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 identify primary osteoporosis patients’ function and environment status based on International Classification of Functioning, Disability and Health (ICF) and provide evidence to clinical treatment, rehabilitation therapy and rehabilitation nursing.MethodsA questionnaire survey was conducted among osteoporosis patients hospitalized in the Center of rehabilitation Medicine of West China Hospital of SiChuan University, from May 2017 to December 2019. The research design was based on a cross-sectional survey. ICF was applied to simplify the core classification set, and a convenient sampling method was adopted.ResultsA total of 240 patients were investigated. All of the patients’ function showed limitation but different level. Meanwhile, including Walking (D450), Sensation of pain(B280), Structure of trunk (S760), Lifting and carrying objects (D430), Mobility of joint function (B710), the proportion of injuries were more than 90%, most of which the limitation level were light and moderate injuries indicating 5%-49% injuries; more than 50% pointed the three parts of environment factors were facilitative factors including Products or substances for personal consumption (E110), Health professionals (E355), Health services, systems and policies (E580), of which the proportion of Health services, systems and policies (E580) were highest.ConclusionOsteoporosis has a significant effect on patients’ function, we should develop clinical treatment, rehabilitation therapy, rehabilitation nursing based on the current evaluation of function.
ObjectiveTo compare the clinical efficacy and safety between percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). MethodsBetween January 2010 and December 2013, 68 patients with single OVCF and IVC were treated, and the clinical data were retrospectively analyzed. Of 68 patients, 48 underwent PVP (PVP group) and 20 underwent PKP (PKP group). There was no significant difference in age, gender, disease duration, fracture level, bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), and preoperative radiological parameters between 2 groups (P > 0.05). The intraoperative incidence of cement leakage, cement volume, and operative time were compared between 2 groups; VAS score was used for evaluation of back pain and ODI for evaluation of dysfunction; the incidence of adjacent vertebral fracture was observed within 2 years. The vertebral height and kyphotic angle were measured on X-ray films; the rate of vertebral compression (CR), reduction rate (RR), progressive height loss (PHL), reduction angle (RA), and progressive angle (PA) were calculated. ResultsThere was no significant difference in cement volume and the incidence of cement leakage between 2 groups (P > 0.05). The operative time in PVP group was shorter than that in PKP group, showing significant difference (t=-8.821, P=0.000). The mean follow-up time was 2.4 years (range, 2.0-3.1 years). The VAS scores and ODI were significantly reduced at 1 day, 1 year, and 2 years after operation when compared with preoperative scores (P < 0.05), but there was no significant difference between different time points after operation in 2 groups (P > 0.05). Adjacent vertebral fracture occurred in 5 cases (10.4%) of PVP group and in 2 cases (10.0%) of PKP group, showing no significant difference (χ2=0.003, P=0.963). BMD was significantly increased at 1 year and 2 years after operation when compared with preoperative BMD (P < 0.05), but no significant difference was found between 2 groups (t=0.463, P=0.642; t=0.465, P=0.646). The X-ray films showed that CR and kyphotic angle were significantly restored at immediate after operation in 2 groups (P < 0.05); but vertebral height and kyphotic angle gradually aggravated with time, showing significant difference between at immediate and at 1 and 2 years after operation (P < 0.05); there was no significant difference in CR and kyphotic angle between 2 groups at each time point (P > 0.05). RR, RA, PHL, and PA showed no significant difference between 2 groups (P > 0.05). ConclusionThere is similar clinical and radiological efficacy between PVP and PKP for treatment of OVCF with IVC. Re-collapse could happen after operation, so strict observation and follow-up are needed.
Objective To study the effectiveness of long segment fixation combined with vertebroplasty (LSF-VP) for severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. Methods Between March 2006 and May 2012, a retrospective analysis was made on the clinical data of 48 cases of severe osteoporotic thoracolumbar compressive fractures with more than 50% collapse of the anterior vertebral body or more than 40 ° of sagittal angulation, which were treated by LSF-VP in 27 cases (LSF-VP group) or percutaneous kyphoplasty (PKP) in 21 cases (PKP group). All patients suffered from single thoracolumbar vertebral compressive fracture at T11 to L2. There was no significant difference in gender, age, spinal segment, and T values of bone mineral density between 2 groups (P gt; 0.05). The effectiveness of the treatment was appraised by visual analogue scale (VAS), Cobb angle of thoracolumbar kyphosis, height of anterior/posterior vertebral body, and compressive ratio of vertebrae before and after operations. Results The LSF-VP group had longer operation time, hospitalization days, and more bone cement injection volume than the PKP group, showing significant differences (P lt; 0.05). Intraoperative blood loss in LSF-VP group ranged from 220 to 1 050 mL (mean, 517 mL). No pulmonaryor cerebral embolism or cerebrospinal fluid leakage was found in both groups. Asymptomatic bone cement leakage was found in 3 cases of LSF-VP group and 2 cases of PKP group. The patients were followed up for 16-78 months (mean, 41.1 months) in LSF-VP group, and 12-71 months (mean, 42.1 months) in PKP group. No fixation failure such as loosened or broken pedicle screw was found in LSF-VP group during the follow-up, and no re-fracture or adjacent vertebral body fracture was found. Two cases in PKP group at 39 and 56 months after operation respectively were found to have poor maintenance of vertebral height and loss of rectification (Cobb angle was more than 40º) with recurrence of pain, which were treated by second surgery of LSF-VP; another case had compressive fracture of the adjacent segment and thoracolumbar kyphosis at 16 months after operation, which was treated by second surgery of LSF-VP. There were significant differences in the other indexes between each pair of the three time points (P lt; 0.05), except the Cobb angle of thoracolumbar kyphosis, and the height of posterior vertebral body between discharge and last follow-up in LSF-VP group, and except the Cobb angle of thoracolumbar kyphosis and compressive ratio of bertebrae between discharge and last follow-up in PKP group (P gt; 0.05). After operation, the other indexes of LSF-VP group were significantly better than those of PKP group at each time point (P lt; 0.05), except the VAS score and the height of posterior vertebral body at discharge (P gt; 0.05). Conclusion The effectiveness of LSF-VP is satisfactory in treating severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. LSF-VP can acquire better rectification of kyphosis and recovery of vertebral body height than PKP.
Primary osteoporosis is a severe social problem. It bothers the health of many aged people. Since May 1993, The doubleenergy density of bone test was carried out in postmenopausal women, among them, in 34 cases the concentration of estrogen, calcitonin parathyroidin, calcium and phosphorus in serum were examined. The results were as follows: the bone density decreased obviously while the serum calitonin and parathyroidun levels were high or low, was risen and fallen, but the serum calcium was higher than normal. Three types of osteoporosis in clinicspo stulated: 1.calcitonin and parathyroidin were normal or absent; 2.calcitonin was higher; 3.parathyroidin was higher. The treatment of the different types shouldbe individulized.
Objective To investigate the efficiency of manual reduction combined with uni-lateral percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF). Methods Between May 2005 and May 2009, the manual reduction combined with uni-lateral PKP was appl ied to treat 42 patients with OVCF (group A), and the simple uni-lateral PKP was appl ied to treat 43 patients with OVCF (group B) at the same period. The visual analogue scale (VAS), the vertebral height, and the Cobb angle were determined before operation, and at 3 days and 6 months after operation. Ingroup A, there were 6 males and 36 females aged 59-93 years (76.5 years on average) with an average disease duration of 7 days (range, 3 hours to 21 days); 27 segments of thoracic vertebrae and 31 segments of lumbar vertebrae were involved, including 15 segments at mild degree, 38 segments at moderate degree, and 5 segments at severe degree according to degree classification system of compression fractures of Zoarski and Peh. In group B, there were 9 males and 34 females aged 54-82 years (75.3 years on average) with an average disease duration of 7 days (range, 1 hour to 20 days); 26 segments of thoracic vertebrae and 35 segments of lumbar vertebrae were involved, including 21 segments at mild degree, 36 segments at moderate degree, and 4 segments at severe degree according to degree classification system of compression fractures of Zoarski and Peh. There were no significant difference (P gt; 0.05) in sex, age, affected site, degree, and disease duration between 2 groups. Results There was no significant difference (P gt; 0.05) in operative time, blood loss, or injected cement volume between 2 groups. No serious compl ication or death occurred in 2 groups. Cement leakage was observed in 4 cases (9.5%) of group A and in 5 cases (11.6%) of group B. The VAS scores after operation significantly decreased in 2 groups (P lt; 0.01). At 3 days and 6 months after operation, the VAS scores in group A were significantly lower than those in group B (P lt; 0.05). The postoperative compression rates of affected vertebral body in 2 groups significantly decreased (P lt; 0.01). The compression rates of affected vertebral body at 3 days and 6 months after operation, and the height recovery rate at 3 days after operation in group A were superior to those in groupB (P lt; 0.05). The postoperative Cobb angles in 2 groups were significantly diminished (P lt; 0.01). The Cobb angles at 3 days and 6 months after operation, and the recovery rate at 3 days after operation in group A were superior to those in group B (P lt; 0.05). Conclusion The cl inical efficiency of the manual reduction combined with uni-lateral PKP is superior to that of simple uni-lateral PKP in treatment of severe OVCF.
Objective To summarize the research progress of bioactive scaffolds in the repair and regeneration of osteoporotic bone defects. Methods Recent literature on bioactive scaffolds for the repair of osteoporotic bone defects was reviewed to summarize various types of bioactive scaffolds and their associated repair methods. Results The application of bioactive scaffolds provides a new idea for the repair and regeneration of osteoporotic bone defects. For example, calcium phosphate ceramics scaffolds, hydrogel scaffolds, three-dimensional (3D)-printed biological scaffolds, metal scaffolds, as well as polymer material scaffolds and bone organoids, have all demonstrated good bone repair-promoting effects. However, in the pathological bone microenvironment of osteoporosis, the function of single-material scaffolds to promote bone regeneration is insufficient. Therefore, the design of bioactive scaffolds must consider multiple factors, including material biocompatibility, mechanical properties, bioactivity, bone conductivity, and osteogenic induction. Furthermore, physical and chemical surface modifications, along with advanced biotechnological approaches, can help to improve the osteogenic microenvironment and promote the differentiation of bone cells. ConclusionWith advancements in technology, the synergistic application of 3D bioprinting, bone organoids technologies, and advanced biotechnologies holds promise for providing more efficient bioactive scaffolds for the repair and regeneration of osteoporotic bone defects.
Objectives To assess the efficacy and safety of statins for adult osteoporosis. Methods We electronically searched The Cochrane Library (Issue 4, 2007), MEDLINE (1990 to November 2007), EMBASE (1990 to November 2007), Current Controlled Trials, The National Research Register, CBM (1990 to November 2007), VIP (1990 to November 2007) and CNKI (1990 to November 2007). We also handsearched some related journals and identified randomized controlled trials of statins versus placebo in adults with osteoporosis. Results Two randomized controlled trials were included. We didn’t perform meta-analysis due to heterogeneity. No significant differences were observed in the changes of bone density at the lumbar spine and total hip from baseline between statins and placebo. However, a significant increase in bone density was found in response to simvastatin at the forearm. Biochemical markers of bone metabolism changes from baseline did not differ significantly between statins and placebo groups. Conclusions The evidence currently available does not support the use of statins in the treatment of osteoporosis. Further randomized, double-blind, placebo-controlled trials are needed in order to define the efficacy and acceptability of statins in the treatment of osteoporosis.
Objective Secondary osteoporosis is very common in patients with primary osteoporosis. Diabetes is a known cause of secondary osteoporosis. While type I diabetes has been clearly linked with diabetic osteoporosis, the effect of type II diabetes on bone health is controversial.Methods In the present study, we investigated the associations between type II diabetes and osteoporosis as well as fractures at different skeletal sites in Women’s Health Initiative participants.Results Common risk factors such as age, race, BMI, HRT use, and the history of fractures were significantly associated with osteoporosis and fractures in this study population. Diabetic women appeared to have a decreased risk of osteoporosis although it no longer remained significant after adjusting for other risk factors (crude HR=0.78, 95%CI 0.61 to 0.99; adjusted HR=0.93, 95%CI 0.73 to 1.19). The impact of diabetes on fractures varied at different body sites. There was a significant increase of risk of hip fracture (HR=2.54, 95%CI 1.14 to 5.66), but not spine fracture (HR=1.71, 95%CI 0.81 to 3.60) and arm fracture (HR=0.92, 95%CI 0.48 to 1.76) among the women with diabetes. Although the overall risk of fractures in diabetic women did not differ significantly from non-diabetic women (HR=1.37, 95%CI 0.89 to 2.09), the difference had a two-fold increase and was statistically significant after 2,000 days (HR=2.01, 95%CI 1.21 to 3.35), indicating a different hazard at different stages of diabetes.Conclusion Our findings suggest that type II diabetes may not be clearly associated with osteoporosis, it increases a site-specific fracture risk at least in the hip. In addition, the overall fracture risk appears to increase in a time-dependent manner.
Objective To investigate the biomechanical influence ofvertebroplasty using autosolidification calcium phosphate cement (CPC) on thoracolumbar osteoporotic fractures. Methods Four cadaver specimens with osteoporosiswere applied to make spine unit. There were 2 females and 2 males, whose average age was 69 years.All underwent flexion-axial loading to result in vertebral body fracture. Following reduction, the middle fractured vertebral body were strengthened by the method of vertebroplasty, using CPC. Before fracture and after vertebroplasty, all were conducted biomechanical test. Results After being packed- CPC to the space in the fractured vertebral body, the strength andstiffness in vertebroplastic group (2 285±34 N，427±10 N/mm) were significantly higher than that in osteoporotic group (1 954±46 N，349±18 N/mm) (Plt;0.05). The vertebral height changing in vertebroplastic group(5.35±0.60 mm) were significantly lower than that in osteoporotic group (5.60±0.70 mm) (Plt;0.05). And the fractured body increases its strength and stiffnessby 16.92% and 22.31% respectively in comparison with its initial situation. Conclusion After being injected CPC into bone trabecular interspaces, the fractured vertebral bodies can restore its strength and stiffness markedly.