Objective To evaluate the effectiveness of Confidence high viscosity bone cement system and postural reduction in treating acute severe osteoporotic vertebral compression fracture (OVCF). Methods Between June 2004 and June2009, 34 patients with acute severe OVCF were treated with Confidence high viscosity bone cement system and postural reduction. There were 14 males and 20 females with an average age of 72.6 years (range, 62-88 years). All patients had single thoracolumbar fracture, including 4 cases of T11, 10 of T12, 15 of L1, 4 of L2, and 1 of L3. The bone density measurement showed that T value was less than —2.5. The time from injury to admission was 2-72 hours. All cases were treated with postural reduction preoperatively. The time of reduction in over-extending position was 7-14 days. All patients were injected unilaterally. The injected volume of high viscosity bone cement was 2-6 mL (mean, 3.2 mL). Results Cement leakage was found in 3 cases (8.8%) during operation, including leakage into intervertebral space in 2 cases and into adjacent paravertebral soft tissue in 1 case. No cl inical symptom was observed and no treatment was pearformed. No pulmonary embolism, infection, nerve injury, or other complications occurred in all patients. All patients were followed up 12-38 months (mean, 18.5 months). Postoperatively, complete pain rel ief was achievedin 31 cases and partial pain refief in 3 cases; no re-fracture or loosening at the interface occurred. At 3 days after operation and last follow-up, the anterior and middle vertebral column height, Cobb angle, and visual analogue scale (VAS) score were improved significantly when compared with those before operation (P lt; 0.05)；and there was no significant difference between 3 days and last follow-up (P gt; 0.05). Conclusion Confidence high viscosity bone cement system and postural reduction can be employed safely in treating acute severe OVCF, which has many merits of high viscosity, long time for injection, and easy-to-control directionally.
ObjectiveTo investigate the effectiveness of Vesselplasty and percutaneous kyphoplasty (PKP) in treatment of Kümmell disease.MethodsBetween January 2015 and December 2018, 63 patients with Kümmell disease were treated. Among them, 28 cases were treated with Vesselplasty (Vesselplasty group) and 35 cases were treated with PKP (PKP group). There was no significant difference in gender, age, disease duration, bone mineral density (T value), fracture distribution, and preoperative pain visual analogue scale (VAS) score, Oswestry Disability Index (ODI), anterior height of injured vertebrae, and kyphosis Cobb angle between the two groups (P>0.05). The operation time, intraoperative fluoroscopy time, bone cement injection volume, the leakage rate of bone cement, the diffusion area ratio of bone cement, and the complications of the two groups were recorded. VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle were compared between the two groups before operation and at 1 day after operation and last follow-up.ResultsAll patients of the two groups were followed up 12-36 months, with an average of 24.2 months. The operation time, intraoperative fluoroscopy time, bone cement injection volume, and diffusion area ratio of bone cement were significantly lower in the Vesselplasty group than in the PKP group (P<0.05). The leakage rate of bone cement was significantly lower in the Vesselplasty group (7.14%) than in the PKP group (34.29%) (χ2=5.153, P=0.023). At 1 day after operation and last follow-up, the VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle of the two groups were superior to those before operation (P<0.05), and no significant difference between the two groups (P>0.05). During the follow-up, there was no re-collapse of vertebrae, and the adjacent vertebrae fracture occurred in 2 cases of the Vesselplasty group and 5 cases of PKP group. There was no significant difference in the incidence of adjacent vertebrae fracture between the Vesselplasty group (7.14%) and the PKP group (14.29%) (χ2=0.243, P=0.622).ConclusionVesselplasty and PKP have similar effectiveness in the treatment of Kümmell disease. They can effectively relieve the pain symptoms, improve the quality of life, partially restore the height of injured vertebrae, and correct kyphosis. But the Vesselplasty has the advantages of shorter operation time, less intraoperative fluoroscopy time, and less bone cement leakage.
Objective To evaluate the effectiveness of induced membrane technique in the treatment of infectious bone defect. Methods Thirty-six patients (37 bone lesions) with infectious bone defects were treated with induced membrane technique between January 2011 and June 2014. There were 28 males and 8 females with an average age of 36 years (range, 20-68 years). All bone defects were post-traumatic infectious bone defect. The bone defect was located at the tibia and fibula in 24 cases (25 bone lesions), at femurs in 6 cases (6 bone lesions), at ulnas and radii in 2 cases (2 bone lesions), at calcanei in 3 cases (3 bone lesions), and at clavicle in 1 case (1 bone lesion). The average time between onset and the treatment of induced membrane technique was 6.2 months (range, 0.5-36.0 months); 15 patients were acute infections (disease duration was less than 3 months). At the first stage, after the removal of internal fixator (applicable for the patients who had internal fixation), complete debridement of infection necrotic bone tissue and surrounding soft tissue was performed and the bone defects were filled with antibiotic-impregnated cement spacers. If the bone was unstable after debridement, external fixator or plaster could be used for stabilization. Patients received sensitive antibiotics postoperatively. At the second stage (usually 6-8 weeks later), the cement spacer were removed, with preservation of the induced membrane formed by the spacer, and filled the bone defect with autologous iliac bone graft within the membrane. Results The hospitalization time after debridement was 17-30 days (mean, 22.2 days), and the hospitalization time after the second stage was 7-14 days (mean, 10 days). All the flaps healed uneventfully in 16 cases treated with local flap transposition or free flap grafting after debridement. One patient of femur fracture received Ilizarov treatment after recurrence of infection at 11 months after operation; 1 patient of distal femoral fracture received amputation after recurrence of infection at 1 month after operation; 1 patient of distal end of tibia and fibula fractures received ankle arthrodesis after repeated debridements due to the recurrence of infection; 1 patient of tibia and fibula fractures lost to follow-up. The other 32 patients (33 bone lesions) were followed up 1-5 years (mean, 2 years) without infection recurrence, and the infection control rate was 91.7% (33/36). All the patients had bony union, and the healing time was 4-12 months (mean, 7.5 months); no refracture occurred. One patient of femur bone defect had a lateral angulation of 15° and leg discrepancy of 1.5 cm. Superficial pin infection was observed in 7 cases and healed after intensive wound care and oral antibiotics. Adjacent joint function restriction were observed in 6 cases at last follow-up. Conclusion Induced membrane technique is a simple and reliable technique for the treatment of infectious bone defect. The technique is not limited to the size of the bone defect and the effectiveness is satisfactory.
Objective To summarize the latest research progress of bone cement type femoral head replacement in the treatment of unstable intertrochanteric fractures in elderly patients. Methods The literature on the application of bone cement type femoral head replacement for unstable intertrochanteric fractures in elderly patients both domestically and internationally was reviewed, and the findings in aspects of selection of prosthesis types, proximal femoral reconstruction methods, postoperative complications, and rehabilitation were summarized and analyzed. Results The bone cement type femoral head replacement has shown significant effectiveness in the treatment of unstable intertrochanteric fractures in elderly patients. The surgery provides immediate stability, allowing patients to quickly bear weight and regain walking function, thereby reducing the incidences of postoperative complications and mortality. However, due to the generally poor physical condition and low surgical tolerance of elderly patients, the risk of postoperative complications significantly increases, which has a significant impact on patients’ postoperative recovery. Common complications include deep vein thrombosis, bone cement implantation syndrome, joint dislocation, prosthesis loosening, and periprosthetic fractures. Therefore, despite the apparent short-term effectiveness of the surgery, it is crucial to emphasize the prevention and management of postoperative complications to improve the long-term prognosis of elderly patients. Conclusion For unstable intertrochanteric fractures in elderly patients, when choosing bone cement type femoral head replacement, it is necessary to strictly adhere to surgical indications, reduce the occurrence of complications, and improve the patients’ quality of life through refined preoperative evaluation, intraoperative operation, and effective postoperative management.
Objective To investigate the effectiveness of posterior short-segmental fixation with bone cement augmentation in treatment of stage Ⅲ Kümmell’s disease with spinal canal stenosis. Methods Between June 2012 and January 2017, 36 patients with stage Ⅲ Kümmell’s disease and spinal canal stenosis were treated by posterior short-segmental fixation and bone cement augmentation. There were 12 males and 24 females, aged 55-83 years (mean, 73.5 years). The disease duration ranged from 2 to 8 months, with an average of 4.6 months. Preoperative bone mineral density examination showed that all patients had different degrees of osteoporosis in the spines. The lesion segments included T10 in 4 cases, T11 in 7 cases, T12 in 8 cases, L1 in 9 cases, and L2 in 8 cases. The preoperative neural function was classified as grade B in 4 cases, grade C in 12 cases, grade D in 13 cases, and grade E in 7 cases according to Frankle classification. The operation time, intraoperative blood loss, and the volume of injected bone cement, and hospital stay were recorded. The visual analogue scale (VAS) score, Oswestry Disability Index (ODI), kyphotic Cobb angle, and the height of anterior edge of injured vertebra were recorded before operation, at 1 week after operation, and at last follow-up; and the leakage of bone cement was observed. Results All operations were completed successfully. The operation time was 90-145 minutes (mean, 110.6 minutes); the intraoperative blood loss was 198-302 mL (mean, 242.5 mL); the volume of injected bone cement was 8.3-10.5 mL (mean, 9.2 mL); the hospital stays were 7-12 days (mean, 8.3 days). All patients were followed up 12-26 months (mean, 24.5 months). At 1 week after operation, the neural function was classified as grade B in 2 cases, grade C in 8 cases, grade D in 12 cases, and grade E in 14 cases, which was significantly improved when compared with that before operation (Z=2.000, P=0.047). The VAS score, ODI, the height of anterior edge of injured vertebra, and Cobb angle were significantly improved at 1 week and last follow-up when compared with preoperative values (P<0.05); but there was no significant difference between 1 week and last follow-up (P>0.05). Two cases had asymptomatic cement leakage to the intervertebral disc at 1 week after operation; and 1 case had adjacent vertebral fracture at 8 months after operation. No complication such as loosening or breaking of internal fixator occurred during the follow-up. Conclusion Posterior short-segmental fixation with bone cement augmentation is a safe and effective surgical scheme for stage Ⅲ Kümmell’s disease combined with spinal canal stenosis, which can avoid the aggravation of nerve injury and complications related to staying in bed.
ObjectiveTo analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. Methods A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. Results Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra (r=0.493, P<0.001). ConclusionThe incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.
Objective To explore the application of intramedullary nail fixation combined with auxiliary plate and bone cement in the palliative treatment of pathologic fracture of extremities caused by metastatic tumors. Methods Clinical data of 11 cases with pathologic fracture of extremities caused by metastatic tumors between April 2015 and October 2016 were retrospectively analyzed. All the patients were treated by intramedullary nail fixation combined with auxiliary plate and bone cement. There were 6 males and 5 females with an age of 54-72 years (mean, 62.9 years). The disease duration was 1.0-1.5 months. Of the 11 patients, 4 metastatic tumors were diagnosed at humerus, 6 at femur, and 1 at tibia, respectively. And the tumor infiltration length ranged from 3.3 to 5.6 cm (mean, 4.6 cm), the depth could reach the bilayer of limb bones. All the patients had suffered the limbs pain and incapability of physical movement. The preoperative visual analogue scale (VAS) score was 6.36±1.03, and the Karnofsky Performance Status (KPS) score was 42.73±10.09. The operation time, intraoperative blood loss, and postoperative complications were recorded. The VAS score, KPS score, and Musculoskeletal Tumor Society (MSTS) score were used to evaluate the effectiveness at 3 months after operation. Results The operation time was 1.1-1.8 hours (mean, 1.5 hours), the intraoperative blood loss was 102.5-211.3 mL (mean, 135.6 mL). Postoperative limb incisions healed well without infection, necrosis, and delayed healing or other complications. All the patients were followed up 7-10 months (mean, 8.2 months). At 3 months after operation, the functions of limbs recovered. The VAS score decreased to 0.82±0.75 and the KPS score increased to 85.45±5.22, both showing significant difference when compared with preoperative ones (t=35.218, P=0.000; t=–18.470, P=0.000); and the MSTS score was 23.91±2.47. At last follow-up, the anteroposterior and lateral X-ray films showed that all the limbs healing well and no breakage of intramedullary nail and steel plate, or loosening in bone cement, limb shortening, malalignment, or other complications occurred. Conclusion In treating metastatic tumors of extremities, the combination of intramedullary nail fixation with auxiliary plate and bone cement will contribute to an invariable length and fixed location for limbs, resulting in biomechanical stability for skeleton. Under this premise, the tumor lesions can be eliminated and pathological pains be relieved, so as to improve patients’ life quality.
Objective To summarize the effectiveness of bone cement combined with screws for repairing tibial plateau defect in total knee arthroplasty (TKA). Methods Between March 2013 and March 2016, 30 patients were treated with TKA and bone cement combined with screws for repairing tibial plateau defect. Of the 30 patients, 8 were male and 22 were female, with an average age of 64.7 years (range, 55-71 years). And 17 cases were involved in left knees and 13 cases in right knees; 22 cases were osteoarthritis and 8 cases were rheumatoid arthritis. The disease duration ranged from 9 to 27 months (mean, 14 months). Knee Society Score (KSS) was 41.63±6.76. Hospital for Special Surgery Knee Score (HSS) was 38.10±7.00. The varus deformity of knee were involved in 19 cases and valgus deformity in 11 cases. According to the Rand classification criteria, tibial plateau defect were rated as type Ⅱb. Results All incisions healed by first intention, without infection or deep vein thrombosis. All the patients were followed up 27.5 months on average (range, 10-42 months). At last follow-up, HSS score was 90.70±4.18 and KSS score was 93.20±3.75, showing significant differences when compared with preoperative values (t=–58.014, P=0.000; t=–60.629, P=0.000). Conclusion It is a simple and safe method to repair tibial plateau defect complicated with varus and valgus deformities with bone cement and srews in TKA.
ObjectiveTo compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF).MethodsThe clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients’ symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded.ResultsThe injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups (t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups (χ2=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation (P<0.05), and there were significant differences among the postoperative time points (P<0.05). The VAS score and ODI score of the observation group were significantly better than those of the control group (P<0.05) at immediate, 2 days, and 3 months after operation, and there was no significant difference between the two groups at last follow-up (P>0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups (P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant (χ2=4.105, P=0.043; χ2=4.661, P=0.031).ConclusionBone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.
Objective To explore the effectiveness of mini external fixators combined with bone cement spacers in the treatment of gouty hallux rigidus with bone defects. Methods A retrospective analysis was conducted on the clinical data of 21 male patients diagnosed with gouty hallux rigidus and bone defects, treated with mini external fixators combined with bone cement spacers between January 2017 and December 2024. The age ranged from 35 to 72 years, with an average age of 61.1 years. The disease duration was 12-35 years, with an average of 18.2 years. The American College of Rheumatology (ACR) gout score ranged from 16 to 23, with an average of 18.6. All 21 cases of hallux rigidus were classified as grade 3 according to the Coughlin classification. Clinical efficacy was evaluated preoperatively and at 6 months postoperatively using the visual analogue scale (VAS) score for pain, the dorsiflexion angle of first metatarsophalangeal joint in a weight-bearing state, and the American Orthopaedic Foot & Ankle Society (AOFAS) score. Radiological evaluation was performed by measuring the hallux valgus angle (HVA) using weight-bearing X-ray films and the tophi volume using dual-energy CT. Results The operation time ranged from 30 to 56 minutes, with an average of 42.05 minutes. The intraoperative blood loss varied between 10 and 30 mL, averaging 20 mL. All 21 patients were followed up 6-15 months, averaging 9.3 months. One patient experienced delayed wound healing due to the liquefaction of residual tophus; no other patients exhibited complications such as wound or pin tract infections, skin necrosis, fractures, or metastatic metatarsalgia. Six patients experienced acute gout attacks 4-7 days postoperatively, which were effectively alleviated through symptomatic treatment. At 6 months after operation, patients showed significant improvements in HVA, tophus volume, VAS scores, AOFAS scores, and the dorsiflexion angle of first metatarsophalangeal joint compared to preoperative values, with significant differences (P<0.05). ConclusionMini external fixator combined with a cement spacer is an effective treatment for gouty hallux rigidus with bone defects.