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RETRACTED:Clinical effect of percutaneous vertebroplasty (pvp) in spinal surgery on senile osteoporotic compressible fractures of the spine
Future Generation Computer Systems 98 (2019) 197–200
Contents lists available at ScienceDirect
Future Generation Computer Systems journal homepage: www.elsevier.com/locate/fgcs
Clinical effect of percutaneous vertebroplasty (pvp) in spinal surgery on senile osteoporotic compressible fractures of the spine ∗
Li Wei a , , Wu Chongling a , Xie Peng b a b
Spinal Surgery Unit 1 in Hanzhong Central Hospital of Shaanxi Province, 723000, PR China Bone And Joint Trauma Department in Hanzhong Central Hospital of Shaanxi Province, 723000, PR China
highlights • Effect of Percutaneous vertebroplasty (PVP) on compression fractures is studied. • 26 Cases were used with this study. • Study concludes that PVP has advantage of invasive, simple and rapid.
article
info
Article history: Received 27 October 2018 Received in revised form 3 December 2018 Accepted 12 December 2018 Available online 26 March 2019 Keywords: Percutaneous vertebral body Percutaneous kyphoplasty (PKP) Osteoporosis Spine fracture Imaging index
a b s t r a c t Clinical effect of percutaneous vertebroplasty (PVP) on senile osteoporotic vertebral compression fractures.Methods: 26 cases (32 vertebrae) with osteoporotic vertebral compression fracture were treated by percutaneous transpedicular pedicle via vertebroplasty under c-arm X-ray fluoroscopy.Eight of the patients were treated with PVP treatment after postural reduction and manual reduction under epidural anesthesia. Bone cement (PMMA) was injected into each vertebral body for 3.5-8ml.PVP is performed by fluoroscopy on C-arm X-ray machine. It is easy to operate and has short operation time, 20–40 min per vertebra.When PVP was performed after postural and manual reduction, the vertebral height of most patients recovered.The lumbago of 23 patients disappeared within 24h after surgery, and moved out of the bed after 24h.3 patients with old fracture had partial relief of back pain and they take painkiller occasionally , no symptom recurrence and high vertebral body loss after 3–32 months of follow-up.There are 4 cases (4 vertebrae) of concomitant bone cement perivertebral leakage and 2 cases (2 vertebrae ) of anterior drainage venous leakage.No clinical symptoms were found among them.Puncture needle was used to extract cerebrospinal fluid in 1 case.Then succeed to carry out the puncture of the other side.Conclusion:①PVP for senile osteoporotic vertebral compression fractures has the advantages of minimally invasive, simple, rapid and definite efficacy.②PVP after postural and manual reduction can recover most of the vertebral height, which is Suitable for relatively young patients with greater wedge compression of the vertebral body.③Unilateral pedicle puncture can achieve clinical purpose with skilled operation. © 2018 Elsevier B.V. All rights reserved.
1. Introduction People with osteoporosis become more and more with the development of aging society. Minor injury can result in vertebral compression fractures and most of them are multiple vertebral compression fractures [1,2]. The traditional open surgical reduction and fixation has the disadvantages of great trauma, poor patient tolerance and unstable internal fixation, which may easily lead to treatment failure and increase the pain and financial burden of the patients [3–5]. Percutaneous balloon kyphosis is a new type of minimally invasive spine surgery which is through injection of ∗ Corresponding author. E-mail address: [email protected] (L. Wei). https://doi.org/10.1016/j.future.2018.12.020 0167-739X/© 2018 Elsevier B.V. All rights reserved.
Bone cement (PMMA) into diseased cone to restore the height of the vertebral body, increase the strength of the vertebral body, improve the stability of the spine, eliminate or alleviate the pain, and correct the deformities of the posterior process. From January 2009 to March 2011, 35 patients admitted to our department were treated with percutaneous vertebroplasty for osteoporotic and compressible fractures with satisfactory results [6–8]. The report is as follows: 2. Clinical data 2.1. General data There were 35 patients in this group, including 13 males and 22 females aging from 53 to 76 years old, average age is 64.7 years old.
198
L. Wei, C. Wu and X. Peng / Future Generation Computer Systems 98 (2019) 197–200
Table 1 Comparison of general data between two groups. Groups
Cases
Male/Female
Age
Average age
Observation group Control group X2 T value P value
25 25 – – –
13/12 14/11 0.081 >0.05
56–86 55–82 – – –
70.2 ± 4.8 69.8 ± 4.2 – 0.314 >0.05
28 cases had a history of minor trauma and 7 cases had no obvious history of trauma. There are total 47 fracture vertebrae, including 16 T11, 13 T12 and 210 L210 fractures. The main manifestations of the patients were pain in the corresponding vertebral body, kyphosis, difficulty in walking, no obvious spinal cord injury and nerve root compression. Imaging and other adjuvant examinations excluded other lesions. X-ray examination showed wedge-shaped vertebral compression fractures and thoracolumbar kyphosis. Both MRI and CT indicated that the posterior wall of the injured vertebra was intact there was no space-occupying lesion in the spinal canal. Bone density test showed that all the 26 patients had moderate osteoporosis, 9 of them had severe osteoporosis.
3.1.2. Preoperative health instructions Posture training: 3 days before operation, guide patients to begin prone, waist extension exercise. Methods: Assist client to lie on his/her stomach with head on one side. A small cotton pillow is placed under the chest and two shoulders, and a large cotton pillow is placed under the pelvis, making the abdomen suspended for easy breathing. Lay your legs flat on the bed and put your hands in a comfortable position on both sides of your torso. Increase the time from 10min to more than 30 min and do it twice every day. Teach patients to do deep breathing and limbs rehabilitation exercise to promote general exercise and active cardiovascular, respiratory and digestive system so that improve the patient’s cardiopulmonary function. 3.1.3. Patient preparation Visit before operation to know about patient’s condition and actively communicate with patient. Make self-introduction to the patient and make him/her understand the operating environment, surgical position and matters needing attention. Fasting for 4 h before surgery, preparing the skin on the back of the waist and conduct the antibiotic and iodine allergy tests. Intramuscular injection of diazepam 10 mg and pethidine 50 mg was performed at 0.5 h before surgery to establish venous channels.
2.2. Operation methods 3.2. Post-operative nursing The patient was in the prone position, and the diseased vertebral body was confirmed by X-ray or CT scanning. Determine the percutaneous puncture site, disinfect the skin, apply a sterile sheet, and use 1% lidocaine topical anesthesia to reach the periosteum. Transcutaneous pedicle puncture was performed by carm X-ray machine. Put the needle into the middle 1/3 of the anterior vertebral body, take out the inner core, insert the guide needle, and pull out the outer tube of the needle. And insert it to the working channel alongside the guide needle. The working channel can be inserted into the vertebral body to exceed 2–3 mm of the posterior edge of the vertebra. Use a bone drill to pierce the vertebral body along the working channel 2–3 mm from the anterior wall of the vertebral body. Pull out the bone drill and place the balloon. After the proper position is determined under fluoroscopy, the balloon is filled with contrast media to dilate the balloon and observe the pressure. The shape of balloon dilatation and reduction of vertebral body were observed under fluoroscopy. After observation for 15 min, no abnormality was observed, small incision was sutured and bandaged, and the operation ended. 3. Nurse 3.1. Preoperative nursing 3.1.1. Mental nursing Osteoporosis is mostly the elderly patients, and they are prone to anxiety, fear, depression and other emotions, which are manifested as psychological characteristics such as paranoia, loneliness and low self-esteem. Patients with fracture are prone to ‘‘worry’’, ‘‘sadness’’ and ‘‘fear’’. Carry on the targeted psychological nursing according to the principle of ‘‘winning each other’s feelings’’ of traditional Chinese medicine. In addition to general psychological care, we should carry on targeted psychological nursing according to the principle of ‘‘one emotion conquer another emotion’’ of traditional Chinese medicine. Therefore, we work with doctors to give patients a detailed description of the current situation of the disease as well as prognosis, surgical purpose, treatment process, anesthesia, precautions, advantages and safety of surgery. In addition, The patients who were treated and recovered from the same disease in the same area were invited to explain the experience and the effect of the operation so as to relieve the tension, strengthen the confidence of overcoming the disease, and cooperate with the operation actively.
3.2.1. Monitoring of vital signs Observe changes in vital signs, especially the changes of blood pressure. The bone cement used in vertebroplasty can temporarily decrease arterial blood pressure, which may be related to the absorption of PMMA monomer or polymer into blood circulation [3]. All patients had stable vital signs after operation. 3.2.2. Observation and nursing of complications 3.2.2.1. Bone cement leakage. The leakage of bone cement into the spinal column or spinal canal can cause compression of the spinal cord and nerve roots. The incidence of bone cement spillover was related to the amount of bone cement injected, which was mainly due to the flow of bone cement to paravertebral tissue, intervertebral space, epidural space, and intervertebral foramen through the damaged bone cortex or vein behind the vertebral body. Therefore, the blood circulation of both lower extremities, muscle strength, sensation and Urination and defecation of the patient should be closely observed. Doctors should be reported timely to any abnormal conditions such as numbness of both lower extremities and muscle weakness etc and carry out treatment. In this group, there were 3 cases with intraoperative bone cement extravasation, and no obvious spinal nerve injury occurred after surgery, and no special treatment was performed. 3.2.2.2. Pulmonary embolus. It is mainly caused by the leakage of bone cement into the vertebral canal. Clinical manifestations included chest tightness, chest pain, palpitations, anterior area discomfort, tachycardia, agitation dyspnea, cough dyspnea hemoptysis, sweating cyanosis and blood pressure drop etc. Once the above signs are found, measures should be taken quickly, absolute bed rest, avoiding moving, oxygen inhalation and ECG monitoring, controlling infusion speed, keeping respiratory tract unobstructed, and treating the disease according to doctor’s advice. No pulmonary embolism occurred in this group 3.2.2.3. Part pain. It is a progressive pain that has nothing to do with bone cement leakage. It could be bone cement entering the vertebral body that causes ischemia or inflammation of the vertebral body to bone cement. And this can be cured by treatment of 2 ∼ 3D with nonsteroidal anti-inflammatory drugs. Local pain occurred in 3 cases after operation and disappeared after taking oral Celebrex.
L. Wei, C. Wu and X. Peng / Future Generation Computer Systems 98 (2019) 197–200
199
Table 2 Comparison of VAS score, Oswestry score and imaging index before and after surgery of the two groups. Oswestry score
Imaging index [angle(◦ ) height(%)]
Preoperative
Postoperative
Preoperative
Postoperative
Kyphotic angle
Anterior height
Centre line height
Posterior height
Preoperative
Postoperative
Preoperative
Postoperative
Preoperative
Postoperative
Preoperative
Postoperative
25
8.79
2.28
90.2
24.9
19.8
4.9
70.2
88.1
72.9
89.2
73.2
97.1
25
8.89
4.27
89.8
34.9
20.2
18.7
68.9
69.7
72.6
74.5
72.7
73.9
– –
0.65
16.1 <0.05
0.31 >0.05
16.4
0.39
17.8
0.75
13.7
>0.05
<0.05
>0.05
0.20 >0.05
0.08
<0.05
12.5 <0.05
9.80
>0.05
<0.05
>0.05
<0.05
VAS score Groups
The observation group The control group T value P
Cases
in Oswestry score between the two groups after operation (P < 0.05), and the decrease in the observation group was larger than that in the control group (P < 0.05). In terms of imaging indicators, the observation group showed significant improvement in the four-image indicators (P < 0.05), while the control group showed no statistically significant difference before and after surgery (P > 0.05), as shown in Table 2. 5. Conclusion
Fig. 1. Experimental results.
3.2.3. The early function rehabilitation After 6 h of postoperative pain relief, the patient was instructed and encouraged to turn over in bed and move the body properly such as Leg elevation movement and exercise the waist and back spine. This operation has the effect of immediate stabilization to the diseased vertebrae and the pain of most patients can be alleviated 6–12 h after operation. Therefore, patients should be encouraged to take early functional exercises. Six hours after surgery, you may wear waist tape to move out of bed. Sudden sitting up should be avoided in early getting-up stage to prevent dizziness, palpitation and other discomfort. The activity time is determined according to the patient’s tolerance, step by step. Do not act too hastily. Pay attention to safety and prevent slipping. 4. Cases analysis 4.1. Comparison of general data between two groups There were 13 males and 12 females in the observation group, ranging from 56 to 86 years old, with an average age of 70.2 + 4.8 years old; The control group included 14 males and 11 females, ranging in age from 55 to 82 years, with an average age of 69.8 + 4.2 years. There was no significant difference in sex, age and other general data between the two groups(P > 0.05) and it is comparable [9]. Please see Table 1. The CT image of the operation is shown in Fig. 1. 4.2. Comparison of VAS score, Oswestry score and imaging index before and after surgery of the two groups Table 2 shows that VAS scores of patients in the two groups significantly decreased after surgery treatment (P < 0.05), while those of the observation group decreased more significantly (P < 0.05). In terms of Oswestry score, there was a significant decrease
With the trend of aging population becoming more and more obvious, the cases of spinal fracture caused by osteoporosis in the elderly show an obvious upward trend, which has a great negative impact on the normal life of the elderly patients. With the development of medical technology, vertebroplasty has made great progress. The kyphoplasty developed by vertebroplasty is of great significance for the treatment of elderly patients with osteoporotic spinal fracture. The advantages of PVP used in this study include low cost, significant anti-pain effect and simple operation. However, it cannot correct kyphosis effectively, and it is difficult to recover the height of injured vertebrae. In addition, PVP is also prone to leakage of bone cement, which may lead to organ failure and vascular embolism. Body percutaneous vertebroplasty is the optimization of PVP, which can effectively avoid the problems in PVP treatment. Its characteristic is that it can correct the vertebral body by balloon expansion, and make the shape and height of vertebral body return to normal to the greatest extent. It can also be seen that the imaging indexes of the observation group treated with percutaneous vertebroplasty were significantly improved compared with those before operation (P < 0.05). At the same time, the Oswestry score and VAS score of the observation group were significantly lower than those of the control group (P < 0.05). It is proved once again that percutaneous vertebroplasty is superior to PVP in the treatment of osteoporotic spinal fracture. The only drawback is that the cost of percutaneous vertebroplasty is significantly higher than that of PVP. Therefore, appropriate treatment should be selected according to the actual situation of patients in the future. References [1] B.L. Riggs, H.W. Wahner, E. Seeman, et al., Changes in bone mineral density of the proximal femur and spine with aging: DIfferences between the postmenopausal and senile osteoporosis syndromes, J. Clin. Invest. 70 (4) (1982) 716–723. [2] A. Cotten, N. Boutry, B. Cortet, et al., Percutaneous vertebroplasty: State of the art, Radiogr. Rev. Publ. Radiol. Soc. N Am. Inc. 18 (2) (1998) 311. [3] R. Civitelli, S. Gonnelli, F. Zacchei, S. Bigazzi, A. Vattimo, LV. Avioli, C. Gennari, Bone turnover in postmenopausal osteoporosis. Effect of calcitonin treatment, J. Clin. Invest. 82 (4) (1988) 1268. [4] K. Wennerberg, CJ. Der, Rho-family GTPases: It’s not only Rac and Rho (and I like it), J. Cell Sci. 117 (8) (2004) 1301–1312. [5] H. Deramond, N.T. Wright, S.M. Belkoff, Temperature elevation caused by bone cement polymerization during vertebroplasty, Bone 25 (2) (1999) 17S–21S.
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[6] T.J. Kaufmann, M.E. Jensen, P.A. Schweickert, et al., Age of fracture and clinical outcomes of percutaneous vertebroplasty, AJNR Am. J. Neuroradiol. 22 (10) (2001) 1860. [7] J.S. Shimony, L.A. Gilula, A.J. Zeller, et al., Percutaneous vertebroplasty for malignant compression fractures with epidural involvement, Radiology 232 (3) (2004) 846–853. [8] Y.J. Rho, W.J. Choe, Y.I. Chun, Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty, Eur. Spine J. 21 (5) (2012) 905–911. [9] U. Rajendra Achary, YukiHagiwara, Sunny Nitin Deshpande, S. Suren, Joel En Wei Koh, Shu Lih Oh, N. Arunkumar, Edward J. Ciaccio, Choo Min Lim, Characterization of focal EEG signals: A review, Future Gener. Comput. Syst. 91 (2019) 290–299.
Li Wei received a bachelor’s degree in medicine from Changzhi Medical College in Shanxi Province. He is now a on-job postgraduate at Suzhou University. His research direction is mainly in spinal surgery. He has published several research papers in scholarly journals in the above research areas and has participated in several conferences.
Wu Chongling received a master’s degree in medicine from Lanzhou University in China. He is currently working in Spine surgery department of Hanzhong Central Hospital in Shaanxi Province. His research fields are Spine surgery. He has published several research papers in scholarly journals in these research fields and has participated in several academic conferences. His interested subjects are the treatment of spinal cord injury and the functional reconstruction of spinal cord injury recovery.
Xie Peng received a bachelor’s degree in medicine from Xi’an Jiao Tong University in Shanxi, China. He is currently working in Hanzhong Central Hospital in Shaanxi Province. His research fields are joint surgery and spinal surgery. He has published several research papers in scholarly journals in these research fields.
Contents lists available at ScienceDirect
Future Generation Computer Systems journal homepage: www.elsevier.com/locate/fgcs
Clinical effect of percutaneous vertebroplasty (pvp) in spinal surgery on senile osteoporotic compressible fractures of the spine ∗
Li Wei a , , Wu Chongling a , Xie Peng b a b
Spinal Surgery Unit 1 in Hanzhong Central Hospital of Shaanxi Province, 723000, PR China Bone And Joint Trauma Department in Hanzhong Central Hospital of Shaanxi Province, 723000, PR China
highlights • Effect of Percutaneous vertebroplasty (PVP) on compression fractures is studied. • 26 Cases were used with this study. • Study concludes that PVP has advantage of invasive, simple and rapid.
article
info
Article history: Received 27 October 2018 Received in revised form 3 December 2018 Accepted 12 December 2018 Available online 26 March 2019 Keywords: Percutaneous vertebral body Percutaneous kyphoplasty (PKP) Osteoporosis Spine fracture Imaging index
a b s t r a c t Clinical effect of percutaneous vertebroplasty (PVP) on senile osteoporotic vertebral compression fractures.Methods: 26 cases (32 vertebrae) with osteoporotic vertebral compression fracture were treated by percutaneous transpedicular pedicle via vertebroplasty under c-arm X-ray fluoroscopy.Eight of the patients were treated with PVP treatment after postural reduction and manual reduction under epidural anesthesia. Bone cement (PMMA) was injected into each vertebral body for 3.5-8ml.PVP is performed by fluoroscopy on C-arm X-ray machine. It is easy to operate and has short operation time, 20–40 min per vertebra.When PVP was performed after postural and manual reduction, the vertebral height of most patients recovered.The lumbago of 23 patients disappeared within 24h after surgery, and moved out of the bed after 24h.3 patients with old fracture had partial relief of back pain and they take painkiller occasionally , no symptom recurrence and high vertebral body loss after 3–32 months of follow-up.There are 4 cases (4 vertebrae) of concomitant bone cement perivertebral leakage and 2 cases (2 vertebrae ) of anterior drainage venous leakage.No clinical symptoms were found among them.Puncture needle was used to extract cerebrospinal fluid in 1 case.Then succeed to carry out the puncture of the other side.Conclusion:①PVP for senile osteoporotic vertebral compression fractures has the advantages of minimally invasive, simple, rapid and definite efficacy.②PVP after postural and manual reduction can recover most of the vertebral height, which is Suitable for relatively young patients with greater wedge compression of the vertebral body.③Unilateral pedicle puncture can achieve clinical purpose with skilled operation. © 2018 Elsevier B.V. All rights reserved.
1. Introduction People with osteoporosis become more and more with the development of aging society. Minor injury can result in vertebral compression fractures and most of them are multiple vertebral compression fractures [1,2]. The traditional open surgical reduction and fixation has the disadvantages of great trauma, poor patient tolerance and unstable internal fixation, which may easily lead to treatment failure and increase the pain and financial burden of the patients [3–5]. Percutaneous balloon kyphosis is a new type of minimally invasive spine surgery which is through injection of ∗ Corresponding author. E-mail address: [email protected] (L. Wei). https://doi.org/10.1016/j.future.2018.12.020 0167-739X/© 2018 Elsevier B.V. All rights reserved.
Bone cement (PMMA) into diseased cone to restore the height of the vertebral body, increase the strength of the vertebral body, improve the stability of the spine, eliminate or alleviate the pain, and correct the deformities of the posterior process. From January 2009 to March 2011, 35 patients admitted to our department were treated with percutaneous vertebroplasty for osteoporotic and compressible fractures with satisfactory results [6–8]. The report is as follows: 2. Clinical data 2.1. General data There were 35 patients in this group, including 13 males and 22 females aging from 53 to 76 years old, average age is 64.7 years old.
198
L. Wei, C. Wu and X. Peng / Future Generation Computer Systems 98 (2019) 197–200
Table 1 Comparison of general data between two groups. Groups
Cases
Male/Female
Age
Average age
Observation group Control group X2 T value P value
25 25 – – –
13/12 14/11 0.081 >0.05
56–86 55–82 – – –
70.2 ± 4.8 69.8 ± 4.2 – 0.314 >0.05
28 cases had a history of minor trauma and 7 cases had no obvious history of trauma. There are total 47 fracture vertebrae, including 16 T11, 13 T12 and 210 L210 fractures. The main manifestations of the patients were pain in the corresponding vertebral body, kyphosis, difficulty in walking, no obvious spinal cord injury and nerve root compression. Imaging and other adjuvant examinations excluded other lesions. X-ray examination showed wedge-shaped vertebral compression fractures and thoracolumbar kyphosis. Both MRI and CT indicated that the posterior wall of the injured vertebra was intact there was no space-occupying lesion in the spinal canal. Bone density test showed that all the 26 patients had moderate osteoporosis, 9 of them had severe osteoporosis.
3.1.2. Preoperative health instructions Posture training: 3 days before operation, guide patients to begin prone, waist extension exercise. Methods: Assist client to lie on his/her stomach with head on one side. A small cotton pillow is placed under the chest and two shoulders, and a large cotton pillow is placed under the pelvis, making the abdomen suspended for easy breathing. Lay your legs flat on the bed and put your hands in a comfortable position on both sides of your torso. Increase the time from 10min to more than 30 min and do it twice every day. Teach patients to do deep breathing and limbs rehabilitation exercise to promote general exercise and active cardiovascular, respiratory and digestive system so that improve the patient’s cardiopulmonary function. 3.1.3. Patient preparation Visit before operation to know about patient’s condition and actively communicate with patient. Make self-introduction to the patient and make him/her understand the operating environment, surgical position and matters needing attention. Fasting for 4 h before surgery, preparing the skin on the back of the waist and conduct the antibiotic and iodine allergy tests. Intramuscular injection of diazepam 10 mg and pethidine 50 mg was performed at 0.5 h before surgery to establish venous channels.
2.2. Operation methods 3.2. Post-operative nursing The patient was in the prone position, and the diseased vertebral body was confirmed by X-ray or CT scanning. Determine the percutaneous puncture site, disinfect the skin, apply a sterile sheet, and use 1% lidocaine topical anesthesia to reach the periosteum. Transcutaneous pedicle puncture was performed by carm X-ray machine. Put the needle into the middle 1/3 of the anterior vertebral body, take out the inner core, insert the guide needle, and pull out the outer tube of the needle. And insert it to the working channel alongside the guide needle. The working channel can be inserted into the vertebral body to exceed 2–3 mm of the posterior edge of the vertebra. Use a bone drill to pierce the vertebral body along the working channel 2–3 mm from the anterior wall of the vertebral body. Pull out the bone drill and place the balloon. After the proper position is determined under fluoroscopy, the balloon is filled with contrast media to dilate the balloon and observe the pressure. The shape of balloon dilatation and reduction of vertebral body were observed under fluoroscopy. After observation for 15 min, no abnormality was observed, small incision was sutured and bandaged, and the operation ended. 3. Nurse 3.1. Preoperative nursing 3.1.1. Mental nursing Osteoporosis is mostly the elderly patients, and they are prone to anxiety, fear, depression and other emotions, which are manifested as psychological characteristics such as paranoia, loneliness and low self-esteem. Patients with fracture are prone to ‘‘worry’’, ‘‘sadness’’ and ‘‘fear’’. Carry on the targeted psychological nursing according to the principle of ‘‘winning each other’s feelings’’ of traditional Chinese medicine. In addition to general psychological care, we should carry on targeted psychological nursing according to the principle of ‘‘one emotion conquer another emotion’’ of traditional Chinese medicine. Therefore, we work with doctors to give patients a detailed description of the current situation of the disease as well as prognosis, surgical purpose, treatment process, anesthesia, precautions, advantages and safety of surgery. In addition, The patients who were treated and recovered from the same disease in the same area were invited to explain the experience and the effect of the operation so as to relieve the tension, strengthen the confidence of overcoming the disease, and cooperate with the operation actively.
3.2.1. Monitoring of vital signs Observe changes in vital signs, especially the changes of blood pressure. The bone cement used in vertebroplasty can temporarily decrease arterial blood pressure, which may be related to the absorption of PMMA monomer or polymer into blood circulation [3]. All patients had stable vital signs after operation. 3.2.2. Observation and nursing of complications 3.2.2.1. Bone cement leakage. The leakage of bone cement into the spinal column or spinal canal can cause compression of the spinal cord and nerve roots. The incidence of bone cement spillover was related to the amount of bone cement injected, which was mainly due to the flow of bone cement to paravertebral tissue, intervertebral space, epidural space, and intervertebral foramen through the damaged bone cortex or vein behind the vertebral body. Therefore, the blood circulation of both lower extremities, muscle strength, sensation and Urination and defecation of the patient should be closely observed. Doctors should be reported timely to any abnormal conditions such as numbness of both lower extremities and muscle weakness etc and carry out treatment. In this group, there were 3 cases with intraoperative bone cement extravasation, and no obvious spinal nerve injury occurred after surgery, and no special treatment was performed. 3.2.2.2. Pulmonary embolus. It is mainly caused by the leakage of bone cement into the vertebral canal. Clinical manifestations included chest tightness, chest pain, palpitations, anterior area discomfort, tachycardia, agitation dyspnea, cough dyspnea hemoptysis, sweating cyanosis and blood pressure drop etc. Once the above signs are found, measures should be taken quickly, absolute bed rest, avoiding moving, oxygen inhalation and ECG monitoring, controlling infusion speed, keeping respiratory tract unobstructed, and treating the disease according to doctor’s advice. No pulmonary embolism occurred in this group 3.2.2.3. Part pain. It is a progressive pain that has nothing to do with bone cement leakage. It could be bone cement entering the vertebral body that causes ischemia or inflammation of the vertebral body to bone cement. And this can be cured by treatment of 2 ∼ 3D with nonsteroidal anti-inflammatory drugs. Local pain occurred in 3 cases after operation and disappeared after taking oral Celebrex.
L. Wei, C. Wu and X. Peng / Future Generation Computer Systems 98 (2019) 197–200
199
Table 2 Comparison of VAS score, Oswestry score and imaging index before and after surgery of the two groups. Oswestry score
Imaging index [angle(◦ ) height(%)]
Preoperative
Postoperative
Preoperative
Postoperative
Kyphotic angle
Anterior height
Centre line height
Posterior height
Preoperative
Postoperative
Preoperative
Postoperative
Preoperative
Postoperative
Preoperative
Postoperative
25
8.79
2.28
90.2
24.9
19.8
4.9
70.2
88.1
72.9
89.2
73.2
97.1
25
8.89
4.27
89.8
34.9
20.2
18.7
68.9
69.7
72.6
74.5
72.7
73.9
– –
0.65
16.1 <0.05
0.31 >0.05
16.4
0.39
17.8
0.75
13.7
>0.05
<0.05
>0.05
0.20 >0.05
0.08
<0.05
12.5 <0.05
9.80
>0.05
<0.05
>0.05
<0.05
VAS score Groups
The observation group The control group T value P
Cases
in Oswestry score between the two groups after operation (P < 0.05), and the decrease in the observation group was larger than that in the control group (P < 0.05). In terms of imaging indicators, the observation group showed significant improvement in the four-image indicators (P < 0.05), while the control group showed no statistically significant difference before and after surgery (P > 0.05), as shown in Table 2. 5. Conclusion
Fig. 1. Experimental results.
3.2.3. The early function rehabilitation After 6 h of postoperative pain relief, the patient was instructed and encouraged to turn over in bed and move the body properly such as Leg elevation movement and exercise the waist and back spine. This operation has the effect of immediate stabilization to the diseased vertebrae and the pain of most patients can be alleviated 6–12 h after operation. Therefore, patients should be encouraged to take early functional exercises. Six hours after surgery, you may wear waist tape to move out of bed. Sudden sitting up should be avoided in early getting-up stage to prevent dizziness, palpitation and other discomfort. The activity time is determined according to the patient’s tolerance, step by step. Do not act too hastily. Pay attention to safety and prevent slipping. 4. Cases analysis 4.1. Comparison of general data between two groups There were 13 males and 12 females in the observation group, ranging from 56 to 86 years old, with an average age of 70.2 + 4.8 years old; The control group included 14 males and 11 females, ranging in age from 55 to 82 years, with an average age of 69.8 + 4.2 years. There was no significant difference in sex, age and other general data between the two groups(P > 0.05) and it is comparable [9]. Please see Table 1. The CT image of the operation is shown in Fig. 1. 4.2. Comparison of VAS score, Oswestry score and imaging index before and after surgery of the two groups Table 2 shows that VAS scores of patients in the two groups significantly decreased after surgery treatment (P < 0.05), while those of the observation group decreased more significantly (P < 0.05). In terms of Oswestry score, there was a significant decrease
With the trend of aging population becoming more and more obvious, the cases of spinal fracture caused by osteoporosis in the elderly show an obvious upward trend, which has a great negative impact on the normal life of the elderly patients. With the development of medical technology, vertebroplasty has made great progress. The kyphoplasty developed by vertebroplasty is of great significance for the treatment of elderly patients with osteoporotic spinal fracture. The advantages of PVP used in this study include low cost, significant anti-pain effect and simple operation. However, it cannot correct kyphosis effectively, and it is difficult to recover the height of injured vertebrae. In addition, PVP is also prone to leakage of bone cement, which may lead to organ failure and vascular embolism. Body percutaneous vertebroplasty is the optimization of PVP, which can effectively avoid the problems in PVP treatment. Its characteristic is that it can correct the vertebral body by balloon expansion, and make the shape and height of vertebral body return to normal to the greatest extent. It can also be seen that the imaging indexes of the observation group treated with percutaneous vertebroplasty were significantly improved compared with those before operation (P < 0.05). At the same time, the Oswestry score and VAS score of the observation group were significantly lower than those of the control group (P < 0.05). It is proved once again that percutaneous vertebroplasty is superior to PVP in the treatment of osteoporotic spinal fracture. The only drawback is that the cost of percutaneous vertebroplasty is significantly higher than that of PVP. Therefore, appropriate treatment should be selected according to the actual situation of patients in the future. References [1] B.L. Riggs, H.W. Wahner, E. Seeman, et al., Changes in bone mineral density of the proximal femur and spine with aging: DIfferences between the postmenopausal and senile osteoporosis syndromes, J. Clin. Invest. 70 (4) (1982) 716–723. [2] A. Cotten, N. Boutry, B. Cortet, et al., Percutaneous vertebroplasty: State of the art, Radiogr. Rev. Publ. Radiol. Soc. N Am. Inc. 18 (2) (1998) 311. [3] R. Civitelli, S. Gonnelli, F. Zacchei, S. Bigazzi, A. Vattimo, LV. Avioli, C. Gennari, Bone turnover in postmenopausal osteoporosis. Effect of calcitonin treatment, J. Clin. Invest. 82 (4) (1988) 1268. [4] K. Wennerberg, CJ. Der, Rho-family GTPases: It’s not only Rac and Rho (and I like it), J. Cell Sci. 117 (8) (2004) 1301–1312. [5] H. Deramond, N.T. Wright, S.M. Belkoff, Temperature elevation caused by bone cement polymerization during vertebroplasty, Bone 25 (2) (1999) 17S–21S.
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[6] T.J. Kaufmann, M.E. Jensen, P.A. Schweickert, et al., Age of fracture and clinical outcomes of percutaneous vertebroplasty, AJNR Am. J. Neuroradiol. 22 (10) (2001) 1860. [7] J.S. Shimony, L.A. Gilula, A.J. Zeller, et al., Percutaneous vertebroplasty for malignant compression fractures with epidural involvement, Radiology 232 (3) (2004) 846–853. [8] Y.J. Rho, W.J. Choe, Y.I. Chun, Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty, Eur. Spine J. 21 (5) (2012) 905–911. [9] U. Rajendra Achary, YukiHagiwara, Sunny Nitin Deshpande, S. Suren, Joel En Wei Koh, Shu Lih Oh, N. Arunkumar, Edward J. Ciaccio, Choo Min Lim, Characterization of focal EEG signals: A review, Future Gener. Comput. Syst. 91 (2019) 290–299.
Li Wei received a bachelor’s degree in medicine from Changzhi Medical College in Shanxi Province. He is now a on-job postgraduate at Suzhou University. His research direction is mainly in spinal surgery. He has published several research papers in scholarly journals in the above research areas and has participated in several conferences.
Wu Chongling received a master’s degree in medicine from Lanzhou University in China. He is currently working in Spine surgery department of Hanzhong Central Hospital in Shaanxi Province. His research fields are Spine surgery. He has published several research papers in scholarly journals in these research fields and has participated in several academic conferences. His interested subjects are the treatment of spinal cord injury and the functional reconstruction of spinal cord injury recovery.
Xie Peng received a bachelor’s degree in medicine from Xi’an Jiao Tong University in Shanxi, China. He is currently working in Hanzhong Central Hospital in Shaanxi Province. His research fields are joint surgery and spinal surgery. He has published several research papers in scholarly journals in these research fields.