Objectives:To observe the changes in spinopelvic sagittal plane parameters after percutaneous kyphoplasty(PKP)in patients with osteoporotic vertebral compression fracture(OVCF),and to explore their impacts on adjacent vertebral compression fracture(AVCF).Methods:201 patients with OVCF who underwent PKP in our hospital from May 2018 to November 2022 were selected as the study subjects.The patients were followed up for 2 years after PKP surgery,and were divided into AVCF group(n=44)and non AVCF group(n=157)based on whether AVCF occurred during the follow-up period.The spinopelvic sagittal parameters,visual analogue scale(VAS)scores,and Oswestry disability index(ODI)were compared between the two groups of patients before operation and at 1 week,1 month,and 3 months after surgery.Pearson correlation test was used to analyze the correlations between the spinopelvic sagittal parameters in the AVCF group and non AVCF group at 3 months after surgery;Logistic regression analysis was used to evaluate the correlation between spinopelvic sagittal parameters and AVCF after PKP surgery.The receiver operating charactertics(ROC)curve was drawn to analyze the predictive value of various spinopelvic sagittal parameters for AVCF in patients with OVCF after PKP.Results:The baseline VAS score and ODI of patients in the AVCF group were significantly higher than those in the non AVCF group(P＜0.05).3 months after surgery,the VAS score and ODI of both groups were significantly reduced,and the non AVCF group was significantly lower than the AVCF group(P＜0.05).There were significant differences in pelvic tilt(PT),sagittal vertical axis(SVA),T1 pelvic angle(TPA),sacral slope(SS),lumbar lordosis(LL),and pelvic incidence(PI)between the two groups at different time points(P＜0.05).The non AVCF group showed a significant difference in thoracic kyphosis(TK)before and after operation(P＜0.05).There was no significant difference in thoracolumbar kyphosis(TLK)and PT(P＞0.05),while there were significant differences in SVA,PI,TPA,LL,SS,and TK(P＜0.05)between the two groups of patients at the same time points.In the non AVCF group,SVA was associated with TPA,TK,TLK,LL,and PT,TPA was associated with TK,TLK,LL,PI,SS,and PT,TK was associated with TLK,PT,and SS,TLK was associated with LL,PI,and PT,LL was associated with PT and SS,and PT was associated with SS at 3 months after surgery(P＜0.05).In the AVCF group,SVA was correlated with TPA,TPA was correlated with LL,PI,PT,and SS,and PT was correlated with PI and SS(P＜0.05).TK,SVA,PI,SS,TPA and LL were significantly correlated with AVCF after PKP in OVCF patients(P＜0.05).After adjustment of age,initial fracture site,vertebral height recovery rate,diabetes,number of fractured vertebrae before operation,bone density,amount of bone cement,and leakage of bone cement into intervertebral disc,SVA(OR=2.633,95％CI:1.857-3.732),TPA(OR=2.497,95％CI:1.684-3.702),TK(OR=3.184,95％CI:2.699-3.755),LL(OR=0.526,95％CI:0.438-0.631),PI(OR=0.478,95％CI:0.320-0.715),and SS(OR=0.592,95％CI:0.500-0.701)were still significantly correlated with AVCF(P＜0.001).SVA,TPA,TK,LL,PI,and SS all had certain predictive values for postoperative AVCF in OVCF patients after PKP[area under the curve(AUC)＞0.750].Among them,SVA had a bigger AUC value(0.826)for predicting AVCF than other parameters,with a sensitivity of 0.827,specificity of 0.757,and accuracy of 0.792.Conclusions:There is a significant correlation between AVCF and spinopelvic sagittal balance in OVCF patients after PKP surgery.SVA,TPA,TK,LL,SS,and PI have certain predictive values for the occurrence of AVCF after PKP;Smaller SVA,TPA,TK and larger LL,SS,PI at 3 months after surgery can reduce the probability of AVCF occurrence in OVCF patients after PKP surgery.

Objectives:To observe the changes in spinopelvic sagittal plane parameters after percutaneous kyphoplasty(PKP)in patients with osteoporotic vertebral compression fracture(OVCF),and to explore their impacts on adjacent vertebral compression fracture(AVCF).Methods:201 patients with OVCF who underwent PKP in our hospital from May 2018 to November 2022 were selected as the study subjects.The patients were followed up for 2 years after PKP surgery,and were divided into AVCF group(n=44)and non AVCF group(n=157)based on whether AVCF occurred during the follow-up period.The spinopelvic sagittal parameters,visual analogue scale(VAS)scores,and Oswestry disability index(ODI)were compared between the two groups of patients before operation and at 1 week,1 month,and 3 months after surgery.Pearson correlation test was used to analyze the correlations between the spinopelvic sagittal parameters in the AVCF group and non AVCF group at 3 months after surgery;Logistic regression analysis was used to evaluate the correlation between spinopelvic sagittal parameters and AVCF after PKP surgery.The receiver operating charactertics(ROC)curve was drawn to analyze the predictive value of various spinopelvic sagittal parameters for AVCF in patients with OVCF after PKP.Results:The baseline VAS score and ODI of patients in the AVCF group were significantly higher than those in the non AVCF group(P＜0.05).3 months after surgery,the VAS score and ODI of both groups were significantly reduced,and the non AVCF group was significantly lower than the AVCF group(P＜0.05).There were significant differences in pelvic tilt(PT),sagittal vertical axis(SVA),T1 pelvic angle(TPA),sacral slope(SS),lumbar lordosis(LL),and pelvic incidence(PI)between the two groups at different time points(P＜0.05).The non AVCF group showed a significant difference in thoracic kyphosis(TK)before and after operation(P＜0.05).There was no significant difference in thoracolumbar kyphosis(TLK)and PT(P＞0.05),while there were significant differences in SVA,PI,TPA,LL,SS,and TK(P＜0.05)between the two groups of patients at the same time points.In the non AVCF group,SVA was associated with TPA,TK,TLK,LL,and PT,TPA was associated with TK,TLK,LL,PI,SS,and PT,TK was associated with TLK,PT,and SS,TLK was associated with LL,PI,and PT,LL was associated with PT and SS,and PT was associated with SS at 3 months after surgery(P＜0.05).In the AVCF group,SVA was correlated with TPA,TPA was correlated with LL,PI,PT,and SS,and PT was correlated with PI and SS(P＜0.05).TK,SVA,PI,SS,TPA and LL were significantly correlated with AVCF after PKP in OVCF patients(P＜0.05).After adjustment of age,initial fracture site,vertebral height recovery rate,diabetes,number of fractured vertebrae before operation,bone density,amount of bone cement,and leakage of bone cement into intervertebral disc,SVA(OR=2.633,95％CI:1.857-3.732),TPA(OR=2.497,95％CI:1.684-3.702),TK(OR=3.184,95％CI:2.699-3.755),LL(OR=0.526,95％CI:0.438-0.631),PI(OR=0.478,95％CI:0.320-0.715),and SS(OR=0.592,95％CI:0.500-0.701)were still significantly correlated with AVCF(P＜0.001).SVA,TPA,TK,LL,PI,and SS all had certain predictive values for postoperative AVCF in OVCF patients after PKP[area under the curve(AUC)＞0.750].Among them,SVA had a bigger AUC value(0.826)for predicting AVCF than other parameters,with a sensitivity of 0.827,specificity of 0.757,and accuracy of 0.792.Conclusions:There is a significant correlation between AVCF and spinopelvic sagittal balance in OVCF patients after PKP surgery.SVA,TPA,TK,LL,SS,and PI have certain predictive values for the occurrence of AVCF after PKP;Smaller SVA,TPA,TK and larger LL,SS,PI at 3 months after surgery can reduce the probability of AVCF occurrence in OVCF patients after PKP surgery.

BACKGROUNDIt is desirable to minimize the risk of adverse radiation effects associated with percutaneous coronary intervention. The aim of this study was to determine the impact of prolonging the interval between coronary angiography and percutaneous coronary intervention on X-ray-induced DNA double-strand breaks in blood lymphocytes using γ-H2AX immunofluorescence microscopy.

METHODSBlood samples of eight patients were taken before the first exposure to ionizing radiation, 10 minutes, 20 minutes, 30 minutes, 1 hour, and 24 hours after the last exposure to determine the γ-H2AX foci repair kinetics. Fifty-eight patients undergoing percutaneous coronary intervention were randomized to an intermittent radiation exposure group and a continuous radiation exposure group. Blood samples were taken before coronary angiography and 15 minutes after the last exposure. By enumerating γ-H2AX foci, the impact of prolonging the interval on DNA double-strand breaks was investigated. Student t-test was used to compare the difference in DNA double-strand breaks between the two groups.

RESULTSAn increase in foci was found in all patients received percutaneous coronary intervention. The maximum number of γ-H2AX foci was found 10-20 minutes after the end of the last exposure. There was no statistically significant difference between the two groups in γ-H2AX foci at baseline. On average there were (0.79 ± 0.15) γ-H2AX foci induced by interventional X-rays per lymphocyte in the continuous radiation exposure group and (0.66 ± 0.21) in the intermittent radiation exposure group after exposure (P < 0.05).

CONCLUSIONSA significant number of γ-H2AX foci develop following the percutaneous coronary intervention procedures. The number of X-ray-induced DNA double-strand breaks may be decreased by prolonging the interval time between coronary angiography and percutaneous coronary intervention to 30 minutes.

Adult ; Coronary Angiography ; adverse effects ; DNA Breaks, Double-Stranded ; radiation effects ; Dose-Response Relationship, Radiation ; Female ; Humans ; Lymphocytes ; metabolism ; radiation effects ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; adverse effects

Objective To discuss operative treatment method for displaced acetabular fractures so as to improve the curative effects.Methods A retrospective study was done on data of 46 patients with displaced acetabular fractures treated operatively from June 2000 to September 2008.According to Letournel-Judet classification,there were eight patients with posterior column fractures combined with posterior walk fractures,four with anterior column fractures combined with posterior wall fractures,11 with transverse fractures combined with posterior wall fractures,eight with type T fractures and 15 with doublecolumn fractures.All patients were treated with open reduction and internal reconstructive plate fixation through Kocher-Langenbeck,iloinguinal or anteroposterior approaches respectively.Results All patients were followed up for 6 months to 8 years(average 3.9 years).According to modified Merle d' Aubigne and Postel score criteria,the result was excellent in 23 patients,good in 14,fair in 7 and poor in 2,with excellence rate of 80%.Postoperative complications included fat liquefaction in two patients(4%),iatrogenic sciatic nerve injury in two(4%),femoral head necrosis in three(7%),heterotopic ossification in three(7%)and traumatic arthritis in four(9%),with no operative death or nonunion occurred.Conclusions Preoperative accurate assessment of fracture type and displacement direction,appropriate selection of operation time and surgical approach as well as good operative reduction and internal fixation are key to providing satisfactory outcome for displaced acetabular fractures.