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Clinical Observation and Prognosis Analysis of Different of Different Types of Bone Cement Augmentation in Pedicle Screw Fixation Operation

Author: YueWenFeng
Tutor: XiaHong
School: Southern Medical University,
Course: Orthopaedic Surgery
Keywords: Bone tissue engineering Implant of fracture Osteoporosis Bonecement Pedicle screw Adjacent segment Intervertebral space height Vertebraldeformation index Endplate concave angle Oswestry disability index Cobb angle
CLC: R687.3
Type: Master's thesis
Year: 2013
Downloads: 4
Quote: 0
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Abstract


BackgroundPedicle screw internal fixation is widely used in spinal operations for its orthopedic and fixation function through connecting spinal three columns. So it is necessary adding auxiliary material to enhance the bone-screw strength in operations of osteoporosis patients whose bone mineral density decreases. The screw stability can be improved in many methods, such as changing position and angle of screw, increasing screw length and diameter, and improving the design of screw, but these methods can’t supply enough fixation strength in patients with severe osteoporosis. As the most widely used clinical medical biological material, polymethylmethacrylate (PMMS) bone cement is the best material to increasing the screw fixation strength, especially in severe osteoporosis patients, because it can immediately increase the strength of fixed vertebral body in operation. In conventional method, polymethylmethacrylate (PMMS) bone cement is injected in the screw track, so it may cause serious dangers if bone cement overflow, such as nerve injury and vertebral canal space occupying lesion. Novel perfusional pedicle screw (NPPS) changes the conventional injection style as a new method, in which the bone cement is injected from the screw tail and diffuses to the anterior and middle part of vertebral body through screw head. This can obviously reduce the risk of bone cement overflow, but meanwhile, the screw fatigue properties and mechanical distribution is changed, because bone cement is only distributed in the anterior and middle part of vertebral body and the screw is hollow. Presently, there is a lack of clinical research on the adjacent segments change and prognosis analysis after different types of pedicle screw fixation operation in osteoporosis patients.ObjectiveReview the clinical follow-up material of osteoporosis patients after operation, and compare three different types operations (conventional pedicle screw (CPS), CPS+polymethylmethacrylate (PMMA) bone cement and novel perfusional pedicle screw (NPPS)+PMMA bone cement). Measuring the adjacent vertebral segments change, analyze the prognosis of patients with osteoporosis after different types of operations.MethodsWe reviewed the medical information of87patients suffering from lumbar disease and osteoporosis who underwent operation of pedicle screw fixation and posterior lumbar spinal decompression, and divided them into three groups according to different types of screw:A group (conventional pedicle screw (CPS)), B group (CPS+polymethylmethacrylate (PMMA) bone cement), and C group (novel perfusional pedicle screw (NPPS)+PMMA bone cement). The mean follow-up duration was nine months (from six months to eighteen months), and the observation indices included age, gender, hospitalization time, operation time, intraoperative blood loss, amount of bone cement in each vertebral body and so on. We recorded some indices such as Jikei classification before operation, the Oswestry Disability Index (ODI) before operation and on the final follow-up point, the fixed lumbar vertebrae Cobb angle of the third day after operation and the final follow-up point, and also, the intervertebral distance of the upper adjacent segments, the deformation index of the upper adjacent vertebral body, the concave angle of the fixed lumbar vertebrae superior end-plate and the upper adjacent vertebral body inferior end-plate of the three time points were recorded. The data of different groups in three time points was analyzed in statistical methods.Results①There was no difference in indices of age, gender, hospitalization time, operation time and intraoperative blood loss between three groups (P>0.05); the bone cement amount of group C was more than group B (P=0.024)②There was no difference in ODI score between three groups before operation and in the final follow-up point (P>0.05), but the change of ODI score in group C was bigger than group A in the two time points (P=0.002)③On the two follow-up points, the Cobb angle change of group A was bigger than the other two groups (P<0.05), and there was no difference between group B and group C (P=0.394)④The intervertebral space height of the final follow-up point all decreased than the other two time points in three groups (P<0.05), but there was no difference between the two time points (P>0.05); the intervertebral space height change of group B and C was bigger than group A (P<0.05), but the difference between group B and group C was not significant (P=0.799)⑤The vertebral deformation index of the final follow-up point remarkably decreased than before operation and the third day after operation in three groups (P<0.05), but there was no difference between the two time points (P>0.05); the change rate of vertebral deformation index in group B and C was bigger than group A (P<0.05), but the difference between group B and group C was not significant (P=0.848) ⑥The concave angle of fixed lumbar vertebrae superior end-plate on the third day after operation and the final follow-up point increased significantly than before in group B and group C (P<0.05), but there was no difference between the two time points (P>0.05); the concave angle change of fixed lumbar vertebrae superior end-plate of group B and C was bigger than group A (P<0.05), but the difference between the two groups was not significant (P=0.608)⑦The concave angle of upper adjacent vertebral body inferior end-plate of the final follow-up point obviously decreased than the third day after operation and before operation in group B and group C (P<0.05), and there was no difference between the two time points (P>0.05); the concave angle change of upper adjacent vertebral body inferior end-plate in group B and C was bigger than group A (P<0.05), but there was no difference between group B and group C (P=0.987)ConclusionsThis research demonstrated that adding bone cement didn’t affect operation time, intraoperative blood loss or hospitalization time in pedicle screw internal fixation operation of osteoporosis patients. The results showed that the bone cement amount in group C (NPPS+PMMA) was obviously more than group B (CPS+PMMA); the possible cause was operators intentionally reduced bone cement in order to prevent the side effect of bone cement overflow, and novel perfusional pedicle screw (NPPS) was better in this respect. Patients underwent any type operation could get obvious function improvement in final follow-up, and the advancement of ODI score with NPPS and PMMA was better than CPS. We found that there was no difference in ODI score between three groups in final follow-up point, but the ODI score of patients with CPS was better than those with NPPS and PMMA before operation, so operations with NPPS and PMMA were better at patients’function improvement. This showed that patients could all obtain satisfying clinical outcome after three different types operations, but operations with NPPS and PMMA may be a better choice for osteoporosis patients whose ODI score was worse before operation.Cobb angle change of patients without bone cement was more obvious than others, so we could think that bone cement could significantly enhance the fixation stability. The normal concentric hollow of endplate was the result of adapting pressure, and meanwhile, it could distribute axial stress. For patients accepted operations with bone cement, the concave angle of the fixed lumbar vertebrae superior end-plate decreased remarkably and the concave angle of the upper adjacent vertebral body inferior end-plate didn’t change on the third day after operations, and the concave angle of the upper adjacent vertebral body inferior end-plate increased significantly in the final follow-up point; but end-plate concave angle in patients without bone cement had no obvious change any time. And also, the adjacent intervertebral space height change and the vertebral deformation index of patients with bone cement was more than those without bone cement. We found that two types of perfusion methods could both reduce end-plate concave angle, so intervertebral disk was under additional stress and more pressure was transferred to adjacent vertebral body. Under the action of stable fixation and high stress of bone cement, little bone fracture would happen in the central region of adjacent end-plate and the bone under it, as a result, the end-plate concave angle increased. In this way, the vertebral height decreased and the sagittal diameter increased. This showed that addition of bone cement in pedicle screw internal fixation operation could enhance stability of the fixed segment of osteoporosis patients; at the same time, it may increase the risk of bone fracture in adjacent vertebral body and degeneration of the adjacent intervertebral disc.As a consequence of the above, adding bone cement in pedicle screw internal fixation operation could enhance stability of the fixed segment of osteoporosis patients, and the novel perfusional pedicle screw (NPPS) was better than conventional screw, especially for patients whose ODI score was worse before operation. However, it could also increase the risk of bone fracture in adjacent vertebral body and degeneration of the adjacent intervertebral disc, so we should strengthen postoperative follow-up in patients underwent operations in the hope of early intervention.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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