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.
Objective To evaluate the effect of remote controlled injection manipulator system (RCIM) assisted percutaneous kyphoplasty (PKP) for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture by comparing with intermittent hand bolus injection of bone cement during operation. Methods Between September 2010 and January 2016, a retrospective analysis was made on the clinical data of 48 senile patients with single segment rupture of the posterior vertebral osteoporotic thoracolumbar fracture undergoing PKP who accorded with the inclusion criteria. Of 48 patients, 22 received intermittent hand bolus injection of bone cement in the control group, and 26 received RCIM assisted bone cement perfusion in the trial group. There was no significant difference in age, gender, duration of disease, causes of injury, implicated vertebral bodies, bone mineral density T value, pain duration, preoperative visual analogue scale (VAS), relative vertebral body height in the anterior part, and posterior convex Cobb angle between groups (P>0.05). The bone cement perfusion time, the radiation dose of both doctors and patients, and the amount of bone cement injection were recorded; treatment effects were evaluated based on VAS score, posterior convex Cobb angle, relative ver-tebral body height in the anterior part, ratios of bone cement diffusion area and bone cement leakage rate. Results The patients were followed up for 6 months; no complications of toxic effect of bone cement, spinal cord or nerve root injuries, infection and vascular embolization occurred during follow-up period. There was no significant difference in bone cement injection amount and radiation dose of doctors between groups (P>0.05), but bone cement perfusion time, ratios of bone cement diffusion area, and radiation dose of patients were significantly lower in the trial group than the control group (P<0.05). Bone cement leakage was observed in 6 cases of the control group (27.27%) and 2 cases of the trial group (7.69%), showing significant difference between groups (χ2=4.850,P=0.029); no cement leakage into the spinal canal was found in both groups. VAS score, relative vertebral body height in the anterior part, and posterior convex Cobb angle were significantly improved at 3 days and 6 months after operation when compared with preoperative ones (P<0.05), but no significant difference was observed in the above indexes between groups at 3 days and 6 months after operation (P>0.05). Conclusion Satisfactory effectiveness can be achieved by applying RCIM assisted PKP for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture. RCIM can shorten perfusion time, reduce radiation dose, and decrease incidence of bone cement leakage.
Objective To evaluate the biomechanical stability of a newly-designed Y type pedicle screw (YPS) in osteoporotic synthetic bone. Methods The osteoporotic synthetic bone were randomly divided into 3 groups (n=20). A pilot hole, 3.0 mm in diameter and 30.0 mm in deep, was prepared in these bones with the same method. The YPS, expansive pedicle screw (EPS), and bone cement-injectable cannulated pedicle screw (CICPS) were inserted into these synthetic bone through the pilot hole prepared. X-ray film examination was performed after 12 hours; the biomechanical stability of YPS, EPS, and CICPS groups was tested by the universal testing machine (E10000). The test items included the maximum axial pullout force, the maximum running torque, and the maximum periodical anti-bending. Results X-ray examination showed that in YPS group, the main screw and the core pin were wrapped around the polyurethane material, the core pin was formed from the lower 1/3 of the main screw and formed an angle of 15° with the main screw, and the lowest point of the inserted middle core pin was positioned at the same level with the main screw; in EPS group, the tip of EPS expanded markedly and formed a claw-like structure; in CICPS group, the bone cement was mainly distributed in the front of the screw and was dispersed in the trabecular bone to form a stable screw-bone cement-trabecular complex. The maximum axial pullout force of YPS, EPS, and CICPS groups was (98.43±8.26), (77.41±11.41), and (186.43±23.23) N, respectively; the maximum running torque was (1.42±0.33), (0.96±0.37), and (2.27±0.39) N/m, respectively; and the maximum periodical anti-bending was (67.49±3.02), (66.03±2.88), and (143.48±4.73) N, respectively. The above indexes in CICPS group were significantly higher than those in YPS group and EPS group (P<0.05); the maximum axial pullout force and the maximum running torque in YPS group were significantly higher than those in EPS group (P<0.05), but there was no significant difference in the maximum periodical anti-bending between YPS group and EPS group (P>0.05). Conclusion Compared with EPS, YPS can effectively enhance the maximum axial pullout force and maximum rotation force in the module, which provides a new idea for the design of screws and the choice of different fixation methods under the condition of osteoporosis.
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 investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures. Methods A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed. All patients underwent bilateral percutaneous vertebroplasty. During operation, the final position of the puncture needle tip reached was observed by C-arm X-ray machine. And 118 cases of bilateral puncture needle tips were at the same level (group A); 156 cases of bilateral puncture needle tips were at different levels (group B), of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively (group B1), and 69 cases were at the adjacent levels (group B2). There was no significant difference in gender, age, fracture segment, degree of osteoporosis, disease duration, and preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between groups A and B and among groups A, B1, and B2 (P>0.05). The operation time, bone cement injection volume, postoperative VAS score, ODI, and bone cement distribution were compared among the groups. Results All operations were successfully completed without pulmonary embolism, needle tract infection, or nerve compression caused by bone cement leakage. There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A, B1, and B2 (P>0.05). All patients were followed up 3-32 months, with an average of 7.8 months. There was no significant difference in follow-up time between groups A and B and among groups A, B1, and B2 (P>0.05). At 3 days after operation and last follow-up, VAS score and ODI were significantly lower in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebrae was significantly better in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). In group A, 7 cases had postoperative vertebral collapse and 8 cases had other vertebral fractures. In group B, only 1 case had postoperative vertebral collapse during follow-up. ConclusionBilateral percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures can obtain good bone cement distribution and effectiveness when the puncture needle tips locate at different levels during operation. When the puncture needle tips locate at the upper 1/3 layer and the lower 1/3 layer of the vertebral body, respectively, the puncture sites are closer to the upper and lower endplates, and the injected bone cement is easier to connect with the upper and lower endplates.
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 explore the correlation between multimorbidity and hip fractures in middle-aged and elderly populations. Methods The population without hip fractures in 2011 was selected in the China Health and Retirement Longitudinal Study database. According to whether the research subjects experienced hip fractures between 2015 and 2020, they were divided into the hip fracture group and the non-hip fracture group. Multiple logistic regression analysis was used to explore the correlation between multimorbidity and hip fracture occurrence. Results A total of 9644 subjects were included. Among them, there were 4406 males and 5238 females. There were 419 cases in the hip fracture group and 9225 cases in the non-hip fracture group. Multivariate logistic regression analysis showed that diabetes, heart disease, arthritis and hearing impairment were independent risk factors for hip fracture. Compared to those without chronic diseases, individuals with ≥3 types of comorbidities among the 4 chronic diseases had a higher risk of hip fracture. Conclusions In the middle-aged and elderly population, diabetes, heart disease, arthritis and hearing impairment are chronic diseases associated with hip fracture. The higher the number of comorbidities of chronic diseases, the higher the risk of new hip fractures.
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.
Osteoporosis (OP) is one of the most serious health problems, causing a huge economic burden to patients, families and society. OP rehabilitation treatment plays an important role in pain-relieving, reducing the risk of fracture, improving the ability of daily activities, and promoting the healing of osteoporosis fractures, and has been increasingly valued and recommended by domestic and foreign guidelines. This guideline was updated based on the Chinese expert consensus on rehabilitation intervention for primary osteoporosis 2019 editions, and was initiated by Chinese Society of Physical Medicine and Rehabilitation professor HE Chengqi, Chairman of the Chinese Medical Association Physical Medicine and Rehabilitation Branch. This guideline development was guided by domestic and international guideline development methods and principles, and selected through clinical issue screening and deconstruction, and two rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the grading of recommendations assessment, development and evaluation (GRADE) was used based on the best available evidence. The ICF is a theoretical framework based on the best available evidence, and uses the GRADE method to grade the quality of evidence and recommendations, and reports them according to the Reporting Items for Practice Guidelines in Healthcare (RIGHT), taking into account patients’ preferences and values and the needs of Chinese clinical practice, resulting in 22 recommendations in 7 aspects of rehabilitation assessment, physical agents therapy, occupational therapy, rehabilitation brace, cognitive behavior and psychological therapy, traditional Chinese medicine therapy and health education to systematically standardize the rehabilitation of osteoporosis.