经后路扩大半椎体切除椎间融合治疗先天性半椎体畸形脊柱侧弯

[目的]探讨一期经后路扩大半椎体切除椎间融合治疗先天性半椎体畸形脊柱侧弯的效果及如何减少并发症.[方法]本组9例患者,半椎体均位于胸腰段,其中男6例,女3例;年龄8～17岁,平均14.2岁.均采用一期经后路扩大半椎体切除,椎体间大量植骨融合、椎弓根钉棒内固定术.术后平均随访43个月(14 ～92个月).[结果]9例患者,术前冠状面平均Cobb角40.3°,矢状面平均Cobb角32.6°,经后路扩大半椎体切除、椎间植骨融合内固定术,术后2周冠状面平均Cobb角10.7°(平均矫正率73.4％,P＜0.05),矢状面平均Cobb角10.2°(平均矫正率68.7％,P＜0.05).末次随访时,所有病例均获骨性愈合,无并发症发生,矫正率和术后2周相比无统计学差异(P＞0.05).[结论]一期经后路扩大半椎体切除、椎间植骨融合内固定治疗先天性半椎体畸形脊柱侧弯的疗效可靠,手术并发症少.     

半椎体切除治疗先天性脊柱侧弯畸形的手术配合

目的探讨后路半椎体切除治疗先天性脊柱侧弯畸形的手术配合体会。方法回顾性分析13例由半椎体病变引起脊柱侧弯畸形的患儿,其中,男10例,女3例。行后路半椎体切除、矫形内固定及植骨融合的手术配合方法。结果 13例手术均顺利完成,术后矫形效果满意,无一例因手术配合不当而影响手术质量。结论脊柱后路半椎体切除,椎弓根钉棒系统矫形内固定和植骨融合手术治疗先天性脊柱侧弯及矫正青少年脊柱结构性畸形达到了满意的效果。     

单纯半椎体切除治疗小儿先天性脊柱侧弯20例疗效观察

[目的]观察单纯行半椎体切除不使用脊柱内固定器械治疗小儿先天性脊柱侧弯的可行性及疗效.[方法]2000年4月～2012年8月在本院获得随访的经后路单纯半椎体切除的先天性脊柱侧弯患儿20例,3岁以下组14例,平均年龄10.9个月;3岁以上组6例,平均年龄6岁.半椎体位于胸段9例,胸腰段8例,腰段4例,骶段3例.术中均行后路经椎弓根单纯半椎体切除.术后随访3～7年,平均5.5年.[结果]手术时间平均173 min,手术出血平均116 ml,4例患儿未输血.3岁以下组Cobb角矫正率平均38.05％;3岁以上组Cobb角矫正率平均23.57％.术前Cobb角＜40°者,术后矫正率平均41.78％;术前Cobb角≥40°者,术后矫正率平均25.25％.[结论]①对于年龄小于3岁的先天性脊柱侧弯患儿,后路半椎体切除而不使用内固定是一种可行的治疗方法,具有手术时间短、出血量少、矫形效果满意的优点;②对于Cobb角＜40°的先天性脊柱侧弯患儿,该手术方式治疗效果优于Cobb角≥40°时的治疗效果.     

后路半椎体切除短节段融合治疗先天性脊柱侧弯

[目的] 探讨单纯经后方人路半椎体切除后,行短节段椎弓根螺钉矫形固定对先天性脊柱侧弯的疗效.[方法] 2l例先天性半椎体畸形的患儿,单纯经后方入路切除半椎体,并一期行后路短节段椎弓根螺钉系统矫形固定和脊柱植骨融合术,比较术前、术后和最后一次随访脊柱全长正侧位x线片,测量并记录脊柱侧弯及后凸的Cobb's角.[结果] 本组病例脊柱畸形明显改善,冠状面,半椎体节段侧弯术前平均41.5°,术后15.1°,矫正率63.6%;最后一次随访时平均14.70,矫正64.6%;冠状面主侧弯术前平均46.9°,术后18.4°,矫正60.8%;最后一次随访时平均17.5.,矫正62.7%;矢状面,半椎体节段术前有15.4°后凸畸形,术后恢复至正常生理曲度范围.手术后头侧和尾侧代偿弯也得到明显改善.[结论] 单纯后方入路切除半椎体后行短节段椎弓根螺钉系统矫形内固定术,可满意地矫正先天性脊柱侧弯,在骨骼成熟之前进行治疗可有效地预防继发性的脊柱改变.     

半椎体切除治疗儿童先天性脊柱侧弯疗效分析

[目的]回顾性比较分析两种手术方法对治疗半椎体所致的先天性脊柱侧凸及侧后凸畸形的效果。[方法]2000年2月²010年8月,本院收治39例先天性脊柱侧凸及侧后凸的儿童患者,男24例,女15例;年龄3个月2010年8月,本院收治39例先天性脊柱侧凸及侧后凸的儿童患者,男24例,女15例;年龄3个月¹4岁,平均3.1岁。分为2组,单纯切除组(组1),19例;后路半椎体切除加椎弓根螺钉内固定组(组2),20例。术后支具固定414岁,平均3.1岁。分为2组,单纯切除组(组1),19例;后路半椎体切除加椎弓根螺钉内固定组(组2),20例。术后支具固定4⁶个月,随访26个月,随访2¹3年,平均3.5年。2组术前、术后及末次随访摄站立前后位和侧位X线片。通过X线片和临床物理检查评估手术前后患者的侧弯矫正、躯干平衡和失代偿情况。[结果]单纯切除组平均手术时间161 min,平均失血量103 ml;内固定组平均手术时间267 min,平均失血量546 ml。两组比较均有显著性差异(P<0.05)。单纯切除组术后及末次随访节段弯矫正率40.3%、59.4%,主弯相应的矫正率为29.7%、37.6%(P<0.05)。内固定组术后及末次随访节段弯及主弯Cobb角矫正率分别为64.43%、67.72%;56.71%、56.7%(P<0.05)。单切组2例术后随访发生矫形丢失,无感染、神经系统并发症及椎弓根骨折现象。[结论]对进展型半椎体畸形,在原发弯发展严重或代偿弯形成结构性弯之前,应早期进行后路半椎体切除应用或不用内固定治疗,后路半椎体切除加椎弓根螺钉内固定对矫正和控制先天性脊柱侧弯冠状面和矢状面畸形效果更好。     

半椎体畸形的诊治

半椎体畸形是造成先天性脊柱侧弯的重要原因之一.脊柱侧弯会随着患儿的生长发育进行性加重,需要尽早诊治.治疗优先考虑手术,手术方式取决于患儿年龄和脊柱侧弯程度.对轻中度脊柱侧弯患儿,原位融合比较适宜,但应警惕曲轴现象的发生,前后路联合植骨融合可避免之.凸侧半骨骺固定术受到年龄和半椎体畸形类型的一定限制,且自发矫形的程度难以预测.半椎体切除是目前最常用的手术方式,尤其适用于中重度脊柱侧弯患儿,一期前后联合入路切除已成为主要的入路选择,单纯后路切除也越来越受到青睐.重建性截骨和内固定术作为补救性手术,需谨慎应用.非融合器械矫形在阻止脊柱侧弯进展的同时可维持脊柱和胸廓发育,近年日益受到临床医师的关注,但长期效果尚不明确,有待进一步研究.     

后路半椎体切除矫形内固定术治疗颈胸段半椎体畸形的疗效分析

目的:评估一期后路半椎体切除矫形内固定术治疗颈胸段半椎体畸形的疗效。方法:回顾性分析2010年6月~2017年4月在我院行一期后路半椎体切除矫形内固定手术且满足入选标准的32例颈胸段半椎体畸形患者,男15例,女17例,年龄5~18岁(10.1±4.2岁)。单个半椎体25例,2个半椎体7例;C7 1例,T1 5例,T2 12例,T3 10例,T4 11例。术前均有不同程度的肩部不平衡和颈部倾斜。在术前、术后和末次随访时的站立位全脊柱X线片上测量局部侧凸角、锁骨角、T1倾斜角、颈部倾斜、头部偏斜以及局部后凸角等参数,采用配对t检验进行比较分析。结果:32例患者均完成矫形手术,手术时间175~275min(223.8±41.6min),出血量310~470ml(342.3±45.9ml)。术中胸膜撕裂1例,术后出现Horner综合征1例,上肢神经根性疼痛2例,经保守治疗后均恢复。共置入261枚椎弓根螺钉,55枚穿破椎弓根皮质,但均未侵犯脊髓及周围脏器和血管,未行翻修手术。术后随访12~48个月(19.3±10.5个月),局部侧凸角由术前41.1°±12.3°矫正到术后17.5°±6.7°(P0.001),末次随访时为20.1°±5.8°,与术后比较无显著性差异(P=0.102);局部后凸角由术前21.5°±9.1°矫正到术后16.8°±6.3°(P0.05),末次随访时为17.5°±4.9°(P=0.622);远端代偿弯由术前16.9°±5.3°减少到术后12.2°±5.5°(P0.001),末次随访时为15.5°±7.7°(P=0.053)。T1倾斜角、锁骨角、颈部倾斜以及头部偏斜在术后均较术前得到显著性改善(P0.05),末次随访时影像学观察指标进一步改善(P0.05)。结论:颈胸段半椎体畸形患者行一期后路半椎体切除矫形内固定术手术时间短、创伤小,可有效矫正侧凸畸形,获得满意的治疗效果。     

单一后路半椎体切除结合椎间融合器治疗先天性脊柱畸形

目的探讨经单纯后路半椎体切除结合椎间融合器在先天性脊柱畸形治疗中的应用及疗效。方法 2009年6月至2010年12月,6例先天性脊柱畸形患者行单纯后路半椎体切除,切除区域植入椎体间融合器,以此为支点,行后路椎弓根钉棒系统矫形,矫形区域行椎体间及后外侧融合。术后经过平均近12个月的随访。对术中出血、围手术期并发症、术后患者的影像学表现、临床症状等进行随访和评价。结果所有患者围手术期中均未发生血管、神经损伤等严重并发症。术后即刻影像学检查见半椎体切除彻底,脊柱侧后凸畸形矫正满意。随访中未见内固定失败及矫形丢失现象。结论后路切除半椎体畸形后,在缺损区域植入椎体间融合器,既可以帮助术中矫形,又可促进手术区域的融合和矫形的保持,减少假关节的发生和内固定的失败。     

半椎体切除术治疗先天性脊柱侧后弯畸形

目的分析一期后路半椎体切除治疗先天性脊柱侧后凸畸形的手术效果,并探讨手术固定融合节段方案的选择。方法回顾分析15例由半椎体引起侧后凸畸形的患儿,其中男9例,女6例,年龄3～17岁,平均13.5岁。均行后路半椎体切除、矫形内固定及情骨融合手术。结果随访15～68个月,平均40.5个月。术后矫形效果满意,侧凸畸形由术前平均45.3°改善至11.4°（矫正率达68.7%）;后凸畸形由术前的平均35.5°,矫正至11.4°（矫形率达67.9%）,远期矫形丢失率低,植骨融合良好,无内固定物断裂松动等并发症。结论一期后路半椎体切除、椎弓根钉棒系统矫形内固定和植骨融合手术,可以有效矫正青少年脊柱结构性侧后凸畸形。     

特发性脊柱侧弯椎旁肌改变与手术治疗相关性的研究

目的　探讨特发性脊柱侧弯椎旁肌病理改变与脊柱畸形的因果关系。方法　对其术前、术后病人取标本进行组织化学及超微结构的研究。结果　术后Cobb′s角小于 5 0°的患者椎旁肌基本正常、双侧肌力平衡 ;而Cobb′s角仍大于 5 0°者椎旁肌病理改变与术前病人相似、双侧肌力不平衡 ,凸侧明显大于凹侧。结论　特发性脊柱侧弯椎旁肌病变是继发的 ,早期诊断、早期治疗有利于终止椎旁肌的继发性病理改变 ,使其得以最大限度的恢复     

生长发育中儿童脊柱侧弯治疗的理论与实践

目的 :从矫正机理上探讨适合于生长发育中儿童脊柱侧弯的手术治疗方法及本院研制的脊柱侧弯板棍系统 (Plate -RodSystemforScoliosis ,PRSS)临床应用的初步报告。方法 :设计新型的脊柱侧弯矫正装置———脊柱侧弯板棍系统 ,并随访从 1998年 9月～ 2 0 0 1年 10月期间应用PRSS装置及不植骨法治疗的生长发育中儿童脊柱侧弯共 2 2例(男 9例 ,女 13例 ) ,平均年龄 (10 .78± 3 .41)岁 ,其中特发性脊柱侧弯 16例 ,先天性脊柱侧弯 5例 ,神经纤维瘤病性脊柱侧弯 2例。结果 :侧弯矫正率为 (60 .0 9± 19.42 ) % ,随访时间平均 (12 .72± 6.79)个月 ,随访期间矫正丢失率为 (11.3 9±2 0 .0 0 ) % ,矫正节段长高 (4 .0 7± 3 .19)mm ,无严重并发症或“曲轴现象”发生。患儿骨发育成熟拆除内固定后 ,脊柱的活动和形态接近正常。结论 :在矫正侧弯的同时允许矫正范围内脊柱继续生长是治疗生长发育中儿童脊柱侧弯的较理想方法。初步应用结果显示PRSS是有效和可靠的方法。     

The anatomical relationship between the aorta and the thoracic vertebral bodies and its importance in the placement of the screw in thoracoscopic correction of Scoliosis

Thoracoscopically-assisted anterior spinal instrumentation is being used widely to treat adolescent idiopathic scoliosis (AIS). Recent studies have showed that screws placed thoracoscopically could counter the aorta or entrance into the spinal canal. There are a few studies defining the anatomic landmarks to identify the relationship between the aorta and the thoracic vertebral body using quantitative measurement for the sake of safe placement of thoracoscopic vertebral screw in anterior correction for AIS. The CT scanning from T4 to T12 in 64 control subjects and 30 AIS patients from mainland China were analyzed manually. Parameters to be measured included the angle for safety screw placement (α), the angle of the aorta relative to the vertebral body (β), the distance from the line between the left and the right rib heads to the anterior wall of the vertebral canal (a), the distance from the left rib head to posterior wall of the aorta (b), the vertebral body transverse diameter (c) and vertebral rotation (γ). No significant differences were found between the groups with respect to age or sex. Compared with the control group, α angle from T7 to T10, β angle from T5 to T10 and b value at T9, T10 were significantly lower in the scoliotic group. The a value was significantly lower in the scoliotic group. The c value showed no significant difference between the two groups. In conclusion, to place the thoracoscopic vertebral screw safely, at the cephalad thoracic spine (T4–T6), the maximum ventral excursion angle should decrease gradually from 20° to 5°, the entry-point of the screw should be close to the rib head. For apical vertebrae (T7–T9), the maximum ventral excursion angle increased gradually from 5° to 12°. At the caudal thoracic spine (T10–T12), the maximum ventral excursion angle increased, the entry-point should shift 3∼5 mm ventrally.     

弹性进钉法制备胸椎椎弓根钉道在胸椎侧凸中的应用

目的：探讨弹性进钉法制备胸椎椎弓根钉道植入螺钉的方法，总结临床应用效果。方法：咬除进钉点骨皮质，以据术前测量的深度和旋转的程度，分别先后用1．5mm、2．5mm克氏针沿椎弓根方向钻孔。达到测定的深度停止进针，球形探子探查无误后改用导锥顺着制造的钉道小心缓慢进入，深度一致后，再次用球形探子探查，植入螺钉。结果：胸椎椎弓根螺钉一次性植入成功为96．2％，其中18枚术中发现，偏内侧5枚，偏下方3枚，偏上方4枚，偏外方6枚，其中偏外侧的4枚螺钉把持力坚强外，另2枚重新阅读影像资料，用2．5mm克氏针，改变锥入方向，5枚偏内侧的螺钉中3枚同时切除了该同侧的椎板，行术中探测，钉道均成功得以置备。钉道制备后增加螺钉直径0．5mm，进行补救。其余的14枚螺钉都是术后通过CT或者X线片发现的，且均偏外侧。1例术中脑脊液漏者骨蜡封闭后术后未发生脑脊液漏，本组无脊髓损伤。平均术后身高增加4．6cm，术后冠状面Cobb角平均21°，平均矫正率73％；矢状面Cobb角平均230°旋转畸形矫正Ⅰ～Ⅱ度。平均随访3．5年。最终随访矫正度丢失率为1．8％。迟发性感染1例，螺钉断裂4例，1例螺钉向椎弓根外侧偏移加重。躯干平衡良好、无平背。结论：弹性进钉法制备胸椎椎弓根钉道准确率高、并发症少。     

Lenke 1型青少年特发性脊柱侧凸病人矫形术后肩平衡的相关因素分析

目的 探讨术前右肩高Lenke 1型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）病人术后的肩关节高度变化,并分析术后肩平衡的影响因素。方法 回顾性分析2015年1月至2017年12月于我院手术治疗的术前右肩高Lenke 1型AIS病人41例,根据术后肩部平衡状态分为双肩平衡组和双肩失衡组。分别测量两组病人术前、术后3个月及术后2年的影像学肩关节高度差（radiographic shoulder height,RSH）、上胸弯Cobb角、主胸弯Cobb角、锁骨角、胸廓锁骨角度差（clavicle chest cage angle difference,CCAD）和T₁倾斜角,并计算主胸弯矫正率、上胸弯矫正率、主胸弯柔韧度、上胸弯柔韧度等;分析双肩失衡组病人末次随访时RSH与术前影像学指标的相关性。结果 双肩失衡组术前的锁骨角和CCAD值均高于双肩平衡组,上胸弯柔韧度低于双肩平衡组（P＜0.05）。Pearson相关分析显示术前锁骨角、CCAD与术后RSH呈正相关（P＜0.05,r＞0）;上胸弯柔韧度与术后RSH呈负相关（P＜0.05,r＜0）;锁骨角变化、主胸弯及上胸弯矫正率、主胸弯角度变化与RSH变化呈正相关（P＜0.05,r＞0）。Logistic回归分析未见双肩失平衡的独立危险因素。结论 术前锁骨角、CCAD及上胸弯柔韧度是Lenke 1型AIS病人术后RSH的预测因素,应避免主胸弯过度矫正导致术后肩失衡的发生。     

一期后路经椎弓根半椎体切除节段固定治疗先天性胸腰椎侧后凸畸形

目的：评价一期后路经椎弓根半椎体切除节段固定术治疗完全分节的胸腰椎半椎体畸形所致的先天性脊柱侧后凸畸形的疗效。方法：采用一期后路经椎弓根半椎体切除内固定矫形术治疗了12例完全分节的胸腰椎半椎体畸形所致的脊柱侧后凸畸形，其中，男8例，女4例，年龄7～17岁，平均11．3岁。观察并测量术前术后及随访时站立位脊柱X线片冠状面和矢状面Cobb角、侧凸的顶椎偏移。结果：随访10-34个月，平均16个月。术后冠状面平均矫正64．1％，随访中无明显丢失。后凸由术前平均320矫正至190，随访中无明显丢失，顶椎偏移由术前4．5cm矫正至1．2cm。无脊髓损伤及切口感染等并发症。结论：一期后路经椎弓根半椎体切除内固定矫形术是治疗完全分节的胸腰椎半椎体畸形所致的脊柱侧后凸畸形的有效方法。     

Symmetry in Paraspinal Muscles as a Predictor of the Development of Pregnancy‐Related Low Back and Pelvic Pain: A Prospective Study

ObjectiveTo determine the asymmetry in the paraspinal muscle before pregnancy and evaluate its association with pregnancy‐associated lumbopelvic pain (LPP).MethodsThis was a prospective case–control study conducted from January 2017 and December 2018. A total of 171 subjects (mean age ± SD, 27.4 ± 5.8 years) were finally divided into the LBP group, PGP group, and no LPP group. Each subject was asked to follow a standardized clinical imaging protocol before the pregnancy. The area of muscles (multifidus, erector spinae, and psoas muscles) on the axial slice at mid‐disc of L₄–L₅ and L₅–S₁ were segmented and then the cross‐sectional area (CSA) of a particular muscle was measured by outlining the innermost fascial border surrounding each muscle. The mean value of F‐CSA''s ratio to T‐CSA (F/T CSA) was used to determine whether the bilateral paraspinal muscle was asymmetrical. Total muscle CSA (T‐CSA) represents the sum of CSA of interested three muscles. The signal intensity can distinguish fat and muscle tissue in a different range. Based on this, functional CSA (F‐CSA), represented by fat‐free area, was evaluated quantitively by excluding the signal of the deposits of intramuscular fat. Total muscle CSA (T‐CSA), functional CSA (F‐CSA), and the ratio of F‐CSA to T‐CSA (F/T CSA) were measured unilaterally and compared between groups. Logistic regression was performed to determine the risk factors for pregnancy‐associated LPP. The Pearson correlation coefficient was performed to test the relationship between asymmetry in F/T‐CSA and pain rating.ResultsA total of 124 subjects (72.5%) (28.5 ± 5.2 years) had LPP during pregnancy. Forty‐eight (38.7%) individuals had low back pain (LBP) and 76 (61.3%) had pelvic girdle pain (PGP). Seventy‐six women (44.4%) were determined to have asymmetry in paraspinal muscle according to the definition in this methods section. The duration of follow‐up was 24 months postpartum. A total of 39 (31.5%) women unrecovered from LPP. F/T‐CSA was significantly decreased for LBP in the PGP group than in the and control group (0.03 ± 0.02 vs 0.05 ± 0.03 vs 0.12 ± 0.05, P < 0.001). Meanwhile, significant differences were detected in both groups (all P < 0.001). In patients with LBP, the level of paraspinal asymmetry, represented by the difference in F/T‐CSA, was positively correlated with pain scores (r = 0.52, P < 0.01). However, no statistically significant correlation between pain scores and paraspinal asymmetry was found in PGP (r = 0.42, P > 0.05). Asymmetry in the paraspinal muscle (adjusted OR = 1.5), LBP (adjusted OR = 1.6), LPP in a previous pregnancy (adjusted OR = 1.4), sick leave ≥90 days (adjusted OR = 1.2), and heavy labor (adjusted OR = 1.2) were risk factors for the unrecovered LPP during pregnancy.ConclusionsAsymmetrical muscular compositions could lead to abnormal biomechanics for the segmental motions. Lateral‐directed physical training and stretching may help decrease the occurrence and severity of this condition.     

Ultrasonography-Guided Percutaneous Nephrolithotomy for the Treatment of Urolithiasis in Patients with Scoliosis

We examined the surgical outcomes of minimally invasive percutaneous nephrolithotomy (MPCNL) in scoliotic patients with complicating urolithiasis. Two patients with scoliosis were hospitalized for MPNCL due to upper tract urolithiasis. Calyx puncture was performed in the prone position under ultrasonographic guidance. The renal access route was established using a set of 8F to 16F dilators, and a transpyelic ballistic lithotriptor was used to fragment the calculi. The stone burdens in the 2 patients were 410 mm² and 500 mm². The entire operative time was 40 to 70 minutes, and the mean time of establishing percutaneous access was 20 minutes. The calculi were completely removed by single-session pneumatic lithotripsy. The 2 patients recovered from MPCNL uneventfully, and the follow-up radiologic examinations identified no stone residual or recurrence. MPCNL is a minimally invasive modality that is effective and safe for the treatment of urolithiasis in patients with scoliosis.     

Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength

This controlled trial was designed to investigate the influence of osteoporosis-related kyphosis (O-K) on falls. Twelve community-dwelling women with O-K (Cobb angle, 50–65° measured from spine radiographs) and 13 healthy women serving as controls were enrolled. Mean age of the O-K group was 76 years (±5.1), height 158 cm (±5), and weight 61 kg (±7.9), and mean age of the control group was 71 years (±4.6), height 161 cm (±3.8), and weight 66 kg (±11.7). Quantitative isometric strength data were collected. Gait was monitored during unobstructed level walking and during stepping over an obstacle of four different heights randomly assigned (2.5%, 5%, 10%, and 15% of the subjects height). Balance was objectively assessed with computerized dynamic posturography consisting of the sensory organization test. Back extensor strength, grip strength, and all lower extremity muscle groups were significantly weaker in the O-K group than the control group ( P <0.05), except right ankle plantar flexors ( P =0.09). There was a significant difference in the anteroposterior and mediolateral displacements and velocities. The O-K subjects had less anteroposterior displacement, greater mediolateral displacement, reduced anteroposterior velocity, and increased mediolateral velocity compared with controls for all conditions of unobstructed and obstructed level walking. Obstacle height had a significant effect on all center-of-mass variables. The O-K subjects had significantly greater balance abnormalities on computerized dynamic posturography than the control group ( P =0.002). Data show that thoracic hyperkyphosis on a background of reduced muscle strength plays an important role in increasing body sway, gait unsteadiness, and risk of falls in osteoporosis.