1.Comparative study on effectiveness of different puncture methods of flexible bone cement delivery device in treatment of osteoporotic vertebral upper 1/3 compression fractures.
Tangbo LI ; Kun LIU ; Nan ZHANG ; Guobing HAO ; Zexing ZHU ; Lin QIAO ; Diyu SONG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(4):470-477
OBJECTIVE:
To compare the effectiveness of different puncture methods of the flexible bone cement delivery device in unilateral percutaneous curved vertebroplasty for osteoporotic vertebral upper 1/3 compression fractures.
METHODS:
A retrospective analysis was conducted on the clinical data of 67 patients with osteoporotic vertebral upper 1/3 compression fractures who were admitted and met the selection criteria between January 2023 and April 2024. The patients were divided into two groups based on the puncture method of the flexible bone cement delivery device: the oblique puncture group ( n=37) and the parallel puncture group ( n=30). There was no significant difference ( P>0.05) between the two groups in terms of gender, age, bone mineral density (T value), distribution of fractured vertebrae, time from injury to operation, and preoperative visual analogue scale (VAS) score for pain, Oswestry disability index (ODI), anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra. The following parameters were compared between the two groups: operation time, incidence of secondary puncture, incidence of bone cement leakage, volume of injected bone cement, bone cement distribution score, as well as VAS score, ODI, anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra at 1 day after operation and at last follow-up.
RESULTS:
Two cases in the oblique puncture group and 7 cases in the parallel puncture group underwent secondary puncture during operation, and the difference in the incidence of secondary puncture was significant ( P<0.05). No complications such as bone cement hypersensitivity, bone cement embolism, nerve injury, or epidural hematoma occurred in both groups. There was no significant difference in operation time, volume of injected bone cement, incidence of bone cement leakage, distribution score and rating of bone cement between the two groups ( P>0.05). All patients were followed up 6-18 months (mean, 12.0 months), and there was no significant difference in the follow-up time between the two groups ( P>0.05). No further fracture collapse or compression occurred in the fractured vertebra during follow-up. Both groups exhibited significant improvements in VAS score, ODI, anterior vertebral height, and Cobb angle of the fractured vertebra after operation compared to baseline ( P<0.05). There were also significant differences between the two time points after operation ( P<0.05). However, there was no significant difference in the above indicators between the two groups ( P>0.05).
CONCLUSION
For osteoporotic vertebral upper 1/3 compression fractures treated with unilateral percutaneous curved vertebroplasty, both oblique and parallel puncture methods of the flexible bone cement delivery device can effectively relieve pain, but the former is more conducive to reducing the incidence of secondary puncture.
Humans
;
Bone Cements/therapeutic use*
;
Fractures, Compression/surgery*
;
Retrospective Studies
;
Vertebroplasty/instrumentation*
;
Osteoporotic Fractures/surgery*
;
Spinal Fractures/surgery*
;
Female
;
Male
;
Aged
;
Middle Aged
;
Treatment Outcome
;
Punctures/methods*
;
Aged, 80 and over
2.Anterior approach for the revision surgery following bone cement augmentation in osteoporotic vertebral compression fractures.
China Journal of Orthopaedics and Traumatology 2025;38(1):81-86
OBJECTIVE:
To observe the clinical outcomes of anterior approach for the revision surgery following unsuccessful bone cement augmentation in osteoporotic vertebral compression fractures.
METHODS:
A total of 10 patients who experienced unsuccessful bone cement augmentation underwent anterior revision surgery between January 2020 and December 2021. There were 2 males and 8 females. The age ranged from 55 to 83 years old. The reasons for revision surgery were postoperative infection in 2 cases, postoperative neurological symptoms in 3 cases, and kyphosis resulting from postoperative vertebral collapse in 5 cases. The involved segments included 2 cases of L1, 4 cases of L2, 3 cases of L3, and 1 case of L4. Among them, 2 patients underwent primary percutaneous vertebroplasty (PVP), while eight patients underwent primary percutaneous kyphoplasty (PKP). The time interval between the first and second surgeries ranged from 1 to 13 months. All patients presented with varying degrees of lumbar pain. X-ray, CT, and MRI scans were conducted prior to the revision procedure. Surgical duration, intraoperative blood loss, and any complications were documented.
RESULTS:
The surgical procedures were successful in all 10 patients, with 9 cases undergoing anterior reconstruction and posterior internal fixation through the interspace of the multifidus longissimus muscle. One patient underwent anterior reconstruction and anterior plate internal fixation. The duration of the anterior approach surgery ranged from 90 to 190 minutes, with a blood loss volume ranging from 130 to 480 ml. None of the patients experienced any intraoperative or postoperative complications such as nerve injury, cerebrospinal fluid leakage, major vessel damage, abdominal organ injury, incision infection, or bleeding. The follow-up period for 10 patients ranged from 3 to 20 months. Throughout the follow-up, none of the patients experienced complications such as displacement, cutting, or loosening of the artificial vertebral body. Prior to the operation, the visual analogue scale(VAS) ranged from 4 to 8 points, the final follow-up assessment ranged from 2 to 3 points. The Oswestry disability index (ODI) score a preoperative ranged from 17% to 37%, the latest follow-up evaluation ranged from 2% to 16%. Notably, significant correction in kyphosis angle was observed in 5 cases. Furthermore, there was notable improvement in VAS and ODI compared to preoperative values.
CONCLUSION
Anterior corpectomy and artificial vertebral body implantation not only facilitate the removal of bone cement but also enable effective debridement and direct decompression. Moreover, by reconstructing anterior and middle column support, restoring vertebral height and local curvature, in combination with pedicle screw internal fixation, surgical segment stability can be achieved. Therefore, for patients requiring revision following failed bone cement augmentation, anterior surgery represents an ideal treatment option.
Humans
;
Female
;
Male
;
Aged
;
Bone Cements
;
Fractures, Compression/surgery*
;
Middle Aged
;
Aged, 80 and over
;
Spinal Fractures/surgery*
;
Osteoporotic Fractures/surgery*
;
Reoperation/methods*
;
Vertebroplasty
3.Clinical research of traditional bone-setting and target puncture techniques in percutaneous vertebroplasty for osteoporotic vertebral compression fractures.
Zhe WU ; Jian-Liang CHEN ; Ying-Zhou LI ; Yong XU
China Journal of Orthopaedics and Traumatology 2025;38(2):119-127
OBJECTIVE:
To compare the bone cement diffusion and clinical effects between conventional percutaneous vertebroplasty(PVP) and the application of positioning reduction and targeted puncture techniques in the treatment of elderly patients with osteoporotic vertebral compression fractures.
METHODS:
A retrospective comparative study was conducted, analyzing the clinical data of 268 elderly patients with single-level vertebral fractures admitted between January 2021 and March 2023. The patients were divided into two groups:the conventional PVP group (138 cases) and the targeted PVP group (130 cases). Among them, 138 patients in the conventional group were treated by traditional PVP with bilateral approach including 26 males and 112 females, with a mean age of (72.9±4.0) years old. Another 130 patients in the targeted PVP group included 23 males and 107 females, with a mean age of (72.2±7.0) years old;vertebral reduction was first achieved using prone traction and compression reduction technique based on preoperative imaging examination, the operating bed was used to maintain spinal hyper-extension of the spine and puncture the fracture space target to inject bone cement. The adequacy of bone cement filling in the fracture gap was evaluated based on imaging examination. The operation time, the rate of bone cement leakage and the type of leakage, bone cement filling in the fracture area, the amount of cement injection, the thoracolumbar back pain visual analogue scale(VAS), Oswestry disability index(ODI), and the local kyphosis Cobb angle of the fractured vertebra were compared between two groups.
RESULTS:
The operation time (43.9±5.7) min, bone cement filling (5.3±1.5) ml in the conventional PVP group were higher than the target group (39.3±3.6) min, (4.1±1.7) ml(P<0.05). There were no statistically significant differences in bone cement leakage rate or type(P>0.05). The targeted PVP group achieved sufficient bone cement filling in the fracture area, while the conventional PVP group had 34 cases (25.0%) with insufficient filling in the fracture area(P<0.01). There was no significant difference in VAS, ODI, and local Cobb angle of the fractured vertebra before operation between two groups(P>0.05). The VAS of 3.64±0.94 and ODI of 11.50±0.38 at 3 day after operation in the target group were better than those of the conventional group 4.69±0.78 and 15.06±1.66 (P<0.05). The local Cobb angle (7.51±5.37)° was less than that of the conventional group (11.68±3.98)°(P<0.05).
CONCLUSION
The application of positioning reduction and targeted puncture techniques in percutaneous vertebroplasty for elderly patients with osteoporotic vertebral compression fractures can restore vertebral height using positioning reduction technique to avoid excessive tension on the intervertebral soft tissue. Targeted puncture technique effectively stabilizes vertebral fractures and achieves adequate bone cement filling, thereby improving surgical outcomes. This technique is safe and effective, representing a new treatment modality.
Humans
;
Male
;
Female
;
Vertebroplasty/methods*
;
Aged
;
Fractures, Compression/surgery*
;
Retrospective Studies
;
Spinal Fractures/surgery*
;
Osteoporotic Fractures/surgery*
;
Aged, 80 and over
;
Bone Cements
;
Middle Aged
4.Comparison of side-opening and front-opening approach bone cement injectors in percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral compression fractures.
Wei-Xin DONG ; Zhen-Tao CHU ; Yong HU ; Ou-Jie LAI ; Zhen-Shan YUAN ; Xiao-Yang SUN
China Journal of Orthopaedics and Traumatology 2025;38(2):128-133
OBJECTIVE:
To compare clinical efficacy between side-opening and front-opening bone cement injectors in percutaneous kyphoplasty(PKP) for the management of thoracolumbar osteoporotic vertebral compression fractures(OVCFs).
METHODS:
A retrospective cohort study was conducted, comprising 62 patients with single-segment thoracolumbar OVCFs (T11-L2), who underwent bilateral PKP at our department during the period from June 2020 to October 2021. Patients were categorized into two groups based on the specific bone cement injector employed during the surgical procedure: the side-opening group (n=29) and the front-opening group (n=33). Among them, the side-opening group consisted of 6 male and 23 female patients, with a mean age of (73.32±9.11) years. The front-opening group included 7 male and 26 female patients, with a mean age of (71.29±10.39) years. The variables encompassed essential patient characteristics were recorded, such as gender, age, bone mineral density (BMD), and fracture level (T11-L2), as well as procedural aspects, including operation duration, cement injection volume, cement distribution type (lobular or diffuse), occurrence of cement leakage, pre-and post-operative visual analogue scale (VAS) pain scores, and vertebral compression ratio.
RESULTS:
All patients underwent successful surgery, with a mean follow-up duration of (15.37±3.03) months. There were no statistically significant differences in gender, age, BMD, fracture level, preoperative vertebral compression degree, and VAS scores between the side-opening group and the front-opening group (P>0.05). The operation time, the mean cement injection volumes, the distribution of bone cement within the vertebrae has no statistically significant difference between two groups(P>0.05). Both the side-opening and front-opening groups showed significant improvements in VAS scores at 3 days and 6 months after operation (P<0.05). However, there was no significant difference in VAS scores between the two groups at both 3 days and 6 months after the operation (P>0.05).
CONCLUSION
Side-opening bone cement injectors in bilateral PKP surgery for single-segment thoracolumbar OVCF achieve similar clinical efficacy as front-opening injectors, without significant improvement in cement distribution and containment.
Humans
;
Female
;
Male
;
Kyphoplasty/instrumentation*
;
Aged
;
Bone Cements
;
Fractures, Compression/surgery*
;
Retrospective Studies
;
Spinal Fractures/surgery*
;
Thoracic Vertebrae/injuries*
;
Lumbar Vertebrae/injuries*
;
Osteoporotic Fractures/surgery*
;
Middle Aged
;
Aged, 80 and over
5.Clinical application of bilateral targeted puncture based on vertebral osteodense zone in percutaneous vertebroplasty.
Bao-Xin JIA ; Jing JU ; Cheng-Zhou LIU ; Xiao-Qiang GAO ; Ting WANG
China Journal of Orthopaedics and Traumatology 2025;38(7):729-736
OBJECTIVE:
To investigate the clinical efficacy of bilateral targeted puncture in percutaneous vertebroplasty(PVP) based on the vertebral osteodense zone.
METHODS:
A retrospective analysis was conducted on 76 patients with fresh symptomatic osteoporotic vertebral compression fractures, characterized by the presence of a dense zone, who underwent percutaneous vertebroplasty (PVP) between January 2021 and December 2021. All patients involved single-level vertebral fractures. There were 19 males and 57 females, aged from 62 to 88 years old, with an average of (68.5±12.5) years old. All patients underwent bilateral transpedicular puncture procedures. Preoperative CT or MRI was utilized to ascertain the relative position of the bone osteodense zone within the vertebral body (specifically, whether this zone is situated in the upper one-third or one-quarter of the left or right sagittal plane). Considering the head and tail regions of the dense zone as puncture targets, the puncture points and paths were meticulously planned, and the working channel was subsequently established. Under continuous monitoring by a C-arm X-ray machine, bone cement was carefully and gradually injected. The operation time, bone cement injection volume, and bone cement leakage were recorded. The visual analogue scale (VAS) and Oswestry disablity index (ODI) were used to evaluate the effectiveness of the operation. ODI and anterior height (AH) of the vertebral body were used to evaluate the efficacy.
RESULTS:
All patients successfully completed the surgery and were followed up for (8.0±1.0) months. The operation time was (36.57±11.25) min, the volume of bone cement injection was(6.07±1.19) ml, and 21 patients of bone cement leakage. There were 3 patients with the VAS exceeded 4 points two days postoperatively, indicating suboptimal pain management. At the three time points of pre-operation, 2 days post-operation and 6 months post-operation, the VAS scores were(7.82±1.29), (2.11±0.44), and (2.04±0.67) respectively;the ODI percentages were(75.65±7.23)%, (29.45±4.16)%, and(28.68±5.62)%;and the AH values were (11.02±1.30), (12.87±3.91), and (12.91±3.86) cm. The differences were all statistically significant(P<0.05). The aforementioned three indices demonstrated significant improvement at both 2 days and 6 months post-operation (all P<0.05). There were no statistically significant differences in these indices between the 2-day and 6-month post-operative periods(P>0.05). The postoperative outcome was satisfactory and durable, with no evidence of vertebral height reduction.
CONCLUSION
Bilateral targeted puncture based on the osteodense dense zone within the vertebral body can achieve bilateral symmetrical and upright full vertebral bone cement reinforcement without increasing bone cement leakage, achieving good early efficacy and preventing late vertebral collapse. This has positive significance for further improving the efficacy of percutaneous vertebroplasty.
Humans
;
Male
;
Female
;
Vertebroplasty/methods*
;
Aged
;
Middle Aged
;
Aged, 80 and over
;
Retrospective Studies
;
Spinal Fractures/surgery*
;
Fractures, Compression/surgery*
;
Punctures
;
Bone Cements
;
Osteoporotic Fractures/surgery*
6.Clinical application of targeted sealing with high viscosity bone cement and secondary injection of low viscosity bone cement in vertebroplasty.
Cheng-Zhou LIU ; Bao-Xin JIA ; Xiao-Qiang GAO ; Wen-Yin LI ; Ai-Guo LIU ; Cong-Hui REN
China Journal of Orthopaedics and Traumatology 2023;36(1):38-42
OBJECTIVE:
To observe the clinical efficacy of targeted sealing with high viscosity bone cement and secondary injection of low viscosity bone cement in the treatment of OVCFs patients with the fracture lines involved vertebral body margin.
METHODS:
The elderly patients who underwent vertebroplasty for osteoporotic vertebral compression fractures from January 2019 to September 2021 were selected as the screening objects. Through relevant standards and further CT examination, 56 patients with fracture lines involving the anterior wall or upper and lower endplates of the vertebral body were selected for the study. There were 21 males and 35 females, aged from 67 to 89 years old with an average of (76.58±9.68) years. All 56 patients underwent secondary injection of bone cement during operation. Only a small amount of high viscosity cement was targeted to seal the edge of the vertebral body for the first time, and low viscosity cement was injected to the vertebral bodies during second bolus with well-distributed. The operation time, bone cement volume and bone cement leakage were recorded, and the pain relief was evaluated by visual analogue scale (VAS).
RESULTS:
All patients were followed up for more than 3 months and the surgeries were successfully complete. The operation time was (50.41±10.30) min and the bone cement volume was (3.64±1.29) ml. The preoperative VAS was (7.21±2.41) points, which decreased significantly to (2.81±0.97) points 3 days after operation(P<0.05). Among the 56 patients, 2 cases(3.57%) had bone cement leakage, 1 case leaked to the paravertebral vein, and 1 case slightly bulged to the paravertebral through the crack when plugging the vertebral crack. Both patients had no obvious clinical symptoms.
CONCLUSION
In vertebroplasty surgery, targeted sealing of high viscosity bone cement and secondary injection of low viscosity bone cement can reduce intraoperative bone cement leakage and improve the safety of operation.
Male
;
Female
;
Humans
;
Aged
;
Aged, 80 and over
;
Bone Cements/therapeutic use*
;
Fractures, Compression/etiology*
;
Spinal Fractures/surgery*
;
Viscosity
;
Osteoporotic Fractures/surgery*
;
Retrospective Studies
;
Vertebroplasty/adverse effects*
;
Treatment Outcome
7.Application of different puncture techniques to inject bone cement in osteoporotic vertebral compression fractures.
China Journal of Orthopaedics and Traumatology 2023;36(1):86-91
OBJECTIVE:
To study the application of different puncture techniques to inject bone cement in osteoporotic vertebral compression fractures (OVCFs).
METHODS:
The clinical data of 282 patients with OVCFs treated from January 2017 to December 2019 were collected for a retrospective study. According to the surgical plan the patients were divided into group A and B, with 141 cases in each group. In group A, extreme lateral puncture was used to inject bone cement through unilateral puncture and bilateral puncture. In group B, bone cement was injected through unilateral pedicle puncture through pedicle approach. The operation status(operation time, radiation exposure time, bone cement injection volume, hospital stay) and complications were observed between two groups. Before operation and 6, 12 months after operation, the pain mediators such as serotonin 5-hydroxytryptamine (5-HT), prostaglandin E2(PGE2), substance P(SP) were compared, bone mineral density, anatomical parameters of the injured vertebrae (height of the anterior edge of the vertebral body, height of the posterior edge of the vertebral body, Cobb angle), visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated between two groups.
RESULTS:
There were no significant difference in operation time, radiation exposure time, hospital stay between two groups (P>0.05). The amount of bone cement injected in group A was greater than that in group B (P<0.05). The serum 5-HT, SP and PGE2 levels of group A were lower than those of group B at 12 months after operation (P<0.05). The height of anterior edge and height of the posterior edge of vertebral body in group A were greater than those of group B at 12 months after operation, Cobb angle of group A was smaller than that of group B, VAS and ODI were lower than those of group B(P<0.05). There was no significant difference in bone mineral density between two groups at 6 and 12 months postoperatively(P<0.05). There was no significant difference between two groups in postoperative complications (P>0.05).
CONCLUSION
Compared with unilateral puncture of the pedicle approach, unilateral puncture and bilateral cement injection technique is more conducive to the recovery of the injured vertebral anatomy and function, and do not prolong operation time, radiation exposure time, hospital stay, nor do increase the risk of nerve damage and bone cement leakage, and postoperative bone metabolism and bone mineral density are improved well, which is a safe and reliable surgical method for the treatment of OVCFs.
Humans
;
Spinal Fractures/surgery*
;
Fractures, Compression/surgery*
;
Bone Cements
;
Vertebroplasty/methods*
;
Retrospective Studies
;
Dinoprostone
;
Serotonin
;
Treatment Outcome
;
Osteoporotic Fractures/surgery*
;
Kyphoplasty
;
Punctures
8.Treatment of spinal burst fractures with pedicle screw fixation at high altitude area.
Jun YUAN ; Xin-Jun ZHANG ; Xiao-Gang HUANG ; Lei DAI ; Chao LIU
China Journal of Orthopaedics and Traumatology 2023;36(5):450-453
OBJECTIVE:
According to the characteristics of spinal burst fractures in high-altitude areas and the local medical conditions, to explore the clinical efficacy of short-segment fixation with pedicle screws combined with screw placement in injured vertebrae in the treatment of thoracolumbar burst fractures.
METHODS:
From August 2018 to December 2021, 12 patients with single-vertebral thoracolumbar burst fractures without neurological symptoms were treated with injured vertebral screw placement technique, including 7 males and 5 females;aged 29 to 54 years old, with an average of(42.50±7.95) years old;6 cases of traffic accident injury, 4 cases of high fall injury, 2 cases of heavy object injury;2 cases of T11, 4 cases of T12, 3 cases of L1, 2 cases of L2, and 1 case of L3. In the operation, screws were first placed in the upper and lower vertebrae of the fracture, pedicle screws were placed in the injured vertebra, and connecting rods were installed, and the fractured vertebral body was reset by positioning and distraction. Visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scoring were used to evaluate the changes in pain and quality of life of patients, and the kyphotic correction rate and correction loss rate of the injured segment were measured by X-ray.
RESULTS:
All operations were successful without significant intraoperative complications. All 12 patients were followed up, the duration ranged from 9 to 27 months, with an mean of (17.75±5.79) months. VAS at 3 days after operation was significantly higher than that at admission (t=6.701, P=0.000). There was significant difference in JOA score between 9 months after operation and at admission (t=5.085, P=0.000). Three days after operation, Cobb angle was (4.42±1.16)°, and the correction rate was (82±5)% compared with (25.67±5.71)° at admission. Cobb angle was (5.08±1.24) °at 9 months after operation, with a corrected loss rate of (16±13)%. No loosening or breakage of internal fixation was found.
CONCLUSION
Under the high-altitude hypobaric and hypoxic environment, the effect of the operation should be ensured while reducing the trauma. The application of the technique of placing screws on the injured vertebra can effectively restore and maintain the height of the injured vertebra, with less bleeding and shorter fixed segments, which is an effective method.
Male
;
Female
;
Humans
;
Adult
;
Middle Aged
;
Pedicle Screws
;
Altitude
;
Quality of Life
;
Lumbar Vertebrae/injuries*
;
Thoracic Vertebrae/injuries*
;
Spinal Fractures/surgery*
;
Fracture Fixation, Internal/methods*
;
Fractures, Compression
;
Treatment Outcome
;
Fractures, Comminuted
9.Effectiveness of TiRobot-assisted and free-hand percutaneous kyphoplasty via pedicle of vertebra in treatment of osteoporotic vertebral compression fracture of thoracic vertebra.
Mingzhi MA ; Zhicong WANG ; Jiahui YE ; Xi CHEN
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(9):1106-1112
OBJECTIVE:
To compare the effectiveness of TiRobot-assisted and C-arm X-ray fluoroscopy assisted percutaneous kyphoplasty (PKP) via pedicle of vertebra in the treatment of osteoporotic vertebral compression fracture (OVCF) of thoracic vertebrae.
METHODS:
The clinical data of 85 patients with OVCF of thoracic vertebrae who were admitted between January 2020 and March 2023 and met the selection criteria was retrospectively analyzed including 40 patients (50 vertebrae) undergoing PKP assisted by TiRobot (group A) and 45 patients (50 vertebrae) undergoing PKP assisted by C-arm X-ray fluoroscopy (group B). There was no significant difference in the comparison of baseline data such as gender, age, body mass index, bone mineral density T-value, fracture segment, trauma history, and preoperative numerical rating scale (NRS) score, Oswestry disability index (ODI), and Cobb angle of injured vertebra between the two groups ( P>0.05). The effectiveness evaluation indexes of the two groups, including the operation time, the volume of injected cement, the times of fluoroscopies, the length of hospital stay, and the occurrence of postoperative complications were collected and compared. Anteroposterior and lateral X-ray films and CT of the injured vertebra were reviewed at 1 day after operation to observe whether there was cement leakage and to evaluate the distribution of cement in the injured vertebra. Before and after operation, pain was assessed using the NRS score, dysfunction was assessed using the ODI, and vertebral height recovery was assessed by measuring the Cobb angle of the injured vertebrae by X-ray films.
RESULTS:
Both groups of patients successfully completed the operation, the operation time, the volume of injected cement, the times of fluoroscopies, and the length of hospital stay in group A were significantly less than those in group B ( P<0.05). The patients in two groups were followed up 4-12 months (mean, 9.6 months). Bone cement leakage occurred in 5 vertebrae in group A and 15 vertebrae in group B after operation, all of which leaked to the intervertebral space and around the vertebral body, and the patients had no obvious clinical symptoms. The difference of bone cement leakage between the two groups was significant ( P<0.05). No severe complication such as intraspinal leakage, infection, or vascular embolism was found in the two groups. At 1 day after operation, the distribution index of bone cement in group A was mostly grade Ⅴ, which was well dispersed; while in group B, it was mostly grade Ⅱ and grade Ⅴ; the difference of bone cement distribution index between the two groups was significant ( P<0.05). The NRS score, ODI, and Cobb angle of injured vertebra in both groups were significantly improved at 1 day after operation when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indexes between the two groups before and after operation ( P>0.05).
CONCLUSION
TiRobot-assisted unilateral PKP in the treatment of OVCF of thoracic vertebrae is safe and effective, which can reduce the X-ray transmission times during operation, shorten the operation time, reduce the volume of bone cement injection, and thus decrease incidence of bone cement leakage.
Humans
;
Thoracic Vertebrae/surgery*
;
Fractures, Compression/surgery*
;
Spinal Fractures/surgery*
;
Kyphoplasty
;
Bone Cements
;
Retrospective Studies
10.Effectiveness of sagittal top compression reduction technique in treatment of thoracolumbar vertebral fractures.
Piyao JI ; Huanyu JIANG ; Yan ZHOU ; Jianghua MING ; Qing CHEN ; Ming DENG ; Yaming LI ; Yonggang MA ; Shiqing LIU
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(10):1246-1252
OBJECTIVE:
To investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures.
METHODS:
A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle.
RESULTS:
There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones ( P<0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation ( P<0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group ( P<0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation ( P>0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up ( P<0.05).
CONCLUSION
The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.
Humans
;
Thoracic Vertebrae/injuries*
;
Lumbar Vertebrae/injuries*
;
Retrospective Studies
;
Blood Loss, Surgical
;
Treatment Outcome
;
Pedicle Screws
;
Spinal Fractures/surgery*
;
Kyphosis
;
Fracture Fixation, Internal
;
Fractures, Compression/surgery*

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