1
|
Chen J, Lu S, Chen Y, Zhang X, Xi Z, Xie L, Li J. Space between bone cement and bony endplate can trigger higher incidence of augmented vertebral collapse: An in-silico study. J Clin Neurosci 2024; 125:152-158. [PMID: 38815301 DOI: 10.1016/j.jocn.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The pathogenesis of postoperative complications in patients with osteoporotic vertebral compressive fractures (OVCFs) undergoing percutaneous vertebroplasty (PVP) is multifaceted, with local biomechanical deterioration playing a pivotal role. Specifically, the disparity in stiffness between the bone cement and osteoporotic cancellous bone can precipitate interfacial stress concentrations, potentially leading to cement-augmented vertebral body collapse and clinical symptom recurrence. This study focuses on the biomechanical implications of the space between the bone cement and bony endplate (BEP), hypothesizing that this interface may be a critical locus for stress concentration and subsequent vertebral failure. METHODS Leveraging a validated numerical model from our previous study, we examined the biomechanical impact of the cement-BEP interface in the L2 vertebral body post-PVP, simulated OVCF and PVP and constructed three distinct models: one with direct bone cement contact with both cranial and caudal BEPs, one with contact only with the caudal BEPs and one without contact with either BEP. Moreover, we assessed stress distribution across cranial and caudal BEPs under various loading conditions to describe the biomechanical outcomes associated with each model. RESULTS A consistent trend was observed across all models: the interfaces between the bone cement and cancellous bone exhibited higher stress values under the majority of loading conditions compared to models with direct cement-BEP contact. The most significant difference was observed in the flexion loading condition compared to the mode with direct contact between BEP and cement. The maximum stress in models without direct contact increased by at least 30%. CONCLUSIONS Our study reveals the biomechanical significance of interfacial stiffness differences at the cement-BEP junction, which can exacerbate local stress concentrations and predispose to augmented vertebral collapse. We recommend the strategic distribution of bone cement to encompass a broader contact area with the BEP for preventing biomechanical failure and subsequent vertebral collapse.
Collapse
Affiliation(s)
- Ji Chen
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu Province, PR China; Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine Kunshan, Soochow 215300, Jiangsu Province, PR China
| | - Shihao Lu
- Naval Medical University, Xiangyin Road, Shanghai 200433, PR China
| | - Yong Chen
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine Kunshan, Soochow 215300, Jiangsu Province, PR China
| | - Xiang Zhang
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine Kunshan, Soochow 215300, Jiangsu Province, PR China
| | - Zhipeng Xi
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu Province, PR China
| | - Lin Xie
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu Province, PR China.
| | - Jingchi Li
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, NO.182, Chunhui Road, Longmatan District, Luzhou, Sichuan Province, PR China.
| |
Collapse
|
2
|
Sun N, Zhang Y, Xie D, Chen Y, Liu Y. Enhancing percutaneous kyphoplasty efficacy in elderly osteoporotic fractures through optimal cement filling ratio. Front Endocrinol (Lausanne) 2024; 15:1359550. [PMID: 38800478 PMCID: PMC11116659 DOI: 10.3389/fendo.2024.1359550] [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: 12/21/2023] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To explore the appropriate bone cement filling ratio in percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). Methods Clinical and radiological data from 150 OVCF patients treated with PKP were retrospectively analyzed. Patients were categorized into three groups based on bone cement filling ratio: low (<0.4), medium (0.4-0.6), and high (>0.6) filling ratio groups. The clinical characteristics (age, gender, BMI, etc.) and related study data (bone cement leakage and its location, pre/post-operative Visual Analogue Scale (VAS), pre/post-operative Oswestry Disability Index (ODI), vertebral height restoration, kyphotic Cobb angle, etc.) among the three groups were compared using statistical software to compare to identify the most appropriate cement filling ratio. Results The 0.4-0.6 group presented a lower cement leakage rate compared to the >0.6 group, and there were no significant differences in pre-operative VAS, post-operative day 2 VAS, post-operative month 1 VAS, and pre-operative ODI (p>0.05). However, significant differences were observed in post-operative month 3 VAS (p=0.002), post-operative day 2 ODI (p=0.002), post-operative month 1 ODI (p<0.001), and post-operative month 3 ODI (p<0.001). The "0.4-0.6" group showed better pain improvement and functional recovery compared with the ">0.6" group at the 3-month follow-up. While presenting the best vertebral height restoration, the ">0.6" group also exhibited the greatest variability. Additionally, no significant difference in Cobb angle changes was observed among the groups. Conclusion A bone cement filling ratio of 0.4-0.6 in PKP treatment for OVCF strikes a favorable balance between complication reduction and positive patient outcomes, warranting it as an optimal filling volume.
Collapse
Affiliation(s)
- Ningxue Sun
- Department of Spinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yu Zhang
- Department of Spinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Deqian Xie
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yating Chen
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yang Liu
- Department of Spinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| |
Collapse
|
3
|
Zhang TD, Cao S, Ren HY, Li YM, Yuan YM. Cemented vertebra and adjacent vertebra refractured in a chronic kidney disease-mineral and bone disorder patient: A case report. World J Clin Cases 2024; 12:1804-1809. [PMID: 38660087 PMCID: PMC11036482 DOI: 10.12998/wjcc.v12.i10.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Although percutaneous vertebral augmentation (PVA) is a commonly used procedure for treating vertebral compression fracture (VCF), the risk of vertebral refracture should be considered. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic disease of mineral and bone metabolism. It is associated with an increased risk of fracture. Few studies have reported the use of PVA in patients with CKD-MBD. We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA. CASE SUMMARY A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago. According to physical examination, imaging and laboratory findings, diagnoses of T12 VCF, CKD-MBD, and chronic kidney disease stage 5 were established. He then received percutaneous vertebroplasty at T12 vertebra. Fourteen weeks later, he presented with T12 and L1 vertebral refractures caused by lumbar sprain. Once again, he was given PVA which was optimized for the refractured vertebrae. Although the short-term postoperative effect was satisfactory, he reported chronic low back pain again at the 3-month follow-up. CONCLUSION It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD. It may increase the risk of vertebral refracture. Furthermore, the PVA surgical technique needs to be optimized according to the condition of the patient. The medium- and long-term effects of PVA remain uncertain in patients with CKD-MBD.
Collapse
Affiliation(s)
- Ti-Dong Zhang
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
| | - Shuai Cao
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
| | - Hui-Yong Ren
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
| | - Yu-Min Li
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
| | - Yi-Ming Yuan
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
| |
Collapse
|
4
|
Zhou Q, Wan Y, Ma L, Dong L, Yuan W. Percutaneous Curved Vertebroplasty Decrease the Risk of Cemented Vertebra Refracture Compared with Bilateral Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures. Clin Interv Aging 2024; 19:289-301. [PMID: 38434576 PMCID: PMC10907131 DOI: 10.2147/cia.s438036] [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] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/21/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose The purpose of this study is to compare the refracture rate of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery, respectively. Refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded. Results The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p<0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p<0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than in the bilateral PKP group (p<0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p<0.01). Conclusion Both PCVP and PKP were safe and effective treatments for OVCF. The PCVP had lower refracture rate of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.
Collapse
Affiliation(s)
- Qiang Zhou
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Yanlin Wan
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Le Ma
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Liang Dong
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Weijian Yuan
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| |
Collapse
|
5
|
Haibier A, Yusufu A, Lin H, Kayierhan A, Abudukelimu Y, Aximu A, Abudurexiti T. Effect of different cement distribution in bilateral and unilateral Percutaneous vertebro plasty on the clinical efficacy of vertebral compression fractures. BMC Musculoskelet Disord 2023; 24:908. [PMID: 37996830 PMCID: PMC10666391 DOI: 10.1186/s12891-023-06997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The ramifications of osteoporotic fractures and their subsequent complications are becoming progressively detrimental for the elderly population. This study evaluates the clinical ramifications of postoperative bone cement distribution in patients with osteoporotic vertebral compression fractures (OVCF) who underwent both bilateral and unilateral Percutaneous Vertebroplasty (PVP). OBJECTIVE The research aims to discern the influence of bone cement distribution on the clinical outcomes of both bilateral and unilateral Percutaneous Vertebroplasty. The overarching intention is to foster efficacious preventive and therapeutic strategies to mitigate postoperative vertebral fractures and thereby enhance surgical outcomes. METHODS A comprehensive evaluation was undertaken on 139 patients who received either bilateral or unilateral PVP in our institution between January 2018 and March 2022. These patients were systematically classified into three distinct groups: unilateral PVP (n = 87), bilateral PVP with a connected modality (n = 29), and bilateral PVP with a disconnected modality (n = 23). Several operational metrics were juxtaposed across these cohorts, encapsulating operative duration, aggregate hospital expenses, bone cement administration metrics, VAS (Visual Analogue Scale) scores, ODI (Oswestry Disability Index) scores relative to lumbar discomfort, postoperative vertebral height restitution rates, and the status of the traumatized and adjacent vertebral bodies. Preliminary findings indicated that the VAS scores for the January and December cohorts were considerably reduced compared to the unilateral PVP group (P = 0.015, 0.032). Furthermore, the recurrence of fractures in the affected and adjacent vertebral structures was more pronounced in the unilateral PVP cohort compared to the bilateral PVP cohorts. The duration of the procedure (P = 0.000) and the overall hospitalization expenses for the unilateral PVP group were markedly lesser than for both the connected and disconnected bilateral PVP groups, a difference that was statistically significant (P = 0.015, P = 0.024, respectively). Nevertheless, other parameters, such as the volume of cement infused, incidence of cement spillage, ODI scores for lumbar discomfort, post-surgical vertebral height restitution rate, localized vertebral kyphosis, and the alignment of cement and endplate, did not exhibit significant statistical deviations (P > 0.05). CONCLUSION In juxtaposition with unilateral PVP, the employment of bilateral PVP exhibits enhanced long-term prognostic outcomes for patients afflicted with vertebral compression fractures. Notably, bilateral PVP significantly curtails the prevalence of subsequent vertebral injuries. Conversely, the unilateral PVP cohort is distinguished by its abbreviated operational duration, minimal invasiveness, and reduced overall hospitalization expenditures, conferring it with substantial clinical applicability and merit.
Collapse
Affiliation(s)
- Abuduwupuer Haibier
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Alimujiang Yusufu
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Hang Lin
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Aiben Kayierhan
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Yimuran Abudukelimu
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Alimujiang Aximu
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Tuerhongjiang Abudurexiti
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China.
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.
| |
Collapse
|
6
|
Liu L, Song F, Shang J, Zhang J, Ma C, Liu G, Han M. Bipedicular percutaneous kyphoplasty versus unipedicular percutaneous kyphoplasty in the treatment of asymmetric osteoporotic vertebral compression fractures: a case control study. BMC Surg 2023; 23:285. [PMID: 37726728 PMCID: PMC10510266 DOI: 10.1186/s12893-023-02180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Bipedicular/unipedicular percutaneous kyphoplasty are common treatments for OVCF, and there are no studies to show which is more beneficial for AVCF. The purpose of this study was to investigate the clinical efficacy of BPKP or UPKP in the treatment of AVCF. METHODS The clinical data of AVCF patients treated by PKP were retrospectively analyzed. They were divided into two groups according to the surgical approach. General demographic data, perioperative complications, and general information related to surgery were recorded for both groups. The preoperative and postoperative vertebral height difference, vertebral local Cobb angle, lumbar pain VAS score and lumbar JOA score were counted for both groups. The above data were compared preoperatively, postoperatively and between the two groups. RESULTS 25 patients with AVCF were successfully included and all were followed up for at least 12 months, with no complications during the follow-up period. 10 patients in the BPKP group and 15 patients in the UPKP group, with no statistically significant differences in general information between the two groups. The VAS scores of patients in the BPKP group were lower than those in the UPKP group at 12 months after surgery, and the differences were statistically significant, and there were no statistically significant differences between the two groups at other follow-up time points. In the BPKP group, 80% of patients had symmetrical and more homogeneous bone cement dispersion. 50% of patients in the UPKP group had a lateral distribution of bone cement and uneven bone cement distribution, and the difference in bone cement distribution between the two groups was statistically significant. CONCLUSION For the treatment of AVCF, the clinical efficacy of both surgical approaches is basically the same. The distribution of cement is more symmetrical and uniformly diffused in the BPKP group, and the clinical efficacy VAS score is lower in the long-term follow-up. Bipedicular percutaneous kyphoplasty is recommended for the treatment of AVCF. THE ETHICAL REVIEW BATCH NUMBER XZXY-LJ-20161208-047.
Collapse
Affiliation(s)
- Lei Liu
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Feifei Song
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Shang
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jianwei Zhang
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chao Ma
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Guangpu Liu
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Meng Han
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China.
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China.
| |
Collapse
|
7
|
Lu HT, Lin JY, Tsuei YC, Hsu YF, Chen CY, Cheng SH, Chu W, Li C, Chu WC. Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution-An Ex Vivo Study in Goat Vertebrae. Bioengineering (Basel) 2023; 10:795. [PMID: 37508822 PMCID: PMC10376675 DOI: 10.3390/bioengineering10070795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Osteoporosis-induced vertebral compression fracture (OVCF) occurs commonly in people over the age of 50, especially among menopausal women. Besides conservative therapy, minimally invasive percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used in clinical treatment and achieved good efficacy. However, the leakage of bone cement (CL) during vertebroplasty (PV) is a major risk that can cause (serious) complications such as compression of the spinal cord, pulmonary embolism, or even paraplegia. In this study, we introduced a new aspiration technique with standard PV procedures (APV) to ameliorate the risk of leakage with quantitative verifications of its effectiveness. APV intends to create a differential pressure to guide the direction of cement flow within the vertebrae. To test this technique, Nubian goats' ex vivo vertebral bodies (VBs) were used to simulate the PV surgical process in humans. Results show that the proposed APV has a lower leakage rate of 13% compared to the 53% of conventional PV. Additionally, the APV approach achieves more uniform cement distribution via the 9-score method with a value of 7 ± 1.30 in contrast to 4 ± 1.78 by conventional PV.
Collapse
Affiliation(s)
- Hsin-Tzu Lu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Jia-Yi Lin
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Yu-Chuan Tsuei
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Yung-Fu Hsu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Chung-Yi Chen
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Shih-Hao Cheng
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - William Chu
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Chuan Li
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Woei-Chyn Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| |
Collapse
|
8
|
Qian Y, Li Y, Shen G, Zhong X, Tang C, He S. Comparison of unipedicular and bipedicular kyphoplasty for treating acute osteoporotic vertebral compression fractures in the lower lumbar spine: a retrospective study. BMC Musculoskelet Disord 2023; 24:410. [PMID: 37221523 PMCID: PMC10204226 DOI: 10.1186/s12891-023-06545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/18/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Unipedicular and bipedicular approaches for percutaneous kyphoplasty are reportedly both effective in treating osteoporotic vertebral compression fractures (OVCFs). However, most studies have reported thoracolumbar fractures, with few reports describing the treatment of the lower lumbar spine. Here, we compared the clinical and radiological results of unipedicular and bipedicular approaches for percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures. METHODS We retrospectively reviewed the records of 160 patients who underwent percutaneous kyphoplasty for lower lumbar (L3-L5) osteoporotic vertebral compression fractures between January 2016 and January 2020. Patient characteristics, surgical outcomes, operation time, blood loss, clinical and radiological features, and complications were compared between two groups. Cement leakage, height restoration, and cement distribution were calculated from the radiographs. Visual pain analog scale (VAS) and Oswestry Disability Index (ODI) were calculated before surgery, immediately post-surgery, and 2 years after surgery. RESULTS The mean age, sex, body mass index, injury time, segmental distribution, and morphological classification of fractures before surgery did not differ significantly between the groups. The results showed significant improvements in the VAS score, ODI score, and vertebral height restoration in each group (p < 0.05), with no significant differences between the two groups (p > 0.05). The mean operation time and extent of blood loss were lower in the unipedicular group than those in the bipedicular group (p < 0.05). Different types of bone cement leakage were observed in both groups. Leakage rate was higher in the bipedicular group than in the unipedicular group. Patients in the bipedicular group showed greater improvement in bone cement distribution than those in the unipedicular group (p < 0.05). CONCLUSIONS The clinical and radiological results of unipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures in the lower lumbar region were similar to those of bipedicular percutaneous kyphoplasty. However, the unipedicular approach resulted in shorter surgical time, less blood loss, and less bone cement leakage. Thus, the unipedicular approach may be preferable owing to its several advantages.
Collapse
Affiliation(s)
- Yunfan Qian
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Yimin Li
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Guangjie Shen
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Xiqiang Zhong
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Chengxuan Tang
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Shaoqi He
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China.
| |
Collapse
|
9
|
Ma X, Zhao Y, Zhao J, Wu H, Feng H. Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of thoracic and lumbar metastatic tumors. J Clin Transl Res 2023; 9:93-100. [PMID: 37033999 PMCID: PMC10075092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/06/2022] [Accepted: 01/12/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Aim With the greatly prolonged survival of cancer patients, more and more patients develop bone metastasis, especially spinal metastasis. Therefore, it is very important to choose the best surgical plan for patients with spinal metastasis in different conditions. This paper aims to evaluate the clinical efficacy of percutaneous pedicle screw fixation (PPSF) combined with percutaneous vertebroplasty (PVP) for the treatment of thoracic and lumbar metastatic tumors. Methods Forty patients with thoracic and lumbar metastatic tumors were treated with PPSF combined with PVP and followed up for 6-33 months. The visual analog scale (VAS) and the Barthel Index of activities of daily living (BIADL) were used to evaluate the pain intensity and quality of life before surgery and at 7 days, 3 months, and 6 months after the treatment. Results In this study, a total of 40 patients were followed up for 6-33 months (the mean time was 14.87 months). The VAS scores of all patients were significantly decreased, while the BIADL scores were significantly increased. No patients suffered from complications such as infection, pedicle screw loosening, or polymethylmethacrylate leakage. Spine stability was observed in all surviving patients during the follow-up. Conclusions PPSF combined with PVP is a new and viable treatment for thoracolumbar metastases in patients with a poor systemic condition, patients who refuse to undergo a conventional open procedure such as en bloc corpectomy, and in patients with vertebral instability or pathological fracture without significant spinal compression. Relevance for Patients Patients with spinal metastases have a great risk of spinal instability and even spinal cord compression while enduring pain. Therefore, timely and appropriate surgical treatment is an effective means to stabilize the spine and avoid spinal cord compression. PPSF combined with PVP is an effective new surgical method for the treatment of multilevel spinal metastases.
Collapse
Affiliation(s)
- Xiaowei Ma
- Departments of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100021, China
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang 050011, Hebei Province, China
| | - Yi Zhao
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang 050011, Hebei Province, China
| | - Jiazheng Zhao
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang 050011, Hebei Province, China
| | - Hongzeng Wu
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang 050011, Hebei Province, China
| | - Helin Feng
- Departments of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100021, China
- Corresponding author: Helin Feng Departments of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100021, China.
| |
Collapse
|
10
|
Jiang LM, Tong YX, Jiang JJ, Pi YW, Gong Y, Tan Z, Zhao DX. The vertebral Hounsfield units can quantitatively predict the risk of adjacent vertebral fractures after percutaneous kyphoplasty. Quant Imaging Med Surg 2023; 13:1036-1047. [PMID: 36819268 PMCID: PMC9929385 DOI: 10.21037/qims-22-588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/04/2022] [Indexed: 01/05/2023]
Abstract
Background Measuring the Hounsfield units (HU) of the vertebrae may yield diagnostic information for fracture risk. This study aimed to measure HU of vertebrae in percutaneous kyphoplasty (PKP) patients using computed tomography (CT) imaging to determine the HU measurements threshold for adjacent vertebral fracture and to assess the relationship between HU measurements and the risk of adjacent vertebral fracture. Methods A retrospective study was conducted on consecutive patients who underwent PKP between January 2019 and October 2021 in the China-Japan Union Hospital of Jilin University. The HU of the vertebra was measured on the reconstructed CT images by 2 independent spine surgeons. The HU measurements of adjacent vertebrae and the ratio of HU measurements between the surgical vertebra and adjacent vertebrae were statistically analyzed to determine the best critical value and evaluate the prediction effectiveness and accuracy of the best critical value. Results A total of 105 patients were identified with complete imaging and follow-up information. Of these, 47 patients (44.8%) had evidence of an adjacent vertebral fracture on follow-up imaging. The mean HU measurements of the fractured adjacent vertebra were significantly different from the mean HU measurements of the unfractured adjacent vertebra (50.94±20.59 vs. 81.74±18.97 HU; P<0.001). There was a significant difference in the ratio of HU measurements between the surgical vertebra and the fractured adjacent vertebra and between the surgical vertebra and the unfractured adjacent vertebra (26.34±17.52 vs. 14.53±9.40; P<0.001). Interactive scatter plots and receiver operating characteristic (ROC) curve showed that a HU measurement of 66.9 and a HU measurements ratio of 15.18 were the best thresholds for predicting the risk of fracture of adjacent vertebrae after PKP surgery, with an area under the curve (AUC) of 0.901 [95% confidence interval (CI): 0.822-0.953; P<0.001] and 0.874 (95% CI: 0.790-0.934; P<0.001), respectively. The prediction accuracy was 90.4% and 84.0%, respectively. Conclusions A low mean HU measurements of adjacent vertebrae or a high ratio of the mean HU measurements of the operated vertebrae to the adjacent vertebrae are risk factors for the vulnerability of adjacent vertebrae to fracture. The risk of fracture in the adjacent vertebrae after PKP can be predicted by measuring HU.
Collapse
|
11
|
Tan Y, Liu J, Li X, Fang L, He D, Tan J, Xu G, Zhou X. Multilevel unilateral versus bilateral pedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Front Surg 2023; 9:1051626. [PMID: 36684261 PMCID: PMC9852753 DOI: 10.3389/fsurg.2022.1051626] [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: 09/23/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Study design Retrospective study. Objective Controversy exists over the need for unilateral vs. bilateral pedicular percutaneous vertebroplasty (PVP) for patients with osteoporotic vertebral compression fractures (OVCFs). Clinical research is scarce comparing two approaches for multi-level PVP. This study aimed at evaluating the clinical and radiographic outcomes of multi-level PVP using two approaches for OVCFs. Methods Seventy-eight patients with OVCFs undergoing multi-level PVP were enrolled including 36 patients undergoing unilateral PVP and 42 undergoing bilateral PVP. The clinical and radiological assessments including the Visual Analogue Scale (VAS), sagittal and coronal segmental Cobb, vertebral compression ratio (VCR), and vertebral sides ratio (VSR) were evaluated preoperatively and postoperatively. Results All patients achieved a minimum 2-year follow-up. A total of 164 fractured vertebrae were enrolled. Regarding clinical efficacy, the VAS score improved in both groups after surgery, but the two groups did not differ significantly. The changes tendency in Sagittal Segmental Cobb, VSR, and VCR were similar postoperatively, and no statistically significant difference between groups. As for the Coronal Segmental Cobb angle, patients in unilateral and bilateral groups were shown to have 5.0° ± 4.0° and 2.6° ± 2.2° degrees loss of correction at a minimum 2-years follow-up duration, respectively. The loss of correction in the Coronal Segmental Cobb of unilateral group was significantly greater than that of bilateral group. Conclusion Both multi-level unilateral and bilateral pedicular PVP achieved significant pain reduction and vertebral height restoration. Moreover, the bilateral PVP has shown advantages in stabilizing Coronal Cobb angle in patients with OVCFs.
Collapse
Affiliation(s)
- Yixuan Tan
- Department of Orthopedics, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jia Liu
- Department of Orthopedics, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiaoming Li
- Department of Orthopedics, The 72nd Army Hospital of the People’s Liberation Army, Huzhou, China
| | - Liangqin Fang
- Department of Orthopedics, The 72nd Army Hospital of the People’s Liberation Army, Huzhou, China
| | - Duowen He
- Department of Organ Transplant Center, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Junming Tan
- Department of Orthopedics, The 72nd Army Hospital of the People’s Liberation Army, Huzhou, China
| | - Guohua Xu
- Department of Orthopedics, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xuhui Zhou
- Department of Orthopedics, Spine Center, Second Affiliated Hospital of Naval Medical University, Shanghai, China,Correspondence: Xuhui Zhou
| |
Collapse
|
12
|
A novel classification of cement distribution patterns based on plain radiographs associated with cement filling rate and relevance to the clinical results of unipedicle vertebroplasty. 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 2023; 32:101-109. [PMID: 36220958 DOI: 10.1007/s00586-022-07412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/21/2022] [Accepted: 09/27/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cement distribution pattern following unipedicle percutaneous vertebroplasty (UVP) for osteoporotic vertebral compression fractures (OVCFs) has been reported in association with clinical results. The present retrospective study aimed to classify the bone cement distribution types following UVP and investigate the differences in clinical efficacy and related complications. MATERIALS AND METHODS We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent UVP. Cement distribution patterns were divided into the diffuse, block, double band, and single band types according to the plain radiographs and further by cement filling rate (CFR) based on a three-dimension reconstruction of post-operative CT. The cutoff values of CFR were > 34% for the diffuse, block between 34 and 20%, and each band of the double or single band < 20%. Clinical efficacy and related complications were compared among the four cement distribution types 24 h after the operation and the last follow-up. RESULTS A total of 155 patients with an average follow-up time of 20.3 months were included. The diffuse type included 26 patients; block, 87; double band, 18; and single band, 24. The VAS and ODI after operation improved significantly in all four groups. The diffuse and block types had similar clinical results. The clinical outcomes in the single band group were the poorest at the last follow-up. The patients with single band type also had the highest rates of body re-collapse and revision surgery for the index level. CONCLUSION Diffuse and block groups can better maintain the height of the vertebral body and reduce the risk of vertebral body recompression. The single band has the poorest results, and intraoperative immediate contralateral vertebroplasty was highly recommended.
Collapse
|
13
|
Yan BC, Fan YF, Tian QH, Wang T, Huang ZL, Song HM, Li Y, Jiao L, Wu CG. Efficacy and Safety of the Safe Triangular Working Zone Approach in Percutaneous Vertebroplasty for Spinal Metastasis. Korean J Radiol 2022; 23:901-910. [PMID: 35926840 PMCID: PMC9434739 DOI: 10.3348/kjr.2021.0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 06/09/2022] [Accepted: 06/19/2022] [Indexed: 12/05/2022] Open
Abstract
Objective This study aimed to assess the technical feasibility, efficacy, and safety of the safe triangular working zone (STWZ) approach applied in percutaneous vertebroplasty (PV) for spinal metastases involving the posterior part of the vertebral body. Materials and Methods We prospectively enrolled 87 patients who underwent PV for spinal metastasis involving the posterior part of the vertebral body, with or without the STWZ approach, from January 2019 to April 2022. Forty-nine patients (27 females and 22 males; mean age ± standard deviation [SD], 57.2 ± 11.6 years; age range, 31–76 years) were included in group A (with STWZ approach), accounting for 54 vertebrae. Thirty-eight patients (18 females and 20 males; 59.1 ± 10.9 years; 29–81 years) were included in group B (without STWZ approach), accounting for 57 vertebrae. Patient demographics, procedure-related variables, and pain relief as assessed using the visual analog scale (VAS) were collected at different time points. Tumor recurrence in the vertebrae after PV was analyzed using Kaplan–Meier curves. Results The STWZ approach was successful from T1 to L5 without severe complications. Cement filling was satisfactory in 47/54 (87.0%) and 25/57 (43.9%) vertebrae in groups A and B, respectively (p < 0.001). Cement leakage was not significantly different between groups A and B (p = 1.000). Mean VAS score ± SD before and 1 week and 1, 3, 6, 9, and 12 months after PV were 7.6 ± 1.8, 4.2 ± 2.0, 2.7 ± 1.9, 1.9 ± 1.5, 1.7 ± 1.4, 1.7 ± 1.1, and 1.6 ± 1.3, respectively, in group A and 7.2 ± 1.7, 4.0 ± 1.3, 3.4 ± 1.6, 2.4 ± 1.2, 1.8 ± 1.0, 1.4 ± 0.5, and 1.7 ± 0.9, respectively, in group B. Kaplan–Meier analysis showed a lower tumor recurrence rate in group A than in group B (p = 0.001). Conclusion The STWZ approach may represent a new, safe, alternative/auxiliary approach to target the posterior part of the vertebral body in the PV for spinal metastases.
Collapse
Affiliation(s)
- Bi Cong Yan
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yan Feng Fan
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qing Hua Tian
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Wang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhi Long Huang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hong Mei Song
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Lei Jiao
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chun Gen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| |
Collapse
|
14
|
Zhou C, Liao Y, Huang S, Li H, Zhu Z, Zheng L, Wang B, Wang Y. Effect of cement distribution type on clinical outcome after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the aging population. Front Surg 2022; 9:975832. [PMID: 36034386 PMCID: PMC9405186 DOI: 10.3389/fsurg.2022.975832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
Objective The study aimed to investigate the effect of the type of bone cement distribution on clinical outcomes following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF) in the elderly. Methods Retrospective analysis of 160 patients diagnosed with OVCF who underwent PVP treatment from March 2018 to December 2020. Based on the kind of postoperative bone cement distribution, bone cement was classified as types I, II, III, IV, and V. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, anterior vertebral height ratio, refracture rate of injured vertebrae, and incidence of adjacent vertebral fractures were compared for the five types before and after three days, and one year of operation. Results VAS and ODI at three days and one year postoperative were significantly lower than those preoperative (P < 0.05) for all five distribution types. VAS and ODI for types I, II, and III were lower at one year postoperatively than for types IV and V (P < 0.05). There was no significant difference in Cobb angle and anterior vertebral body height ratio between preoperative and three days postoperative groups (P < 0.05); however, there were significant differences between three days and one-year postoperative and preoperative groups (P < 0.05). Following one year of surgery, the Cobb angle and the anterior vertebral height ratio of types IV and V were significantly different from those of types I, II, and III (P < 0.05), and there was a statistically significant difference between types IV and V (P < 0.05). In terms of the incidence of injured vertebral refractures and adjacent vertebral fractures, the evenly distributed types I, II, and III were significantly lower than the unevenly distributed types IV and V, and the incidence of type V was higher (P < 0.05). Conclusions The clinical efficacy of cement distribution following PVP of types I, II, and III is better than that of types IV and V, which can better relieve pain with long-lasting efficacy and minimize the occurrence of refractures of injured vertebrae and adjacent vertebral body fractures.
Collapse
Affiliation(s)
- Chengqiang Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Graduate School of Xuzhou Medical University, Xuzhou, China
| | - Yifeng Liao
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Graduate School of Xuzhou Medical University, Xuzhou, China
| | - Shaolong Huang
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Graduate School of Xuzhou Medical University, Xuzhou, China
| | - Hua Li
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ziqiang Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Li Zheng
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Bin Wang
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yunqing Wang
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| |
Collapse
|