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Huang S, Wu X, Zhou C, Zhang X, Tang Z, Qi X, Zhao S. Static study and numerical simulation of the influence of cement distribution in the upper and lower adjacent vertebrae on sandwich vertebrae in osteoporotic patients: Finite element analysis. JOR Spine 2024; 7:e1343. [PMID: 38911099 PMCID: PMC11191753 DOI: 10.1002/jsp2.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/13/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Objective We analyzed the influence of the location of the upper and lower cement on the sandwich vertebrae (SV) by computer finite element analysis. Materials and Methods A finite element model of the spinal segment of T11-L1 was constructed and 6 mL of cement was built into T11 and L1 simultaneously. According to the various distributions of bone cement at T11 and L1, the following four groups were formed: (i) Group B-B: bilateral bone cement reinforcement in both T11 and L1 vertebral bodies; (ii) Group L-B: left unilateral reinforcement in T11 and bilateral reinforcement in L1; (iii) Group L-R: unilateral cement reinforcement in both T11 and L1 (cross); (iv) Group L-L: unilateral cement reinforcement in both T11 and L1 (ipsilateral side). The maximum von Mises stress (VMS) and maximum displacement of the SV and intervertebral discs were compared and analyzed. Results The maximum VMS of T12 was in the order of size: group B-B < L-B < L-R < L-L. Group B-B showed the lowest maximum VMS values for T12: 19.13, 18.86, 25.17, 25.01, 19.24, and 20.08 MPa in six directions of load flexion, extension, left and right lateral bending, and left and right rotation, respectively, while group L-L was the largest VMS in each group, with the maximum VMS in six directions of 21.55, 21.54, 30.17, 28.33, 19.88, and 25.27 MPa, respectively. Conclusion Compared with the uneven distribution of bone cement in the upper and lower adjacent vertebrae (ULAV), the uniform distribution of bone cement in the ULAV reduced and uniformed the stress load on the SV and intervertebral disc. Theoretically, it can lead to the lowest incidence of sandwich vertebral fracture and the slowest rate of intervertebral disc degeneration.
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Affiliation(s)
- Shaolong Huang
- Department of Orthopedics The Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xue Wu
- Graduate School of Wenzhou Medical University Wenzhou Zhejiang China
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, Zhejiang China
| | - Chengqiang Zhou
- Department of Orthopedics The Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xu Zhang
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Zhongjian Tang
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xiangyu Qi
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Shuai Zhao
- Department of Orthopedics The Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
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Liu XY, Feng M, Zhang XL, Zou T, Huang Z, Yang JD, Sun HH. Are Sandwich Vertebrae Prone to Refracture After Percutaneous Vertebroplasty or Kyphoplasty? A Meta-Analysis. Int J Spine Surg 2024; 18:8577. [PMID: 38413236 PMCID: PMC11265482 DOI: 10.14444/8577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The formation of sandwiched vertebrae (SDVs) after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) has become a common phenomenon. Whether SDVs are more likely to fracture is still controversial. Therefore, we conducted a meta-analysis to provide medical evidence for whether SDVs are more prone to refracture than non-SDVs (NSDVs) after PVP or PKP. METHODS This study was conducted in accordance with the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Several databases, including PubMed, Embase, Medline databases, China National Knowledge Infrastructure, Wanfang, and Weipu, were thoroughly searched for relevant studies included from any point up until June 2022. Statistical analyses were performed using Revman 5.4. RESULTS A total of 4052 individuals from 9 studies were enrolled. Overall, patients with SDV presented more risk to have refracture than patients with NSDV (OR = 1.57, P = 0.04). The incidences of refracture were comparable between the 2 cohorts in studies with a follow-up time less than 3 years (OR = 1.28, P = 0.49). However, patients with SDV were more prone to have refracture than patients with NSDV in studies with a follow-up time longer than 3 years (OR = 1.92, P = 0.009). Moreover, patients with SDV were more likely to have refracture than patients with NSDV in studies that involved both PVP and PKP (OR = 1.62, P = 0.002). In addition, age, low bone density, and postoperative kyphosis angle of sandwich fracture segments >10° were independent factors to predict refracture. CONCLUSIONS Patients with SDV were more likely to have refracture after PVP or PKP, especially when the follow-up time was longer than 3 years. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Xue-Yang Liu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Min Feng
- Day treatment ward, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiang-Long Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Tao Zou
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Zhi Huang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Jian-Dong Yang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Hui-Hui Sun
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
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Huang S, Zhou C, Zhang X, Tang Z, Liu L, Meng X, Xue C, Tang X. Biomechanical analysis of sandwich vertebrae in osteoporotic patients: finite element analysis. Front Endocrinol (Lausanne) 2023; 14:1259095. [PMID: 37900139 PMCID: PMC10600377 DOI: 10.3389/fendo.2023.1259095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Objective The aim of this study was to investigate the biomechanical stress of sandwich vertebrae (SVs) and common adjacent vertebrae in different degrees of spinal mobility in daily life. Materials and methods A finite element model of the spinal segment of T10-L2 was developed and validated. Simultaneously, T11 and L1 fractures were simulated, and a 6-ml bone cement was constructed in their center. Under the condition of applying a 500-N axial load to the upper surface of T10 and immobilizing the lower surface of L2, moments were applied to the upper surface of T10, T11, T12, L1, and L2 and divided into five groups: M-T10, M-T11, M-T12, M-L1, and M-L2. The maximum von Mises stress of T10, T12, and L2 in different groups was calculated and analyzed. Results The maximum von Mises stress of T10 in the M-T10 group was 30.68 MPa, 36.13 MPa, 34.27 MPa, 33.43 MPa, 26.86 MPa, and 27.70 MPa greater than the maximum stress value of T10 in the other groups in six directions of load flexion, extension, left and right lateral bending, and left and right rotation, respectively. The T12 stress value in the M-T12 group was 29.62 MPa, 32.63 MPa, 30.03 MPa, 31.25 MPa, 26.38 MPa, and 26.25 MPa greater than the T12 stress value in the other groups in six directions. The maximum stress of L2 in M-T12 in the M-L2 group was 25.48 MPa, 36.38 MPa, 31.99 MPa, 31.07 MPa, 30.36 MPa, and 32.07 MPa, which was greater than the stress value of L2 in the other groups. When the load is on which vertebral body, it is subjected to the greatest stress. Conclusion We found that SVs did not always experience the highest stress. The most stressed vertebrae vary with the degree of curvature of the spine. Patients should be encouraged to avoid the same spinal curvature posture for a long time in life and work or to wear a spinal brace for protection after surgery, which can avoid long-term overload on a specific spine and disrupt its blood supply, resulting in more severe loss of spinal quality and increasing the possibility of fractures.
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Affiliation(s)
- Shaolong Huang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chengqiang Zhou
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xu Zhang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhongjian Tang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Liangyu Liu
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xiao Meng
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Cheng Xue
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xianye Tang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Han B, Pang D, Hai Y, Yang J, Fan Z, Gao H, Yin P. Treatment of multisegmental vertebral compression, burst fractures, and sandwich vertebra with severe osteoporosis using the PKP technique: a case report and literature review. Front Neurol 2023; 14:1118891. [PMID: 37745651 PMCID: PMC10511751 DOI: 10.3389/fneur.2023.1118891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
This study aimed to present a special case of treatment of a patient with multisegmental vertebral compression fracture, burst fracture, and sandwich vertebra and to review the literature on this condition. An 85 year-old female presented with severe low back pain but no radiating pain in the lower extremities. The patient was diagnosed with T12 and L5 vertebral compression fractures, fresh vertebral burst fractures in L2 and L3, and osteoporosis. The focus was on formulating a surgical treatment strategy. At the 12 month follow-up, no neurological deficits were observed, and the chosen surgical treatment approach yielded favorable clinical outcomes. A comprehensive literature review indicates that percutaneous kyphoplasty (PKP) can effectively alleviate pain and ensure safety in managing osteoporotic vertebral burst fractures. While complications remain a theoretical risk, they can be mitigated through meticulous assessment, careful surgical procedures, and appropriate preventive measures. PKP is an effective and safe treatment modality for osteoporotic vertebral burst fractures. Conservative management of sandwich vertebrae can yield positive clinical outcomes, but regular anti-osteoporosis treatment is necessary.
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Affiliation(s)
| | | | - Yong Hai
- Department of Orthopedics, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | | | | | | | - Peng Yin
- Department of Orthopedics, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
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Wu Y, Yang L, Chen L, Geng M, Xing Z, Chen S, Zeng Y, Zhou J, Sun K, Yang X, Shen B. Core-Shell Structured Porous Calcium Phosphate Bioceramic Spheres for Enhanced Bone Regeneration. ACS APPLIED MATERIALS & INTERFACES 2022; 14:47491-47506. [PMID: 36251859 DOI: 10.1021/acsami.2c15614] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Adequate new bone regeneration in bone defects has always been a challenge as it requires excellent and efficient osteogenesis. Calcium phosphate (CaP) bioceramics, including hydroxyapatite (HA) and biphasic calcium phosphates (BCPs), have been extensively used in clinical bone defect filling due to their good osteoinductivity and biodegradability. Here, for the first time, we designed and fabricated two porous CaP bioceramic granules with core-shell structures, named in accordance with their composition as BCP@HA and HA@BCP (core@shell). The spherical shape and the porous structure of these granules were achieved by the calcium alginate gel molding technology combined with a H2O2 foaming process. These granules could be stacked to build a porous structure with a porosity of 65-70% and a micropore size distribution between 150 and 450 μm, which is reported to be good for new bone ingrowth. In vitro experiments confirmed that HA@BCP bioceramic granules could promote the proliferation and osteogenic ability when cocultured with bone marrow mesenchymal stem cells, while inhibiting the differentiation of RAW264.7 cells into osteoclasts. In vivo, 12 weeks of implantation in a critical-sized femoral bone defect animal model showed a higher bone volume fraction and bone mineral density in the HA@BCP group than in the BCP@HA or pure HA or BCP groups. From histological analysis, we discovered that the new bone tissue in the HA@BCP group was invading from the surface to the inside of the granules, and most of the bioceramic phase was replaced by the new bone. A higher degree of vascularization at the defect region repaired by HA@BCP was revealed by 3D microvascular perfusion angiography in terms of a higher vessel volume fraction. The current study demonstrated that the core-shell structured HA@BCP bioceramic granules could be a promising candidate for bone defect repair.
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Affiliation(s)
- Yuangang Wu
- Orthopedic Research Institute, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Long Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Li Chen
- Analytical & Testing Center, Sichuan University, No. 29 Jiuyanqiao Wangjiang Road, Chengdu 610064, China
| | - Mengyu Geng
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Zhengyi Xing
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Siyu Chen
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Yi Zeng
- Orthopedic Research Institute, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jinhan Zhou
- Core Facilities of West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kaibo Sun
- Orthopedic Research Institute, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Bin Shen
- Orthopedic Research Institute, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
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Yang B, Zhao Y, Zhao Y. Is the incidence of sandwich vertebral fracture higher than that of ordinary adjacent vertebral fracture after PKP? Medicine (Baltimore) 2022; 101:e29900. [PMID: 35801767 PMCID: PMC9259101 DOI: 10.1097/md.0000000000029900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To compare the incidence of fracture between sandwich vertebra and ordinary adjacent vertebra after percutaneous kyphoplasty (PKP). METHOD We analyzed 225 consecutive patients with osteoporotic vertebral compression fractures who underwent PKP between January 2016 and December 2020 at our medical institution. The sandwich vertebrae was located between 2 cement-augmented vertebra and was followed for at least 12 months. The clinical data of patients with sandwich vertebra and ordinary adjacent vertebra were recorded, and the incidence of postoperative fracture between sandwich vertebra and ordinary adjacent vertebra was compared. RESULTS The mean continuous follow-up time was 31.30 ± 18.04 months in patients with sandwich vertebra and 25.85 ± 7.96 months in patients with ordinary adjacent vertebra. It should be noted that the incidence of sandwich vertebral fractures was 10.00%, which was not statistically higher than 3.26% for ordinary adjacent vertebral fractures. However, a significant difference was observed in the cement volume of single vertebral body, procedure time, and bleeding. CONCLUSION Although the volume of cement in a single vertebral body is less and the procedure time and bleeding are more, the incidence of sandwich vertebral fracture is not higher than that of ordinary adjacent vertebral body.
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Affiliation(s)
- Bo Yang
- Graduate School of Xi’an Medical University, Xi’an, China
- Department of Orthopaedics, The Ninth Hospital of Xi’an, Xi’an, China
| | - Yu Zhao
- Department of Orthopaedics, The Ninth Hospital of Xi’an, Xi’an, China
| | - Yangxue Zhao
- Department of Orthopaedics, The Ninth Hospital of Xi’an, Xi’an, China
- * Correspondence: Yangxue Zhao, Department of Orthopaedics, The Ninth Hospital of Xi’an, No. 151, East Section of South 2nd Ring Road, Beilin District, Xi'an City, 710054, Xi'an, Shaanxi Province, China. (e-mail: )
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Shaul JL, Hill RS, Bouxsein ML, Burr DB, Tilton AK, Howe JG. AGN1 implant material to treat bone loss: Resorbable implant forms normal bone with and without alendronate in a canine critical size humeral defect model. Bone 2022; 154:116246. [PMID: 34744020 DOI: 10.1016/j.bone.2021.116246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Fractures secondary to osteoporosis, particularly those of the hip and spine, are a major public health concern with high social and economic costs. The Local Osteo-Enhancement Procedure (LOEP) is an approach intended to strengthen skeletal areas that are at the highest risk for fracture due to osteoporosis. LOEP involves the implantation of AGN1, a triphasic, calcium-based, osteoconductive material which is then resorbed and replaced by bone. Since alendronate is the most prescribed osteoporotic treatment, the purpose of this canine study is to determine if the newly formed bone has the same properties as normal bone and whether alendronate treatment impacts AGN1 resorption and replacement with bone. METHODS Sixty skeletally mature male hounds (24-38 kg) were evenly divided between alendronate (0.2 mg/kg/day) and non-alendronate treatment groups. A critical-size core bone defect created in one proximal humerus was implanted with AGN1 while the contralateral non-operated humerus served as a paired control in each animal. Animals were sacrificed 13, 26, and 52 weeks post-operatively (10 per treatment per timepoint). The control and treatment site bone specimens from each animal were examined using radiographic, histomorphometric, and biomechanical techniques. Results between alendronate-treated and non-alendronate-treated animals were compared as groups. RESULTS AGN1 implant material was consistently resorbed and replaced by bone in all animals. At 52 weeks, only minimal residual implant material could be detected (0.9 ± 2.3% non-alendronate group; 2.2 ± 3.1% alendronate group), and new bone filled the defects in both the non-alendronate and alendronate groups. At 13 and 26 weeks, microCT revealed the newly formed bone in the defects had significantly higher trabecular bone volume and number connectivity than control bone in both groups. Mechanical testing demonstrated that the new bone had ultimate compressive strength and modulus equivalent to control bone as early as 13 weeks post-surgery which was maintained to 52 weeks in both groups. CONCLUSIONS In this canine critical-sized humeral core defect model, AGN1 was progressively replaced by normal bone as evaluated by all outcome measures. Concurrent alendronate therapy did not significantly impact AGN1 resorption or new bone formation. These results demonstrate that AGN1 can be used in conjunction with alendronate in non-osteoporotic animals. CLINICAL RELEVANCE This study suggests that the AGN1 implant material demonstrates potential for local restoration of bone in critical-size core defects, and that the material is compatible with alendronate drug therapy. Further studies will be required to determine if these results apply to other osteoporosis medications.
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Affiliation(s)
| | - Ronald S Hill
- AgNovos Healthcare, Rockville, MD, United States of America
| | - Mary L Bouxsein
- Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - David B Burr
- Indiana University, Indianapolis, IN, United States of America
| | | | - James G Howe
- AgNovos Healthcare, Rockville, MD, United States of America; University of Vermont, Burlington, VT, United States of America
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Zhang Y, Sun Z, Yin P, Zhu S, Hai Y, Su Q. Do sandwich vertebral bodies increase the risk of post-augmentation fractures? A retrospective cohort study. Arch Osteoporos 2021; 16:180. [PMID: 34853924 DOI: 10.1007/s11657-021-00922-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Until now, there have been only a few retrospective studies that focused on the outcomes of sandwich vertebral bodies (SVBs). This is a long-term retrospective cohort study to investigate the SVBs. We found that although patients with SVBs had a relatively high risk of developing new fractures after VA, the incidence rate of new fractures was not significantly different from that of the control group. However, the statistical power of this study was very limited. Therefore, and because the refracture rate in these patients is substantial, routine long-term monitoring of patients after VA for osteoporosis is strongly recommended. BACKGROUND Sandwich vertebral bodies (SVBs) are intact unaugmented vertebral bodies between two previously augmented vertebrae. Until recently, only a few studies have reported the outcomes and strategies for SVBs. This retrospective cohort study aimed to describe the clinical features and incidence of new fractures in patients with SVBs. METHODS The clinical data were collected from 179 patients with 237 symptomatic osteoporotic vertebral compression fractures who underwent vertebral augmentation (VA). Among them, 23 patients with 24 levels of SVBs were included. Spinal radiographs (X-ray and CT) of all patients were evaluated prior to surgery 1 day after primary VA and during follow-up. RESULTS All patients successfully underwent PKP with an average follow-up period of 21.48 months. Asymptomatic cement leakage occurred in four patients (17.4%), and eight patients (34.8%) developed new fractures following primary PKP, including four sandwich, six adjacent, four remote vertebral fractures, and one re-collapse of cemented vertebrae. The incidence of new fractures in the SVB and control groups was 16.7% (4/24) and 13.0% (6/46), respectively, but there was no significant difference. CONCLUSIONS Although patients with SVBs had a relatively high risk of developing new fractures after VA, the incidence rate of new fractures was not significantly different from that of the control group. However, the statistical power of this study was very limited. Therefore, and because the refracture rate in these patients is substantial, routine long-term monitoring of patients after VA for osteoporosis is strongly recommended.
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Affiliation(s)
- Yaoshen Zhang
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zhencheng Sun
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Peng Yin
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Shiqi Zhu
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Qingjun Su
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
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Liu J, Tang J, Chen G, Gu Z, Zhang Y, Yu S, Liu H. [Comparison of refracture risk between sandwich vertebrae and ordinary adjacent vertebrae]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1161-1166. [PMID: 34523282 DOI: 10.7507/1002-1892.202104060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To compare the refracture risk between sandwich vertebrae and ordinary adjacent vertebrae, and to explore the risk factors related to refracture. Methods Retrospective analysis was performed on the data of patients who received percutaneous vertebral augmentation (PVA) and formed sandwich vertebrae between April 2015 and October 2019. Of them, 115 patients were enrolled in the study. There were 27 males and 88 females with an average age of 73.9 years (range, 53-89 years). Univariate analysis was performed to analyzed the patients' general data, vertebral augmentation related indexes, and sandwich vertebrae related indexes. Survival analysis was performed for all untreated vertebrae at T 4-L 5 of the included patients at the vertebra-specific level, and risk curves of refracture probability of untreated vertebrae between sandwich vertebrae and ordinary adjacent vertebrae were compared. Cox's proportional hazards regression model was used to analyze risk factors for refracture. Results The 115 patients were followed up 12.6-65.9 months (mean, 36.2 months). Thirty-seven refractures involving 51 vertebral bodies occurred in 31 patients. The refracture rate of 27.0% (31/115) in patients with sandwich vertebrae was significantly higher than that of 15.2% (187/1228) in all patients who received PVA during the same period ( χ 2=10.638, P=0.001). Univariate analysis results showed that there was a significant difference in the number of augmented vertebrae between patients with and without refractures ( Z=0.870, P=0.004). However, there was no significant difference in gender, age, body mass index, whether had clear causes of fracture, whether had dual energy X-ray absorptiometry testing, whether the sandwich vertebra generated through the same PVA, puncture method, method of PVA, number of PVA procedures, number of vertebrae with old fracture, whether complicated with spinal deformity, bone cement distribution, and kyphosis angle of sandwich vertebral area ( P>0.05). Among the 1 293 untreated vertebrae, there were 136 sandwich vertebrae and 286 ordinary adjacent vertebrae. The refracture rate of sandwich vertebrae was 11.3% which was higher than that of ordinary adjacent vertebrae (6.3%)( χ 2=4.668, P=0.031). The 1- and 5-year fracture-free probabilities were 0.90 and 0.87 for the sandwich vertebrae, and 0.95 and 0.93 for the ordinary adjacent vertebrae, respectively. There was a significant difference between the two risk curves of refracture ( χ 2=4.823, P=0.028). Cox's proportional hazards regression model analysis results showed that the sandwich vertebrae, thoracolumbar location, the number of the augmented vertebrae, and the unilateral puncture were significant risk factors for refracture ( P<0.05). Conclusion The sandwich vertebrae has a higher risk of refracture when compared with the ordinary adjacent vertebrae, and its 1- and 5-year fracture-free probabilities are lower than those of the ordinary adjacent vertebrae. However, the 5-year fracture-free probability of sandwich vertebrae is still 0.87, so prophylactic enhancement is not recommended for all sandwich vertebrae. In addition, the sandwich vertebrae, thoracolumbar location, the number of the augmented vertebrae, and the unilateral puncture were important risk factors for refracture.
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Affiliation(s)
- Jin Liu
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China.,Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jing Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Guo Chen
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Zuchao Gu
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Yu Zhang
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Shenghui Yu
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Improved Anti-Washout Property of Calcium Sulfate/Tri-Calcium Phosphate Premixed Bone Substitute with Glycerin and Hydroxypropyl Methylcellulose. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11178136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Calcium sulfate/calcium phosphate (CS-CP)-based bone substitutes have been developed in premixed putty for usage in clinical applications. However, it is difficult to completely stop the bleeding during an operation because premixed putty can come into contact with blood or body fluids leading to disintegration. Under certain conditions depending on particle size and morphology, collapsed (washed) particles can cause inflammation and delay bone healing. In this context, anti-washout premixed putty CS-CP was prepared by mixing glycerin with 1, 2, and 4 wt% of hydroxypropyl methylcellulose (HPMC), and the resultant anti-washout properties were evaluated. The results showed that more than 70% of the premixed putty without HPMC was disintegrated after being immersed into simulated body fluid (SBF) for 15 min. The results demonstrated that the more HPMC was contained in the premixed putty, the less disintegration occurred. We conclude that CS-CP pre-mixed putty with glycerin and HPMC is a potential bone substitute that has good anti-washout properties for clinical applications.
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Liu J, Tang J. In Reply: A Retrospective Analysis in 1347 Patients Undergoing Cement Augmentation for Osteoporotic Vertebral Compression Fracture: Is the Sandwich Vertebra at a Higher Risk of Further Fracture? Neurosurgery 2021; 89:E255-E256. [PMID: 34318897 DOI: 10.1093/neuros/nyab278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jin Liu
- Department of Orthopedics Chengdu First People's Hospital Chengdu, China
| | - Jing Tang
- Department of Radiology Sichuan University West China Hospital Chengdu, China
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Chen Z, Song C, Lin H, Sun J, Liu W. Does prophylactic vertebral augmentation reduce the refracture rate in osteoporotic vertebral fracture patients: a meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2691-2697. [PMID: 34132903 DOI: 10.1007/s00586-021-06899-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/09/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE In order to prevent the recurrent fracture after vertebral augmentation, the concept of prophylactic vertebral augmentation has been proposed, but its efficacy is still controversial. This study aimed to determine the efficacy of prophylactic vertebral augmentation for prevention of refracture in osteoporotic vertebral fracture patients. METHODS Following PRISMA guidelines, a literature search was performed using PubMed, Embase and Web of Science databases for relevant studies published until February 2021. A meta-analysis of randomized controlled trials and retrospective controlled trials comparing prophylactic group versus nonprophylactic group was conducted. The primary outcome was the incidence of new vertebral compression fracture (VCF), and secondary outcomes were incidence of adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF). RESULTS A total of 6 studies encompassing 618 patients were included in the meta-analysis. The incidence of new VCF was reported in all six studies, and the result showed no significant difference between the two groups (OR: 0.509; 95% CI: 0.184-1.409). Four studies provided data on the incidence of AVF, and it was revealed that there was no significant difference between the two groups (OR: 0.689; 95% CI: 0.109-4.371). In view of the incidence of RVF, prophylactic group also did not differ significantly compared with nonprophylactic group (OR: 0.535; 95% CI: 0.167-1.709). CONCLUSIONS The current evidence suggested that prophylactic vertebral augmentation might not be appropriate to diminish the risk of new VCF. Therefore, there is a need to investigate the mechanism of refracture and explore other preventive regimens to reduce the risk.
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Affiliation(s)
- Zhi Chen
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Chenyang Song
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Hailin Lin
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Jun Sun
- Department of Emergency, Zhaotong Traditional Chinese Medicine Hospital, Zhaotong, 657000, Yunnan, China
| | - Wenge Liu
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
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Qin DA, Song JF, Liang QY. Adjacent Intravertebral Cement Leakage During Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. PAIN MEDICINE 2021; 22:1453-1455. [PMID: 33155031 DOI: 10.1093/pm/pnaa339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- De-An Qin
- Department of Spinal Surgery, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jie-Fu Song
- Department of Spinal Surgery, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qing-Yuan Liang
- Department of Spinal Surgery, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
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Chen M, Wang R, Jia P, Bao L, Tang H. Stentoplasty with Resorbable Calcium Salt Bone Void Fillers for the Treatment of Vertebral Compression Fracture: Evaluation After 3 Years. Clin Interv Aging 2021; 16:843-852. [PMID: 34040361 PMCID: PMC8139642 DOI: 10.2147/cia.s308667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Mengmeng Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ruideng Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Pu Jia
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Li Bao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai Tang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Liu J, Tang J, Gu Z, Zhang Y, Yu S, Liu H. Fracture-free probability and predictors of new symptomatic fractures in sandwich, ordinary-adjacent, and non-adjacent vertebrae: a vertebra-specific survival analysis. J Neurointerv Surg 2021; 13:1058-1062. [PMID: 33468608 DOI: 10.1136/neurintsurg-2020-016985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is unclear whether the sandwich vertebra, is at higher risk of new symptomatic fractures (NSFs), and whether prophylactic augmentation might benefit patients with sandwich vertebrae. OBJECTIVE To compare fracture-free probabilities of sandwich, ordinary-adjacent, and non-adjacent vertebrae, and identify predictors of NSFs. METHODS Data were retrospectively analyzed for patients who had undergone vertebral augmentation resulting in sandwich vertebrae. NSF rates were determined and predictors were identified using Cox proportional hazard models. RESULTS The analysis included 1408 untreated vertebrae (147 sandwich, 307 ordinary-adjacent, 954 non-adjacent vertebrae) in 125 patients. NSFs involved 19 sandwich, 19 ordinary-adjacent, and 16 non-adjacent vertebrae. The NSF rate was significantly higher in the patients with sandwich vertebrae (27.2%) than among all patients (14.8%). At the vertebra-specific level, the NSFs rate was 12.9% for sandwich vertebrae, significantly higher than 6.2% for ordinary-adjacent and 1.7% for non-adjacent vertebrae. The corresponding fracture-free probabilities of sandwich, ordinary-adjacent, and non-adjacent vertebrae were 0.89, 0.95, and 0.99 at 1 year, and 0.85, 0.92, and 0.98 at 5 years (p<0.05). Cox modeling identified the following as predictors for occurrence of an NSF in a given vertebra: vertebra location, type of vertebrae, number of augmented vertebrae, and puncture method. CONCLUSION Sandwich vertebrae are at higher risk of NSFs than ordinary-adjacent and non-adjacent vertebrae, and several NSF risk factors were identified. Since 85% of sandwich vertebrae are fracture-free for 5 years and NSF risk increases with the number of augmented vertebrae, prophylactic augmentation of every sandwich vertebra may be unnecessary.
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Affiliation(s)
- Jin Liu
- Department of Orthopaedics, Sichuan University West China Hospital, Chengdu, Sichuan, China.,Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Jing Tang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Zuchao Gu
- Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Shenghui Yu
- Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Hao Liu
- Department of Orthopaedics, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Tan L, Wen B, Guo Z, Chen Z. The effect of bone cement distribution on the outcome of percutaneous Vertebroplasty: a case cohort study. BMC Musculoskelet Disord 2020; 21:541. [PMID: 32791975 PMCID: PMC7427078 DOI: 10.1186/s12891-020-03568-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/04/2020] [Indexed: 01/11/2023] Open
Abstract
Background To analyze the effect of different types of bone cement distribution after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fracture (OVCF). Methods One hundred thirty seven patients with single level OVCF who underwent PVP were retrospectively analyzed. The patients were divided into two groups according to bone cement distribution. Group A: bone cement contacted both upper and lower endplates; Group B: bone cement missed at least one endplate. Group B was divided into 3 subgroups. Group B1: bone cement only contacted the upper endplates; Group B2: bone cement only contacted the lower endplates; Group B3: bone cement only located in the middle of vertebral body. The visual analogue scale (VAS) score at 24 h post operation and last follow-up, anterior vertebral height restoration ratio (AVHRR), anterior vertebral height loss ratio (AVHLR), local kyphotic angle change and vertebral body recompression rate were compared. Results 24 h post operation, the pain of all groups were significantly improved. The average follow-up time was 15.3 ± 6.3 (6–24) months. At last follow-up, the VAS score of group A was lower than that of group B. There were 14 cases (10.2%) of adjacent vertebral fracture, 5 cases (8.6%) in group A and 9 cases (11.4%) in group B. There were 9 cases (6.6%) of cement leakage, 4 cases (6.9%) in group A and 5 cases (6.3%) in group B. At last follow-up, there were 16 cases (11.7%) of vertebral body recompression, including 3 cases (5.2%) in group A and 13 cases (16.5%) in group B. There was no significant difference in AVHRR between two groups. Local kyphotic angle change was significant larger in group B. At last follow-up, AVHLR in group B was higher than that in group A. Analysis in subgroup B revealed no significant difference in VAS score, local kyphotic angle change, vertebral recompression rate, AVHRR or AVHLR. Conclusions If the bone cement fully contacted both the upper and lower endplates, it can better restore the strength of the vertebral body and maintain the height of the vertebral body, reduce the risk of the vertebral body recompression and long-term pain.
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Affiliation(s)
- Lei Tan
- Department of Orthopaedics, Peking University International Hospital, Life Park Road No.1 Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Bingtao Wen
- Department of Orthopaedics, Peking University International Hospital, Life Park Road No.1 Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China.
| | - Zhaoqing Guo
- Department of Orthopaedics, Peking University International Hospital, Life Park Road No.1 Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China.,Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University International Hospital, Life Park Road No.1 Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China.,Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
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Local osteo-enhancement of osteoporotic vertebra with a triphasic bone implant material increases strength-a biomechanical study. Arch Orthop Trauma Surg 2020; 140:1395-1401. [PMID: 32108254 PMCID: PMC7505880 DOI: 10.1007/s00402-020-03382-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE The aim of this study was to assess the biomechanical properties of intact vertebra augmented using a local osteo-enhancement procedure to inject a triphasic calcium sulfate/calcium phosphate implant material. METHODS Twenty-one fresh frozen human cadaver vertebra (Th11-L2) were randomized into three groups: treatment, sham, and control (n = 7 each). Treatment included vertebral body access, saline lavage to displace soft tissue and marrow elements, and injection of the implant material to fill approximately 20% of the vertebral body by volume. The sham group included all treatment steps, but without injection of the implant material. The control group consisted of untreated intact osteoporotic vertebra. Load at failure and displacement at failure for each of the three groups were measured in axial compression loading. RESULTS The mean failure load of treated vertebra (4118 N) was significantly higher than either control (2841 N) or sham (2186 N) vertebra (p < 0.05 for: treatment vs. control, treatment vs. sham). Treated vertebra (1.11 mm) showed a significantly higher mean displacement at failure than sham vertebra (0.80 mm) (p < 0.05 for: treatment vs. sham). In the control group, the mean displacement at failure was 0.99 mm. CONCLUSIONS This biomechanical study shows that a local osteo-enhancement procedure using a triphasic implant material significantly increases the load at failure and displacement at failure in cadaveric osteoporotic vertebra.
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Zhao R, Chen S, Yuan B, Chen X, Yang X, Song Y, Tang H, Yang X, Zhu X, Zhang X. Healing of osteoporotic bone defects by micro-/nano-structured calcium phosphate bioceramics. NANOSCALE 2019; 11:2721-2732. [PMID: 30672553 DOI: 10.1039/c8nr09417a] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The micro-/nano-structured calcium phosphate bioceramic exhibited a higher new bone substitution rate in an osteoporotic bone defect rat model.
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Affiliation(s)
- Rui Zhao
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Siyu Chen
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Bo Yuan
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Xuening Chen
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Xi Yang
- Department of Orthopaedics
- West China Hospital of Sichuan University
- Chengdu 610041
- China
| | - Yueming Song
- Department of Orthopaedics
- West China Hospital of Sichuan University
- Chengdu 610041
- China
| | - Hai Tang
- Department of Orthopedics
- Beijing Friendship Hospital
- Capital Medical University
- Beijing 100050
- China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Xiangdong Zhu
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Xingdong Zhang
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
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Answer to the Letter to the Editor of Ming Yang et al. concerning "Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebroplasty" by Ren HL et al. (2015) Eur Spine J;24(4):750-758. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:1561-1563. [PMID: 28271276 DOI: 10.1007/s00586-017-5027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
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