Objective:To evaluate the clinical efficacy of the preoperative digita1 design combined with three dimensional(3D)printing models to assist percutaneous kyphoplasty(PKP)treatment for thoracolumbar compression frac tur...Objective:To evaluate the clinical efficacy of the preoperative digita1 design combined with three dimensional(3D)printing models to assist percutaneous kyphoplasty(PKP)treatment for thoracolumbar compression frac tures.Methods:From January 2018 to August 2020,we obtained data of 99 patients diagnosed thoracolumbar compression fractures.These patients were divided into control group(n=50)underwent traditional PKP surgery,and observation group(n=49)underwent preoperative digital design combined with 3D printing model assisted PKP treatment.The clinical efficacy was evaluated with five parameters,including operation time,number of intraoperative radiographs,visual analogue scale(VAS)score,Cobb Angle change,and high compression rate of injured vertebrae.Results:There were statistically significant differences of operation time and number of intraoperative radio graphs between the two groups(P<0.05).For VAS score,Cobb Angle change and vertebral height compression rate,all of these three parameters were significantly improved when the patients accepted surgery teatment in two groups(P<0.05).However,there were no significant differences between control group and observation group for these three parameters either before or after surgery(P>0.05).Conclusions:Through the design of preoperative surgical guide plate and the application of 3D printing model to guide the operation,the precise design of preoperative surgical puncture site and puncture Angle of the injured vertebra was realized,the number of intraoperative radiographs was reduced,the operation time was shortened and the operation efficiency was improved.展开更多
Objective: To compare the clinical efficacy between percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) in the treatment of Kümmell's disease in Chinese patients.Methods: The studies using rand...Objective: To compare the clinical efficacy between percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) in the treatment of Kümmell's disease in Chinese patients.Methods: The studies using randomized controlled trials to compare clinical efficacy between PVP and PKP in the treatment of Kümmell's disease in Chinese patients were retrieved from Embase, Pubmed, Central, Cinahl, PQDT, CNKI, CQVIP, Wanfang Data, and CBM(from September 2008 to September 2018). Keywords for both Chinese and English search were: percutaneous vertebroplasty, PVP, percutaneous kyphoplasty, PKP, and Kümmell's disease. A total of 132 articles were retrieved based on the search strategy through online database searching and manual searching. Finally, one foreign report and seven Chinese reports were included. After extracting the data, statistical software Review Manager 5.3 was used for data analysis.Results: Through comparison, Cobb angle(95% CI [0.54, 4.42), P = 0.01] and Oswestry Dysfunction Index(ODI)(95% CI [0.21, 2.15], P= 0.02) of PKP group was smaller than that of PVP group. Postoperative anterior vertebral body height of the PKP group was better than PVP group(95% CI [-1.27,-0.66], P < 0.001]. However, the PVP group had shorter operation time than PKP group(95% CI [-13.48,-7.43), P = 0.001]. In the other outcome measures, including Visual Analogue Scale(VAS) score(95% CI [-0.04, 0.27), P = 0.15), cement volume(95% CI [-0.82, 0.32], P = 0.39) and cement leakage(95% CI [0.90, 2.76], P = 0.11), there was no significant differences between the two procedures.Conclusions: At this stage, there is sufficient evidence to support that PKP is better than PVP in the treatment of Kümmell's disease in Chinese patients. Although PVP surgery requires much less operation time, PKP has better postoperative radiological results and lower ODI. Moreover, both of them had similar clinical results(e.g., analgesic effects, cement dosage, and leakage rate). Further evidence is dependent on the emergence of randomized controlled trials with higher quality and larger sample sizes in the future.展开更多
Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat...Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.展开更多
<strong>Background:</strong> Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy o...<strong>Background:</strong> Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. <strong>Purpose:</strong> To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). <strong>Method:</strong> A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (<em>β</em>-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. <strong>Results:</strong> After normalized treatment, the bone metabolism indexes of PINP and <em>β</em>-CTX were improved and BMD was increased in three groups. <strong>Adverse Reactions:</strong> There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). <strong>Conclusion:</strong> Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.展开更多
BACKGROUND Percutaneous kyphoplasty(PKP)is a pivotal intervention for osteoporotic fractures,pathological vertebral compression fractures,and vertebral bone tumors.Despite its efficacy,the procedure presents challenge...BACKGROUND Percutaneous kyphoplasty(PKP)is a pivotal intervention for osteoporotic fractures,pathological vertebral compression fractures,and vertebral bone tumors.Despite its efficacy,the procedure presents challenges,notably complications arising from intradural cement leakage.Timely and accurate diagnosis,coupled with emergent intervention is imperative to improve patient prognosis.This case report illuminates the intricacies and potential complications associated with PKP,emphasizing the critical need for vigilant monitoring,prompt diagnosis,and immediate intervention to mitigate adverse outcomes.CASE SUMMARY A 58-year-old male patient,experiencing a T7 osteoporosis-related pathological compression fracture,underwent PKP at a local hospital.Two weeks postprocedure,the patient developed paraplegic and dysuric symptoms,necessitating emergency decompression surgery.Gradual improvement was achieved,marked by the restoration of muscle strength,sensation,and mobility.CONCLUSION PKP Intradural cement leakage following PKP is unusual and potentially fatal.Prompt imaging examinations,urgent evaluation,and the decompression surgery are essential,which help alleviate symptoms associated with spinal damage,markedly improving the overall prognosis.展开更多
We investigated the feasibility of applying polymethylmethacrylate bone cement composited with biomimetic bone-mineralizsed collagen to percutaneous kyphoplasty(PKP).We performed PKP in 95 patients diagnosed with oste...We investigated the feasibility of applying polymethylmethacrylate bone cement composited with biomimetic bone-mineralizsed collagen to percutaneous kyphoplasty(PKP).We performed PKP in 95 patients diagnosed with osteoporotic vertebral compression fracture.All patients had fractures of a single vertebral body,and they were divided randomly into control(group A,47 patients)and experimental(group B,48 patients)groups.Patients in group A were treated with acrylic cement,and those in group B were treated with acrylic cement composited with the bone graft material.All patients were evaluated by a visual analogue scale(VAS),Oswestry disability index(ODI),Cobb angle and anterior vertebral body height preoperatively,and 3 days and 3 months postoperatively.All patients successfully completed surgery and were followed up thereafter.The VAS score,ODI index,Cobb angle and anterior vertebral body height compression rate in both groups had significant changes(P<0.05)preoperatively,and at 3 days and 3 months postoperatively.There was no significant difference between the two groups at different times(P>0.05).The analgesic effects of bone cement composited with bone-mineralized collagen are similar to those of bone cement only.Mineralized collagen has excellent promotion prospects by inducing new bone formation and reducing the incidence of adverse reactions caused by bone cement.展开更多
Osteoporotic vertebral compression fracture(OVCF)has become a major public health issue that becomes more pressing with increasing global aging.Percutaneous kyphoplasty(PKP)is an effective treatment for OVCF.Robot-ass...Osteoporotic vertebral compression fracture(OVCF)has become a major public health issue that becomes more pressing with increasing global aging.Percutaneous kyphoplasty(PKP)is an effective treatment for OVCF.Robot-assisted PKP has been utilized in recent years to improve accuracy and reduce complications.However,the effectiveness of robot-assisted PKP in the treatment of multi-segmental OVCF has yet to be proved.This study was designed to compare the efficacy of robot-assisted and conventional fluoroscopy-assisted multi-segmental PKP.A total of 30 cases with multi-segmental OVCF between April 2019 and April 2021 were included in this study.Fifteen cases were assigned to the robot-assisted PKP group(robot group)and 15 cases to the conventional fluoroscopy-assisted PKP group(conventional fluoroscopy group).The number of fluoroscopic exposures,fluoroscopic dose,operation time,cement leakage rate,visual analog scale(VAS)score,vertebral kyphosis angle(VKA),and height of fractured vertebral body(HFV)were compared between the 2 groups.The number of fluoroscopic exposures,fluoroscopic doses,and cement leakage rates in the robot group were lower than in the conventional fluoroscopy group(P<0.05)while the operative time in the robot group was longer than in the conventional fluoroscopy group(P<0.05).VAS score and VKA were decreased and HFV was increased after surgery in both groups(P<0.05).Therefore,robot-assisted PKP for the treatment of multi-segmental OVCF can reduce the number of fluoroscopic exposures,fluoroscopic doses,and cement leakage compared to conventional treatment.As such,robot-assisted PKP has good application prospects and is potentially more effective in the treatment of multi-segmental OVCF.展开更多
基金supported in part by the General Program of Natural Science Foundation of Hubei Province,China(Grant No.2020CFB548)a Project in 2021 of Science and Technology Support Plan of Guizhou Province,China(Grant No.202158413293820389).
文摘Objective:To evaluate the clinical efficacy of the preoperative digita1 design combined with three dimensional(3D)printing models to assist percutaneous kyphoplasty(PKP)treatment for thoracolumbar compression frac tures.Methods:From January 2018 to August 2020,we obtained data of 99 patients diagnosed thoracolumbar compression fractures.These patients were divided into control group(n=50)underwent traditional PKP surgery,and observation group(n=49)underwent preoperative digital design combined with 3D printing model assisted PKP treatment.The clinical efficacy was evaluated with five parameters,including operation time,number of intraoperative radiographs,visual analogue scale(VAS)score,Cobb Angle change,and high compression rate of injured vertebrae.Results:There were statistically significant differences of operation time and number of intraoperative radio graphs between the two groups(P<0.05).For VAS score,Cobb Angle change and vertebral height compression rate,all of these three parameters were significantly improved when the patients accepted surgery teatment in two groups(P<0.05).However,there were no significant differences between control group and observation group for these three parameters either before or after surgery(P>0.05).Conclusions:Through the design of preoperative surgical guide plate and the application of 3D printing model to guide the operation,the precise design of preoperative surgical puncture site and puncture Angle of the injured vertebra was realized,the number of intraoperative radiographs was reduced,the operation time was shortened and the operation efficiency was improved.
基金supported by National Project of International Science and technology Cooperation program of China(No.2015DFA33050)National Natural Science Foundation of China for Youths(No.81601949)
文摘Objective: To compare the clinical efficacy between percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) in the treatment of Kümmell's disease in Chinese patients.Methods: The studies using randomized controlled trials to compare clinical efficacy between PVP and PKP in the treatment of Kümmell's disease in Chinese patients were retrieved from Embase, Pubmed, Central, Cinahl, PQDT, CNKI, CQVIP, Wanfang Data, and CBM(from September 2008 to September 2018). Keywords for both Chinese and English search were: percutaneous vertebroplasty, PVP, percutaneous kyphoplasty, PKP, and Kümmell's disease. A total of 132 articles were retrieved based on the search strategy through online database searching and manual searching. Finally, one foreign report and seven Chinese reports were included. After extracting the data, statistical software Review Manager 5.3 was used for data analysis.Results: Through comparison, Cobb angle(95% CI [0.54, 4.42), P = 0.01] and Oswestry Dysfunction Index(ODI)(95% CI [0.21, 2.15], P= 0.02) of PKP group was smaller than that of PVP group. Postoperative anterior vertebral body height of the PKP group was better than PVP group(95% CI [-1.27,-0.66], P < 0.001]. However, the PVP group had shorter operation time than PKP group(95% CI [-13.48,-7.43), P = 0.001]. In the other outcome measures, including Visual Analogue Scale(VAS) score(95% CI [-0.04, 0.27), P = 0.15), cement volume(95% CI [-0.82, 0.32], P = 0.39) and cement leakage(95% CI [0.90, 2.76], P = 0.11), there was no significant differences between the two procedures.Conclusions: At this stage, there is sufficient evidence to support that PKP is better than PVP in the treatment of Kümmell's disease in Chinese patients. Although PVP surgery requires much less operation time, PKP has better postoperative radiological results and lower ODI. Moreover, both of them had similar clinical results(e.g., analgesic effects, cement dosage, and leakage rate). Further evidence is dependent on the emergence of randomized controlled trials with higher quality and larger sample sizes in the future.
文摘Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.
文摘<strong>Background:</strong> Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. <strong>Purpose:</strong> To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). <strong>Method:</strong> A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (<em>β</em>-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. <strong>Results:</strong> After normalized treatment, the bone metabolism indexes of PINP and <em>β</em>-CTX were improved and BMD was increased in three groups. <strong>Adverse Reactions:</strong> There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). <strong>Conclusion:</strong> Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.
文摘BACKGROUND Percutaneous kyphoplasty(PKP)is a pivotal intervention for osteoporotic fractures,pathological vertebral compression fractures,and vertebral bone tumors.Despite its efficacy,the procedure presents challenges,notably complications arising from intradural cement leakage.Timely and accurate diagnosis,coupled with emergent intervention is imperative to improve patient prognosis.This case report illuminates the intricacies and potential complications associated with PKP,emphasizing the critical need for vigilant monitoring,prompt diagnosis,and immediate intervention to mitigate adverse outcomes.CASE SUMMARY A 58-year-old male patient,experiencing a T7 osteoporosis-related pathological compression fracture,underwent PKP at a local hospital.Two weeks postprocedure,the patient developed paraplegic and dysuric symptoms,necessitating emergency decompression surgery.Gradual improvement was achieved,marked by the restoration of muscle strength,sensation,and mobility.CONCLUSION PKP Intradural cement leakage following PKP is unusual and potentially fatal.Prompt imaging examinations,urgent evaluation,and the decompression surgery are essential,which help alleviate symptoms associated with spinal damage,markedly improving the overall prognosis.
基金This work is in part supported by NSFC No.51402176the Inner Mongolia autonomous region natural science fund No.20070501.
文摘We investigated the feasibility of applying polymethylmethacrylate bone cement composited with biomimetic bone-mineralizsed collagen to percutaneous kyphoplasty(PKP).We performed PKP in 95 patients diagnosed with osteoporotic vertebral compression fracture.All patients had fractures of a single vertebral body,and they were divided randomly into control(group A,47 patients)and experimental(group B,48 patients)groups.Patients in group A were treated with acrylic cement,and those in group B were treated with acrylic cement composited with the bone graft material.All patients were evaluated by a visual analogue scale(VAS),Oswestry disability index(ODI),Cobb angle and anterior vertebral body height preoperatively,and 3 days and 3 months postoperatively.All patients successfully completed surgery and were followed up thereafter.The VAS score,ODI index,Cobb angle and anterior vertebral body height compression rate in both groups had significant changes(P<0.05)preoperatively,and at 3 days and 3 months postoperatively.There was no significant difference between the two groups at different times(P>0.05).The analgesic effects of bone cement composited with bone-mineralized collagen are similar to those of bone cement only.Mineralized collagen has excellent promotion prospects by inducing new bone formation and reducing the incidence of adverse reactions caused by bone cement.
基金supported by the National Natural Science Foundation of China (Grants No. 81672152 and 81871773)Jiangsu Provincial Science and Technology Department Key R&D Program (Grant No. BE2018132)
文摘Osteoporotic vertebral compression fracture(OVCF)has become a major public health issue that becomes more pressing with increasing global aging.Percutaneous kyphoplasty(PKP)is an effective treatment for OVCF.Robot-assisted PKP has been utilized in recent years to improve accuracy and reduce complications.However,the effectiveness of robot-assisted PKP in the treatment of multi-segmental OVCF has yet to be proved.This study was designed to compare the efficacy of robot-assisted and conventional fluoroscopy-assisted multi-segmental PKP.A total of 30 cases with multi-segmental OVCF between April 2019 and April 2021 were included in this study.Fifteen cases were assigned to the robot-assisted PKP group(robot group)and 15 cases to the conventional fluoroscopy-assisted PKP group(conventional fluoroscopy group).The number of fluoroscopic exposures,fluoroscopic dose,operation time,cement leakage rate,visual analog scale(VAS)score,vertebral kyphosis angle(VKA),and height of fractured vertebral body(HFV)were compared between the 2 groups.The number of fluoroscopic exposures,fluoroscopic doses,and cement leakage rates in the robot group were lower than in the conventional fluoroscopy group(P<0.05)while the operative time in the robot group was longer than in the conventional fluoroscopy group(P<0.05).VAS score and VKA were decreased and HFV was increased after surgery in both groups(P<0.05).Therefore,robot-assisted PKP for the treatment of multi-segmental OVCF can reduce the number of fluoroscopic exposures,fluoroscopic doses,and cement leakage compared to conventional treatment.As such,robot-assisted PKP has good application prospects and is potentially more effective in the treatment of multi-segmental OVCF.
