Objective To ascertain whether augmentation pedicle screw fixation with polymethylmethacrylate (PMMA) can enhance the stability of unstable thoracolumbar burst fractures of osteoporotic spine. Methods Six fresh frozen female osteoporotic spines (T10-L5) were harvested and an anterior and posterior columnunstable model of L1 was made. Each specimen was fixated with plate and the stability test were performed by flexion, extension, axial rotation and lateral bending. The test of fatigue was done with MTS 858.The tests were repeated after screws were augmented with PMMA. To compare the biomechanical stability of 6 different conditions:○anormal specimens(control), ○bdefectmodel fixed with plate, not augmented and not fatigued, ○cafter fatigued, not augmented, ○dscrews augmented with PMMA, not fatigued, ○e after augmented and fatigued. ResultsIn ○b,○d and ○e conditions, the ranges of motion(ROM) were 6.23±1.56，4.49±1.00，4.46±1.83 inflexion and 6.60±1.80，4.41±0.82，4.46±1.83 in extension. There was no significant difference (Pgt;0.05), they were significantly smaller than those in ○a and ○c conditions (8.75±1.88，1.47±2.25 and 8.92±2.97，12.24±3.08) (Plt;0.01).Conclusion The results demonstrated that augmentation pedicle screws fixation with PMMA can increase the stability of osteoporotic spine.
ObjectiveTo preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).MethodsThirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤−2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.ResultsThe DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤−2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.ConclusionsPostmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.
Objective To compare the efficacy and indication of the three different surgical methods in the treatment of the senile osteoporotic comminuted proximal humerus fracture. Methods From January 2006 to April 2008, 70 senile patients with osteoporotic comminuted proximal humerus fracture were randomly divided into three groups to receive different surgical methods. There were 21 patients in the group A receiving Kirschner tension band or screw internal fixation, 37 patients in group B receiving internal fixation of locking proximal humeral plate, and 12 patients in group C receiving humeral head replacement. There were 36 males and 34 females aged 53-76 years old (average 61.9 years old). All the fractureswere closed, osteoporotic, and III and IV-part according to Neer classification. The disease course was 1-8 days (average 2.8 days). There was no significant difference among three groups in terms of basel ine information (P gt; 0.05). The effective antiosteoporosis therapy was given during perioperative period. Results All the incision healed by first intention. All patients reached anatomical or almost anatomical reduction without compl ications such as postoperative infection, neurovascular injury, and nonunion of bone. Seventy patients were followed up for 9-20 months (average 11.5 months). The heal ing time of the fracture was 8-12 weeks in group A and group B, the average heal ing time was 10.5 weeks in group A and 10 weeks in group B, and there was no significant difference between two groups (P gt; 0.05). Group C presented with no sign of prosthesis loosening or shoulder dislocation. Six cases in group A suffered from frozen shoulder, pain or acromion impingement syndrome 6 months after operation and obtained various degrees of improvement via functional exercises. One of them had humeral head avascular necrosis 12 months later and achieved fair recovery after performing humeral head replacement. Two cases in group B had frozen and painful shoulder 6 months after operation and achieved fair recovery after functional exercises. One cases in group C had frozen shoulder and poor performance of abduction and upl ifting and achieved improvement after exercises. The rest patients achieved satisfactory curative effects. The incidence of compl ication was 28.6% in group A, 5.4% in group B, and 8.3% in group C. The incidence of complication in group A was significantly higher than that of group B and group C (P lt; 0.05), and there was no significant difference between group B and group C (P gt; 0.05). Neer scale system was adopted to evaluate the postoperative shoulder function, the excellent and good rate was 66.7% in group A, 78.4% in group B, and 83.3% in group C. The excellent and good rate in group A was significantly less than that of group B and group C (P lt; 0.05), and there was no significant difference between group B and group C (P gt; 0.05). Conclusion The senile osteoporotic comminuted proximal humerus fracture treated by surgery can obtain satisfied results. Most patients can use locking plate fixation. Those with poor general condition can use Kirschner wire fixation with tension band or screws, but this method is subject to certain constraints. For some elder patients with humeral head necrosis and humeral head crushed, priority should be given to the use of humeral head replacement.
Objective To review the progress of the pedicle screw augmentation technique by bone cement. Methods Recent literature about the pedicle screw augmentation technique by bone cement was reviewed and analysed. The characters were summarized. Results Pedicle augmentation technique includes the augmentation of ordinary solid pedicle screw and hollow pedicle screw. Both types could increase the fixation strength and gain satisfactory clinical results. Bone cement leakage had a certain incidence rate, but most of cases were asymptom. Conclusion Bone cement augmentation of pedicle screw is an effective and safe internal fixation for poor bone condition.
Objective To investigate the prel iminary effectiveness of percutaneous kyphoplasty (PKP) in treating vertebral compressive fractures in patients with osteoporosis. Methods Between February 2008 and June 2010, 31 cases (31vertebrae) of osteoporotic vertebral compressive fractures were treated with PKP. Of 31 cases, 10 were male and 21 were female, aged from 64 to 80 years (mean, 70.7 years). All fractures were caused by mild trauma with an disease duration of 1-13 days. Affected vertebrae included T12 in 8 cases, L1 in 9 cases, L2 in 12 cases, and L4 in 2 cases. The effectiveness was evaluated with visual analogue scale (VAS), the Cobb’s angle, and the anterior vertebral height. Results The operation was completed successfully in all cases, without serious postoperative complication. Cement leakage occurred in 11 cases (35.5%), including 3 cases at the anterior vertebral edge, 4 cases at the lateral vertebra, and 4 cases at the puncture tunnel. All the cases were followed up 6-15 months (mean, 11 months). The mean fracture healing time was 11.5 weeks (range, 8-12 weeks). VAS score was decreased from 8.1 ± 1.2 preoperatively to 2.5 ± 0.6 at 3 months postoperatively and to 2.3 ± 0.8 at last follow-up; the Cobb’s angle was improved from (30.2 ± 5.3)° to (21.3 ± 3.6)° and (23.5 ± 3.8)° respectively; and the anterior vertebral height was increased from (13.98 ± 4.62) mmto (22.03 ± 4.93) mm and (22.56 ± 4.34) mm respectively. There were significant differences in VAS, the Cobb’s angle, and the anterior vertebral height between pre- and post-operation (P lt; 0.05), but there was no significant difference between 3 months postoperatively and last follow-up (P gt; 0.05). Conclusion PKP is effective for osteoporotic vertebral compressive fractures, which can rel ieve pain effectively, correct kyphosis, and prevent collapse of vertebra.
Objective To investigate the association between the genetic polymorphisms of osteoprotegerin gene and bone mineral density ( BMD) in elderly patients with chronic obstructive pulmonary disease ( COPD) .Methods 178 elderly COPD patients admitted in respiratory department between January 2008 and December 2009 were recruited as a COPD group. 195 elderly healthy subjects without COPD were recruited as a control group. The subjects were all chosen from the Han population in Lanzhou city, Gansu province. Pulmonary function ( FEV1 /FVC, FEV1% pred) , body mass index ( BMI) , serum calcium ( Ca) , serum phosphate ( P) , and alkaline phosphatase ( ALP) were determined in all subjects. The OPG gene polymorphisms were analyzed by polymerase chain reaction and restriction fragment length polymorphism ( PCR-RFLP) . BMD was examined by dual-energy X-ray absorptiometry. Results In the COPD group, the distribution frequency of AAGG, GATA, and GGTT in OPG HTT gene-linked polymorphic region G209A and T245G were 2.5%, 27.2% , and 72.3% , respectively, which in the control group were 2.2% , 26.9% , and 70.9%, respectively. The genotype distribution difference of two groups had no statistical significance ( P gt; 0.05) . There were also no statistical differences in BMI, serum Ca, serum P, serum ALP or BMD between different genotype subgroups in two groups ( P gt;0.05) . In the COPD group, the genotype distribution had no statistical significance between different BMD subgroups( P gt; 0.05) . Conclusion In the elderly patients with COPD from Han population at Lanzhou city, OPG HTT gene-linked polymorphic region and T245G gene polymorphism have no significant correlation with reduced lung function, reduced BMD and bone metabolism which are not likely to be susceptibility loci for osteoporosis in COPD patients.
ObjectiveTo evaluate the efficacy and safety of bisphosphonates in preventing and treating glucocorticoid induced osteoporosis. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CNKI, WanFang Data and VIP were searched to collect randomized controlled trials (RCTs) related bisphosphonates for the prevention and treatment of glucocorticoid induced osteoporosis from inception to January 2016. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 20 RCTs were included, which involved 2 330 patients. The results of meta-analysis showed that, compared with the placebo group, the bisphosphonates group could significantly increase the bone mineral density (BMD) at lumbar and femoral neck (MD=3.70, 95%CI 2.65 to 4.75, P<0.000 01; MD=2.18, 95%CI 1.30 to 3.06, P<0.000 01), but the bisphosphonates group could not decrease the incidence rates of vertebral fracture or non-vertebral fracture (OR=0.66, 95%CI 0.38 to 1.16, P=0.15; OR=0.73, 95%CI 0.42 to 1.28, P=0.28). There were no significant differences in the incidence rates of total adverse reactions and total severe adverse reactions between the two groups (OR=0.89, 95%CI 0.62 to 1.28, P=0.53; OR=0.93, 95%CI 0.62 to 1.39, P=0.72). ConclusionCurrent evidence shows that, compared with placebo, bisphosphonates canld effectively prevent and treat the decrease of bone mineral density of glucocorticoid induced osteoporosis, not decrease the incidence of fracture, but not increase the incidence of adverse reactions.
To evaluate the effects of XiangLingGuBao (XLGB) on femoral fracture heal ing in ovariectomized (OVX) rats. Methods Forty 12-week-old female SD rats weighing (258 ± 14) g were divided randomly into 4 groups (n=10 per group): group A, sham operation by opening the abdominal cavity; group B, bilateral ovariectomy; group C, bilateral ovariectomy, transverse midshaft fracture of the right femur with intramedullary nail fixation, and normal sal ine by gavage; group D, bilateral ovariectomy, transverse midshaft fracture of the right femur with intramedullary nail fixation, and 250 mg/(kg•d) XLGB by gavage. The weight of rabbits in groups A and B was measured 0, 1, 2, 3, 4 and 5 weeks after operation. The right femur of each rat was obtained 5 weeks after operation. Total femur bone mineral density (tBMD), distal femur bone mineral density (dBMD) and middle femur bone mineral density (mBMD) were measured by double energy X-ray absorptiometry CR filming, HE staining and immunohistochemistry staining of groups C and D were performed. Results The weight of rats in group B was obviously higher than that of group A at 3, 4 and 5 weeks after operation (P lt; 0.05), indicating the animal model of postmenopausal osteoporosis was establ ished successfully. CR films showed more callus and obscure fracture l ine in group D, while less callus and distinct fracture l ine in group C. The tBMD and the dBMD of group B were far less than that of group A, the mBMD of group D was significantly higher than that of group C(P lt; 0.05), the tBMD and the dBMD of group D were higher than that of group C, but no significant difference was evidentbetween two groups (P gt; 0.05). Histology observation showed, when compared with group C, most fracture ends in groupD reached bone union, and the introduction of capillaries was evident in the marrow cavity. Immunohistochemistry staining demonstrated that the BMP-2 integrated absorbance (IA) value in groups C and D was 2.236 6 ± 0.181 8 and 3.727 3 ± 0.874 2, respectively, the VEGF IA value in groups C and D was 2.835 5 ± 0.537 0 and 3.839 6 ± 0.223 0, respectively, indicating there were significant differences between two groups (P lt; 0.05). Conclusion XLGB can obviously promote the femoral fracture heal ing in OVX rats, and speed the transformation of woven bone into lamellar bone, which may rely on its role of enhancing expression of BMP-2 and VEGF.
Objective To establish an osteoporosis screening tool for Chinese40-years-old or above women. Methods The T-score was calculated based on the mean bone mineral density(BMD) of 20-39 years women. Considering the result of dualenergy X-ray absorptiometry(DXA) as the golden criteria, the Bayes discriminant analysis was employed to explore the function. Results The formula of the screening tool for Chinese 40-years-old or above women as following:osteoporosis screenig tool for Chinese(OSTC):Weight-2×age+50. OSTC≤0was classified into high risk, OSTCgt;0 was low risk. The hit rate of OSTC was 75.78%.The sensitivity is 76.8%. The specificity is 75.1%, Kappa value was 0.51(P=0.000).That means the consistency of diagnosis result between OSTC and DXA was relatively good. Conclusion OSTC is a simple tool. Just based on age and weight, it can evaluate the osteoporosis risk of Chinese 40-years-old or above women. But the effect of OSTC has not been proved by other datasetand should be tested further.
Objective To summary the functional roles and molecular mechanisms of microRNA (miRNA) in osteoblast differentiation so as to supply information for basic and cl inical researches. Methods Recent l iterature concerning miRNA in osteoblast differentiation was reviewed. The information was classified and summarized. Results miRNAs critically regulate bone morphogenetic protein, transforming growth factor β, and Wnt/β-catenin signal ing pathways during osteoblast differentiation. In pathological conditions, especially in some disorders of abnormal osteoblast differentiation, downregulated miRNA expression has been observed. Conclusion miRNA may represent a novel biomarker for diagnosis, and a candidate target therapies for the disorders with abnormal osteoblast differentiation.