PURPOSE To evaluate the differences of radiological outcomes of uniportal and biportal vertebroplasty in the point of bone cement distribution and leakage. MATERIALS AND METHODS A retrospective study reviewing the period between May 2002 and January 2006 investigated 100 vertebrae which underwent vertebroplasty and followed for more than three months by uniportal approach (55 vertebrae, group 1) and biportal approach (45 vertebrae, group 2). The operative time, the amount of bone cement injected, anterior vertebral height restoration, kyphotic angle, bone cement distribution, and bone cement leakage were evaluated. RESULTS The amount of injected bone cement of group 1 (3.9 cc) was statistically smaller than that of group 2 (5.1 cc) (p=0.016). There were no significant differences in the operative time, anterior vertebral height restoration, kyphotic angle in both groups. The rate of bone cement distribution over 8 zones was significantly higher in group 2 than in group 1 (p=0.014). However, the rate of bone cement distribution over 7 zones and the rate of bone cement distributed on whole anterior vertebral body were not significantly different in both groups. The cement leakage was not also significantly different in both groups. CONCLUSION Although the amount of injected bone cement was smaller in uniportal vertebroplasty, the radiological results and cement leakage were similar to biportal vertebroplasty. These findings suggest that uniportal vertebroplasty can be the operative options in osteoporotic vertebral fracture.
PURPOSE To evaluate whether progression of compression correlates with bone densiometry index in patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine. MATERIALS AND METHODS Using the results of bone densiometry, 30 patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine between March 2002 to March 2005 were categorized into 4 groups; above 80%, 70 to 80%, 60 to 70%, and below 60%. We compared the measurements of sagittal index and anterior vertebral height from the plain radiographs taken at the time of injury and following three consecutive months after the injury. RESULTS Patients with lower bone densiometry index had greater amount of compression at the time of injury and more rapid progression of compression. We also found that progression of compression was lowest during the first month after injury in all groups. CONCLUSION Patients with low bone densiometry index in osteoporotic thoracolumbar compression fracture are susceptible to more rapid progression of compression and should have early brace application and longer duration of treatment for osteoporosis.
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External fixation for severe fractures of the distal radius is accepted treatment offering the potential advantages of controlled distraction, accurate positioning of fracture fragments, and avoidance of extensive open procedures. One of the limitation of external fixation for distal radius fractures is excessive distraction, which affect the outcome. This study was conducted to evaluate the changes of the distraction of the intercarpal and radiocarpal joint, developed after treatment of distal radius fractures with external fixator. Restrospective study was done for 28 paitents, who were evaluated by chart review, questionnaire, radiograph, and physical examination. The carpal height ratio, radial inclination, velar tilt, radial length were measured in the postoperative and follow-up radiographs. The carpal height ratio was used to quantify the distraction. Functional evaluation was performed with Demerit-Point system described by Garthland and Werley. Five fractures had an excellent results, 16 had a good results, 4 had a fair results, and 3 had poor results. After union, average radial inclination was 21.3 degree, average dorsal angulation was -0.5 degree, and radial shortening was 1mm. Increased carpal height ratio of the 9 cases did not decrease to less than 0.56 at one year after operation. The over-distraction of intercarpal and radiocarpal joint developed after external fixation of the distal radius fracture, did not have decreased in the one year follow-up radiographs after operation. The over- distraction should be avoided intraoperativly.
The purposes of this study are to make an operative treatment option of thoracolumbar burst fractures by the degree of initial kyphotic deformity or by the degree of initial loss of anterior vertebral height. We analyzed sixty-three cases of one segmental thoracolumbar bursting fractures treated surgically by posterior or posterolateral fusion with short segmental transpedicular screws fixation method using Diapason or CD from January, 1992 to October, 1996. Indications of operative treatment were that the degree of initial kyphotic deformity was above 15degreesor initial loss of anterior vertebral height was above 30%. Minimum follow-up period was 12 months and the results were as follows : 1. Entirely, mean kyphotic angle was 21.6degreesinitially, 11.3degreespostoperatively and 14.2degrees at the end of follow-up. Mean anterior vertebral height was 59.6% initially, 83.8% postoperatively and 80.8% at the end of follow-up. So 10.3degrees , 24.2% was corrected postoperatively and loss of correction was 2.9degrees , 3% at the end of follow-up. 2. In the respect of the degree of initial kyphotic deformity, when compared above 30degrees with below 30degrees , loss of correction was 7.3degrees , 1.4degrees at the end of follow-up respectively and this result had significant difference between these two groups statistically. 3. In the respect of initial loss of anterior vertebral height, when compared above 55% with below 55%, loss of correction was 7.7%, 2.2% at the end of follow-up respectively and this result had significant difference between these two groups statistically. 4. In the respect of time interval from injury to operation, when compared within 2 weeks with after 2 weeks, respectively loss of correction was 1.7-2.2degrees , 3-3.9% and 4.1degrees , 6.7% at the end of follow-up and this results had significant difference between these two groups statistically. These data suggested if initial kyphotic angle is below 30degrees or initial loss of anterior vertebral height less than 55%, short segmental transpedicular screw fixation provide sufficient stability but if initial kyphotic angle is above 30degrees or initial loss of anterior vertebral height is above 55%,additional anterior interbody fusion may be considered.
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Osteoporosis is the metabolic bone disease and the bone is easily fracture by minimal stress due to decreased bone mass. It gets to attract more and more interest due to surprisingly high incidence and prevalence as well as its complications, fracture. We compared the bone mineral density between 45 osteoporotic patients group with compression fractures of the spine, 105 osteoporotic patients group without fractures and 45 normal control group using dual energy X-ray absorptiometry.
We obtained following results. 1. There are statistically no significant differences between bone mineral density of the osteoporotic group with compression fracture of the spine and bone mineral density of the osteoporotic group without fractures. 2. Height and weight had statistically significant correlation with bone mineral density of the lumbar spine anteroposterior view, lateral view and Ward triangle. 3. Fracture threshold of the lumbar spine anteroposterior view, lateral wiew and Ward triangle are 0.884g/cm2, 0.694g/cm2 and 0.514g/cm2 according to 90percentile, 0.979g/cm2, 0.732g/cm2, 0.545g/cm2 according to 95percentile.
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