ObjectiveTo analyze the effect of core stabilization exercise with unstable support surface on rehabilitation of patients with osteoporotic vertebral fracture.MethodsFrom January 2018 to January 2020, 66 patients with osteoporotic vertebral fractures in the Fifth Affiliated Hospital of Zhengzhou University were selected as the research objects. All patients were treated with percutaneous vertebroplasty. After operation, they were randomly divided into intervention group and control group by random number table method, with 33 cases in each group. Both groups were given routine rehabilitation intervention after operation, while the intervention group was given core stabilization exercise with unstable support surface at the same time. The vertebral height, shape, stability and gait of the two groups were compared 1 day before operation and 1 day after rehabilitation training.ResultsThere was no significant difference in gender, age, injured vertebral body, course of osteoporosis, years of education and marital status between the two groups (P>0.05). Before surgery, there was no statistically significant difference in the height ratio of the front edge of the injured vertebra, middle height ratio of the injured vertebra, back convex Cobb angle, track length when eyes were open, track length when eyes were closed, Romberg rate, track length per unit time when eyes were open, track length per unit time when eyes were closed, Romberg rate per unit time, deviation of the center of gravity on X-axis when eyes were open, deviation of the center of gravity on X-axis when eyes were closed, deviation of the center of gravity on Y-axis when eyes were open, deviation of the center of gravity on Y-axis when eyes were closed, stride length, step frequency or comfortable pace between the two groups (P>0.05). After training, the height ratio of the front edge of the injured vertebra [(79.26±12.15)% vs. (72.26±13.36)%], middle height ratio of the injured vertebra [(82.11±10.26)% vs. (75.64±9.56)%], back convex Cobb angle [(9.87±7.10) vs. (14.41±2.36)°], track length when eyes were closed [(1856.29±457.16) vs. (2358.48±786.45) mm], Romberg rate [(1.32±0.29)% vs. (1.87±0.54)%], track length per unit time when eyes were closed [(33.45±3.26) vs. (41.55±4.69) mm], Romberg rate per unit time [(1.41±0.30)% vs. (1.95±0.77)%], deviation of the center of gravity on X-axis when eyes were open [(11.06±1.36) vs. (16.54±2.22) mm], deviation of the center of gravity on X-axis when eyes were closed [(11.15±0.96) vs. (23.31±3.06) mm], deviation of the center of gravity on Y-axis when eyes were open [(12.57±1.84) vs. (15.56±2.06) mm], deviation of the center of gravity on Y-axis when eyes were closed [(15.69±2.05) vs. (18.96±3.56) mm], stride length [(0.57±0.12) vs. (0.49±0.10) m], step frequency [(1.09±0.29) vs. (0.94±0.20) step/s] and comfortable pace [(0.35±0.12) vs. (0.29±0.10) m/s] of the intervention group were better than those of the control group (P<0.05). There was no significant difference in the track length when eyes were open or track length per unit time when eyes were open between the two groups (P>0.05).ConclusionIn patients with osteoporotic vertebral body fractures, core stabilization exercise with unstable support surface on the basis of conventional rehabilitation interventions after surgery can effectively restore the height and shape of the vertebral body, and improve the stability and gait to a certain extent.
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 evaluate the clinical effect of bipolar long-stem prosthetic replacement on the treatment of comminuted intertrochanteric fracture of hip in the elderly osteoporotic patients. Methods From March 2000 to August 2003, 18 patients who were more than 72 years old with comminuted intertrochanteric fracture were treated with bipolar longstem prosthetic replacement. There were 8 males and 10 females (aged from 72 to 91). Fractured fragments of large trochanter and minor trochanter should be preserved during the operation so that the fragments can be fixed with steel wires and insertion of artificial femoral head.The surgical approach and operative technique, the average course of treatment in hospital, the average time to ambulate with full-weight bearing on the operated limb after the operation, complication, and mortality were observed. Results All patients were followed up 6 to 28 months(16.2 months on average). The average course of stay at hospital was 16 days. The average time to ambulate was 32 days. The incidence of the pain of the hip joint was one-eighteenth, and one patient due to another disease was unable to walk without using twocrutches one month after the surgery. The mortality of the patients was oneeighteenth one year after the surgery. Conclusion Bipolar longstem prosthetic replacement for the treament of comminuted intertrochanteric fractures in the elderly osteoporotic patients proves to be a suitable alternative.Patients have better prognosis, early full-weight bearing, rapid rehabilitation, and fewer complications.
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.
ObjectiveEvaluating the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) for osteoporotic vertebral compressive fracture (OVCF). MethodsPatients with OVCF were retrospectively analyzed from Feb. 2008 to Feb. 2013 in Department of Orthopaedics, Tianjin Medical University General Hospital. Patients were divided into the PVP group and the PKP group. The VAS, vertebral kyphosis angle, vertebral height and bone cement leakage of both groups were compared, and the SPSS13.0 software was used for data analysis. ResultsA total of 55 patients were included. Of which, 25 patients were in the PVP group and 30 patients were in the PKP group. All patients were followed up from 5 to 20 months, with an average time of 15.5 months. The VAS scores in both groups were all improved after the operation (P<0.05), but no significant difference was found between both groups. The vertebral kyphosis angle in both groups were improved after the operation (P<0.05), and the PKP group was better than the PVP group. Six patients in the PVP group occurred the leakage of bone cement, and 4 patients in the PKP group. Five patients in the PVP groups occurred vertebral fracture again, while 7 patients in the PKP group. ConclusionUsing PVP and PKP for the treatment of OVCF can quickly relieve pain and increase the stability of the vertebral body. PKP can restore vertebral body height better and reduce the incidence of cement leakage.
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 investigate whether signal molecule mitogen-activated protein kinases (MAPKs) involves in the process of the mineralization and maturation of rat calvarial osteoblasts promoted by 50 Hz, 0.6 mT pulsed electromagnetic fields. MethodsRat calvarial osteoblasts were obtained by enzyme digestion from the skull of 6 neonatal Wistar rats of SPF level. The primary osteoblasts were treated in 50 Hz and 0.6 mT pulsed electromagnetic fields for 0, 5, 10, 20, 40, 60, and 120 minutes; the protein expression of phosphorylated MAPKs was detected by Western blot. The osteoblasts were randomly divided into group A (control group), group B (low frequency pulse electromagnetic fields treatment group), group C (SB202190 group), and group D (SB202190+low frequency pulse electromagnetic fields treatment group); the alkaline phosphatase (ALP) activities were tested after corresponding treatment for 1, 4, and 7 days. The corresponding treated more than 90% confluenced osteoblasts were cultured under condition of osteogenic induction, then ALP staining and alizarin red staining were carried out at 9 and 12 days respectively. ResultsThe results of Western blot showed that there was no significant changes in the protein expressions of phosphorylated level of extracellular signal-related kinases 1/2 and c-Jun amino N-terminal kinases 1/2 in 50 Hz, 0.6 mT pulsed electromagnetic fields P>0.05), but the phosphorylated level of p38 began to increase at 5 minutes, peaked at 40 minutes, then gradually decreased, and it was significantly higher at 5-120 minutes than at 0 minute (P<0.05). After the activities of p-p38 was inhibited by inhibitor SB202190, the ALP activities, positive colonies and area of ALP and calcified nodules of group B were significantly higher than groups A, C, and D (P<0.05). Conclusionp38 is one of the signal molecules involved in the process of the mineralization and maturation of rat calvarial osteoblasts promoted by 50 Hz, 0.6 mT pulsed electromagnetic fields.
Objective To explore the effectiveness of bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients. Methods Bipolar femoral head replacement combined with tension band wire fixation were used for intertrochanteric fracture in 48 elderly osteoporotic patients between January 2004 and December 2010. Of 48 patients, 15 were male and 33 were female, aged 90-99 years (mean, 94.1 years). All fractures were caused by falling, and pathological fracture was excluded. It was 2-7 days (mean, 4.2 days) from fracture to surgery. According to the Tronzo Evans classification, 25 cases were rated as type IV, 20 cases as type III, and 3 cases as type II. And all of the cases were accompanied with severe osteoporosis and accompanied by more than one medical diseases, and 10 cases had spinal compression fracture. Results All patients underwent the operation successfully. Six cases died of underlying medical illness within 2 years postoperatively. A total of 39 cases were followed up 2-7 years, averaged 3.1 years. After operation, short-term mental disorders occurred in 9 cases, suspected urinary tract infection in 2 cases, sacral rear bedsore in 1 case, hip pain in 1 case, thigh pain in 1 case, and deep vein thrombosis of affected limb in 1 case. All the incisions healed by first intension, and X-ray film showed bone union in all cases; no complications of bone osteolysis, prosthesis loosening, subsidence, rupture, and heterotopic ossification occured postoperatively. No case needed revision. According to the Harris score system, the results were excellent in 5 cases, good in 28 cases, fair in 5 cases, and poor in 1 case, with an excellent and good rate of 84.6%; the score at 2 years was significantly higher than that at 6 weeks (t= — 14.79, P=0.00). The physical health score and mental health score of SF-12 at 2 years postoperatively were significantly higher than those at 6 weeks postoperatively (P lt; 0.05). The visual analogue scale (VAS) scores at 6 weeks and 2 years postoperatively were significantly lower than those at preoperation (P lt; 0.05), and the score at 2 years was significantly lower than that at 6 weeks (P lt; 0.05). Conclusion The bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients has the advantages of firm fixation, early function exercise with load bearing, pain relieving, improving hip function, and avoiding complication in bed.
Objective To assess the efficacy and safety of parathyroid hormone (PTH) on bone mineral density (BMD) and fractures in postmenopausal women with osteoporosis. Methods We searched MEDLINE (1966 to March 2008), EMBASE (1974 to March 2008), The Cochrane Library (Issue 1, 2008), Current Controlled Trials, The National Research Register, CBM (1983 to March 2008) and CNKI (1994 to March 2008). Some related journals were hand searched as well. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by The Cochrane Collaboration’s software RevMan 4.2.10. Results Twelve studies involving 5550 patients were included. PTH alone or in combination with antiresorptive drugs reduced the risk of vertebral fracture (RR=0.34, 95%CI 0.26 to 0.45, Plt;0.000 01), and increased spine BMD (SMD 0.41, 95%CI 0.17 to 0.65, P=0.0009) and femoral neck BMD (SMD 0.13, 95%CI 0.03 to 0.22, P=0.008). The rate of drop out and loss to follow-up because of adverse events was significantly higher in the PTH group (Peto-OR=1.69, 95%CI 1.39 to 2.05, Plt;0.000 01). Conclusion PTH is effective in the prevention and treatment of postmenopausal osteoporosis, especially in patients with preexisting osteoporotic fractures or with very low bone density. PTH alone or in combination with antiresorptive drugs can reduce the risk of vertebral fractures and increase spine and femoral neck BMD. PTH is more effective than alendronate, but these two should not be used as a combined treatment.
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.