破坏载荷下老年人椎间盘退变对胸腰椎应力分布影响的研究

目的 探讨老年人椎间盘退变后胸腰椎损伤的生物力学背景,为临床上认识老年人胸腰椎骨折发生的机制提供理论依据。方法 用三维有限元法建立老年人胸腰椎活动节段的力学模型,并对其在垂直压缩、压缩屈曲、分离屈曲三种外加载荷下的应力进行分析。结果 垂直压缩及压缩屈曲载荷下,椎体松质骨的应力分布相对平均,邻近终板的中央部分水平减低,周边部分的应力水平相应上升,椎间盘纤维环的后侧应力集中,后部结构应力集中于椎弓根、     

骨密度与颈椎间盘退变关系的实验研究

目的 探讨骨密度与颈椎间盘退变的相互关系. 方法 利用14月龄雌性大鼠,采用去势造成骨质疏松(A组)、破坏鼠颈后部软组织结构造成颈椎间盘退变(B组)、及两者合并(C组)等3种动物模型,通过观察各组鼠骨密度(BMD)、颈椎间盘退变的形态学分级变化,与正常组(D组)对比,进行相关性分析. 结果 B组中,颈椎间盘退变程度与颈椎BMD呈正相关(P<0.01).在C组中,颈椎间盘退变程度与颈椎BMD呈正相关(P<0.05),与腰椎BMD呈负相关(P<0.01),在其余各组中,也有这种趋势,但没有统计学意义(P0.05).各组中,全身BMD与颈椎间盘退变程度之间的关系,没有显著意义(P0.05). 结论 颈椎间盘退变与颈椎骨密度呈正相关,与腰椎骨密度呈负相关,与全身骨密度没有关系.     

影像参数对老年患者L4椎体发生退变性滑脱的影响

目的探讨影像参数对老年人群L4椎体发生退变性滑脱的影响。方法 45例L4椎体发生退变性滑脱的老年患者为观察组及75例L4椎体退变性但未滑脱的老年患者为对照组,均行腰椎影像学检查,X线上测量椎间盘高度、椎体大小、倾角、前凸角等,CT测量关节角。应用Logistic回归分析其对L4椎体发生退变性滑脱的影响。结果观察组L4Ⅰ度滑脱39例,占86.7%,Ⅱ度滑脱6例,占13.3%,滑脱指数为(0.18±0.05)。观察组女性比例高于对照组,骨密度低于对照组(P0.05),年龄、体重指数、病程差异无统计学意义(P0.05)。观察组椎间盘高度、L4椎体大小低于对照组,但椎间盘退变指数、L4椎体倾角、腰椎前凸角、骨盆折射角、关节突关节角、L3~4及L4~5关节突头尾差角高于对照组(P0.05)。L4椎体小,腰椎前凸角大、骨盆折射角大是老年椎体退变性滑脱的独立危险因素(P0.05)。结论老年患者L4椎体退变性滑脱与骨质疏松相关,L4椎体滑脱的发生多受到椎体小,腰椎前凸角大、骨盆折射角大的影响。     

老年人退变性腰椎侧凸症几个问题

腰椎退变性疾病包括因椎间盘退变导致的椎间盘突出症、退变性腰椎椎管狭窄症、退变性椎滑脱症及退变性腰椎侧凸症等.这些因退变引起的病变,总称为腰椎退变性疾病.这些病变极少单纯存在,通常两种以上疾病同时发生.     

腰椎滑脱椎弓根螺钉内固定融合术后椎体骨密度的变化

31例腰椎滑脱行腰椎内固定融合术的患者,术后10～16个月固定椎体骨密度明显降低,固定L5～S1者固定融合区邻近椎体(L4)骨密度明显降低,固定L4～L5者固定融合区邻近椎体(L3、S1)骨密度有一定程度的降低.认为腰椎内固定融合术后,固定融合区椎体退变明显;非悬浮固定后固定融合区邻近椎体退变明显,而悬浮固定后固定融合区邻近椎体退变不明显.     

腰椎退变性疾病患者出现椎间盘真空现象的相关因素

目的分析腰椎退变性疾病患者发生椎间盘真空现象的相关因素。方法腰椎退变性疾病患者103例,采用腰椎CT观察椎间盘真空现象的发生,其中发生真空现象者44例(观察组),未发生真空现象者59例(对照组),比较两组患者VAS评分、Modic改变及椎间盘退变Pfirrmann分级。结果观察组、对照组VAS评分分别为(8.2±1.3)、(6.8±1.8)分,Modic改变分别为24、59例;Pfirrmann分级Ⅲ级分别为0、9例;Pfirrmann分级Ⅳ级分别为19、29例;Pfirrmann分级Ⅴ级分别为25、21例,两组比较,P均<0.01。结论腰椎退变性疾病中椎间盘真空现象发生率较高,其发生可能与椎间盘退变及终板退变有关。     

老年腰椎后皮下水肿样信号改变与腰椎疾病的相关性

目的探究椎间盘退行性变、Modic终板退变和小关节退变、强直性脊柱炎和感染性脊柱炎与腰椎后皮下水肿样信号改变(PLSE)的关系。方法取2016年1月至2018年12月行腰椎磁共振成像(MRI)检查的65岁以上患者,进行短时反转恢复序列MRI检查并由两位医师分别独立阅片共同判读有无PLSE,采用Logistic多元回归模型分析PLSE与各因素的相互关系。结果研究对象共324例,年龄65～97岁,平均78.31岁;椎间盘退变,Modic终板退变合并小关节退变,强直性脊柱炎及感染性脊柱炎4组年龄、体重指数(BMI)及性别差异均有统计学意义(P0.05);23%患者有PLSE,其中椎间盘退变患者17%,Modic终板退变合并小关节退变患者24%,强直性脊柱炎患者14%,感染性脊柱炎患者53%;在Modic终板退变合并小关节退变患者中,年龄与PLSE有相关性(P0.05)。除感染性脊柱炎外,其余各组PLSE与BMI均有相关性(P0.05)。结论 PLSE与老年各种退行性、免疫性和感染性腰椎疾病有关,特别是在肥胖患者中,PLSE很可能是腰椎疾病的早期表现,影像科医师应重视PLSE征象以更好地指导临床诊疗。     

腰椎间盘退变组织中NF-kB、MMP-1/TIMP-1的表达及意义

目的 探讨NF-KB、基质金属蛋白酶(MMP)-1/基质金属蛋白酶抑制剂(TMP)-1表达在椎间盘退变过程中的作用.方法 应用免疫组织化学方法和ELISA方法检测38例椎间盘退变所致腰椎间盘突出症患者退变椎间盘髓核组织(观察组)和8例腰椎爆裂骨折患者的正常椎间盘髓核组织(对照组)中NF-KB,MMP-1、TIMP-1的表达,计算MMP-1与TIMP-1的比值.结果 观察组的NF-KB表达及MMP-1/TIMP-1均明显高于对照组,P均<0.05.结论 NF-KB,MMP-1/TIMP-1在腰椎间盘退变过程中起重要作用.     

腰椎间盘退变组织中NFκ-B、MMP-1/TIMP-1的表达及意义

目的探讨NFκ-B、基质金属蛋白酶（MMP）-1基/质金属蛋白酶抑制剂（TIMP）-1表达在椎间盘退变过程中的作用。方法应用免疫组织化学方法和ELISA方法检测38例椎间盘退变所致腰椎间盘突出症患者退变椎间盘髓核组织（观察组）和8例腰椎爆裂骨折患者的正常椎间盘髓核组织（对照组）中NFκ-B、MMP-1、TIMP-1的表达,计算MMP-1与TIMP-1的比值。结果观察组的NFκ-B表达及MMP-1/TIMP-1均明显高于对照组,P均〈0.05。结论 NFκ-B、MMP-1/TIMP-1在腰椎间盘退变过程中起重要作用。     

氧化应激在椎间盘退变发病机制中的作用进展

椎间盘退变性疾病主要包括椎间盘突出症、脊髓病、椎管狭窄和椎体不稳等。通常人20岁以后椎间盘就开始发生退变,并随着年龄的增长逐渐严重。氧化应激可能改变椎间盘细胞的结构或功能,并导致椎间盘退变的发生。现将氧化应激在椎间盘退变发病机制中的作用综述如下。     

Association of transforming growth factor beta1 genotype with spinal osteophytosis in Japanese women

OBJECTIVE: To examine the possible relationship between a T-->C polymorphism at nucleotide position 29 of the transforming growth factor beta1 (TGFbeta1) gene and genetic susceptibility to radiographic spinal osteophytosis. METHODS: A total of 540 postmenopausal Japanese women were subjected to radiography of the spine and determination of bone mineral density (BMD) for the lumbar spine and total body. Changes in lumbar intervertebral discs were examined in 67 individuals with either osteoporosis or spinal osteophytosis by magnetic resonance imaging (MRI). TGFbeta1 genotype was determined with an allele-specific polymerase chain reaction assay. The serum concentration of TGFbeta1 was measured in 29 control subjects and in 36 patients with spinal osteophytosis. RESULTS: Among all study subjects, the prevalence of radiographic spinal osteophytosis in individuals with the CC genotype was greater than that in those with the TC or TT genotype. Logistic regression analysis, adjusted for age, height, body weight, time since menopause, smoking status, body fat, lean mass, and either lumbar spine or total body BMD, demonstrated that the frequency of the C allele in subjects with spinal osteophytosis was significantly greater than that in those without this condition. Comparison among control, osteoporosis, and spinal osteophytosis groups also revealed that the C allele was more prevalent in subjects with osteophytosis than in controls, even after adjustment for BMD. In contrast, as previously shown, the frequency of the C allele was lower in osteoporosis patients than in controls. The intervertebral disc area and the ratio of disc area to vertebral body area, as determined by MRI, were also lowest in subjects with the CC genotype. The serum concentration of TGFbeta1 increased with the number of C alleles in both controls and patients with spinal osteophytosis. CONCLUSION: The T29-->C polymorphism of the TGFbeta1 gene exhibited inverse patterns of association with genetic susceptibility to spinal osteophytosis and with osteoporosis. Although radiographic evaluation of osteophytes might not reflect the actual disease severity, the C allele, which protects against osteoporosis, may be a risk factor for genetic susceptibility to spinal osteophytosis.     

Radiographic features of lumbar disc degeneration and bone mineral density in men and women

OBJECTIVES: To determine the association between individual radiographic features of lumbar disc degeneration and bone mineral density (BMD) at the spine and hip. METHODS: SUBJECTS: were recruited from a population register for a screening survey of vertebral osteoporosis. BMD was assessed at the spine and hip using dual energy x ray absorptiometry. Lateral spinal radiographs were evaluated for features of lumbar disc degeneration. Each vertebral level from L1/2 to L4/5 was assessed for the presence and severity of osteophytes, end plate sclerosis, and disc space narrowing. Linear regression was used to determine the association between each of these features and BMD at the spine and hip, with adjustments for age, body mass index, and levels of physical activity. Analyses were done separately in men and women. RESULTS: 250 women and 256 men (mean age around 65 years) were studied. At the lumbar spine, after age adjustment there was an increase in BMD with increasing grade for all radiographic features of disc degeneration in both men and women. At the femoral neck, after age adjustment there was an increase in BMD with increasing osteophyte and end plate sclerosis grade though not disc space narrowing. Adjusting for body mass index and physical activity did not influence the strength of the associations. CONCLUSIONS: Radiographic features of lumbar disc degeneration are associated with an increase in BMD at the spine. Osteophytes and end plate sclerosis, but not disc space narrowing, are associated with an increase in BMD at the hip.     

High prevalence of osteoporotic vertebral fractures in patients with Crohn's disease

BACKGROUND AND AIMS: Osteopenia and osteoporosis are frequent in Crohn's disease. However, there are few data on related vertebral fractures. Therefore, we evaluated prospectively the prevalence of osteoporotic vertebral fractures in these patients. METHODS: A total of 293 patients were screened with dual energy x ray absorptiometry of the lumbar spine (L1-L4) and proximal right femur. In 156 patients with lumbar osteopenia or osteoporosis (T score <-1), x ray examinations of the thoracic and lumbar spine were performed. Assessment of fractures included visual reading of x rays and quantitative morphometry of the vertebral bodies (T4-L4), analogous to the criteria of the European Vertebral Osteoporosis Study. RESULTS: In 34 (21.8%; 18 female) of 156 Crohn's disease patients with reduced bone mineral density, 63 osteoporotic vertebral fractures (50 fx. (osteoporotic fracture with visible fracture line running into the vertebral body and/or change of outer shape) and 13 fxd. (osteoporotic fracture with change of outer shape but without visible fracture line)) were found, 50 fx. in 25 (16%, 15 female) patients and 13 fxd. in nine (5.8%, three female) patients. In four patients the fractures were clinically evident and associated with severe back pain. Approximately one third of patients with fractures were younger than 30 years. Lumbar bone mineral density was significantly reduced in patients with fractures compared with those without (T score -2.50 (0.88) v -2.07 (0.66); p<0.025) but not at the hip (-2.0 (1.1) v -1.81 (0.87); p=0.38). In subgroups analyses, no significant differences were observed. CONCLUSIONS: In patients with Crohn's disease and reduced bone mineral density, the prevalence of vertebral fractures-that is, manifest osteoporosis-was strikingly high at 22%, even in those aged less than 30 years, a problem deserving further clinical attention.     

High prevalence of osteoporosis in patients with gastric adenocarcinoma following gastrectomy

AIM: To evaluate the prevalence and predictive factors of osteoporosis in patients with gastric adenocarcinoma after gastrectomy. METHODS: The study included 133 patients diagnosed with gastric adenocarcinoma but who did not undergo prior diagnostic work-up for osteoporosis. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) and vertebral deformity was assessed by plain X-rays. We evaluated the effects of age, sex, body mass index (BMI), anemia, back pain, vertebral deformity, tumor staging, reconstruction type, and past medical history to determine predictive factors of osteoporosis in these patients. RESULTS: The prevalence of osteoporosis in the lumbar spine was 38.3% (male, 28.9%; female, 54.0%), and 15.0% in the femoral neck (male, 10.8%; female, 22.0%). The vertebral deformity rate was 46.6% (male, 43.4%; female, 52.0%). Age, BMI and hemoglobin correlated with BMD (P < 0.01). In males, anemia and age > 64 years were independent predictive factors of osteoporosis in multivariate analysis. In females, back pain was an independent factor for osteoporosis. CONCLUSION: The results of this study revealed that prevalence of osteoporosis and vertebral bone deformity rate were high in gastric cancer patients, regardless of post-gastrectomy duration and operation type. Early diagnosis and a proper management plan must be established in these patients.     

Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus

OBJECTIVE: To examine the prevalence of and risk factors for low bone mineral density (BMD) and vertebral fractures in patients with systemic lupus erythematosus (SLE). METHODS: We studied 107 SLE patients. Demographic and clinical data were collected, and radiographs of the thoracic and lumbar spine and BMD measurements by dual x-ray absorptiometry were performed. Vertebral deformities were scored according to the method of Genant et al: fractures were defined as a reduction of > or = 20% of the vertebral body height. Osteoporosis was defined as a T score less than -2.5 SD and osteopenia as a T score less than -1.0 SD in at least 1 region of measurement. RESULTS: Osteopenia was present in 39% of the patients and osteoporosis in 4% (93% female; mean age 41.1 years). In multiple regression analysis, low BMD in the spine was associated with a low body mass index (BMI), postmenopausal status, and 25-hydroxyvitamin D deficiency. Low BMD in the hip was associated with low BMI and postmenopausal status. At least 1 vertebral fracture was detected in 20% of the patients. Vertebral fractures were associated with ever use of intravenous methylprednisolone and male sex. CONCLUSION: Risk factors for low BMD in SLE patients are low BMI, postmenopausal status, and vitamin D deficiency. While osteoporosis defined as a low T score was found in only 4% of the patients, osteoporotic vertebral fractures were detected in 20%. The high prevalence of low BMD and vertebral fractures implies that more attention must be paid to the prevention and treatment of osteoporosis and fractures in SLE.     

A comparison of bone mineral density in elderly female patients with COPD and bronchial asthma

BACKGROUND: A recent study has shown that osteoporosis and vertebral fractures are quite common in patients with advanced COPD and showed a significant relationship to the mortality of these patients. These results suggested that management of osteoporosis in advanced COPD is an important intervention. But whether patients with COPD who had never received chronic systemic corticosteroids have a high incidence of osteoporosis and whether these patients require treatment strategies to decrease osteoporotic fracture is not yet known. Furthermore, it is unclear whether there are differences in terms of the degree of osteoporosis between patients with COPD and patients with bronchial asthma. OBJECTIVES: To compare the degree of osteoporosis and bone metabolism markers between elderly women with COPD and those with bronchial asthma who had never received chronic systemic corticosteroids, and to determine the factors influencing bone metabolism in these patients. DESIGN: Cross-sectional medical survey. PATIENTS: A total of 44 elderly female patients with COPD (n = 20) or bronchial asthma (n = 24) who had not received chronic systemic corticosteroids were enrolled (mean +/- SEM age, 74.6 +/- 1.0 years). MEASUREMENTS: Total body and lumbar bone mineral density (BMD) were measured by dual-energy x-ray absorptiometry, and the data were compared between the two groups. In addition, the association between bone mass and clinical variables was determined. RESULTS: When lumbar BMD was expressed as a Z score, the Z scores of patients with COPD were significantly lower than those of patients with bronchial asthma (p < 0.01). The prevalence of osteoporosis was also significantly higher in patients with COPD (50% vs 21%, p < 0.05). In patients with COPD, body mass index was positively correlated with BMD in the lumbar spine (r = 0.55, p = 0.02) and total body (r = 0.49, p = 0.03). Other clinical, biochemical, and anthropometric variables were not correlated with BMD. CONCLUSIONS: In elderly female patients, osteoporosis is more common in cases of COPD than in bronchial asthma, even if these patients had not received long-term systemic corticosteroids. The explanation for the higher prevalence of osteoporosis in COPD is still not known, but preventive strategies to decrease osteoporotic fractures should be added to the management of elderly patients with COPD.     

Enhancement of bone mass in osteoporotic women with parathyroid hormone followed by alendronate

Treatment of osteoporosis with PTH causes a marked increase in vertebral bone mineral density (BMD). However, this effect is rapidly reversed when the treatment is stopped. The purpose of the present study was to determine whether the bisphosphonate alendronate could preserve or enhance bone density in patients previously treated with PTH. Sixty-six postmenopausal osteoporotic women were treated for 1 yr with 50, 75, or 100 microg recombinant human PTH-(1-84) or placebo, and then were given 10 mg alendronate daily for an additional year. BMD was measured in the femoral neck, lumbar spine, and whole body. Markers of bone turnover included skeletal alkaline phosphatase, osteocalcin, and N-telopeptide. During the first year, changes in BMD (mean +/- SD) in women receiving PTH (all doses combined) were 7.1 +/- 5.6% (spine), 0.3 +/- 6.2% (femoral neck), and -2.3 +/- 3.3% (total body). After switching to alendronate for 1 yr in women who previously had received PTH, mean changes in BMD were 13.4 +/- 6.4% (spine), 4.4 +/- 7.2% (femoral neck), and 2.6 +/- 3.1% (whole body). In the subgroup of patients who had received the highest dose of PTH, the mean increase in vertebral BMD was 14.6 +/- 7.9%. All markers of bone turnover increased during treatment with PTH and decreased to below baseline after 1 yr of alendronate. In conclusion, sequential treatment of osteoporosis with PTH and alendronate results in an increase in vertebral bone density that is considerably more than has been reported with alendronate or estrogens alone. This combination of drugs may be a useful approach to maximizing bone density in women with vertebral osteoporosis.     

Disc degeneration of the lumbar spine in relation to overweight

OBJECTIVE: To study the association between overweight and lumbar disc degeneration. DESIGN: Population-based 4-y follow-up magnetic resonance imaging (MRI) study. SUBJECTS: The subjects were 129 working middle-aged men selected to the baseline magnetic resonance imaging (MRI) study from a cohort of 1832 men representing three occupations: machine drivers, construction carpenters, and office workers. The selection was based on the paticipants' age (40-45 y) and place of residence. MR images of the lumbar spines were obtained at baseline and at 4-y follow-up. MEASUREMENTS: Signal intensity of the nucleus pulposus of the discs L2/L3-L4/L5 was visually assessed by two readers using the adjacent cerebrospinal fluid as an intensity reference. The weight (at age 25 and 40-45 y) and height of the subjects, history of car driving, smoking, and back injuries were assessed by questionnaire. RESULTS: Multiple regression analyses allowing for occupation, history of car driving, smoking, and back injuries showed that persistent overweight (body mass index (BMI) > or =25 kg/m(2) at both ages) associated strongly with an increased risk of the number of lumbar discs with decreased signal intensity of nucleus pulposus at follow-up, adjusted odds ratio (OR) being 4.3 (95% confidence intervals (95% CIs) 1.3-14.3). Overweight at young age (risk ratio (RR) 3.8; 95% CI 1.4-10.4) was a stronger predictor of an increase in the number of degenerated discs during follow-up than overweight in middle age (RR 1.3; 95% CI 0.7-2.7). CONCLUSIONS: The study provides evidence that the BMI above 25 kg/m(2) increases the risk of lumbar disc degeneration. Overweight at young age seems to be particularly detrimental.     

Separate measurement of radial trabecular and cortical bone mineral density by peripheral quantitative computed tomography (pQCT) in degenerative joint disease]

Degenerative joint disease and osteoporosis, both of which tend to increase with advance in age, were thought to be essentially different mainly because of the artifactually high lumbar spine bone mineral density (BMD) in the former unlike osteoporosis characterized by persistent decrease of BMD. To clarify the relationship between these two diseases, three-dimensional BMD of the trabecular and cortical bone was measured separately in an area of the radius relatively free of degenerative changes by peripheral computed tomography (pQCT). In addition to radiological assessment of spondylosis deformans, quantification of vertebral deformity was attempted by calculation of standard deviation, coefficient of variation, difference between maximum and minimum density divided by the mean of L1-L4. With advance in age and progress of spondylosis deformans, the standard deviation, coefficient of variation difference between the maximum and minimum density and this difference divided by the mean of L1-L4 increased, but radial trabecular bone density, cortcal density and relative cortical volume decreased, suggesting parallel advance of degenerative joint disease and osteoporosis. Sodium etidronate, an antiresorber commonly used in the treatment of osteoporosis, increased mean lumbar spine BMD and markedly decreased the standard deviation, coefficient of variation, difference between the maximum and minimum density and this difference divided by the mean of L1 and L2 but maintained maximum BMD constant, decreasing vertebral deformity due to spondylosis deformans. It is conceivable that calcium release from bone on increased resorption leads to osteoporosis, and calcium entrance into cartilage, causing its hardening, disappearance and degeneration, direct contact between bones, osteoarthritis and subsequent deformity in a single sequence of events.     

Relationship of body composition with prevalence of osteoporosis in central south Chinese postmenopausal women

Objectives To elucidate the relationship between body composition and bone mineral density (BMD) and the prevalence of osteoporosis in central south Chinese postmenopausal women. Methods A cross‐sectional study was conducted on 954 healthy central southern Chinese postmenopausal women, aged 50–82. Total body, lumbar spine and left femur BMD and total body soft tissue composition were measured by dual X‐ray absorptiometry. Results Among the study population, 578 (60·5%) subjects were without osteoporosis and 376 (39·4%) subjects were osteoporotic. The osteoporotic women were older, shorter and thinner, had an earlier age at menopause, a lower BMD and bone mineral content (BMC) of the total body and at different sites, and had lower body mass and body mass components than the women without osteoporosis. Both fat mass and lean mass were positively correlated with age at menopause, height, weight, body mass index (BMI) and BMD at all sites. Fat mass and lean mass were also inversely correlated with age and years since menopause (P < 0·05). After controlling for age, age at menopause and height, both fat mass and lean mass were positively correlated with BMD at the lumbar_1–4 spine, the femoral neck and the total hip. Fat mass was the most significant determinant of BMD at the lumbar_1–4 spine with a higher R² change and a partial R² compared with that of lean mass, while lean mass had more impact on the total hip values. Either a fat mass below 18·4 kg or a lean mass below 33·9 kg was correlated with a higher prevalence of osteoporosis at the lumbar spine or total hip. Conclusions In central south Chinese postmenopausal women, both fat mass and lean mass are correlated with BMD at the lumbar spine and hip. Fat mass was the most significant determinant of BMD at the lumbar spine, while lean mass had more impact on the total hip value. Both lower values of fat mass and lean mass are related to a higher prevalence of osteoporosis at either the lumbar spine or the total hip. Thus, it is important to maintain a reasonable body weight to balance bone health and other metabolic disorders.