04±9.28. At the last follow-up, the measurements were 78.04±2.30, 13.15±2.38, 27.07±4.87, 2.04±0.65, and 22.85±5.06, respectively. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P<0.05). Compared the results of SF-36 preoperative and at the last follow-up, there were significant differences in physical function, role-physical, body pain, vitality, and social function these 5 items (P<0.05). However, there were no significant differences in general health, emotional function and mental health. Finally, 26 patients (96.3%) had good to excellent clinical outcomes according to Odom's criteria. Conclusions: This 3-year follow-up study shows that the novel bone cement screw system combined with vertebroplasty has a good short and medium-term therapeutic effect on patients with Kummell disease and bone deficiency at vertebral anterior border, while its long-term efficacy is subject to further studies.

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Comparison of Clinical Outcomes With Proximal Femoral Nail Anti-rotation Versus Bipolar Hemiarthroplasty for the Treatment of Elderly Intertrochanteric Fractures

10.21203/rs.3.rs-527679/v1 ◽

2021 ◽

Author(s):

Wen-Bo Wei ◽

Sha-Jie Dang ◽

Ling Wei ◽

MengXi Xin

Keyword(s):

Postoperative Complications ◽

Operation Time ◽

The Elderly ◽

Proximal Femoral Nail ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Hospitalization Time ◽

Femoral Nail ◽

Time Operation ◽

Significant Difference

Abstract Background: Although proximal femoral nail anti-rotation (PFNA) and bipolar hemiarthroplasty (BHA) are selected by most of the orthopaedic surgeons for elderly intertrochanteric fractures (ITFs) patients, there is still no consensus on the superiority of PFNA and BPH for ITFs in the elderly. The study aims to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (BHA) on ITFs in the elderly. Methods: From January 2012 to December 2016, a total of 62 patients participated in the study: BHA (Group B, n=30), PFNA (Group P, n=32). The fractures were classified according to Evans-Jensen. Hospitalization time, operation time, bleeding loss, Harris scores and postoperative complications were compared between the two groups. Results: The operation time was (125.76 ± 33.49) min and (94.38 ± 20.94) min in PFNA group and BHA group (P < 0.05); bleeding loss was (153.33 ± 59.96) mL and (335.31 ± 90.87) mL(P < 0.05); hospitalization time was (17.13 ± 2.92) days and (16.63 ± 3.64) days (P > 0.05); and the Harris scores were (73.20 ± 6.56) points and (68.91 ± 8.15) points (P < 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion: Both PFNA and BHA are safe and effective treatments for femoral intertrochanteric fractures in elderly patients. Nonetheless, BHA can be considered for those with the poor bone condition and short life expectancy.

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