椎体内裂隙样变对经皮椎体后凸成形术疗效的影响

 目的 探讨椎体内裂隙样变对经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)疗效的影响。方法 回顾性分析2009年12月至2011年12月,采用PKP治疗183例骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)患者资料,根据影像学表现,将患者分为裂隙组和无裂隙组。裂隙组44例,男5例,女39例;年龄56～89岁,平均71.6岁。无裂隙组139例,男22例,女117例;年龄51～91岁,平均70.2岁。比较两组患者骨折椎体分布情况、骨水泥注入量、骨水泥渗漏发生率、渗漏类型、骨折椎体高度恢复情况等。采用视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index, ODI)评价疗效。结果裂隙组与无裂隙组在骨折椎体的分 布存在差异,裂隙组骨折椎体主要分布在T₁₁～L₂椎体,无裂隙组主要分布在T₁₁～L₅及T₇～₉。裂隙组和无裂隙组骨水泥注入量及渗漏率分别为3.4～5.6 ml和3.5～5.1 ml, 45.3%(24/53)和41.9%(72/172),两项指标比较差异无统计学意义;但两组骨水泥渗漏类型存在差异,裂隙组主要在椎体周 围软组织渗漏,无裂隙组主要沿血管渗漏。两组术后骨折椎体高度均明显恢复,裂隙组较无裂隙组椎体前缘高度恢复明显。裂隙 组和无裂隙组术后VAS评分及ODI指数分别为(2.8±1.1)分和(2.4±0.7)分,29.3%±6.8%和27.6%±6.9%,两项指标比较差异 无统计学意义。结论 伴椎体内裂隙样变的OVCFs的骨折椎体主要分布在活动度较大的T₁₁～L₂椎体。采用 PKP治疗伴椎体内裂隙样变的OVCFs可获得满意的临床疗效,术后椎体前缘高度恢复明显。     

骨填充网袋成形术与经皮椎体后凸成形术治疗Kümmell病的疗效比较

目的:比较骨填充网袋成形术与经皮椎体后凸成形术(percutanous kyphoplasty,PKP)治疗Kümmell病的临床疗效。方法:对2018年7月至2019年12月收治的Kümmell病患者进行回顾性分析,根据不同的治疗方法分为网袋组及PKP组。网袋组20例,男2例,女18例;年龄54~83(67.40±7.44)岁;T₁₀骨折1例,T₁₂骨折3例,L₁骨折9例,L₂骨折5例,L₃骨折2例。PKP组20例,男3例,女17例;年龄56~81(67.20±7.01)岁;T₁₀骨折2例,T₁₁骨折1例,T₁₂骨折6例,L₁骨折10例,L₃骨折1例。记录两组患者术前,术后1 d和术后1年的视觉模拟评分(visual analogue scale,VAS),Cobb角及椎体前缘高度变化,观察术前、术后1个月和术后1年的Oswestry功能障碍指数(Oswestry Disability Index,ODI),比较两组术后骨水泥渗漏率。结果:所有患者获得1年以上的随访。网袋组术后1年VAS(1.20±0.41)分,Oswestry功能障碍指数(13.50±3.10)%,Cobb角(17.20±3.12)°,椎体前缘高度(20.20±1.35) mm;PKP组术后1年VAS(1.15±0.40)分,Oswestry功能障碍指数(13.20±3.00)%,Cobb角(17.10±3.19)°,椎体前缘高度(20.10±1.37) mm;组内对比两组均较术前显著好转(P<0.05),组间对比差异无统计学意义(P>0.05)。网袋组共20例20椎,其中1例出现骨水泥向上终板处渗漏,渗漏率为5%;PKP组20例20椎,骨水泥向上终板渗漏3例,向下终板渗漏1例,向椎体前方渗漏1例,向椎体侧方渗漏2例,共7例,渗漏率为35%。两组对比差异有统计学意义(P<0.05)。结论:网袋成形术在Kümmell病的治疗中可更好地降低骨水泥渗漏率,减少并发症产生。     

改良悬吊复位法联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折的临床研究

目的:探讨改良悬吊复位法联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的临床疗效。方法:自2020年2月至2021年10月采用经皮椎体成形术治疗胸腰椎骨质疏松性压缩骨折患者92例,按照治疗方式不同分为观察组和对照组,观察组先行改良悬吊复位法给予伤椎复位,再行经皮椎体成形术治疗,对照组则单纯给予经皮椎体成形术治疗。观察组47例,男20例,女27例;年龄59~76(69.74±4.50)岁;骨折椎体节段T₁₀ 2例,T₁₁ 7例,T₁₂ 19例,L₁₁4例,L₂ 5例;对照组45例,男21例,女24例;年龄61~78(71.02±3.58)岁;骨折椎体节段:T₁₀ 3例,T₁₁ 8例,T₁₂17例,L₁ 12例,L₂ 5例。观察术中骨水泥渗漏情况,记录并比较两组手术前后疼痛视觉模拟评分(visual analogue scale,VAS)、腰椎Oswestry功能障碍指数(Oswestry disability index,ODI)、伤椎前缘高度、伤椎后凸Cobb角及骨水泥注入量等指标。结果:所有患者获得随访,时间6~10(8.45±1.73)个月。观察组2例出现骨水泥渗漏,对照组3例出现骨水泥渗漏。观察组术后伤椎前缘高度较术前均增加(P<0.05),伤椎后凸Cobb角较术前降低(P<0.05);对照组术后伤椎后凸Cobb角及伤椎前缘高度与术前比较,差异无统计学意义(P>0.05);观察组术后伤椎后凸Cobb角(9.82±2.55)°,低于对照组(15.87±4.60)°(P<0.05),伤椎前缘高度观察组(21.29±3.65) mm,高于对照组(17.16±2.91) mm(P<0.05)。观察组VAS术前(7.32±1.05)分,术后1周及3、6个月分别为(3.56±1.18)、(1.83±0.67)、(1.27±0.34)分,ODI评分术前(40.12±14.69)分,术后1周及3、6个月分别为(23.76±10.19)、(20.15±6.39)、(13.45±3.46)分。对照组VAS术前(7.11±5.26)分,术后1周及3、6个月分别为(3.82±0.68)、(1.94±0.88)、(1.36±0.52)分,ODI评分术前(41.38±10.23)分,术后1周及3、6个月分别为(25.13±14.22)、(20.61±5.82)、(14.55±5.27)分。两组术后VAS、ODI评分较术前均下降(P<0.05),术后两组VAS及ODI比较,差异无统计学意义(P>0.05)。结论:改良悬吊复位法联合PVP手术治疗骨质疏松性胸腰椎压缩骨折均取得良好的临床疗效,可有效减轻患者腰背部疼痛,恢复椎体高度,矫正后凸畸形,改善患者腰椎功能,提高患者生活质量。     

退变性脊柱侧凸患者发生骨质疏松性椎体压缩骨折的危险因素分析

目的探讨退变性脊柱侧凸(degenerative scoliosis,DS)患者发生骨质疏松性椎体压缩骨折(osteoporotic vertebral compressive fracture,OVCF)的危险因素。方法回顾性分析自2011-03-2015-08收治的130例DS患者,依据发生OVCF与否,分为骨折组(37例)与非骨折组(93例),统计两组患者的相关指标数据,包括年龄、性别、吸烟史、酗酒史、体重指数(BMI)、骨密度值、外伤史,腰椎前凸角、侧凸角、VAS评分、形成骨桥与否等,进行单因素与多因素回归分析。结果单因素分析发现,年龄、外伤史、VAS评分、骨密度、形成骨桥等几项指标,在有骨折组与无骨折组之间的差异有显著性(P0.05),提示上述指标与DS患者发生OVCF有关。多因素Logistic回归分析提示,骨质疏松(β=1.829,S.E=0.498,P=0.035)、形成骨桥(β=1.986,S.E=0.502,P=0.023)、外伤史(β=3.472,S.E=0.613,P=0.012),均是DS患者发生OVCF的独立危险因素。结论 DS合并OVCF患者的疼痛程度较高、年龄偏大;外伤史、骨桥形成、骨质疏松这三项均是影响患者发生OVCF的独立危险因素。     

椎体骨折2周与4周内行椎体后凸成形术后疗效的比较研究

 目的 比较骨质疏松性椎体压缩骨折后2周内(接受手术时病程≤14d)与2～4周(14 d＜接受手术时病程≤ 28d)行椎体后凸成形术后椎体高度及骨水泥渗漏的情况。方法 回顾性分析2010年1月至2011年1月,采用椎体后凸 成形术治疗48例骨质疏松性椎体压缩骨折患者资料,根据患者受伤至手术时间分为2周内和2～4周手术组,2周内手术 组22例,男4例,女18例;年龄54～85岁,平均71.17岁。2～4周手术组26例,男5例,女21例;年龄56～88岁,平均73.12 岁。两组患者骨折椎体均位于T₇～L₄。比较两组患者年龄、性别、骨密度T值、术前椎体高度丢失率、 术中注入骨水泥量、 术后椎体高度恢复率、术后1年椎体高度丢失率、骨水泥渗漏率。结果 2周内和2～4周手术组术前椎体压缩程度、骨水泥注入量、骨密度T值、椎体高度恢复率分别为47%±21%和48%±19%、(3.69±1.03)ml和(3.66±0.71)ml、-2.79±0.57和- 2.87±0.95、25%±8.3%和23%±7.7%,两组上述四项指标比较,差异均无统计学意义。2周内手术组1年椎体高度丢失率为 9%±2.8%,2～4周手术组为11%±2.9%,两组比较差异有统计学意义。2周内和2～4周手术组骨水泥渗漏率分别为22.2% (6/27)和11.8%(4/34),两组比较差异无统计学意义。结论 骨质疏松性椎体压缩骨折后,2周内与2～4周行椎体后凸成 形术均能较好恢复椎体高度,且骨水泥渗漏率相似,但2周内手术的患者术后1年椎体高度丢失率较小。     

腰椎定量CT在合并脊柱侧弯的骨质疏松性骨折行椎体成形术的应用价值

目的：探讨腰椎定量CT （QCT）在合并脊柱侧弯的骨质疏松性骨折行椎体成形术中的应用价值。方法：对2017年12月至2019年12月采用椎体成形术治疗的60例合并不同程度脊柱侧弯的骨质疏松性骨折患者进行回顾性研究分析。其中男18例,女42例;年龄65~81（72.63±3.34）岁。60例患者术前均进行腰椎QCT检测,根据QCT检测值分为3个等级：骨量减少组（QCT值>80 g/L,10例,12个椎体）;骨质疏松组（QCT值40~80 g/L,35例,48个椎体）;严重骨质疏松组（QCT值<40 g/L,15例,22个椎体）。观察不同程度QCT值患者的骨水泥在伤椎内的弥散及渗漏情况,并分析QCT值对脊柱侧弯患者行椎体成形术穿刺点选择、术后侧凸Cobb角矫正及椎体高度恢复的应用价值。结果：60例82个椎体中,共有41例55个椎体采用凹侧单边穿刺,占67.07%。其中骨量减少组采用凹侧单边穿刺的有2例2个椎体,骨质疏松组采用凹侧单边穿刺的有26例35个椎体,严重骨质疏松组采用凹侧单边穿刺的有13例18个椎体;且3组患者间采用单侧或双侧穿刺的例数比较,差异有统计学意义（χ²=13.699,P=0.001）;3组间发生骨水泥渗漏的例数比较,差异无统计学意义（χ²=1.403,P=0.496）。术前与术后随访时脊柱侧凸Cobb角比较差异有统计学意义（P<0.05）;术前与术后随访时伤椎椎体高度比较差异有统计学意义（P<0.05）。结论：对于合并脊柱侧弯的骨质疏松性骨折患者行椎体成形术时,根据腰椎QCT检测明确骨质疏松严重程度,选择脊柱侧弯的凹侧进行穿刺,有利于改善脊柱侧弯及恢复脊柱稳定性,提高手术安全性。     

退变性脊柱侧凸的外科治疗进展

成人脊柱侧凸和退变性脊柱侧凸是不同的概念,成人脊柱侧凸既包括青少年特发性脊柱侧凸到成年期后的进一步发展,也包括退变性脊柱侧凸。退变性脊柱侧凸是由于椎间盘或小关节突退变、塌陷及椎体的骨质疏松等造成脊柱的弯曲畸形所致。成人脊柱侧凸中的两种情况虽然病因不同,但在后期的病理进展中有相似的结局,     

脊柱调衡手法与药物治疗退变性脊柱侧凸症的病例对照研究

目的:对比脊柱调衡手法与药物治疗对退变性脊柱侧凸症患者的疼痛及功能状态的影响。方法:2010年7月至2013年6月, 将38例退变性脊柱侧凸症患者采用掷硬币的方法随机分为脊柱调衡手法组(手法组)和药物组。手法组20例, 其中男9例, 女11例, 年龄58～74岁, 平均(66.63±7.73)岁, 病程3～8个月, 平均(5.65±2.58)个月;采用脊柱调衡手法(依次循经理筋、松解痉挛、整骨扳拿、通络放松法)治疗, 时间30 min,1次/d,4 d为1疗程, 共9个疗程。药物组男8例, 女10例, 年龄57～70岁, 平均(63.51±6.61)岁, 病程3～5个月, 平均(4.82±1.43)个月;予口服塞来昔布加盐酸乙哌立松, 4 d为1疗程, 共 9个疗程。观察治疗前后两组患者的VAS评分、脊柱侧凸Cobb角及腰椎ODI评分。结果:治疗后, 手法组VAS评分5.38±0.99与药物组6.36±1.31比较差异有统计学意义(t=2.618,P<0.05);手法组Cobb角(16.51±4.89)°与药物组(19.85±5.03) °比较差异有统计学意义(t=2.074,P<0.05);手法组腰椎ODI评分20.20±2.93与药物组26.01±3.11比较差异有统计学意义(t=5.592,P<0.05).结论:采用脊柱调衡手法治疗退变性脊柱侧凸症, 能够调整脊柱两侧的肌力平衡, 矫正脊柱冠状面失衡, 恢复脊柱正常序列, 减少和消除对神经根的压迫和刺激, 缓解腰腿痛症状, 改善生活质量。     

老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形后路截骨矫形的术式选择

目的：观测Smith-Petersen截骨（SPO）、经椎弓根截骨（PSO）和全椎体切除截骨（VCR）3种术式治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形的矫形效果和临床疗效,探讨截骨矫形术式选择。方法：自2015年6月至2017年8月对8例老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形患者后路截骨矫形术,患者均为陈旧性骨质疏松性胸腰椎骨折（>6个月）,经过严格保守治疗3个月无效,包括应用非甾体类消炎镇痛药物、抗骨质疏松药物、针灸等。其中男3例,女5例;年龄66~83岁,平均73.4岁;病程8~60个月,平均34.6个月。8例患者共8个椎体骨折。骨折节段：T₁₀ 1个;T₁₁ 1个;T₁₂ 3个;L₁ 2个,L₂ 1个。8例患者均表现为单节段椎体陈旧性骨折楔形变引起的脊柱后凸畸形。患者胸腰段局部后凸和疼痛症状均呈渐进性发展,表现为中枢性矢状位失衡。术式选择上采用SPO截骨3例,PSO截骨3例,VCR截骨2例。通过影像学测量分析矫形效果,包括术前后脊柱后凸Cobb角,伤椎局部后凸角（localized kyphosis,LK）,胸椎后凸角（thoracic kyphosis,TK）,腰椎前凸角（1umbar lordosis,LL）,骶骨水平角（sacral tilt angle,ST）及骶骨后上角至脊柱矢状轴线的距离（sagittal vertical axis,SVA）。采用疼痛视觉模拟评分（VAS）评估疼痛情况,应用Oswestry功能障碍指数（ODI）分析临床疗效。结果：8例患者术后均获得随访,时间8~24个月,平均13.5个月。所有患者腰背疼痛症状明显减轻或消失,VAS评分由术前的5~8分（平均6.5分）降低至末次随访时的1~4分（平均1.88分）,评分明显改善。ODI评分由术前的36~78分（平均60.25分）降低至末次随访时10~32分（平均20.38分）,功能评分明显进步。随访期间X线检查可见部分患者术后植骨融合椎间隙高度稍微降低,植骨均骨性愈合,未见明显矫正度数丢失和内固定松动失败,胸腰段后凸畸形明显改善。T₁₀-L₂ Cobb角平均值由术前的25.3°矫正至2.8°,矫正率89.3%。LK由术前的平均43.4°改善为术后的7.1°,平均矫正率为86.2%。TK由术前的平均49.9°改善为术后的30.6°。LL由术前的平均43.6°减小为术后的30.8°。ST由术前的平均24.0°改善为术后的32.1°。SVA由术前平均6.23 cm减小为术后的2.40 cm。结论：针对不同病理特征和畸形程度的老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形患者,选用SPO、PSO或VCR矫治均可取得良好矫形效果及临床疗效。     

单侧穿刺椎体后凸成形术骨水泥分布与穿刺角度的关系

目的:探讨胸腰椎压缩骨折单侧穿刺椎体后凸成形术椎体内骨水泥理想分布与穿刺角度的关系。方法:对2013年1月至2014年3月收治的37例(37椎)胸腰椎骨质疏松性压缩骨折患者临床资料进行回顾性分析,其中男6例,年龄65～78岁,平均(71.83±6.15)岁;女31例,年龄57～89岁,平均(71.06±7.89)岁。37例患者均行单侧穿刺椎体后凸成形术。术前对影像学资料进行分析,并测量病椎穿刺角度、穿刺点,术中参考术前测量数据进行穿刺,术后对X线片骨水泥分布面积进行计算,分析经皮单侧穿刺在合适的穿刺角度下骨水泥的双侧分布效果,并按照VAS评分对疗效进行评定。结果:胸椎T₈-T₁₂穿刺角度28°～33°,平均30.4°;腰椎L₁-L₅穿刺角度28°～35°,平均31.3°。术后复查X线片正位片双侧骨水泥面积比值为0.97±0.15,双侧弥散面积基本均等,总体趋势为穿刺测面积略大于对侧面积。患者术后VAS评分较术前有显着降低,术后疼痛明显缓解。结论:行单侧穿刺时,掌握适当外展角,使椎体内骨水泥分布达到双侧穿刺效果。通过术前对影像学资料进行分析,确定穿刺角度及进针点,术中参考术前测量数据进行穿刺,单侧穿刺椎体内骨水泥的分布即可达到双侧穿刺分布效果。     

骨质疏松性胸腰椎骨折椎体强化术后发生邻近椎体骨折的危险因素分析

目的 探讨骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)病人椎体强化术治疗后发生邻近椎体骨折的高危因素.方法 回顾性研究2012年3月至2014年8月苏北人民医院骨科收治的OVCF病人200例(263椎),收集病人的年龄、性别、椎体高度恢复、Cobb角、脊柱侧凸畸形、骨折病史、骨水泥量、骨水泥渗漏、骨密度等资料,应用单因素分析观察每种因素与椎体再骨折发生的相关性,筛查出可疑的相关因素,然后采用多因素Logistic回归分析得出影响椎体强化术后发生邻近椎体骨折的高危因素.结果 所有病人均获2年以上随访,平均随访时间为2.5年.共35例(45椎)发生再骨折,再骨折率为17.5%.单因素统计分析发现对椎体成形术后邻近节段再发骨折有影响的变量有:年龄、椎体高度恢复、Cobb角恢复、脊柱侧凸畸形、骨折病史、骨水泥渗漏、骨密度.多因素Logistic回归分析结果显示,年龄(OR:1.08,95%CI:1.04~1.13)、椎体高度恢复(OR:1.06,95%CI:1.01~1.11)、Cobb角(OR:4.03,95%CI:1.21~13.40)、脊柱侧凸畸形(OR:2.56,95%CI:1.12~5.85)和发生骨水泥渗漏(OR:6.25,95%CI:0.04~0.73)是发生再骨折的危险因素,而骨密度(OR:0.37,95%CI:0.22~0.65)是发生再骨折的保护因素.结论 年龄越大、椎体高度恢复越高、Cobb角越大、骨密度越低、有脊柱侧凸畸形和骨水泥渗漏的病人更容易发生术后邻近椎体再骨折.     

In elderly men and women treated for osteoporosis a low creatinine clearance of <65 ml/min is a risk factor for falls and fractures

Recently, a low creatinine clearance (CrCl) of <65 ml/min was described as a new significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population. In this study we investigated if a low creatinine clearance of <65 ml/min is also a risk factor for falls and fractures in elderly men and women treated for osteoporosis. In a cross-sectional study with the help of questionnaires we assessed the prevalence of having experienced falls within the last 12 months according to renal function in 5,313 German men and women receiving treatment for osteoporosis. The CrCl was calculated using the established Cockcroft-Gault formula. The prevalence of falls and fractures was assessed in multivariate-controlled logistic regression models according to a CrCl cut off of 65 ml/min. The P -values were two-sided. In this study of elderly men and women treated for osteoporosis ( n =5,313), 60.9% ( n =3,238) had a CrCl of <65 ml/min, which was associated in multivariate controlled analyses, compared to a CrCl of 65 ml/min ( n =2,075), with a significant increased risk of experiencing falls (1,775/3,238 vs. 773/2,075, OR 1.69, 95% CI 1.50–1.91, P <0.0001) and an increased risk for multiple falls (37.1 vs. 22.6%, OR 1.63, 95% CI 1.42–1.87, P <0.0001). Furthermore, compared to a creatinine clearance of 65 ml/min, a creatinine clearance of <65 ml/min was also associated with a significant increased multivariate controlled risk for hip fractures (OR 1.57, 95%CI 1.18–2.09, P =0.002), for radial fractures (OR 1.79, 95%CI 1.39–2.31, P =<0.0001), for total vertebral fractures (OR 1.31, 95%CI 1.19–1.55, P =0.003) and for fall-associated vertebral fractures (OR 1.24, 95% CI 1.03–1.54, P =0.031). Similar to community-dwelling elderly, in elderly men and women treated for osteoporosis a CrCl of less than 65 ml/min is a significant and independent risk factor for falls. Furthermore, we could show for the first time that a low creatinine clearance in elderly men and women treated for osteoporosis is also associated with a significantly increased risk of vertebral, hip and radial fractures.     

退行性腰椎侧凸与骨质疏松症的相关性分析

目的:研究成年人腰椎退变性侧凸与骨质疏松的相互关系。方法:自2012年3月至2016年6月,采用回顾性分析方法对53例腰椎退变性侧凸患者进行腰椎退变性侧凸与骨质疏松症相关性研究,男11例,女42例,年龄63～76岁,平均69岁,匹配同期就诊的非腰椎侧凸患者53例,其中腰椎间盘突出症33例,腰椎管狭窄症13例,腰椎滑脱症7例,男16例,女37例,年龄59～74岁,平均68.5岁。53例患者均拍摄腰椎正侧位X线片及腰椎MRI确诊,测量并记录腰椎侧凸Cobb角。运用双能X射线吸收法对所有患者进行骨密度检查,记录腰椎(L_2-L_4)、股骨颈、股骨粗隆、Ward三角部位T值。采用Linear regression研究腰椎侧凸角度与骨质疏松的相关性。结果:腰椎侧凸组与非腰椎侧凸组两者骨密度T值差异有统计学意义,腰椎退变性侧凸患者骨密度T值(-2.56±0.65)明显高于非腰椎侧凸组(-1.39±0.77)(P0.05),腰椎侧凸患者腰椎(L_2-L_4)、股骨颈、股骨粗隆、Ward三角部位的T值与侧凸Cobb角无明显相关性。结论:骨质疏松是发生腰椎退变性侧凸的危险因素,但侧凸程度与骨质疏松程度无明显相关性。     

Hospitalized osteoporotic vertebral fracture increases the risk of stroke: A population‐based cohort study

The association between osteoporosis and cardiovascular diseases has been demonstrated. Higher cardiovascular risk has also been correlated with vertebral fractures. However, the association between osteoporotic vertebral fracture and the possibly higher risk of stroke remains uncertain. This study aimed to evaluate the incidence, risk, and type of stroke in patients with osteoporotic vertebral fracture. Patients with osteoporotic vertebral fracture were identified (n = 380) and 10 age‐ and sex‐matched controls per case (comparison group, n = 3795) were chosen from a nationwide representative cohort of 999,997 people from 1998 to 2005. Both groups were followed‐up for stroke events for 3 years, matched by propensity scores with adjustments for covariates such as comorbidities (ie, hypertension, diabetes, arrhythmia, or coronary heart diseases) and exposure to medications (ie, aspirin, lipid lowering drug, or nitrates), and assessed by Kaplan‐Meier and Cox regression analyses. The incidence rate of stroke in the osteoporotic vertebral fracture group (37.5 per 1000 person‐years; 95% confidence interval [CI], 27.5–51.2) was significantly higher than in the comparison group (14.0 per 1000 person‐years; 95% CI, 12.0–16.4, p < 0.001). Stroke was more likely to occur in the osteoporotic vertebral fracture patients than in the normal controls (crude hazard ratio [HR] 2.68, 95% CI 1.89–3.79, p < 0.001; adjusted HR 2.71, 95% CI 1.90–3.86, p < 0.001). In conclusion, patients with osteoporotic vertebral fracture have a higher risk of stroke (ie, both ischemic and hemorrhagic) and require stroke prevention strategies. © 2013 American Society for Bone and Mineral Research.     

Effects of alfacalcidol alone or in combination with elcatonin on incidence of osteoporotic vertebral fractures in postmenopausal women with spondylosis

Osteoporosis and spondylosis often occur simultaneously. However, there are no previous reports about the effects of osteoporosis medication on incidence of vertebral fractures in people with spondylosis. In this study, we conducted a retrospective investigation of the effects of alfacalcidol alone or in combination with elcatonin on incidence of osteoporotic vertebral fractures in women with spondylosis. The present subjects were 101 postmenopausal women with osteoporosis aged >60 years, divided into three groups: D group (n = 45), treated for >5 years with alfacalcidol; D+ECT group (n = 26), treated for >5 years with alfacalcidol plus elcatonin; control group (n = 30), who received no medications for >5 years. Over the 5-year treatment period, bone mineral density (BMD) of the lumbar spine and proximal femur did not significantly change in the D and D+ECT groups, but they significantly decreased in the control group (P < 0.05). The number of incident vertebral fractures per patient was significantly higher in the control group (2.9) than in the D group (1.2) and D+ECT group (1.5) (P < 0.01). There was no significant difference in BMD or incident vertebral fractures between the D and D+ECT groups. In all three groups, the number of incident vertebral fractures positively correlated with the number of prevalent vertebral fractures (0.303 ≤ r ≤ 0.434), and negatively correlated with baseline BMD (−0.703 ≤ r ≤ −0.326) and the osteophyte score representing the degree of spondylosis (−0.769 ≤ r ≤ −0.365). Further multiple regression analysis revealed that the medication (D or D+ECT, P < 0.001) and the osteophyte score (P < 0.001) were the most significant contributors for the number of incident vertebral fractures. In conclusion, elcatonin had no additive effects on BMD or prevention of vertebral fractures in postmenopausal women receiving alfacalcidol. Presence of spondylosis (indicated by a high osteophyte score) appears to have an effect on prevention of vertebral fractures.     

Effects of Abaloparatide‐SC on Fractures and Bone Mineral Density in Subgroups of Postmenopausal Women With Osteoporosis and Varying Baseline Risk Factors

Abaloparatide‐SC is a novel 34–amino acid peptide created to be a potent and selective activator of the parathyroid hormone receptor type 1 (PTHR1) signaling pathway. In the Abaloparatide Comparator Trial in Vertebral Endpoints (ACTIVE) Phase 3 trial (NCT01343004), abaloparatide reduced new morphometric vertebral fractures by 86% compared with placebo (p < 0.001) and nonvertebral fractures by 43% (p = 0.049) in postmenopausal women with osteoporosis. Abaloparatide‐SC increased bone mineral density (BMD) 3.4% at the total hip, 2.9% at the femoral neck, and 9.2% at the lumbar spine at 18 months (all p < 0.001 versus placebo). The analysis reported here was designed to evaluate whether fracture risk reductions and BMD accrual were consistent across different levels of baseline risk. Risk factor subgroups were predefined categorically for BMD T‐score of the lumbar spine, total hip, and femoral neck (≤–2.5 versus >–2.5 and ≤–3.0 versus >–3.0), history of nonvertebral fracture (yes versus no), prevalent vertebral fracture (yes versus no), and age (<65 versus 65 to <75 versus ≥75 years) at baseline. Forest plots show that there were no clinically meaningful interactions between any of the baseline risk factors and the treatment effect of abaloparatide‐SC on new morphometric vertebral fractures, nonvertebral fractures, or BMD increases. Abaloparatide provides protection against fractures consistently across a wide variety of ages and baseline risks, including those with and without prior fractures, and it has potential utility for a broad group of postmenopausal women with osteoporosis. © 2016 American Society for Bone and Mineral Research.     

老年髋部骨折患者术后对侧髋部骨折发生因素的Meta分析

目的通过Meta分析评价影响老年髋部骨折患者术后对侧髋部骨折的相关因素。方法检索Pubmed、Cochrane、中国生物医学文献数据库、CNKI中国期刊全文数据库、万方数据库自2005年1月至2018年4月国内外正式刊物上公开发表的有关老年髋部骨折术后对侧髋部骨折相关因素的文献,严格评价质量及提取相关资料,获取患者的性别、年龄(>65岁)、吸烟、初次髋部骨折类型、骨质疏松症(Singh指数≥4为骨质疏松)、伴有原发性高血压、伴有帕金森病、伴有脑卒中、伴有老年痴呆症、伴有白内障、伴有类风湿关节炎、伴有糖尿病、初次骨折内固定种类、患者治疗配合的依从性。运用RevMan5.0软件进行统计分析,评估各项指标的优势比(OR)和95%可信区间(CI)。结果共纳入17项研究13717例老年髋部骨折患者,发生对侧髋部骨折1504例。影响老年髋部骨折术后对侧髋部骨折的相关因素有患者年龄(OR=-3.55,95%CI:-5.60^-1.50,P<0.001)、骨质疏松症(OR=2.38,95%CI:1.36~4.17,P=0.002)、伴有帕金森病(OR=4.54,95%CI:2.74~7.53,P<0.001)、脑卒中(OR=0.33,95%CI:0.18~0.59,P<0.001)、老年痴呆症(OR=0.43,95%CI:0.29~0.62,P<0.001)、白内障(OR=0.37,95%CI:0.22~0.63,P<0.001)、类风湿关节炎(OR=0.32,95%CI:0.21~0.50,P<0.001)、糖尿病(OR=0.65,95%CI:0.47~0.91,P=0.01)、初次骨折内固定种类(OR=0.51,95%CI:0.30~0.85,P=0.01)、治疗配合依从性(OR=0.36,95%CI:0.21~0.64,P<0.001),而与性别(OR=1.07,95%CI:0.45~2.56,P=0.88)、吸烟(OR=0.86,95%CI:0.40~1.86,P=0.70)、初次髋部骨折类型(OR=0.97,95%CI:0.60~1.57,P=0.90)、伴有原发性高血压(OR=0.70,95%CI:0.41~1.21,P=0.20)无关。结论影响老年髋部骨折患者术后对侧髋部骨折的相关因素有年龄偏大、伴有骨质疏松症、帕金森病、脑卒中、老年痴呆症、白内障、类风湿关节炎、糖尿病、初次骨折内固定种类、治疗配合依从性差。而患者性别、吸烟、骨折类型、伴有原发性高血压目前尚无足够的证据与对侧髋部骨折有关。     

Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture

BACKGROUND CONTEXTAlthough risk factors of new adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF) after vertebroplasty may differ, research on this topic is lacking.PURPOSETo determine the natural course of new vertebral fractures after vertebroplasty for osteoporotic vertebral compression fracture (OVCF) and to analyze each risk factor for understanding the incidence of AVF and RVF.STUDY DESIGNRetrospective cohort study.PATIENT SAMPLEThe study subjects included 205 patients who received vertebroplasty for OVCF and were followed-up for at least 1-year.OUTCOME MEASURESData on factors that could affect the occurrence of vertebral fractures, such as age, body mass index, and bone density, were collected from the patients’ medical records. Fracture pattern, fracture location, sagittal imbalance, degree of segmental kyphosis after vertebroplasty, cement distribution, and cement leakage were radiologically examined.METHODSxDuring the follow-up period, any newly developed vertebral fractures were identified. We analyzed whether the time of occurrence differed between AVF and RVF by performing a survival analysis and each risk factor separately.RESULTSNew vertebral fractures occurred in 47 patients (22.9%) after vertebroplasty, AVF occurred in 21 patients (10.2%), and RVF occurred in 26 patients (12.7%). The onset time of AVF was 6.2±1.8 months after vertebroplasty, showing a significant difference from that of RVF, which was 15.2±1.8 months (p<.001). In the univariate analysis, the risk factors of AVF included severe osteoporosis (T-score<−3.0), vertebroplasty in the thoracolumbar junction, sagittal imbalance, and segmental kyphosis angle >15° (p=0.029, p=0.033, p=0.001, and p=0.021, respectively). The risk factors of RVF included severe osteoporosis (T-score <−3.0) and sagittal imbalance (p=0.013 and p=0.004). In the multivariate analysis, the risk factors of AVF included vertebroplasty in the thoracolumbar junction and sagittal imbalance (hazard ratio=3.34, p=0.032 and hazard ratio=4.05, p=0.008), and those of RVF included only sagittal imbalance (hazard ratio=2.66, p=0.024).CONCLUSONAfter vertebroplasty for OVCF, a significant difference in the meantime of occurrence was found; it took 6 months for AVF and 15 months for RVF to develop. Vertebroplasty in the thoracolumbar junction was identified as a risk factor for AVF, whereas sagittal imbalance was a risk factor of both AVF and RVF.     

妇科恶性肿瘤患者术后深静脉血栓危险因素的Meta分析

背景与目的 妇科恶性肿瘤患者术后发生深静脉血栓（DVT）,可引起患者肺栓塞或猝死,严重威胁患者的生命,本研究通过Meta分析明确妇科恶性肿瘤患者术后发生DVT的危险因素,为预防和降低妇科恶性肿瘤患者术后DVT的发生提供循证依据。方法 计算机检索多个国内外数据库,搜集有关妇科恶性肿瘤患者术后DVT危险因素的队列研究或病例对照研究,检索时限均为建库至2021年3月,采用Revman 5.3软件进行Meta分析。结果 共纳入19篇文献,包含4 964例患者,其中病例组1 040例,对照组3 924例,共研究了36项危险因素。将其中10项危险因素进行了数据合并分析显示,既往有DVT史（OR=3.70,95% CI=2.15~6.35,P<0.001）、年龄大（OR=2.99,95% CI=1.85~4.82,P<0.001）、合并高血压（OR=2.25,95% CI=1.32~3.83,P=0.003）、手术时间长（OR=1.03,95% CI=1.02~1.04,P<0.001）、BMI增加（OR=1.87,95% CI=1.55~2.25,P<0.001）、术后卧床时间长（OR=3.17,95% CI=2.56~3.92,P<0.001）、纤维蛋白原高（OR=2.80,95% CI=2.26~3.47,P<0.001）、肿瘤分期晚（OR=2.56,95% CI=1.83~3.57,P<0.001）、发生淋巴结转移（OR=2.88,95% CI=1.58~5.25,P=0.000 6）、D-二聚体高（OR=2.52,95% CI=1.84~3.43,P<0.001）均为妇科恶性肿瘤患者术后发生危险因素。结论 临床医护人员应结合本研究结果所确定10项危险因素,积极识别术后易发生DVT的妇科恶性肿瘤高危人群,并提供针对性的措施预防或降低其术后发生DVT风险。