OBJECTIVE:To investigate the differences in clinical efficacy between percutaneous curved kyphoplasty(PCKP) and unilateral percutaneous kyphoplasty(UPKP) in the treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCF),with a focus on evaluating cement distribution,leakage risk,and vertebral biomechanical restoration. METHODS:A total of 78 patients with acute thoracolumbar OVCF admitted between January 2022 and April 2024 were included. They were divided into a PCKP group and a UPKP group based on the surgical technique. The PCKP group comprised 37 cases,including 12 males and 25 females,with an age of (78.84±11.24) years and a bone mineral density T value of -4.05±0.81. The UPKP group included 41 cases,comprising 17 males and 24 females,with an age of (77.68±10.73) years and a bone mineral density T value of -4.15±0.82. Comparisons were made between the two groups regarding preoperative and postoperative visual analogue scale (VAS) pain scores,Oswestry disability index (ODI) scores,anterior vertebral body height,rate of good/excellent cement distribution,cement leakage rate,and surgery-related parameters. RESULTS:All patients were followed up for 12 months. In the PCKP group,the mean VAS preoperatively,and at 2 days,3 months,and 12 months postoperatively were (6.35±2.34),(2.95±0.70),(1.76±1.19),and (0.97±0.80) points,respectively. Corresponding scores in the UPKP group were (6.83±2.23),(3.15±0.82),(1.73±1.12),and (1.17±0.74) points. The mean ODI scores in the PCKP group at the same time points were (75.73±3.42),(34.57±3.18),(24.03±5.24),and (22.84±1.68) points,respectively,compared to (74.41±2.85),(35.54±3.49),(24.95±2.85),and (22.66±1.70) points in the UPKP group. Both groups showed significant improvement in VAS and ODI scores postoperatively (P<0.05),but no statistically significant differences were observed between the groups (P>0.05). The rate of good/excellent cement distribution in the PCKP group was 91.89% (34/37),significantly higher than the 65.85% (27/41) in the UPKP group (P=0.001). The cement leakage rate was 13.51% (5/37) in the PCKP group,which was significantly lower than the 34.15% (14/41) in the UPKP group (P=0.030). No significant difference was found in the degree of vertebral compression between patients with poor cement distribution/leakage and those without in either group (P>0.05). The mean anterior vertebral body height in the PCKP group increased from (13.22±2.47) mm preoperatively to (16.68±1.42) mm at 2 days postoperatively. In the UPKP group,it increased from (13.80±2.50) mm to (17.02±1.35) mm at 2 days postoperatively. Both groups showed significant restoration of anterior vertebral height postoperatively (P<0.05),with no significant intergroup difference (P>0.05). Re-fractures occurred in 4 cases in the PCKP group and 6 cases in the UPKP group,showing no significant intergroup difference (P>0.05). No significant differences were found in operative time or fluoroscopy frequency between the two groups (P>0.05). CONCLUSION:PCKP,utilizing a curved drill technique,optimizes bilateral cement dispersion,significantly improving distribution uniformity and reducing leakage risk,making it particularly suitable for moderate-to-severe compression fractures. Its technical characteristics such as unilateral puncture and low-pressure cement infusion-provide a safer and more effective minimally invasive solution for thoracolumbar OVCF without increasing operative time or radiation exposure. Future studies with larger sample sizes and longer follow-up are needed to verify its long-term biomechanical advantages.
Abstract Objective To systematically review the clinical efficacy (pain, function, quality of life) and safety of platelet-rich plasma (PRP) in the treatment of frozen shoulder through meta-analysis, and provide evidence-based medical evidence for the effectiveness of PRP in the treatment of frozen shoulder. Methods A search was conducted on international databases (Pubmed, Web of science, Embase) and Chinese databases (CNKI, Wanfang, VIP) to search the clinical studies on the efficacy of platelet-rich plasma in treating frozen shoulder (adhesive capsulitis/periarthritis/50 shoulder) and their corresponding references published from inception until January 2024. Thoroughly excluded literature not meeting the predetermined inclusion criteria, extracted relevant data from the literature, and input it into RevMan5.4 for meta-analysis. Results This study ultimately included 14 RCTs, with a total of 1024 patients. The results showed that PRP has significant advantages compared with control groups in VAS (mean difference (MD) =-0.38, 95% confidence interval(CI)(-0.73, -0.03), P = 0.03), UCLA (MD = 3.31, 95% CI (1.02,5.60),P = 0.005), DASH (MD = -4.94,95% CI (-9.34, -0.53),P = 0.03), SPADI (SPADI Total: MD =-16.87, 95% CI (-22.84, -10.91), P < 0.00001; SPADI Pain: MD =-5.38, 95% CI (-7.80, -2.97), P < 0.0001; SPADI Disability: MD =-11.00, 95% CI (-13.61,-8.39), P < 0.00001), and the active and passive Range of Motion (active flexion: MD = 12.70, 95% CI (7.44, 17.95), P < 0.00001; passive flexion: MD = 9.47, 95% CI(3.80, 15.14), P = 0.001; active extension: MD = 3.45, 95% CI(2.39, 4.50), P < 0.00001; active abduction: MD = 13.54, 95% CI(8.42, 18.67), P < 0.00001; passive abduction: MD = 14.26, 95% CI (5.97, 22.56), P = 0.0008; active internal rotation: MD = 5.16, 95% CI (1.84, 8.48), P = 0.002; passive internal rotation: MD = 3.65, 95% CI(1.15, 6.15), P = 0.004; active external rotation: MD = 10.50, 95% CI(5.47, 15.53), P < 0.0001; passive external rotation: MD = 6.00, 95% CI (1.82, 10.19), P = 0.005) except passive extension (MD = 2.25, 95% CI (-0.77, 5.28), P = 0.14). In terms of safety, most studies reported no adverse effects, and only one study reported common complications of joint puncture such as swelling and pain after treatment in both PRP and control groups. Previous studies have shown a risk of osteonecrosis caused by corticosteroids. Therefore, the safety of PRP treatment is more reliable. Conclusion The results showed that PRP was more durable and safer than corticosteroids and other control groups in the treatment of frozen shoulder. Study Design Systematic review. Trial registration PROSPERO CRD42022359444, date of registration: 22-09-2022.
BACKGROUND:This study examined whether pericapsular nerve group (PENG) block combined with local infiltration analgesia (LIA) could improve pain management and functional recovery after total hip arthroplasty. METHODS:All patients were randomly assigned to receive PENG block combined with LIA (PENG group) or sham PENG block and LIA (Sham group). The primary outcome was cumulative morphine consumption within 24 hours after surgery. Secondary outcomes were pain scores on a visual analog scale (VAS); time to first rescue analgesia; cumulative morphine consumption during hospitalization; intraoperative consumption of opioids; postoperative recovery; and postoperative complications. RESULTS:PENG patients consumed significantly less morphine within the first 24 hours and throughout hospitalization and smaller amounts of intraoperative opioids. There were significantly lower pain scores at rest and during motion within 24 hours in PENG patients. PENG patients took significantly longer until the first rescue analgesia and showed significantly better postoperative rehabilitation. However, the absolute change in morphine consumption and VAS scores did not exceed the reported minimal clinically important differences (morphine consumption: 10 mg; VAS scores: 1.5 at rest and 1.8 during movement). The two groups showed no difference in quadriceps muscle strength and postoperative complications. CONCLUSION:PENG block combined with LIA could improve postoperative pain relief, reduce opioid use, and enhance recovery in total hip arthroplasty patients, without weakening the quadriceps muscle strength. This work justifies further trials to examine the safety and efficacy of this block and to explore maximal effective volume of local anesthetic for motor-sparing PENG block.
目的 探索心率变异性(heart rate variability,HRV)参数与胸腰椎骨折患者术后并发症风险关系.方法 选取我院 2019 年 11 月至 2023 年 1 月手术治疗的 212 例胸腰椎骨折患者.患者手术前 1 天佩戴 12 导联动态心电监护仪 24 h,收集 HRV 参数:极低频(very low frequency,VLF)、低频(low frequency,LF)、高频(high frequency,HF)和 LF/HF 比值.通过单因素和多因素 Logistic 回归模型和受试者操作特征(receiver operating characteristic,ROC)曲线分析评估 HRV 参数与术后 3 个月内并发症风险关系.结果 212 例患者术后总体并发症发生率为 46.7%(99/212),58 例有非手术并发症,26 例有手术并发症.多因素 Logistic回归分析结果显示 HRV 参数 VLF 和 LF/HF 比值降低与术后总体并发症(P<0.05)、术后非手术并发症(P<0.05)和术后手术并发症(P<0.05)风险相关.VLF 在诊断术后总体并发症、术后非手术并发症和术后手术并发症的 AUC 分别为 0.842(0.752～0.895)、0.889(0.847～0.932)和 0.801(0.746～0.856).LF/HF 比值在诊断术后总体并发症、术后非手术并发症和术后手术并发症的 AUC 分别为 0.874(0.840～0.908)、0.817(0.754～0.880)和 0.802(0.743～0.855).结论 胸腰椎骨折患者术后总体并发症发生率较高.评估和定位 HRV 参数VLF 和 LF/HF 能有效对患者术后并发症风险分层并用于确定需要加强围术期监测和预防性治疗的患者.
目的 系统评价比较单纯减压与减压融合术治疗退行性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)的临床疗效.方法 计算机检索 PubMed、Web of Science、The Cochrane library、Embase、中国生物医学文献服务系统、中国知网、万方数据库,检索时间从建库至 2022 年 12 月.提取纳入研究的基本信息、Oswestry 功能障碍指数(oswestry disability index,ODI)、腰腿痛的疼痛数字评分(numeric rating scale,NRS)、欧洲五维健康量表(European quality of life-5 dimensions,EQ-5D)、临床优良率、并发症及再手术率等指标,采用 RevMan 5.4.1 软件进行 Meta 分析.结果 共纳入随机对照研究 5 篇,队列研究19 篇,共 82 787 例患者(其中单纯减压组 9678 例,减压融合组 73 109 例).术后第 1 年,在 ODI(P = 0.0006,MD = 2.40,95%CI:1.03～3.77),EQ-5D(P = 0.01,MD =-0.05,95%CI:-0.10～-0.01),腰背痛NRS 评分(P = 0.008,MD = 0.57,95%CI:0.15～1.00),腿痛 NRS 评分(P = 0.0008,MD = 0.53,95%CI:0.22～0.84)改善方面,两组差异有统计学意义,减压融合组优于单纯减压组.术后第 2 年,两组 ODI、EQ-5D、腰背痛、腿痛 NRS 评分差异无统计学意义(分别为 P = 0.12,P = 0.59,P = 0.55,P = 0.12).两组再手术率差异无统计学意义(P = 0.50,RR = 1.08,95%CI:0.86～1.37),而单纯减压组并发症发生率(P<0.0001,RR = 0.71,95%CI:0.59～0.84)低于减压融合组,且单纯减压组可缩短手术时间、住院时间,减少术中出血量.结论 减压融合较单纯减压治疗 DLS 短期内有优势,但术后 2 年随访,两者临床疗效相当,且单纯减压组与更少的术后并发症,更短的手术时间、住院时间,更少的出血量相关.
