Objective Through the retrospective study, the efficacy and safety of percutaneous vertebroplasty (PVP) in the treatment of cervical and upper thoracic metastases were evaluated. Through survival analysis, the accuracy of traditional spine metastases scoring system was evaluated, the prognostic factors affecting patients' survival outcomes were explored, and a new survival prediction model was established. Methods We retrospectively selected 85 patients with advanced cervical and upper thoracic metastases who were treated at Beijing Friendship Hospital from October 2012 to February 2018, including 65 patients with PVP surgery and 20 patients with internal medicine. All patients were in advanced stage of the tumor with severe neck and back pain, no spinal cord compression, and the estimated survival time was less than 6 months (Tokuhashi correction score ≤ 8 points or Tomita score ≥ 7 points). We collected basic patient information and survival time, as well as efficacy indicators before treatment and 3 days, 3 months, and 6 months after treatment, including VAS score, analgesic score, neck disability index (NDI), and daily life. State score (Karnofsky performance socre, KPS). Firstly, the differences in the efficacy index before and after PVP surgery, as well as the difference between the surgical and non-surgical treatment effects were compared. Secondly, the accuracy of Tokuhashi correction score, Tomita score and modified Bauer score was evaluated, and the difference in survival time of patients with different treatment methods was compared. Finally, the prognostic factors affecting the survival outcome were screened out and a new survival prediction model was constructed. Results All PVP surgery were successfully completed without serious complications. The cement leakage rates of the cervical and upper thoracic groups were 46.88% (15/32) and 33.87% (21/62), respectively. VAS score, analgesic score, NDI index and KPS score of PVP in cervical spine group were significantly improved compared with preoperative (P<0.05). VAS score, analgesic score, NDI score, and KPS score were also significantly improved in the upper thoracic group after PVP (P<0.001). There was no significant difference in the VAS score (P=0.341), analgesic score (P=0.444), and KPS score (P=0.587) between the cervical spine group and the upper thoracic spine group, but the NDI index of the cervical spine group improved better ( P < 0.001). Compared with the non-surgical group, the surgical group had better improvement in VAS score (P<0.001) and analgesic score (P=0.011), but there was no significant difference in KPS score (P=0.062). The area under the ROC curve for Tomita score was [0.679 (6 months), 0.793 ( 12 months), 0.756 (18 months)] and the predictive power of Tomita score was better than that of Tokuhashi correction score and modified Bauer score. The median survival time was 9 months in both surgical and non-surgical groups, with no significant difference (P=0.183). The median survival time of patients in the traditional medical treatment combined with target therapy group and the traditional medical treatment group were 16 months and 8 months, respectively, and the difference was significant (P<0.001). Tumor type, KPS score, targeted therapy, organ metastasis and bone metastasis were important prognostic factors affecting the survival outcome of patients with advanced cervical and upper thoracic metastases. Through these five factors, a new survival prediction model was established, the area under the ROC curve was [0.869 (6 months), 0.915 (12 months), 0.910 (18 months)], and the predictive ability was better than Tomita scoring system. Conclusion For patients with advanced cervical and upper thoracic metastases with short life expectancy, PVP could effectively relieve neck and back pain symptoms, improve quality of life. The analgesic effect of PVP surgery was better than that of conservative treatment, but there was no significant improvement in survival outcome. Targeted therapy was very important for the survival outcome of such patients.

A novel interspinous distraction fusion (ISDF) device has been used to treat lumbar degenerative diseases. As a minimally invasive technique, ISDF differs from the traditional interspinous process distraction devices. Currently, biomechanical studies on ISDF are rare. To investigate the biomechanical properties of the ISDF device (BacFuse) which is used to treat lumbar degenerative diseases. Three-dimensional L3-L5 models were created. The models were divided into four groups: intact (M1), local decompression alone (M2), internal fixation alone (M3) and local decompression combined with internal fixation (M4), based on different surgical procedures. Local laminectomy was performed to resect the lower part of the L4 lamina and the upper part of the L5 lamina at the right lamina of L4/5 in the M2 and M4 groups. After meshing the models elements, Abaqus were used to perform the finite element (FE) analysis. The intervertebral range of motion (ROM) was measured during flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation under a follower load of 400 N with a 7.5Nm moment. The distributions of disc and facet joint stresses were observed and recorded. Spinal vertebral stress was compared, and internal fixation device stress was observed. The ROM of L4/5 in M2 increased in flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation compared with that in M1. In all motion directions, the ROM at L4/5 decreased, and the ROM at L3/4 increased after implantation of the ISDF device in M3 and M4 groups. The disc stress and facet joint stresses in the instrumented segment decreased after implantation of the ISDF device. The spinous process loaded a certain amount of stress in M3 and M4 groups. The spikes of the internal fixation device were loaded with the maximum stress. BacFuse exhibited a reduction in intervertebral ROM, as well as decreased stress on the intervertebral disc and facet joint, while also demonstrating a discernible impact on the upper adjacent segment.

目的 分析13例接受局麻下经皮椎体强化术(percutaneous vertebral augmentation,PVA)的患者发生短暂性截瘫的临床特点.方法 对北京友谊医院 13 例PVA短暂性截瘫患者进行分析,收集包括手术、椎体节段、麻醉剂量、手术时间、截瘫恢复时间和随访在内的临床数据.结果 13 例患者中男 5 例、女 8 例;年龄 62～83 岁、平均 73.3 岁.每个椎体注射的平均麻醉剂量为 5.84 mL,患者平均需要 217.3 min才能完全恢复感觉和运动,麻醉剂量与完全恢复所需时间无关.患者术前疼痛视觉模拟评分(Visual Analog Scale,VAS)7.462±0.183(n=13)、术后1个月1.615±0.213(n=13)、术后3个月1.538±0.447(n=13)、术后 6 个月1.273±0.273(n=11),术后均较术前明显改善(P＜0.000 1).术前Oswestry 功能障碍指数(Oswestry Dis-ability Index,ODI)(69.540±1.323)%(n= 13)、术后 1 个月(12.310±1.517)%(n= 13)、术后 3 个月(12.460±2.980)%(n=13)、术后6个月(7.000±0.884)%(n=11),术后均较术前有明显改善(P＜0.000 1).结论 局麻下经皮椎体强化术中短暂性截瘫的临床特点与蛛网膜下腔麻醉恢复期相似.

目的 探讨骨折风险评估工具(Fracture Risk Assessment Tool,FRAX)对绝经后女性骨折风险的预测价值.方法 回顾性分析 750 名北京地区绝经后女性的FRAX评分,收集每位受试者股骨颈骨密度(bone mineral density,BMD)及FRAX算法中需要的危险因素,并随访收集 10 年内是否新发骨折,计算年龄及体质量指数(body mass index,BMI),用FRAX工具计算10 年内骨质疏松引起主要部位骨折(脊柱、前臂、肩部骨折)概率(the 10-year probability of major osteoporotic fractures,PMOF)和 10 年内髋骨骨折概率(the 10-year probability of hip osteoporotic fractures,PHF).分析FRAX预测值与年龄、BMI、股骨颈BMD的相关性,建立二分类Logistic回归方程研究 10 年内新发骨折的显著危险因素,并建立模型得到预测值,以 10 年内是否新发骨折为标准绘制受试者工作曲线(receiver operating characteristic curve,ROC),计算FRAX预测值、BMD及模型预测值曲线下面积(area under curve,AUC),以AUC评估FRAX工具的预测价值.结果 研究对象平均年龄为(62.49±6.59)岁,平均体质量为(63.03±9.63)kg,平均身高为(156.11±5.10)cm,平均股骨颈BMD(T值)为-1.12±0.95.危险因素与FRAX预测值的相关性分析显示,除吸烟和饮酒外,余危险因素与PMOF的差异均有统计学意义(P＜0.05);除饮酒和风湿性关节炎外,余危险因素与PHF的差异均有统计学意义(P＜0.05).年龄、BMI和股骨颈BMD与FRAX评分的相关性分析显示,年龄与PMOF和PHF呈正相关,差异有统计学意义(P＜0.05),而BMI、股骨颈BMD与PMOF和PHF均 呈负相关,差异有统计学意义(P＜0.05).以 10 年内是否新发骨折为因变量生成Logistic回归方程评估危险因素,得出骨折史、吸烟、股骨颈BMD、体重、身高对女性骨折风险的影响较大并得到预测模型.ROC曲线分析PMOF、PHF、股骨颈BMD和回归模型预测 10 年内骨折的AUC分别为 0.616、0.600、0.573 和 0.670(P＜0.05),但诊断能力较低.结论 FRAX可应用于北京地区绝经后女性骨折风险评估,但预测准确性有待提高.绝经后女性如果有骨折史,应尽早行FRAX及DXA评估,并尽快得到医疗建议.

Objective:To explore the clinical efficacy of percutaneous vertebroplasty(PVP) in the treatment of osteoporotic vertebral compression fractures(OVCF) patients with chronic kidney disease-mineral and bone disorder(CKD-MBD), and analyzed the efficacy of the operation in relieving pain and improving quality of life.Methods:This retrospective study selected 71 patients who underwent PVP treatment for OVCF at Beijing Friendship Hospital, Capital Medical University from December 2013 to December 2018. Among them, there were 24 males and 47 females, with an age range of 66-92 years and an average age of (73.7±8.4) years. Based on whether the patients had CKD-MBD, the patients were divided into two groups: 31 patients with CKD-MBD comprised the experimental group, and 40 patients without CKD-MBD comprised the control group. General patient information and perioperative data were collected, including surgical time, bone cement fill volume, preoperative, postoperative, and different follow-up timepoint visual analog scale (VAS) pain scores, analgesic medication usage scores, oswestry disability index (ODI) scores. Measure and record patient vertebral anterior, middle, and posterior heights and Cobb′s angle, as well as patient blood calcium, blood phosphorus, bone metabolic markers, serum 25-hydroxyvitamin D, parathyroid hormone, total hip bone density, femoral neck bone density, and bone fracture indicators. Measurement data were represented as mean±standard deviation( ± s), the comparison between groups was conducted using the t-test; and repeated measure ANOVA was used for comparison before and after operation; the comparison of count data between groups was conducted by Chi-square test. Results:The surgical duration for the patients in this group was 20-50 min, average (29.8±7.2) min, and the volume of bone cement used was 2.0-5.0 mL, average (3.0±1.0) mL. In the experimental group, VAS scores of postoperative pain, analgesic medication usage scores, and ODI showed statistically significant differences compared to preoperative values ( P<0.001). At the last follow-up, there were no statistically significant differences in analgesic medication usage scores and ODI compared to postoperative values, but VAS scores had improved to a certain extent compared to postoperative values, with statistical significance ( P<0.001). In the experimental group, vertebral anterior height increased from (2.26±0.20) cm preoperatively to (2.57±0.28) cm postoperatively, and vertebral middle height increased from (1.96±0.18) cm preoperatively to (2.21±0.16) cm postoperatively, both with statistically significant differences ( P<0.001). Three patients (9.7%) experienced recurrent fractures, including 1 case of surgical vertebral recurrent fracture (3.2%). The experimental group showed a general increasing trend in blood calcium levels, with the last follow-up blood calcium being (2.31±0.09) mmol/L, which was significantly higher than preoperative ( P=0.002). There was no statistically significant difference in the changes in blood phosphorus ( P>0.05), and parathyroid hormone levels showed a slight decrease in the last follow-up when compared to preoperative, but the difference was not statistically significant ( P>0.05). Both total hip bone mineral density(BMD) and femoral neck BMD at the last follow-up showed significant increases compared to preoperative values. The experimental group had higher levels of blood phosphorus and parathyroid hormone than the control group at both preoperative and last follow-up assessments, with statistical significance ( P<0.05). Conclusion:PVP can effectively alleviate pain and enhance the quality of life for patients with OVCF accompanied by CKD-MBD.

Objective:To analyze the clinical efficacy of inter-spinal distraction fusion and fixation and Posterior lumbar interbody fusion in the treatment of lumbar disc herniation with stenosis, and to evaluate the health economics of the two surgical methods.Methods:Retrospectivly analyzed the clinical data of 400 patients with lumbar disc herniation with stenosis, who were enrolled in Beijing Friendship Hospital, Capital Medical University from Jan. 2015 to Jan. 2019, including 190 male cases and 210 female cases, aged from 50 to 87 years old, with the average age of 67.97. All patients were divided into two groups according to different surgical methods. Among them, 200 patients used interspinous process fusion and distraction fixation (ISDFF group), the other 200 cases used posterior lumbar decompression and pedicle internal fixation (PLIF group). All patients completed the follow-up time of more than 1 year after operation. The basic information of patients′ age, gender, total number of days in hospital, intraoperative bleeding, operation time, surgical incision length and other basic information were observed. The Oswestry dysfunction index (ODI), the Japanese Orthopaedic Association Score (JOA) and the visual analog scale (VAS) were used to evaluate the relief of symptoms before and after the two groups of patients. Total medical expenses, anesthesia expenses, surgical expenses and other expenses were analysed. The software of SPSS 20.0 were conducted to analyze data.Results:The patients in the ISDFF group were (70.84±8.93) years old, and the PLIF group was (65.10±10.23) years old ( t=5.98, P=0.008). The operation time in the ISDFF group was (59.21±16.22) min, and the operation time in the PLIF group was (81.31±17.24) min( t=13.20, P<0.001). The bleeding volume of the ISDFF group was (33.24±11.31) mL, and the bleeding volume of the PLIF group was (67.30±17.61) mL ( t=23.02, P<0.001). The length of the surgical incision in the ISDFF group was (8.27±2.53) cm, and the length of the surgical incision in the PLIF group was (11.15±1.91) cm ( t=11.848, P<0.001). The total hospitalization time in the ISDFF group was (15.15±0.54) days, and the total hospitalization time in the PLIF group was (19.86±0.97) days( t=4.26, P<0.001). There was no significant difference in preoperative ODI, JOA and VAS between the two groups ( P>0.05). Symptoms of postoperative patients were significantly improved compared with preoperative. There were statistical differences in ODI, JOA and VAS between the two groups before and after operation ( P<0.05). However, ODI, JOA and VAS were no statistical difference between the two groups after operation. Complications occurred in 5 cases of the two groups of patients, including two cases of superficial infection in the PLIF group, two cases of dural tear in the PLIF group, one case of spinous process fracture in the ISDFF group. The total hospitalization fee for ISDFF was (57 450±8 670) (yuan), and the total hospitalization fee for PLIF was (75 770±1 640) (yuan), with statistical differences ( t=9.92, P<0.001). The cost of ISDFF operation was 1864±38.19 (yuan), and the cost of PLIF operation was 2352±41.39 (yuan) ( t=8.65, P<0.001). ISDFF antibacterial drug usage fee was 635.5±64.69 (yuan), PLIF antibacterial drug usage fee was 1449±307.1 (yuan) ( t=2.59, P<0.001). The one-time medical material cost during the ISDFF operation was (38 990±300) (yuan), and the one-time medical material cost during the PLIF operation was (52 110±150) (yuan) ( t=5.88, P<0.001). The excellent and good rate of ISDFF group was 92%, and that of PLIF group was 86%. In this study, the total cost of hospitalization was used as an indicator to measure the cost, and further cost-effectiveness evaluation was made. For every good patient, the cost of the ISDFF group was 62 450 yuan, and the cost of the PLIF group was 88, 100 yuan. Conclusions:ISDFF is beneficial to reduce the cost of medical insurance in China, which is in line with the direction of national reform to reduce medical expenditure. It is a surgical method worthy of wide promotion and has a good application prospect.

Objective:To study the efficacy and safety of bone-filling mesh container plasty in the treatment of posterior wall fracture of vertebra caused by spinal metastases.Methods:This study is a retrospective analysis of 65 patients with pathological fractures of the vertebra caused by vertebral metastases treated with bone-filling mesh container plasty from January 2015 to December 2019. There were 21 males and 44 females, 70.3±10.8 (46-90) (years). According to primary tumor, there were 25 cases of lung cancer, 14 cases of breast cancer, 11 cases of digestive system cancer, 13 cases of urinary system cancer, 1 case of lymphoma and 1 case of ovarian cancer. In the segment of vertebral metastases, there were 2 cases of T 2 vertebra, 1 case of T 5 vertebra, 1 case of T 6 vertebra, 2 cases of T 8 vertebra, 1 case of T 9 vertebra, 5 cases of T 10 vertebra, 4 cases of T 11 vertebra, 15 cases of T 12 vertebra, 12 cases of L 1 vertebra, 8 cases of L 2 vertebra, 8 cases of L 3 vertebra, 4 cases of L 4 vertebra, and 2 cases of L 5 vertebra. According to the CT images of the patient's vertebra before operation, the area of the damaged posterior wall of the vertebra is measured as s, and the area of the posterior wall of the intact vertebra is measured as S. The ratio of posterior wall damage is calculated as R= s/ S, and the value of R represents the degree of damage to the posterior wall of the vertebra. According to the size of the R value, the patients were divided into four groups, typeⅠ( R≤25%, 21 cases), typeⅡ(25%< R≤50%, 22 cases), typeⅢ (50%< R≤75%, 14 cases), typeⅣ( R>75%, 8 cases). The visual analog scale (VAS), Oswestry disability index (ODI) and activity of daily living (ADL) before and 1 day after surgery, 1 month after surgery, and 3 months after surgery were analyzed and compared to evaluate the efficacy of bone-filling mesh container plasty. Pairwise comparisons were performed to verify whether there is a difference in efficacy, bone cement leakage and postoperative complications. Results:All 65 patients were followed up for 3-6 months, with an average of 3.8 months. The VAS scores before surgery, postoperative day 1, postoperative 1, 3 months were 7.32±0.99, 4.14±1.06, 4.11±0.97, and 4.34±1.11, respectively, with a statistically significant difference ( F=149.20, P<0.001). ODI of preoperative, postoperative day 1, postoperative 1, and 3 months were 69.45%±4.15%, 36.65%±3.72%, 36.84%± 3.38%, 37.78%±3.45%, respectively, with a statistically significant difference ( F=840.88, P<0.001). ADL score of preoperative, postoperative day 1, postoperative 1, and 3 months were 71.31±12.81, 79.85±9.14, 78.92±8.95, and 78.31±8.67, respectively, with a statistically significant difference ( F=149.20, P<0.001). There was no significant difference in VAS, ODI and ADL scores between types I and IV (all P>0.05), but with the increase of R value, the leakage rate of intraspinal bone cement would increase correspondingly. Eleven cases occurred bone cement leakage with the rate of 17%. The leakage rate of type I and II was 0, type III was 7.1% (1/14), and type IV was 37.5% (3/8). All patients did not have systemic complications such as allergies, shock, decreased oxygen saturation, etc., and there were no bleeding, infection, nerve root symptoms or cement insertion syndrome after surgery. Conclusion:Bone-filling mesh container plasty can significantly improve the pain symptoms of patients with spinal metastases and recovery functions. The degree of damage to the posterior vertebra has no effect on the efficacy of the surgery. As the degree of damage to the posterior wall of the vertebra increases, the risk of complications of bone cement leakage in the spinal canal will increase.

Pulmonary cement embolism (PCE) was a rare but fatal complication for percutaneous vertebral augmentation (PVA). Thus we did a systematic review and meta-analysis of cohort studies to investigate the risk factors for PCE after PVA.We systematically searched PubMed, EMBASE, Cochrane library, Google Scholar, web of science, and ClinicalTrial.gov from the establishment of the database to September 2021. All eligible studies assessing the risk factors for PCE after PVA were incorporated. Dichotomous data was calculated by risk difference (RD) from Mantel-Haenszel method (M - H method); continuous data was analyzed by mean difference (MD) from Inverse-Variance method (I-V method). All variables were taken as measure of effect by fixed effect model. Heterogeneity, sensitivity, and publication bias analyses were also performed.This study totally included 13 studies. According to the Newcastle-Ottawa Scale (NOS), 7 studies were considered as low quality, with NOS< 6. The others were of relatively high quality, with NOS≥6. 144/6251 patients (2.3%) had PCE after PVA. percutaneous vertebroplasty (PVP) (RD = 0.02, 95%CI: [0.01, 0.04], Z = 3.70, P < 0.01), thoracic vertebra (RD = 0.03, 95%CI: [0.01, 0.05], Z = 3.53, P < 0.01), higher cement volume injected per level (MD = 0.23, 95%CI: [0.05, 0.42], Z = 2.44, P = 0.01), more than three vertebrae treated per session (MD = -0.05, 95%CI: [-0.08, -0.02], Z = 3.65, P < 0.01), venous cement leakage (RD = 0.07, 95%CI: [0.03, 0.11], Z = 3.79, P < 0.01) were more likely to cause PCE.This study showed that risk factors for PCE included PVP, thoracic vertebra, higher cement volume injected per level, more than three vertebrae treated per session, venous cement leakage. As a serious complication, PCE should be paid attention and avoided.

目的 探讨分析发生骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)后不同时期行新型骨囊袋填充椎体成型术(Vesselplasty)干预,在临床症状、影像学和术后并发症等方面的区别.方法 对自2018年1月至2020年1月在首都医科大学附属北京友谊医院采用Vesselplasty治疗的125例OVCF患者的临床资料进行回顾性分析,根据手术时机分为两组:早期手术组(4周内手术)72例,共115个椎体;延迟手术组(4周后手术)53例,共73个椎体.比较所有患者手术前、术后1 d和术后1年的VAS评分、ODI评分、伤椎前缘高度比、脊柱后凸角(LKA)和手术并发症等情况.结果 两组患者术后1 d和术后1年的VAS、ODI和LKA与术前相比均明显减小(P<0.05),两组间同随访时期的VAS、ODI评分无明显差别(P>0.05),但A组的LKA明显小于B组(P<0.05).两组中所有患者术后1 d与1年的椎体前缘高度与术前相比均明显恢复(P<0.05),但同随访时期A组的椎体前缘高度比明显大于B组(P<0.05),且在术后1年时B组伤椎高度丢失明显大于A组(P<0.05).两组间的骨水泥渗漏率无明显差别(P>0.05),术后1年相邻椎体继发骨折患者例数与再手术率B组高于A组(P<0.05).结论 对OVCF早期与延迟行Vesselplasty干预在改善VAS、ODI和在骨水泥渗漏方面无明显差别,但早期Vesselplasty治疗可更好地恢复椎体高度,减轻术后椎体再塌陷和减少相邻椎体继发骨折.

•Pulmonary cement embolism (PCE) would lead to respiratory symptoms . So PCE should be paid more and more attention.•Risk factors for PCE included percutaneous vertebroplasty (PVP), thoracic vertebra, higher cement volume injected per level, more than three vertebrae treated per session, venous cement leakage.•The treatment for PCE depended on symptoms, localisation of the embolus, and time lapse between cement augmentation and clinical manifestation.

Objective:To analyze the effect of inter-spinal distraction fusion and fixation (ISDFF) combined with limited decompression on the treatment of lumbar spinal stenosis in elderly patients.Methods:A total of 32 elderly patients with lumbar spinal stenosis, aged from 80 to 87 years old (mean age: 82.0±2.0 years) including 10 males and 22 females, in the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University from January 2016 to January 2020 were enrolled in this retrospective study. Clinical evaluation and imaging measurement were performed before operation, after operation, 6 months and 24 months after operation. SPSS software was used for statistical analysis. Measured data of normal distribution were expressed as means±standard deviation. One way analysis of variance was used for comparison between groups. Paired t-test was used to compare between preoperative and postoperative as well as between preoperative and 24 months′ follow-up. Results:All of the 32 patients had one or more common accompanying diseases, such as hypertension, diabetes, coronary heart disease, and so on. All patients were successfully completed the operation with a total of 32 segments. VAS score was decreased from (6.22±0.91) before operation to (1.94±0.76) at 24 months( t=16.52, P<0.001). ODI score was also demonstrated the similar trend, from (54.17±10.65) preoperatively to (19.91±4.20) at 24 months follow-up( t=15.89, P<0.001). JOA score was significantly increased from (11.69±3.36) before surgery to (23.44±1.66) at the last follow-up ( t=-19.90, P<0.001). In the change of imaging, the intervertebral angle was decreased from preoperation (9.12±4.65) to (6.77±2.70) at 24 months( t=3.53, P=0.001). The posterior disk height was increased from (0.68±0.19) cm to (0.76±0.19) cm at the last follow-up( t=-2.45, P=0.020). Conclusions:As a new type of minimally invasive internal fixator, the ISDFF combined with limited decompression can relieve the pain of elderly patients with lumbar spinal stenosis and improve the quality of life. It is suitable for the treatment of elderly patients with lumbar spinal stenosis.

Purpose: The aim of the study is to investigate the clinical and radiological outcomes of vertebral compression fractures treated by stentoplasty with resorbable calcium salt bone void fillers compared with balloon kyphoplasty (BKP). Methods: This prospective study included patients with fresh mono-thoracolumbar vertebral compression fractures. Patients enrolled were randomly divided into three groups. The patients in group A underwent stentoplasty with calcium sulfate/calcium phosphate (CSCP) composite filler and patients in group B with hydroxyapatite/collagen (HAP/COL) composite filler, while patients in group C underwent BKP with polymethylmethacrylate (PMMA). The clinical outcome was evaluated with visual analogue pain scale (VAS) and Oswestry disability score (ODI). The radiological results were evaluated with anterior height (AH) and Cobb angle of vertebral body. Computed tomography (CT) was used to assess osteogenesis effect. Results: Each group included 14 patients. The VAS, ODI, Cobb angle and AH were statistically improved compared with preoperative and there was no significant difference between the three groups. However, the AH in group A and group B at 1-year follow-up presented slight loss compared with 1 day after surgery. CT results suggested both group A and group B presented obvious bone trabecula formation and variations of CT value. Conclusion: The stentoplasty with resorbable calcium salt bone void fillers demonstrated clinical outcomes similar to traditional BKP for vertebral compression fractures. Both HAP/ COL and CSCP performed certain osteogenesis. However, stentoplasty with studied fillers showed slight loss of AH within 1 year after surgery.

To explore a suitable indication of interspinous process distraction device for lumbar spinal stenosis with BacFuse. Patients of lumbar spinal stenosis (LSS) who experienced interspinous process distraction device surgery with BacFuse from June 2014 to January 2015 in our institute were included. We classified LSS into central and lateral types, and then divided these into severe and moderate according to the degree of stenosis. Each type was divided into 2 groups. Patients in group A underwent distraction without bone decompression (stand-alone), while patients in group B underwent bone decompression combined with distraction. Follow-up was performed at 1 month, 3 months, 6 months, 2 years, and 5 years after surgery. Zurich Claudication Questionnaire (ZCQ) was recorded to assess the patient's postoperative condition at each follow-up. A total of 142 patients were available for follow up at each time interval. There was a significant difference between the preoperative and final follow-up ZCQ scores for every LSS type. In addition, there was no difference between group A and group B in the postoperative ZCQ scores with the exception of the lateral severe type. In the study, 22 of the 23 patients (95.65%) in the lateral moderate type were considered to have a satisfactory result in group B, with a similar result of 93.33% (14/15) in group A (P = .75). In the lateral severe type, the patient satisfaction rate was 65.22% (15/23) and 90.63% (29/32) in group A and group B (P = .02), respectively. In the central moderate type, the patient satisfaction rate was 81.82% (15/23) and 76.92% (10/13) in group A and group B (P = .77), respectively. Satisfaction rate for the follow-up results in the central severe type reached 57.14% (4/7) in group A, and 54.55% (6/11) in group B (P = .91). Moreover, no relationship was found between satisfaction and neurogenic intermittent claudication. The most suitable indication for BacFuse treatment was the lateral moderate type. For lateral severe patients, distraction combined with decompression is suggested for a higher satisfaction rate. Severe central spinal stenosis was shown to be a relative contraindication for BacFuse.

Objective:To compare the clinical outcomes of percutaneous vertebroplasty (PVP) and the Vesselplasty for kümmell′s disease.Methods:A retrospective case-control study was used.The clinical data of 62 patients with kümmell′s disease were selected in Beijing Friendship Hospital, Capital Medical University, from January 2017 to January 2019. There were 19 males and 43 females, aged (70.94±7.69) years, with range from 60 to 85 years. The patients were divided into two groups according to different operation methods. The 36 patients treated by PVP and 26 patients treated by Vesselplasty were followed up at least one year after operation. The follow-up time was (17.55±4.22) months. The operation time, incidence of cement leakage, preoperative and postoperative Cobb′s angle, visual analogue score (VAS) 1 week and 1 year after operation were observed. The measurement data were expressed as mean±standard deviation ( Mean± SD), independent sample t-test was used for comparison between groups. The count data were expressed as percentage (%), chi-square test was used for comparison between groups. Results:All the operation was successfully completed. No serious complications such as paraplegia, bone cement allergy, pulmonary embolism were occurred. The operation time was no significant difference between the two groups ( P< 0.05). The incidence of cement leakag was 41.67% (15/36) in PVP group and 11.54% (3/26) in Vesselplasty group. The latter was significantly lower than the former, with statistically significant differences between the two groups ( P< 0.05). In PVP group, the Cobb′s angles of preoperation, postoperation 1 year and difference were (26.23 ± 5.62)°, (17.46 ± 3.01)° and (8.78 ± 4.62)°, respectively, in Vesselplasty group, they were (28.74 ± 6.68)°, (16.68 ± 2.79)° and (12.07 ± 5.72)°, respectively. Cobb′s angle of the two groups was significantly improved after operation. In the comparison between the groups, the improvement of the Cobb′s angle in the Vesseplasty group was better than that of the PVP group, and the difference was statistically significant ( P< 0.05). The VAS score in PVP group was (8.42±1.03) scores in preoperation, (3.06±1.01) scores in 1 week, (0.81±0.75) scores in 1 year. The VAS score in Vesselplasty group was (8.35±1.02) scores in preoperation, (2.88±1.11) scores in 1 week and (1.04±0.87) scores in 1 year. Compared with pre-operation, the VAS scores of the two groups decreased significantly at 1 week and 1 year after operation, and the difference was statistically significant ( P<0.05). There was no significant difference in VAS between groups 1 week after operation and 1 year after operation ( P>0.05). Conclusion:Vesselplasty can effectively control the flow and distribution of bone cement in the vertebral body, effectively reduce the leakage of bone cement, and better correct kyphosis.

Objective:To evaluate the clinical effect of interspinous process fusion (BacFuse) in the treatment of lumbar disc herniation (LDH) with rheumatoid arthritis (RA).Methods:A retrospective analysis of the clinical data of 50 patients with RA and LDH from May 2013 to June 2018 in department of orthopedics, Beijing Friendship Hospital, Capital Medical University was conducted. Among them, there were 9 males and 41 females, aged (66.60±4.23) years, with an age ranging from 54 to 84 years. According to different surgical methods, the patients were divided into posterior lumbar interbody fusion (PLIF) group ( n=26) and BacFuse group ( n=24). Operative time, intraoperative blood loss and operative complications of the two groups were observed. Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) scores were used to evaluate the clinical effect at preoperative, 3 days of postoperative and the last follow-up. The measurement data were expressed as mean±standard deviation( Mean± SD), comparison between groups used t test and the count data were expressed as percentage(%), the chi-square test was used for comparison between the two groups. The clinical effect of the two groups were compared by repeated analysis of variance. Results:In the PLIF group, the operation time and bleeding volume were (174.62±55.59) min, (309.62±30.26) mL, respectively. In the BacFuse group, the operation time and bleeding volume were (71.25±12.96) min, (57.92±9.32) mL, respectively. The differences between the two groups were statistically significant ( P<0.05). The operative complications in the PLIF group (8 cases) was significantly higher than that in the BacFuse group (2 cases) , the difference between the two groups was statistically significant ( χ2 = 3.926, P=0.048). There were significant differences between every two scores among the preoperative, 3 days of postoperative and last follow-up in ODI of the PLIF group( F=760.231, P<0.001). The preoperative, 3 days of postoperative and last follow-up ODI scores of the BacFuse group were significant differences between every two scores ( F= 952.525, P<0.001). There were no significant differences in ODI scores between the two groups [( t=-1.13, P=0.263), ( t=0.706, P=0.483), ( t=0.389, P=0.699)]. There were significant differences between every two scores among the preoperative, 3 days of postoperative and last follow-up in JOA of the PLIF group( F=406.012, P<0.001). The preoperative, 3 days of postoperative and last follow-up in JOA scores of the BacFuse group were significant difference between every two scores ( F=457.760, P<0.001). There were no significant differences in JOA scores between the two groups [( t=0.825, P=0.414), ( t=1.909, P=0.062), ( t=1.086, P=0.283). Conclusions:Compared with PLIF, BacFuse has a similar clinical effect in the treatment of LDH with RA, but BacFuse is less invasive and has fewer postoperative complications. BacFuse is an effective minimally surgical method for the treatment of LDH with RA.

Percutaneous vertebroplasty (PVP) is a minimally invasive treatment that has been widely used for the treatment of osteoporotic vertebral compression fractures and vertebral tumors. However, the maximum number of vertebral segments treated in a single PVP remains controversial. Furthermore, PVP may cause complications, including cement leakage, pulmonary embolism, bone cement toxicity, and spinal nerve-puncture injury. We report the rare case of a patient who underwent multilevel PVP for vertebral metastases, with no bone cement leakage or spinal cord injury, but who developed temporary paraparesis.

目的 观察和评估多节段经皮椎体成形术(PVP)治疗溶骨性椎体转移瘤的疗效及安全性.方法 回顾性选取2014年1月至2017年1月首都医科大学附属北京友谊医院收治的多节段PVP治疗椎体转移瘤的72例患者.收集患者的病例资料,分别记录患者术前24 h、术后3 d、术后1个月的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分.使用配对t检验分析术前和术后VAS和ODI差异,评估疗效.通过术后复查CT,观察骨水泥渗漏情况,记录术中及术后并发症进行安全性评价.结果 本研究共纳入72例多节段PVP的椎体转移瘤患者,其中男性36例,女性36例;年龄为32～87岁,平均(61.28±1.53)岁.行2个节段PVP治疗的患者30例(41.67％),3个节段8例(11.11％),4个节段9例(12.5％),5个节段12例(16.67％),6个节段7例(9.72％),7个节段2例(2.78％),8个节段4例(5.56％).原发肿瘤中最多见的3个原发肿瘤部位是肺癌(41.67％)、乳腺癌(16.67％)、肾癌(8.33％).所有患者均顺利完成手术,术后疼痛明显缓解.VAS评分从术前的(7.39±0.10)分降至术后3 d的(4.40±0.12)分(P<0.05)、术后1个月的(3.82±0.13)分(P<0.05);ODI评分从术前的(74.30±1.02)％降至术后3 d的(45.46±1.19)％(P<0.05)、术后1个月的(37.82±0.93)％(P<0.05).共268个节段行PVP,术后CT证实40个椎体无症状性骨水泥渗漏,渗漏率为14.9％.结论 多节段经皮椎体成形术治疗溶骨性椎体转移瘤的是一种安全有效的技术,其可用作对镇痛药耐药的首选治疗方法.

Objective To assess the preoperative and postoperative changes in MRI image and the short-term efficacy of the ISDF with BacFuse covering 3 years. Methods 32 patients who underwent ISDF were involved in this retrospective study. The symptoms assessment including VAS, ODI, and SF-12 were evaluated preoperative and postoperative at 1 year and 3 years. The X-ray was used to measure posterior disk height (PDH), foramina height (FH), foramina width (FW), and MRI was taken to assess the cross-sectional area of dura sac (CSADS), cross-sectional area of canal (CSAC), herniated disc area, ligamentum flavum area. The preoperative ratio of herniated disc area and ligamentum flavum area to CSAC were compared with post-operative ratio. The modified Pfirrmann grade system was used to assess the surgical lumbar disc. Results The symptom indexes were significantly improved after surgery. PDH and FH increased significantly (P < 0.05) after surgery compared with that before surgery, but there was no statistical difference in FW (P > 0.05). CSADS and CSAC increased obviously (P < 0.05), while the area of herniated disc and ligamentum flavum decreased significantly (P < 0.05). The ratio changes showed a significant difference between last follow-up and pre-operation (P < 0.05), but there was no statistical significance in grade changes of surgical disc. Conclusion ISDF with BacFuse could relieve clinical symptoms and expanse the spinal canal area in MRI. During 3-year observation, it could provide continuous traction and maintain the area of spinal canal, so as to partially retract the herniated disc and make it possible to repair the disc.

Rationale: Percutaneous osteoplasty (POP) has been proved effective to relieve pain in metastases of vertebral, pelvis, and femur. Nevertheless, there are few reports about the effectiveness of POP in the humeral head metastases. In this study, we described 2 patients with humeral head metastases treated with POP in our hospital. Patient concerns: Case 1 was a 79-year-old man with vertebral and right humeral head metastasis after radical surgery or and periods of chemotherapy for bladder cancer. He suffered constant severe back and right shoulder joint pain even if taking much non-steroidal anti-inflammatory drugs. Case 2 was a 59-year-old woman with vertebral and right humeral head metastasis from lung cancer. She received regular radiotherapy and took much painkillers to relieve pain. However, the pain could not be relieved any more after 1 month and severely affects sleeping and daily activities. Diagnosis: Both 2 patients were diagnosed as vertebral metastases and right proximal humeral head metastases. Interventions: POP was performed to treat the right humeral head metastases. Percutaneous vertebroplasty (PVP) was performed to treat vertebral metastases. Outcomes: After surgery, the patients experienced significant decrease in pain and better motor function. Both patients did not suffer from pulmonary embolism, infection, nerve injury, and bone cement syndrome. Lessons: For the pain that cannot be relieved by radiotherapy and analgesic drugs, POP is a safe and beneficial minimally invasive procedure that provides immediate and substantial relief from pain for humerus head metastases.

Objective To investigate the efficacy and safety of percutaneous vertebroplasty (PVP)with different cement volume in the treatment of osteoporotic vertebral compression fractures (OVCF).Methods From June 2015 to January 2017,30 patients with thoracolumbar OVCF in the Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University were randomly selected from low dose group (less than 4 mL),conventional dose group (4-6 mL) and high dose group (more than 6 mL)according to the different cement volume injected during PVP.The operation time,cement volume,cement leakage,visual analogue scale (VAS) score and oswestry disability index (ODI) score before operation,1 month after operation and 1 year after operation in the three groups were analyzed.Data were processed with one-way analysis of variance,Bonferroni correction,and chi-square test.Results All patients of 3 groups were treated by PVP successfully,without serious complications.(1) Operative time:low dose group:(22.30 ± 2.71) minutes,routine dose group:(23.10 ± 5.00) minutes,high dose group:(26.17 ± 3.50) minutes,there was statistically significant difference among the three groups(F =8.382,P =0.000);the operation time of high dose group was significantly higher than that of low dose group and routine dose group,the differences are statistically significant (P =0.001,0.008),but there was no significant difference between low dose group and routine dose group (P ＞ 0.05).(2) The cement volume used during PVP:low dose group:(3.37 ±0.41) mL,routine dose group:(5.17 ±0.50) mL,high dose group:(6.53 ± 0.64) mL,there were statistical differences among the 3 groups (F =273.194,P =0.000).(3)Bone cement leakage:low dose group:8 cases,routine dose group:18 cases,high dose group:21 cases.The incidence of bone cement leakage in routine dose group and high dose group was significantly higher than that in low dose group,the differences are statistically significant (x2 =6.787,11.279,P =0.027,0.003).There was no significant difference in the incidence of bone cement leakage between routine dose group and high dose group (x2 =0.659,P =1.251).(4)VAS scores:the preoperative VAS scores of the three groups were 8.70 ± 1.21,8.50 ± 1.17 and 8.17 ± 1.12 respectively;the VAS scores of 1 month after operation were 3.37 ± 1.03,3.83 ± 1.23 and 3.47 ± 1.11;the VAS scores of 1 year after operation were 0.93 ± 0.87,0.97 ± 0.77 and 1.23 ± 0.86.VAS score of 3 groups within 1 month and 1 year after PVP were significantly lower than those preoperatively,the differences are statistically significant (with P values below 0.05),but there were no significant differences among the three groups(with P values above 0.05).(5)ODI scores:the preoperative ODI scores of the three groups were 41.20 ± 2.43,40.83 ± 2.20 and 39.93 ± 2.08,respectively;the 1 month post-operative ODI scores were 23.07 ± 2.70,23.17 ± 2.95 and 22.80 ± 3.20;and the 1 year post-operative ODI scores were 11.33 ± 1.83,11.27 ± 1.82 and 11.47 ± 1.78.VAS score and ODI score of 3 groups within 1 month and 1 year after PVP were significantly lower than those preoperatively,the differences are statistically significant(with P values below 0.05),but there were no significant differences among the three groups(with P values above 0.05).Conclusion Low dose cement injected in PVP can achieve satisfied pain relief and functional recovery,and cau siguificantly shorten the operation time and reduce the risk of cement leakage.