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.
Objective To investigate the causes and preventive methods of the bone cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fracture (OVCF). Methods From April 2003 to November 2007, 116 patients with OVCF were treated with PKP, including 57 males and 59 females aged 65-92 years old (average 67.7 years old). All the patients suffered from trauma and the course of disease was 1-14 days (average 5.7 days). There were 159compressed and fractured vertebral bodies, including one vertebral body in 83 cases, two vertebral bodies in 24 cases, three vertebral bodies in 8 cases, and four vertebral bodies in 1 case. The diagnosis of OVCF was confirmed by imaging examination before operation. All the patients had intact posterior vertebral walls, without symptoms of spinal and nerve root injury. During operation, 3.5-7.1 mL bone cement (average 4.8 mL) was injected into single vertebral body. Results The operation time was 30-90 minutes (average 48 minutes). Obvious pain rel ief was achieved in all the patients after operation. X-rays examination 2 days after operation revealed that the injured vertebral bodies were well replaced without further compression and deformation, and the bone cement was evenly distributed. Fourteen vertebral bodies had bone cement leakage (4 of anterior leakage, 4 of lateral leakage, 3 of posterior leakage, 2 of intervertebral leakage, 1 of spinal canal leakage). The reason for the bone cement leakage included the individual ity of patient, the standardization of manipulation and the time of injecting bone cement. During the follow-up period of 12-30 months (average 24 months), all the patients got their normal l ife back, without pain, operation-induced spinal canal stenosis, obvious height loss of injured vertebral bodies and other compl ications. Conclusion For OVCF, PKP is a mini-invasive, effective and safe procedure that provides pain rel ief and stabil ization of spinal stabil ity. The occurrence of bone cement leakages can be reduced by choosing the suitable case, improving the viscosity of bone cement, injecting the proper amount of bone cement and precise location during operation.
ObjectiveTo review the effects and mechanisms of various myokines secreted by skeletal muscle on various bone tissue cells.MethodsLiterature related to myokines and their regulation of bone tissue cells was reviewed and analyzed comprehensively in recent years.ResultsBone and skeletal muscle are important members of the motor system, and they are closely related in anatomy, genetics, and physiopathology. In recent years, it has been found that skeletal muscle can secrete a variety of myokines to regulate bone marrow mesenchymal stem cells, osteoblasts, osteoclasts, and bone cells; these factors mutual crosstalk between myoskeletal unit, contact each other and influence each other, forming a complex myoskeletal micro-environment, and to some extent, it has a positive impact on bone repair and reconstruction.ConclusionMyokines are potential targets for the dynamic balance of bone tissue cells. In-depth study of its mechanism is helpful to the prevention and treatment of myoskeletal diseases.
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.
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.
Objective To systematically review the efficacy and adverse events of alendronate on bone mineral density and fractures in men with osteoporosis. Methods We electronically searched MEDLINE (1990 to 2005), EMBASE (1990 to 2005), The Cochrane Library (Issue 3, 2005), Controlled Trials Register and The National Research Register, CBM disc, VIP, and CNKI. We also handsearched some related journals. The search was conducted in Nov., 2005. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by RevMan 4.2.8. Results We identified 7 studies including 817 patients. Sufficient evidence showed that alendronate plus calcium was superior as preventive treatment to calcium in increasing the bone mineral density (SMD 0.59, 95% CI 0.15 to 1.03, P=0.009) of the lumbar spine. The incidence of withdrawal and lost to follow-up due to adverse events of the alendronate plus calcium was lower than that of calcium (RR 0.32, 95% CI 0.11 to 0.87). Two studies showed that alendronate was superior to placebo in increasing the bone mineral density in men with osteoporosis but with no significantly statistical difference in reducing fractures. Two studies showed alendronate was superior to alfacalcidol in increasing the bone mineral density and reducing the vertebral fractures in men with osteoporosis. One study showed alendronate was not superior to calcitonin or alfacalcidol in increasing the bone mineral density in men at high risk of osteoporosis. One study comparing anledronate or parathyroid hormone with combination of these drugs in men with osteoporosis suggested that anledronate wasn’t superior to parathyroid hormone in increasing the bone mineral density, and the combination did not show any difference compared to parathyroid hormone alone. Conclusions Alendronate is more effective in prevention and treatment of men with osteoporosis compared to placebo. Alendronate is more effective than alfacalcidol in increasing bone mineral density and reducingvertebral fractures in men with osteoporosis. Alendronate is not superior to alfacalcidol or calcitonin in increasing the bone mineral density in preventing men osteoporosis. Alendronate compared to combination of parathyroid hormone does not show more effectiveness in increasing the bone mineral density in men with osteoporosis. More RCTs of high quality, especially multiple center trials are needed to generate ber evidence.
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.
ObjectiveTo explore the protective effects of sodium valproic acid (VPA) on oxidative stress injury of osteoblasts induced by carbonyl cyanide 3-chlorophenylhydrazone (CCCP) and its mechanism. Methods Osteoblasts were isolated from the skulls of 10 newborn Sprague Dawley rats and cultured by tissue block method, and the 1st generation cells were identified by alkaline phosphatase (ALP) and alizarin red staining. The 3rd generation osteoblasts were cultured with 2-18 μmol/L CCCP for 2-18 minutes, and cell counting kit 8 (CCK-8) was used to detect the cell survival rate. An appropriate inhibitory concentration and culture time were selected for the preparation of osteoblasts oxidative stress injury model based on half maximal concentration principle. The cells were cultured with 0.2- 2.0 mmol/mL VPA for 12-72 hours, and CCK-8 was used to detect cell activity, and appropriate concentration was selected for further treatment. The 3rd generation cells were randomly divided into 4 groups, including blank control group (normal cultured cells), CCCP group (the cells were cultured according to the selected appropriate CCCP concentration and culture time), VPA+CCCP group (the cells were pretreated according to the appropriate VAP concentration and culture time, and then cultured with CCCP), VPA+CCCP+ML385 group (the cells were pretreated with 10 μmol/L Nrf inhibitor ML385 for 2 hours before VPA treatment, and other treatments were the same as VPA+CCCP group). After the above treatment was complete, the cells of 4 groups were taken to detect oxidative stress indicators [reactive oxygen species (ROS), superoxide dismutase (SOD), malondialdehyde (MDA)], cell apoptosis rate, ALP/alizarin red staining, and the relative expressions of osteogenic related proteins [bone morphogenetic protein 2 (BMP-2), RUNX2], anti-apoptotic family protein (Bcl2), apoptotic core protein (Cleaved-Caspase-3, Bax), channel protein (Nrf2) by Western blot. Results The osteoblasts were successfully extracted. According to the results of CCK-8 assay, the oxidative stress injury model was established by 10 μmol/L CCCP cultured for 10 minutes and 0.8 mmol/mL VPA cultured for 24 hours was selected for subsequent experiments. Compared with blank control group, the activity and mineralization capacity of osteoblasts in CCCP group decreased, the contents of ROS and MDA increased, the activity of SOD decreased, and the apoptosis rate increased. Meanwhile, the relative expressions of BMP-2, RUNX2, and Bcl2 decreased, and the relative expressions of Cleaved-Caspase-3, Nrf2, and Bax increased. The differences were significant (P<0.05). After further VPA treatment, the oxidative stress damage of osteoblasts in VPA+CCCP group was relieved, and the above indexes showed a recovery trend (P<0.05). In VPA+CCCP+ML385 group, the above indexes showed an opposite trend (P<0.05), and the protective effects of VPA were reversed. Conclusion VPA can inhibit the CCCP-induced oxidative stress injury of osteoblasts and promote osteogenesis via Keap1/Nrf2/Are pathway.