Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

To determine the role of percutaneous vertebroplasty (PVP) in bone formation and the union of vertebral pseudarthrosis, we analyzed 14 patients with an average follow-up duration of 21 months. Evaluation methods included back pain (visual analog scale: VAS), wedge angle, dynamic mobility, radiographic remodeling including callus and spur formation, and union status. The Student's t test was used for statistical analysis and a probability of less than 0.05 was determined as a significant difference. Back pain improved in all 14 patients with a VAS score of 57.8 ± 23.5 mm (average ± standard deviation) preoperatively and 14.7 ± 16.4 mm at the final follow-up (P < 0.001). The wedge angle decreased from 21.6° ± 8.3° (average ± standard deviation) preoperatively to 13.2° ± 6.9° at the final follow-up (P < 0.001). Callus formation was seen in four patients. Bony spurs were seen in the affected vertebra in preoperative radiographs in all patients, and were further developed to a solidified form during follow up after PVP. Dynamic mobility of the affected vertebrae was 6.9 ± 2.9 mm preoperatively, which decreased to 1.1° ± 0.7° at the final follow-up (P < 0.001). Notably, all patients showed the dynamic vertebral mobility of 2 mm or less. Nevertheless, only two patients exhibited the dynamic vertebral mobility of 0 mm at the final follow-up, which is referred to as bone union. These findings indicate that PVP serves as a mechanical stabilizer for vertebral pseudarthrosis, which leads to immediate pain relief and segmental bony responses.     

Vertebroplasty with self-locking hexagonal metal implants shows comparable primary and secondary stiffness to PMMA cement augmentation techniques in a biomechanical vertebral compression fracture model

With the growing incidence of vertebral compression fractures in elderly patients having a fair overall health condition, minimal-invasive treatment techniques are getting in focus of surgical therapy. Cement augmentation is widely performed and its complications and mechanical limitations are well described. Implants avoiding the side effects of cement augmentation while reaching the same level of stability would be desirable. The primary and secondary stability of a new augmentation method with self-locking hexagonal metal implants were investigated and compared with the performance of established augmentation options. 18 fresh-frozen human spinal specimens (Th12–L2/L3–L5) were tested with pure moments of 7.5 Nm in a six-degree-of-freedom spine simulator to investigate primary and secondary stability of three augmentation techniques: (1) vertebroplasty, (2) PMMA filled cavity and (3) hexagonal metal implants. An increasing three-step cyclic loading model was included. Elastic displacement and height loss under loading did not show significant differences between the three test groups. Investigation of primary and secondary stability evenly demonstrated comparable results for all techniques indicating an insufficiency to stabilise the fracture with higher load cycles. The newly introduced method for augmentation with the metal implant Spine Pearls achieved comparable results to bone cement based techniques in a biomechanical in vitro study. Midterm and longterm reduction preservation and ingrowth of the implants have to be proven in further studies.     

One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits

The number of reports describing osteoporotic vertebral fracture has increased as the number of elderly people has grown. Anterior decompression and fusion alone for the treatment of vertebral collapse is not easy for patients with comorbid medical problems and severe bone fragility. The purpose of the present study was to evaluate the efficacy of one-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. A consecutive series of 21 patients who sustained osteoporotic vertebral collapse with neurological deficits were managed with posterior decompression and short-segmental pedicle screw instrumentation augmented with ultra-high molecular weight polyethylene (UHMWP) cables with or without vertebroplasty using calcium phosphate cement. The mean follow-up was 42 months. All patients showed neurologic recovery. Segmental kyphotic angle at the instrumented level was significantly improved from an average preoperative kyphosis of 22.8–14.7 at a final follow-up. Spinal canal occupation was significantly reduced from an average before surgery of 40.4–19.1% at the final follow-up. Two patients experienced loosening of pedicle screws and three patients developed subsequent vertebral compression fractures within adjacent segments. However, these patients were effectively treated in a conservative fashion without any additional surgery. Our results indicated that one-stage posterior instrumentation surgery augmented with UHMWP cables could provide significant neurological improvement in the treatment of osteoporotic vertebral collapse.     

Bilateral vertebral artery balloon occlusion for giant vertebrobasilar aneurysms

We describe the clinical presentation, radiological and clinical results in six consecutive patients with a giant vertebrobasilar aneurysm treated by bilateral vertebral artery balloon occlusion. Five patients presented with headache and signs of brain-stem compression and one with subarachnoid haemorrhage. In all patients vertebral artery balloon occlusion was performed. In four, this followed successful test occlusion. In one patient, who did not tolerate the test occlusion, a bypass from the external carotid to the posterior cerebral artery preceded definitive vertebral artery occlusion. One patient underwent bypass surgery prior to test occlusion. At 6–22 months follow-up three patients had a good functional outcome and showed unchanged size or shrinkage of the aneurysm on MRI. Three other patients died; one from recurrent haemorrhage, and two probably from delayed brain-stem ischaemia. The presence of two large posterior communicating arteries predicted good functional outcome, which was also related to the clinical condition at presentation, and the degree of brain-stem compression and oedema on MRI. Bilateral vertebral artery balloon occlusion can be considered in patients with otherwise untreatable giant vertebrobasilar aneurysms. If test occlusion is not tolerated, a surgical bypass to the posterior circulation can be considered. Received: 1 December 1999 Accepted: 6 October 2000     

经皮椎体成形术治疗C2椎体转移性肿瘤

目的探讨经皮C2椎体成形术的方法和效果。方法1例49岁的男性肺癌患者和1例45岁的女性乳腺癌患者,出现C2椎体转移,均有明显的颈部疼痛,女性患者因疼痛已不能下床行走1个月。采取在CT引导下,用13G骨穿针,由颈椎侧方经椎动脉与颈动脉鞘之间的间隙穿刺到C2椎体内,分别注入骨水泥(聚甲基丙烯酸甲酯,PMMA)3 ml和3.5 ml。结果术后CT扫描显示骨水泥在椎体内填充分布好,无骨水泥外漏。术后两例的疼痛均有不同程度缓解,1周后疼痛完全消失,女性患者能下地自由行走。男性患者半年后死于多个器官转移引起的全身衰竭。女性患者术后配合放化疗,随访至今1年多,无任何不适。结论在CT引导下,采取颈椎侧方入路,经椎动脉与颈动脉鞘之间的间隙,行经皮椎体成形术是一种安全、有效治疗C2椎体转移性肿瘤的方法。     

The Z‐plasty contributes to the coalescence of a chronic non‐healing wound

This study aimed to explore the treatment effect of Z‐plasty on a non‐healing wound. A total of 72 patients diagnosed with a chronic non‐healing wound in Peking University Third Hospital from November 2009 to August 2019 were retrospectively analysed. Among them, 27 patients were treated with Z‐plasty, and 45 patients were treated with the general method. Detailed patient information was retrieved from medical records, including age, gender, body mass index (BMI), alcohol, smoking, and comorbidities (diabetes mellitus, hypertension, heart disease). Surgical parameters included operation time and intraoperative blood loss. Wound swelling, epidermal blisters, wound edge colour, and skin temperature at 1 day after surgery were assessed to evaluate the blood supply of the wound. Surgical complications included infection, haematoma, dehiscence, and non‐healing within 2 weeks postoperatively. Student t test (for continuous data) and Chi‐square test (for categorical data) were conducted to determine the statistical difference. We found no significant differences in age, gender, BMI, alcohol, smoking, and comorbidities between the two groups. Z‐plasty did not show any advantages in the surgical time, invasive blood loss, hospital days, and hospitalisation expenses. The incidence of abnormal wound edge colour with Z‐plasty was significantly lower than that with the general treatment (P < .05), and the Z‐plasty enables better healing of the patient''s wound (P < .05). Z‐plasty promoted better recovery of chronic non‐healing wounds than direct suturing.     

红外线透视导航下经皮椎体成形术治疗椎体骨质疏松压缩性骨折28例

目的探讨红外线透视导航下经皮椎体成形术(percutaneous vertebrop lasty,PVP)治疗骨质疏松性压缩性骨折的疗效。方法红外线透视导航下PVP治疗骨质疏松性压缩性骨折28例(41个椎体),骨折部位为T6~L4,其中胸椎16个椎体,腰椎25个椎体。将参考架固定于病椎棘突,C形臂X线机拍正侧位图像,对穿刺针进行记录获得透视图像上的虚拟影像。术后复查X线及CT检查了解骨折椎体复位情况、椎体的容量变化、骨水泥分布及外漏情况,CT容量分析法观测手术前后椎体的容积变化,观察手术前后疼痛强度评价的视觉类比评分的变化。结果41个椎体成功注射骨水泥。13个椎体行PVP;28个椎体行经皮后凸成形术(percutaneous kyphop last,PKP),其中12例行球囊扩张成形,16例行sky膨胀式椎体成形。单椎体注射17例,2个椎体注射9例,3个椎体注射2例。26个椎体采用单侧椎弓根注射,15个椎体采用双侧椎弓根注射。无手术死亡,无神经根及脊髓受损情况无肺栓塞及心脑血管系统急性反应。PVP手术时间7.7~20.7 m in/椎体,(14.2±3.3)m in/椎体;PKP手术时间11.2~32.4 m in/椎体,(21.8±5.4)m in/椎体。X线照射剂量为5.4~19.6 dGy/椎体,(12.5±3.6)dGy/椎体。注射骨水泥2.2~6.8 m l/椎体,(4.6±1.2)m l/椎体。椎体体积由术前(21.4±4.6)cm3增至术后(25.8±5.4)cm3(t=5.623,P=0.000)。VAS由术前(7.6±1.2)分下降为术后48 h(2.9±0.7)分(t=12.946,P=0.000)。28例平均随访8个月(3~14个月),无严重并发症,无椎体塌陷。结论红外线透视导航PVP可行,可提高手术精确度和安全性。     

Trapeze-flap plasty: Effective method for postburn neck contracture elimination

The new method for postburn neck contracture management is presented. The method is found to be most effective when using the local flap procedures on patients who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration (children, elderly patients, patients with inadequate donor sites, and patients with cosmetically acceptable scar appearance). The method consists of the opposite transposition of trapezoid scar-fascial flaps which are prepared one on each antero-lateral neck surface. Both flaps include scars, fat, platysma and deep cervical fascia. As a result of the trapeze-flap plasty, the anterior surface of the neck is lengthened approximately by 100–200%, the contracture is eliminated and mentocervical angle and head movement are restored. The flaps have reliable blood circulation through the superficial cervical artery perforators, therefore flap loss is rare. The functional results were good in 24 out of 26 patients. The flaps surface does not decrease; therefore, the mild contracture becomes an exception.     

CT介导同轴套管针脊柱病变经皮活检术

目的探讨CT介导同轴套管针经皮活检术在脊柱病变临床诊治中的价值。方法CT引导下同轴穿刺套管针经皮穿刺活检脊柱病变37例,其中胸椎9例,腰椎13例,骶椎8例,胸腰椎同时累及7例。根据病变的部位,采用经椎弓根或椎旁入路,进入病变部位后旋转套管切割病变组织,送组织学检查。结果所有37例患者均穿刺成功,每例患者获穿刺组织块1～4块,平均2.1块;34例获明确诊断,分别为转移性肿瘤15例,结核9例,脊索瘤5例,多发性骨髓瘤2例,骨巨细胞瘤2例,嗜酸性细胞肉芽肿1例,成功率91.9%;无一例严重并发症。结论CT介导同轴套管针脊柱病变经皮活检术诊断率高,并发症少,且微创、安全,价格低廉,值得在临床推广应用。     

Mechanical augmentation of the vertebral body by calcium phosphate cement injection

The effectiveness of transpedicular calcium phosphate cement (CPC) injection as a new treatment for osteoporotic compression fracture of vertebrae was evaluated by measuring the compressive strength and the mode of failure in vertebrae experimentally injected with CPC. Forty-five human cadaver vertebrae were divided into three groups: a control group; group A, in which CPC was injected into the upper half of the vertebral body; and group B, in which CPC was injected into the whole vertebra. The load-displacement curve characteristically had two peaks in group A, and decreased rapidly after failure in group B. The failure site was the cancellous bone immediately below the cranial endplate in the control group, cancellous bone immediately below the CPC injection area in group A, and in the CPC injection area in group B. Although mechanical strength was greatest in those vertebrae in which the entire cancellous bone was replaced with CPC, the compressive strength of the vertebrae was also increased by partial replacement of cancellous bone with CPC injection. In terms of mode of failure and mechanical gradient with adjacent vertebrae, there were several advantages for those vertebrae in which the cranial half of the cancellous bone was replaced with CPC. Received: May 29, 2000 / Accepted: September 20, 2000