Osteoporosis as a systemic chronic skeletal disease is characterized by low bone mineral density and increased risk to osteoporotic fractures.Osteoporosis is prevalent in the middle-aged and elderly population,especia...Osteoporosis as a systemic chronic skeletal disease is characterized by low bone mineral density and increased risk to osteoporotic fractures.Osteoporosis is prevalent in the middle-aged and elderly population,especially in the postmenopausal women.With population aging,osteoporosis has become a world-wide serious public health problem.Early recognition of the high-risk population followed by timely and efficient intervention and/or treatment is important for preventing osteoporotic fractures.In light of the high heritability and complex pathogenesis of osteoporosis,comprehensive consideration of vital biological/biochemical factors is necessary for accurate risk evaluation of fractures.For this purpose,we review recent research progress on molecules which can be applied to assess risk for osteoporotic fractures.Future integrative analyses and systematic evaluation of these molecules may facilitate developing novel methodologies and/or test strategies,i.e.,biochips,for early recognition of osteoporosis,hence contributing to preventing osteoporotic fractures.展开更多
With the global population aging,especially in China,the prevention and management of osteoporotic fragility fractures has become increasingly important.Bone mineral density(BMD)is an important index of osteoporotic f...With the global population aging,especially in China,the prevention and management of osteoporotic fragility fractures has become increasingly important.Bone mineral density(BMD)is an important index of osteoporotic fracture risk,which has become aroutine measurement inclinical practice and thus formed the cornerstone in monitoring treatment efficacy of osteoporosis.In the past 30 years,several pharmacologic therapies have been developed to increase BMD and reduce osteoporotic fractures,especially vertebral fractures.However,the management of nonvertebral fractures and hip fractures remains challenging as low BMD is only one of the multi-factors for these conditions.Hip fractures mainly result from a fall and its incidence is higher in the frigid zone due to low temperature affecting neuromuscular function and high latitude with less sunlight,the conditions rendering less active vitamin D conversion,apart from increased falling.In this paper,we focus on two therapeutic strategies targeting both skeletal and non-skeletal factors,that is,Tai Chi(TC)exercise for improving balance and"kidney-tonifying"traditional Chinese medicine(TCM)against muscle atrophy.TC is a mind-body exercise that has the potential as an effective and safe intervention for preventing fall-related fractures in the elderly.This makes it a promising and feasible physical activity for the elderly in frigid zone to prevent osteoporotic fractures.Several TCM formula popular in northeast of China within frigid zone are also introduced.They are reportedly effective in maintaining or improving BMD and muscle strength with the potential of reducing osteoporotic fracture.However,more rationally designed vigorous basic investigations and prospective clinical trials are highly desired to validate and consolidate the preliminary observations in the future.展开更多
Postmenopausal osteoporosis is a kind of degenerative disease,also described as“invisible killer.”Estrogen is generally considered as the key hormone for women to maintain bone mineral content during their lives.Iro...Postmenopausal osteoporosis is a kind of degenerative disease,also described as“invisible killer.”Estrogen is generally considered as the key hormone for women to maintain bone mineral content during their lives.Iron accumulation refers to a state of human serum ferritin that is higher than the normal value but less than 1000μg/L.It has been found that iron accumulation and osteoporosis could occur simultaneously with the decrease in estrogen level after menopause.In recent years,many studies indicated that iron accumulation plays a vital role in postmenopausal osteoporosis,and a significant correlation has been found between iron accumulation and fragility fractures.In this review,we summarize and analyze the relevant literature including randomized controlled trials,systematic reviews,and meta-analyses between January 1996 and July 2022.We investigate the mechanism of the effect of iron accumulation on bone metabolism and discuss the relationship of iron accumulation,osteoporosis,and postmenopausal fragility fractures,as well as the main clinical treatment strategies.We conclude that it is necessary to pay attention to the phenomenon of iron accumulation in postmenopausal women with osteoporosis and explore the in-depth mechanism of abnormal bone metabolism caused by iron accumulation,in order to facilitate the discovery of effective therapeutic targets for postmenopausal osteoporosis.展开更多
OBJECTIVE: To investigate the effectiveness of osteoking, a Traditional Chinese Medicine originating from Yi nationality, against osteoporosis(OP) and osteoporotic fracture(OPF), and to elucidate its mechanism of acti...OBJECTIVE: To investigate the effectiveness of osteoking, a Traditional Chinese Medicine originating from Yi nationality, against osteoporosis(OP) and osteoporotic fracture(OPF), and to elucidate its mechanism of action.METHODS: An osteoporotic fracture rat model was established;animals were divided into three treatment groups: parathyroid hormone, osteoking and0.9%NaCl. After 4, 8 and 12 weeks of treatment, serum and bone tissues were collected. Enzyme-linked immuno sorbent assay, x-ray, histopathological evaluation and proteomics were used.Proteomics and GO annotation were performed based on identified peptides. The relative network was obtained from the STRING database and verified by polymerase chain reaction and Western blotting.RESULTS: After osteoking treatment, the bone mineral density(BMD) increased with time in the osteoking group. At week 12, the BMD and bone mineral salt content of the osteoking group were 4.5%and 20.6% higher than those of the negative control group, respectively. Furthermore, the body weight followed the order of positive control group > osteoking group > negative control group,with significant differences among the groups(P <0.05). Micro-CT analysis of femur sections revealed that the bone surface/volume ratio was significantly higher in the osteoking group than that in the negative control group. X-ray images demonstrated that the osteoking group showed clear callus.Moreover, high-voltage micro-CT demonstrated a massive cortical bone accumulation in the osteoking group. The gray values of callus in the osteoking group were higher than those in the negative group. From week 4 to 12, the serum bone alkaline phosphatase level increased by 49.6% in the osteoking group and the serum propeptide of type procollagen level decreased by 80.6%. Alizarin reⅠd staining demonstrated that the calcium deposition in the osteoking group was higher than that in the negative control group. Notably, the expression of Mgp, a key osteogenesis inhibitor, was lower in the osteoking group compared with the negative control group. Moreover, Sparc, bone morphogenetic protein-2 and Bglap expression was higher in the osteoking group through activation of the transforming growth factor-receptor activator of nuclear factor κB Ligand pathway.CONCLUSION: Osteoking treatment increased bone quality and promoted calcium deposition.The results suggest that osteoking inhibits Mgp through the TGF-β/RANKL pathway to improve OP/OPF.展开更多
This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture(OVCF),who received b...This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture(OVCF),who received balloon kyphoplasty.Patients were divided into four groups:Group 1 had no superior endplate fracture,Group 2 had fractures on the anterior portion of the superior endplate,Group 3 had fractures on the posterior portion of the superior endplate,and Group 4 had complete superior endplate fractures.Anterior and middle vertebral body height,vertebral compression ratio,vertebral height loss rate,and kyphosis Cobb angle of each patient were measured and visual analogue scale(VAS) and Oswestry disability index(ODI) scores were recorded.The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery,whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up.Although the vertebral height loss rate and the Cobb angle in Group 2,3 and 4 were larger compared with Group 1 at the last follow-up,only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1.The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores,but there was no significant difference among these groups.Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis.Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery.Postoperative aggravation of kyphosis was observed in Group 2.Furthermore,severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery.Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture.Therefore,surgery should not only restore compressed vertebral body height and correct kyphosis,but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.展开更多
BACKGROUND Osteoporosis is a global disease affecting 6.6%of the total population.Osteoporosis complications include fractures,increased bone fragility,and reduced bone strength.The most commonly affected parts are th...BACKGROUND Osteoporosis is a global disease affecting 6.6%of the total population.Osteoporosis complications include fractures,increased bone fragility,and reduced bone strength.The most commonly affected parts are the vertebral body,hip,and wrist.AIM To examine the effect of alendronate sodium combined with InterTan for osteoporotic femoral intertrochanteric fractures on bone and fracture recurrence METHODS In total,126 cases of osteoporotic femoral intertrochanteric fractures were selected and divided into two groups according to the 1:1 principle by the simple random method.They were admitted to the Department of Orthopedics,First Affiliated Hospital of Xingtai Medical College,from January 2018 to September 2020.The control group was treated with InterTan fixation combined with placebo,and the observation group with alendronate sodium based on InterTan fixation.Operation-related indicators,complications,and recurrent fractures were compared between the groups.Changes in bone metabolism markers,t value for hip bone mineral density,and Harris Hip Score were observed.RESULTS Operation time,intraoperative blood loss,postoperative ambulation time,and complications were compared between the groups,and no significant difference was found.The fracture healing time was significantly shorter in the observation group than in the control group.β-Collagen-specific sequence(β-CTX)and total aminoterminal propeptide of type I procollagen(T-PINP)in the control group at 3 mo after operation were compared with those before operation,and the difference was not significant.Six months after the operation,theβ-CTX level decreased and T-PINP level increased.β-CTX level at 3 and 6 mo in the observation group after operation was lower,and TPINP level was higher,than that before operation.Compared with the control group,T-PINP level of the observation group was significantly higher andβ-CTX level was significantly lower at 3 and 6 mo after operation.The t value of hip bone mineral density was compared in the control group before and 1 mo after operation,and significant difference was not found.Compared with the control group,the t value of hip bone mineral density in the observation group was significantly higher at 1,3,6,and 12 mo after operation.Compared with the control group,the Harris score of the observation group was significantly higher at 1,3,6,and 12 mo after operation.The recurrence rate of fractures in the observation group within 12 mo was 0.00%,which was significantly lower than 6.35%in the control group.CONCLUSION Alendronate sodium combined with InterTan in the treatment of osteoporotic femoral intertrochanteric fractures can increase bone mineral density,improve hip joint function,promote fracture healing,and reduce fracture recurrence.展开更多
Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review ...Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.展开更多
BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral comp...BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.展开更多
Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat...Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.展开更多
<strong>Background:</strong> Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy o...<strong>Background:</strong> Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. <strong>Purpose:</strong> To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). <strong>Method:</strong> A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (<em>β</em>-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. <strong>Results:</strong> After normalized treatment, the bone metabolism indexes of PINP and <em>β</em>-CTX were improved and BMD was increased in three groups. <strong>Adverse Reactions:</strong> There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). <strong>Conclusion:</strong> Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.展开更多
Osteoporotic Vertebral Fracture(OVFs)is a common lumbar spine disorder that severely affects the health of patients.With a clear bone blocks boundary,CT images have gained obvious advantages in OVFs diagnosis.Compared...Osteoporotic Vertebral Fracture(OVFs)is a common lumbar spine disorder that severely affects the health of patients.With a clear bone blocks boundary,CT images have gained obvious advantages in OVFs diagnosis.Compared with CT images,X-rays are faster and more inexpensive but often leads to misdiagnosis and miss-diagnosis because of the overlapping shadows.Considering how to transfer CT imaging advantages to achieve OVFs classification in X-rays is meaningful.For this purpose,we propose a multi-modal semantic consistency network which could do well X-ray OVFs classification by transferring CT semantic consistency features.Different from existing methods,we introduce a feature-level mix-up module to get the domain soft labels which helps the network reduce the domain offsets between CT and X-ray.In the meanwhile,the network uses a self-rotation pretext task on both CT and X-ray domains to enhance learning the high-level semantic invariant features.We employ five evaluation metrics to compare the proposed method with the state-of-the-art methods.The final results show that our method improves the best value of AUC from 86.32 to 92.16%.The results indicate that multi-modal semantic consistency method could use CT imaging features to improve osteoporotic vertebral fracture classification in X-rays effectively.展开更多
Background: Novel coronavirus pneumonia (NCP) and osteoporotic vertebral compression fractures (OVCF) are the high incidences of diseases in the elderly. During the epidemic period, if not treated in time, the complic...Background: Novel coronavirus pneumonia (NCP) and osteoporotic vertebral compression fractures (OVCF) are the high incidences of diseases in the elderly. During the epidemic period, if not treated in time, the complications are high and the mortality is high. If we do not pay attention to infection prevention and control in pre-hospital emergency care, it will lead to the first time infection of medical staff and in-hospital cross infection in emergency outpatient receiving area. The correct consideration of both and the establishment of perfect pre-hospital emergency treatment and infection prevention and control synchronous strategy is an important premise to ensure the stable, orderly and safe medical treatment. Objective: To explore the effect of synchronous implementation of pre-hospital emergency care, nursing and infection pre-vention and control for senile OVCF during the epidemic. In order to improve the efficiency of pre-hospital emergency care and prevent the spread of infection. Method: A total of 92 elderly patients with OVCF who received pre-hospital treatment in 18 hospitals in Zhangjiakou City during the epidemic prevention and control period from January 2020 to November 2022 and met the inclusion criteria were selected as research objects, including 24 males and 68 females, aged 65 - 82 (74.2 ± 2.2) years. All patients were associated with concomitant injuries and underlying diseases. All patients in this group underwent predictive pre-hospital rescue and infection prevention and control procedures. Results: All the 92 elderly patients with OVCF received timely pre-hospital treatment during the epidemic period, and no aggravation occurred of the 92 patients, 35 were in the high risk area, 10 were in the medium risk area, and 47 were in the low risk area. Exclude OVCF for NCP Patients were treated according to the conventional diagnosis and treatment principles. Suspected and confirmed cases are transferred to designated surgical hospitals for treatment. All patients were followed up 3 months, 6 months and 12 months after treatment. There was no death rate, high satisfaction of pre-hospital first aid, high diagnostic accuracy, and good curative effect. None of the rescue personnel had any infection rate, and no hospital infection transmission and nosocomial cross infection occurred. Conclusion: It is the first step to safely treat patients and prevent cross infection to establish a perfect synchronous strategy of pre-hospital first aid and infection prevention and control.展开更多
Objective:The influence of vertebral compression fracture on the degeneration of adjacent disc was analyzed.Methods:88 patients with osteoporotic vertebral compression fractures admitted to the orthopedic pain departm...Objective:The influence of vertebral compression fracture on the degeneration of adjacent disc was analyzed.Methods:88 patients with osteoporotic vertebral compression fractures admitted to the orthopedic pain department from July 2014 to July 2019 were selected as the research objects.According to the previous MRI and the improved MRI results of admission,the patients were converted into old fractures after conservative treatment.They were followed up in 3,6 and 12 months after discharge,and the VAS score at each time point(visual acuity score)was calculated We collected and analyzed the classifcation of intervertebral disc degeneration and MRI index.Results:The follow-up rate was 659%(58/88);There were 42 cases(72.4%)of degenerative disc adjacent to the diseased vertebra,and 16 cases(27.5%)of adjacent intervertebral disc did not degenerate;VAS scores were 1ower at 14 days,3 months,6 months and 12 months after admission;The number of grade 1 of disc degeneration was lower in 6 months and 12 months than that in admission(P<0.05),and the number of grade 2,3 and 4 was significantly higher than that in the follow-up in December(P<0.05).The difference between 6 and 12 months was not statistically significant(P>0.05);MRI index at 6 and 12 months follow-up was lower than that at admission(P<0.05).Conclusion:Through the research and analysis,we found that osteoporotic vertebral compression fracture will have a corresponding impact on the adjacent intervertebral disc,which can make the adjacent intervertebral disc degenerate.展开更多
Objective:To explore the clinical value of kyphoplasty and conservative treatment for osteoporotic vertebral compression fractures.Methods:40 patients with Osteoporotic vertebral compression fracture from May 2019 to ...Objective:To explore the clinical value of kyphoplasty and conservative treatment for osteoporotic vertebral compression fractures.Methods:40 patients with Osteoporotic vertebral compression fracture from May 2019 to November 2021 were selected.The control group was treated with conservative treatment and the experimental group was treated with kyphoplasty.Results:Compared with the control group,the experimental group had higher total effective rate(95.00%),better recovery of Cobb Angle and vertebral height,and higher quality of life score.The data was more meaningful(P<0.05).Conclusion:For patients with osteoporotic vertebral compression fractures,the application of kyphoplasty can improve the treatment effect,accelerate the recovery of vertebral body function and enhance the quality of life,which is worthy of popularization.展开更多
Objective To compare the clinical outcomes of 2 surgical interventions for osteoporotic vertebral compression fractures(OVCF).Methods Sixty-five patients with OVGF from March 2005 to March 2009 were included in this c...Objective To compare the clinical outcomes of 2 surgical interventions for osteoporotic vertebral compression fractures(OVCF).Methods Sixty-five patients with OVGF from March 2005 to March 2009 were included in this clinical study.They展开更多
BACKGROUND Locking plate fixation in osteoporotic ankle fractures may fail due to cut-out or metalwork failure.Fibula pro-tibia fixation was a technique prior to the advent of locking plates that was used to enhance s...BACKGROUND Locking plate fixation in osteoporotic ankle fractures may fail due to cut-out or metalwork failure.Fibula pro-tibia fixation was a technique prior to the advent of locking plates that was used to enhance stability in ankle fractures by achieving tri or tetra-cortical fixation.With locking plates,the strength of this fixation construct can be further enhanced.There is lack of evidence currently on the merits of tibiapro-fibula augmented locking plate fixation of unstable ankle fractures.AIM To assess if there is increased strength to failure,in an ankle fracture saw bone model,with a fibula pro-tibia construct when compared with standard locking plate fixation.METHODS Ten osteoporotic saw bones with simulated supination external rotation injuries were used.Five saw bones were fixed with standard locking plates whilst the other 5 saw bones were fixed with locking plates in a fibula pro-tibia construct.The fibula pro-tibia construct involved fixation with 3 consecutive locking screws applied across 3 cortices proximally from the level of the syndesmosis.All fixations were tested in axial external rotation to failure on an electromagnetic test frame(MTS 858 Mini-Bionix test machine,MTS Corp,Eden Praire,MN,United States).Torque at 30 degrees external rotation,failure torque,and external rotation angle at failure were compared between both groups and statistically analyzed.RESULTS The fibula pro-tibia construct demonstrated a statistically higher torque at 30 degrees external rotation(4.421±0.796 N/m vs 1.451±0.467 N/m;t-test P=0.000),as well as maximum torque at failure(5.079±0.694N/m vs 2.299±0.931 N/m;t-test P=0.001)compared to the standard locking plate construct.The fibula pro-tibia construct also had a lower external rotation angle at failure(54.7±14.5 vs 67.7±22.9).CONCLUSION The fibula pro-tibia locking plate construct demonstrates biomechanical superiority to standard locking plates in fixation of unstable ankle fractures in this saw bone model.There is merit in the use of this construct in patients with unstable osteoporotic ankle fractures as it may aid improved clinical outcomes.展开更多
Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures(OVCFs) after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation(PSF)...Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures(OVCFs) after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation(PSF) with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation(PSF),two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.展开更多
BACKGROUND As one of the most common complications of osteoporosis,osteoporotic vertebral compression fracture(OVCF)increases the risk of disability and mortality in elderly patients.Percutaneous vertebroplasty(PVP)is...BACKGROUND As one of the most common complications of osteoporosis,osteoporotic vertebral compression fracture(OVCF)increases the risk of disability and mortality in elderly patients.Percutaneous vertebroplasty(PVP)is considered to be an effective,safe,and minimally invasive treatment for OVCFs.The recollapse of cemented vertebrae is one of the serious complications of PVP.However,the risk factors associated with recollapse after PVP remain controversial.AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.METHODS A systematic search in EMBASE,MEDLINE,the Cochrane Library,and PubMed was conducted for relevant studies from inception until March 2020.Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis.Odds ratios(ORs)or standardized mean differences with 95%confidence interval(CI)were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test.The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale.RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls.The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction(OR=2.09;95%CI:1.30 to 3.38;P=0.002),preoperative intravertebral cleft(OR=2.97;95%CI:1.93 to 4.57;P<0.00001),and solid lump distribution pattern of the cement (OR = 3.11;95%CI: 1.91 to 5.07;P < 0.00001).The analysis did not support that age, gender, lumbar bone mineral density,preoperative visual analogue scale score, injected cement volume, intradiscalcement leakage, or vertebral height restoration could increase the risk forcemented vertebra recollapse after PVP in OVCFs.CONCLUSIONThis meta-analysis suggests that thoracolumbar junction fractures, preoperativeintravertebral cleft, and solid lump cement distribution pattern are associatedwith the recollapse of cemented vertebrae after PVP in OVCF patients.展开更多
BACKGROUND Intradural anesthesia caused by anesthetic drug leakage during percutaneous vertebroplasty(PVP)has rarely been reported.We here report a 71-year-old woman who suffered this rare and life-threatening complic...BACKGROUND Intradural anesthesia caused by anesthetic drug leakage during percutaneous vertebroplasty(PVP)has rarely been reported.We here report a 71-year-old woman who suffered this rare and life-threatening complication during PVP.CASE SUMMARY A 71-year-old woman,who suffered from 2 wk of severe back pain with a visual analog score of 8,came to our outpatient clinic.She was later diagnosed with a newly compressed L1 fracture and was then admitted in our department.PVP was initially attempted again under local anesthesia.However,serendipitous intradural anesthesia leading to total spinal anesthesia happened.Fortunately,after successful resuscitation of the patient,PVP was safely and smoothly performed.Great pain relief was achieved postoperatively,and she was safely discharged on postoperative day 4.The patient recovered normally at 3-mo follow-up.CONCLUSION Total spinal anesthesia secondary to PVP by anesthetic drug leakage rarely occurs.In cases of inadvertent wrong puncture leading to drug leakage when performing it under local anesthesia,surgeons should be highly vigilant during the whole procedure.Electrocardiogram monitoring,oxygen inhalation,intravenous cannula set prior to surgery,regular checking of motor activity and a meticulous imaging monitoring with slower pushing of anesthetic drugs,etc.should be highly recommended.展开更多
We investigated the feasibility of applying polymethylmethacrylate bone cement composited with biomimetic bone-mineralizsed collagen to percutaneous kyphoplasty(PKP).We performed PKP in 95 patients diagnosed with oste...We investigated the feasibility of applying polymethylmethacrylate bone cement composited with biomimetic bone-mineralizsed collagen to percutaneous kyphoplasty(PKP).We performed PKP in 95 patients diagnosed with osteoporotic vertebral compression fracture.All patients had fractures of a single vertebral body,and they were divided randomly into control(group A,47 patients)and experimental(group B,48 patients)groups.Patients in group A were treated with acrylic cement,and those in group B were treated with acrylic cement composited with the bone graft material.All patients were evaluated by a visual analogue scale(VAS),Oswestry disability index(ODI),Cobb angle and anterior vertebral body height preoperatively,and 3 days and 3 months postoperatively.All patients successfully completed surgery and were followed up thereafter.The VAS score,ODI index,Cobb angle and anterior vertebral body height compression rate in both groups had significant changes(P<0.05)preoperatively,and at 3 days and 3 months postoperatively.There was no significant difference between the two groups at different times(P>0.05).The analgesic effects of bone cement composited with bone-mineralized collagen are similar to those of bone cement only.Mineralized collagen has excellent promotion prospects by inducing new bone formation and reducing the incidence of adverse reactions caused by bone cement.展开更多
基金the Startup Fund from Soochow University(Q413900712)the Project of the Priority Academic Program Development of Jiangsu Higher Education Institution.
文摘Osteoporosis as a systemic chronic skeletal disease is characterized by low bone mineral density and increased risk to osteoporotic fractures.Osteoporosis is prevalent in the middle-aged and elderly population,especially in the postmenopausal women.With population aging,osteoporosis has become a world-wide serious public health problem.Early recognition of the high-risk population followed by timely and efficient intervention and/or treatment is important for preventing osteoporotic fractures.In light of the high heritability and complex pathogenesis of osteoporosis,comprehensive consideration of vital biological/biochemical factors is necessary for accurate risk evaluation of fractures.For this purpose,we review recent research progress on molecules which can be applied to assess risk for osteoporotic fractures.Future integrative analyses and systematic evaluation of these molecules may facilitate developing novel methodologies and/or test strategies,i.e.,biochips,for early recognition of osteoporosis,hence contributing to preventing osteoporotic fractures.
基金supported by the National Nature Science Foundation of China(No.81773964)Joint Laboratory for Biomaterials SIAT-HKU-CUHK under CUHK-CAS Joint Laboratory Fund(Project Code:4750376).
文摘With the global population aging,especially in China,the prevention and management of osteoporotic fragility fractures has become increasingly important.Bone mineral density(BMD)is an important index of osteoporotic fracture risk,which has become aroutine measurement inclinical practice and thus formed the cornerstone in monitoring treatment efficacy of osteoporosis.In the past 30 years,several pharmacologic therapies have been developed to increase BMD and reduce osteoporotic fractures,especially vertebral fractures.However,the management of nonvertebral fractures and hip fractures remains challenging as low BMD is only one of the multi-factors for these conditions.Hip fractures mainly result from a fall and its incidence is higher in the frigid zone due to low temperature affecting neuromuscular function and high latitude with less sunlight,the conditions rendering less active vitamin D conversion,apart from increased falling.In this paper,we focus on two therapeutic strategies targeting both skeletal and non-skeletal factors,that is,Tai Chi(TC)exercise for improving balance and"kidney-tonifying"traditional Chinese medicine(TCM)against muscle atrophy.TC is a mind-body exercise that has the potential as an effective and safe intervention for preventing fall-related fractures in the elderly.This makes it a promising and feasible physical activity for the elderly in frigid zone to prevent osteoporotic fractures.Several TCM formula popular in northeast of China within frigid zone are also introduced.They are reportedly effective in maintaining or improving BMD and muscle strength with the potential of reducing osteoporotic fracture.However,more rationally designed vigorous basic investigations and prospective clinical trials are highly desired to validate and consolidate the preliminary observations in the future.
基金Outstanding Youth Science Fund Project of the First Affiliated Hospital of Bengbu Medical College(No.2021byyfyyq04),China.
文摘Postmenopausal osteoporosis is a kind of degenerative disease,also described as“invisible killer.”Estrogen is generally considered as the key hormone for women to maintain bone mineral content during their lives.Iron accumulation refers to a state of human serum ferritin that is higher than the normal value but less than 1000μg/L.It has been found that iron accumulation and osteoporosis could occur simultaneously with the decrease in estrogen level after menopause.In recent years,many studies indicated that iron accumulation plays a vital role in postmenopausal osteoporosis,and a significant correlation has been found between iron accumulation and fragility fractures.In this review,we summarize and analyze the relevant literature including randomized controlled trials,systematic reviews,and meta-analyses between January 1996 and July 2022.We investigate the mechanism of the effect of iron accumulation on bone metabolism and discuss the relationship of iron accumulation,osteoporosis,and postmenopausal fragility fractures,as well as the main clinical treatment strategies.We conclude that it is necessary to pay attention to the phenomenon of iron accumulation in postmenopausal women with osteoporosis and explore the in-depth mechanism of abnormal bone metabolism caused by iron accumulation,in order to facilitate the discovery of effective therapeutic targets for postmenopausal osteoporosis.
基金Supported by the National Science Foundation of China-Yunnan Province Joint Fund(The mechanisms of the Osteoking for promoting bone formation in OP and OPF,No.U1502227)。
文摘OBJECTIVE: To investigate the effectiveness of osteoking, a Traditional Chinese Medicine originating from Yi nationality, against osteoporosis(OP) and osteoporotic fracture(OPF), and to elucidate its mechanism of action.METHODS: An osteoporotic fracture rat model was established;animals were divided into three treatment groups: parathyroid hormone, osteoking and0.9%NaCl. After 4, 8 and 12 weeks of treatment, serum and bone tissues were collected. Enzyme-linked immuno sorbent assay, x-ray, histopathological evaluation and proteomics were used.Proteomics and GO annotation were performed based on identified peptides. The relative network was obtained from the STRING database and verified by polymerase chain reaction and Western blotting.RESULTS: After osteoking treatment, the bone mineral density(BMD) increased with time in the osteoking group. At week 12, the BMD and bone mineral salt content of the osteoking group were 4.5%and 20.6% higher than those of the negative control group, respectively. Furthermore, the body weight followed the order of positive control group > osteoking group > negative control group,with significant differences among the groups(P <0.05). Micro-CT analysis of femur sections revealed that the bone surface/volume ratio was significantly higher in the osteoking group than that in the negative control group. X-ray images demonstrated that the osteoking group showed clear callus.Moreover, high-voltage micro-CT demonstrated a massive cortical bone accumulation in the osteoking group. The gray values of callus in the osteoking group were higher than those in the negative group. From week 4 to 12, the serum bone alkaline phosphatase level increased by 49.6% in the osteoking group and the serum propeptide of type procollagen level decreased by 80.6%. Alizarin reⅠd staining demonstrated that the calcium deposition in the osteoking group was higher than that in the negative control group. Notably, the expression of Mgp, a key osteogenesis inhibitor, was lower in the osteoking group compared with the negative control group. Moreover, Sparc, bone morphogenetic protein-2 and Bglap expression was higher in the osteoking group through activation of the transforming growth factor-receptor activator of nuclear factor κB Ligand pathway.CONCLUSION: Osteoking treatment increased bone quality and promoted calcium deposition.The results suggest that osteoking inhibits Mgp through the TGF-β/RANKL pathway to improve OP/OPF.
基金supported by National Natural and Science Foundation(81271988)Jiangsu Natural and Science Foundation (BK2012876)
文摘This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture(OVCF),who received balloon kyphoplasty.Patients were divided into four groups:Group 1 had no superior endplate fracture,Group 2 had fractures on the anterior portion of the superior endplate,Group 3 had fractures on the posterior portion of the superior endplate,and Group 4 had complete superior endplate fractures.Anterior and middle vertebral body height,vertebral compression ratio,vertebral height loss rate,and kyphosis Cobb angle of each patient were measured and visual analogue scale(VAS) and Oswestry disability index(ODI) scores were recorded.The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery,whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up.Although the vertebral height loss rate and the Cobb angle in Group 2,3 and 4 were larger compared with Group 1 at the last follow-up,only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1.The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores,but there was no significant difference among these groups.Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis.Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery.Postoperative aggravation of kyphosis was observed in Group 2.Furthermore,severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery.Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture.Therefore,surgery should not only restore compressed vertebral body height and correct kyphosis,but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.
基金Supported by Special Projects for Social Development Areas.
文摘BACKGROUND Osteoporosis is a global disease affecting 6.6%of the total population.Osteoporosis complications include fractures,increased bone fragility,and reduced bone strength.The most commonly affected parts are the vertebral body,hip,and wrist.AIM To examine the effect of alendronate sodium combined with InterTan for osteoporotic femoral intertrochanteric fractures on bone and fracture recurrence METHODS In total,126 cases of osteoporotic femoral intertrochanteric fractures were selected and divided into two groups according to the 1:1 principle by the simple random method.They were admitted to the Department of Orthopedics,First Affiliated Hospital of Xingtai Medical College,from January 2018 to September 2020.The control group was treated with InterTan fixation combined with placebo,and the observation group with alendronate sodium based on InterTan fixation.Operation-related indicators,complications,and recurrent fractures were compared between the groups.Changes in bone metabolism markers,t value for hip bone mineral density,and Harris Hip Score were observed.RESULTS Operation time,intraoperative blood loss,postoperative ambulation time,and complications were compared between the groups,and no significant difference was found.The fracture healing time was significantly shorter in the observation group than in the control group.β-Collagen-specific sequence(β-CTX)and total aminoterminal propeptide of type I procollagen(T-PINP)in the control group at 3 mo after operation were compared with those before operation,and the difference was not significant.Six months after the operation,theβ-CTX level decreased and T-PINP level increased.β-CTX level at 3 and 6 mo in the observation group after operation was lower,and TPINP level was higher,than that before operation.Compared with the control group,T-PINP level of the observation group was significantly higher andβ-CTX level was significantly lower at 3 and 6 mo after operation.The t value of hip bone mineral density was compared in the control group before and 1 mo after operation,and significant difference was not found.Compared with the control group,the t value of hip bone mineral density in the observation group was significantly higher at 1,3,6,and 12 mo after operation.Compared with the control group,the Harris score of the observation group was significantly higher at 1,3,6,and 12 mo after operation.The recurrence rate of fractures in the observation group within 12 mo was 0.00%,which was significantly lower than 6.35%in the control group.CONCLUSION Alendronate sodium combined with InterTan in the treatment of osteoporotic femoral intertrochanteric fractures can increase bone mineral density,improve hip joint function,promote fracture healing,and reduce fracture recurrence.
文摘Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.
基金Supported by National Natural Science Foundation of China,No.81972108.
文摘BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.
文摘Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.
文摘<strong>Background:</strong> Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. <strong>Purpose:</strong> To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). <strong>Method:</strong> A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (<em>β</em>-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. <strong>Results:</strong> After normalized treatment, the bone metabolism indexes of PINP and <em>β</em>-CTX were improved and BMD was increased in three groups. <strong>Adverse Reactions:</strong> There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). <strong>Conclusion:</strong> Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.
基金National Natural Science Foundation of China(U21A20390)National Key Research and Development Program of China(2018YFC2001302)+2 种基金Development Project of Jilin Province of China(nos.20200801033GH,20200403172SF,YDZJ202101ZYTS128)Jilin Provincial Key Laboratory of Big Data Intelligent Computing(no.20180622002JC)The Fundamental Research Funds for the Central University,JLU.
文摘Osteoporotic Vertebral Fracture(OVFs)is a common lumbar spine disorder that severely affects the health of patients.With a clear bone blocks boundary,CT images have gained obvious advantages in OVFs diagnosis.Compared with CT images,X-rays are faster and more inexpensive but often leads to misdiagnosis and miss-diagnosis because of the overlapping shadows.Considering how to transfer CT imaging advantages to achieve OVFs classification in X-rays is meaningful.For this purpose,we propose a multi-modal semantic consistency network which could do well X-ray OVFs classification by transferring CT semantic consistency features.Different from existing methods,we introduce a feature-level mix-up module to get the domain soft labels which helps the network reduce the domain offsets between CT and X-ray.In the meanwhile,the network uses a self-rotation pretext task on both CT and X-ray domains to enhance learning the high-level semantic invariant features.We employ five evaluation metrics to compare the proposed method with the state-of-the-art methods.The final results show that our method improves the best value of AUC from 86.32 to 92.16%.The results indicate that multi-modal semantic consistency method could use CT imaging features to improve osteoporotic vertebral fracture classification in X-rays effectively.
文摘Background: Novel coronavirus pneumonia (NCP) and osteoporotic vertebral compression fractures (OVCF) are the high incidences of diseases in the elderly. During the epidemic period, if not treated in time, the complications are high and the mortality is high. If we do not pay attention to infection prevention and control in pre-hospital emergency care, it will lead to the first time infection of medical staff and in-hospital cross infection in emergency outpatient receiving area. The correct consideration of both and the establishment of perfect pre-hospital emergency treatment and infection prevention and control synchronous strategy is an important premise to ensure the stable, orderly and safe medical treatment. Objective: To explore the effect of synchronous implementation of pre-hospital emergency care, nursing and infection pre-vention and control for senile OVCF during the epidemic. In order to improve the efficiency of pre-hospital emergency care and prevent the spread of infection. Method: A total of 92 elderly patients with OVCF who received pre-hospital treatment in 18 hospitals in Zhangjiakou City during the epidemic prevention and control period from January 2020 to November 2022 and met the inclusion criteria were selected as research objects, including 24 males and 68 females, aged 65 - 82 (74.2 ± 2.2) years. All patients were associated with concomitant injuries and underlying diseases. All patients in this group underwent predictive pre-hospital rescue and infection prevention and control procedures. Results: All the 92 elderly patients with OVCF received timely pre-hospital treatment during the epidemic period, and no aggravation occurred of the 92 patients, 35 were in the high risk area, 10 were in the medium risk area, and 47 were in the low risk area. Exclude OVCF for NCP Patients were treated according to the conventional diagnosis and treatment principles. Suspected and confirmed cases are transferred to designated surgical hospitals for treatment. All patients were followed up 3 months, 6 months and 12 months after treatment. There was no death rate, high satisfaction of pre-hospital first aid, high diagnostic accuracy, and good curative effect. None of the rescue personnel had any infection rate, and no hospital infection transmission and nosocomial cross infection occurred. Conclusion: It is the first step to safely treat patients and prevent cross infection to establish a perfect synchronous strategy of pre-hospital first aid and infection prevention and control.
基金This work was supported by the Project of the Department of Science And Technology in Shaanxi Province(2020JM-702).
文摘Objective:The influence of vertebral compression fracture on the degeneration of adjacent disc was analyzed.Methods:88 patients with osteoporotic vertebral compression fractures admitted to the orthopedic pain department from July 2014 to July 2019 were selected as the research objects.According to the previous MRI and the improved MRI results of admission,the patients were converted into old fractures after conservative treatment.They were followed up in 3,6 and 12 months after discharge,and the VAS score at each time point(visual acuity score)was calculated We collected and analyzed the classifcation of intervertebral disc degeneration and MRI index.Results:The follow-up rate was 659%(58/88);There were 42 cases(72.4%)of degenerative disc adjacent to the diseased vertebra,and 16 cases(27.5%)of adjacent intervertebral disc did not degenerate;VAS scores were 1ower at 14 days,3 months,6 months and 12 months after admission;The number of grade 1 of disc degeneration was lower in 6 months and 12 months than that in admission(P<0.05),and the number of grade 2,3 and 4 was significantly higher than that in the follow-up in December(P<0.05).The difference between 6 and 12 months was not statistically significant(P>0.05);MRI index at 6 and 12 months follow-up was lower than that at admission(P<0.05).Conclusion:Through the research and analysis,we found that osteoporotic vertebral compression fracture will have a corresponding impact on the adjacent intervertebral disc,which can make the adjacent intervertebral disc degenerate.
文摘Objective:To explore the clinical value of kyphoplasty and conservative treatment for osteoporotic vertebral compression fractures.Methods:40 patients with Osteoporotic vertebral compression fracture from May 2019 to November 2021 were selected.The control group was treated with conservative treatment and the experimental group was treated with kyphoplasty.Results:Compared with the control group,the experimental group had higher total effective rate(95.00%),better recovery of Cobb Angle and vertebral height,and higher quality of life score.The data was more meaningful(P<0.05).Conclusion:For patients with osteoporotic vertebral compression fractures,the application of kyphoplasty can improve the treatment effect,accelerate the recovery of vertebral body function and enhance the quality of life,which is worthy of popularization.
文摘Objective To compare the clinical outcomes of 2 surgical interventions for osteoporotic vertebral compression fractures(OVCF).Methods Sixty-five patients with OVGF from March 2005 to March 2009 were included in this clinical study.They
文摘BACKGROUND Locking plate fixation in osteoporotic ankle fractures may fail due to cut-out or metalwork failure.Fibula pro-tibia fixation was a technique prior to the advent of locking plates that was used to enhance stability in ankle fractures by achieving tri or tetra-cortical fixation.With locking plates,the strength of this fixation construct can be further enhanced.There is lack of evidence currently on the merits of tibiapro-fibula augmented locking plate fixation of unstable ankle fractures.AIM To assess if there is increased strength to failure,in an ankle fracture saw bone model,with a fibula pro-tibia construct when compared with standard locking plate fixation.METHODS Ten osteoporotic saw bones with simulated supination external rotation injuries were used.Five saw bones were fixed with standard locking plates whilst the other 5 saw bones were fixed with locking plates in a fibula pro-tibia construct.The fibula pro-tibia construct involved fixation with 3 consecutive locking screws applied across 3 cortices proximally from the level of the syndesmosis.All fixations were tested in axial external rotation to failure on an electromagnetic test frame(MTS 858 Mini-Bionix test machine,MTS Corp,Eden Praire,MN,United States).Torque at 30 degrees external rotation,failure torque,and external rotation angle at failure were compared between both groups and statistically analyzed.RESULTS The fibula pro-tibia construct demonstrated a statistically higher torque at 30 degrees external rotation(4.421±0.796 N/m vs 1.451±0.467 N/m;t-test P=0.000),as well as maximum torque at failure(5.079±0.694N/m vs 2.299±0.931 N/m;t-test P=0.001)compared to the standard locking plate construct.The fibula pro-tibia construct also had a lower external rotation angle at failure(54.7±14.5 vs 67.7±22.9).CONCLUSION The fibula pro-tibia locking plate construct demonstrates biomechanical superiority to standard locking plates in fixation of unstable ankle fractures in this saw bone model.There is merit in the use of this construct in patients with unstable osteoporotic ankle fractures as it may aid improved clinical outcomes.
基金supported by the National High Technology Research and Development Program("863"Program)of China(No.SS2012AA022811)the Science and Technology Program of Guangzhou(No.201508020253)the Special Project on the Integration of Industry,Education and Research of Guangzhou(No.158100062)
文摘Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures(OVCFs) after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation(PSF) with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation(PSF),two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.
文摘BACKGROUND As one of the most common complications of osteoporosis,osteoporotic vertebral compression fracture(OVCF)increases the risk of disability and mortality in elderly patients.Percutaneous vertebroplasty(PVP)is considered to be an effective,safe,and minimally invasive treatment for OVCFs.The recollapse of cemented vertebrae is one of the serious complications of PVP.However,the risk factors associated with recollapse after PVP remain controversial.AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.METHODS A systematic search in EMBASE,MEDLINE,the Cochrane Library,and PubMed was conducted for relevant studies from inception until March 2020.Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis.Odds ratios(ORs)or standardized mean differences with 95%confidence interval(CI)were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test.The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale.RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls.The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction(OR=2.09;95%CI:1.30 to 3.38;P=0.002),preoperative intravertebral cleft(OR=2.97;95%CI:1.93 to 4.57;P<0.00001),and solid lump distribution pattern of the cement (OR = 3.11;95%CI: 1.91 to 5.07;P < 0.00001).The analysis did not support that age, gender, lumbar bone mineral density,preoperative visual analogue scale score, injected cement volume, intradiscalcement leakage, or vertebral height restoration could increase the risk forcemented vertebra recollapse after PVP in OVCFs.CONCLUSIONThis meta-analysis suggests that thoracolumbar junction fractures, preoperativeintravertebral cleft, and solid lump cement distribution pattern are associatedwith the recollapse of cemented vertebrae after PVP in OVCF patients.
文摘BACKGROUND Intradural anesthesia caused by anesthetic drug leakage during percutaneous vertebroplasty(PVP)has rarely been reported.We here report a 71-year-old woman who suffered this rare and life-threatening complication during PVP.CASE SUMMARY A 71-year-old woman,who suffered from 2 wk of severe back pain with a visual analog score of 8,came to our outpatient clinic.She was later diagnosed with a newly compressed L1 fracture and was then admitted in our department.PVP was initially attempted again under local anesthesia.However,serendipitous intradural anesthesia leading to total spinal anesthesia happened.Fortunately,after successful resuscitation of the patient,PVP was safely and smoothly performed.Great pain relief was achieved postoperatively,and she was safely discharged on postoperative day 4.The patient recovered normally at 3-mo follow-up.CONCLUSION Total spinal anesthesia secondary to PVP by anesthetic drug leakage rarely occurs.In cases of inadvertent wrong puncture leading to drug leakage when performing it under local anesthesia,surgeons should be highly vigilant during the whole procedure.Electrocardiogram monitoring,oxygen inhalation,intravenous cannula set prior to surgery,regular checking of motor activity and a meticulous imaging monitoring with slower pushing of anesthetic drugs,etc.should be highly recommended.
基金This work is in part supported by NSFC No.51402176the Inner Mongolia autonomous region natural science fund No.20070501.
文摘We investigated the feasibility of applying polymethylmethacrylate bone cement composited with biomimetic bone-mineralizsed collagen to percutaneous kyphoplasty(PKP).We performed PKP in 95 patients diagnosed with osteoporotic vertebral compression fracture.All patients had fractures of a single vertebral body,and they were divided randomly into control(group A,47 patients)and experimental(group B,48 patients)groups.Patients in group A were treated with acrylic cement,and those in group B were treated with acrylic cement composited with the bone graft material.All patients were evaluated by a visual analogue scale(VAS),Oswestry disability index(ODI),Cobb angle and anterior vertebral body height preoperatively,and 3 days and 3 months postoperatively.All patients successfully completed surgery and were followed up thereafter.The VAS score,ODI index,Cobb angle and anterior vertebral body height compression rate in both groups had significant changes(P<0.05)preoperatively,and at 3 days and 3 months postoperatively.There was no significant difference between the two groups at different times(P>0.05).The analgesic effects of bone cement composited with bone-mineralized collagen are similar to those of bone cement only.Mineralized collagen has excellent promotion prospects by inducing new bone formation and reducing the incidence of adverse reactions caused by bone cement.
