Validity of the DEXA diagnosis of involutional osteoporosis in patients with femoral neck fractures

Background:

There exists no study comparing dual energy X-ray absorptimetry (DEXA) with histomorphometry to evaluate its accuracy and validity as an assessment tool. A prospective study was done comparing the measurements of osteoporosis in patients with femoral neck fractures using the histological method of diagnosis and in the same patients with DEXA postoperatively.

Patients and Methods:

The histological method depends on histomorphometric analysis of bone biopsies taken from the neck of femur during surgical treatment of the fracture. We depend on three indices in histomorphometric analysis: these are osteoid seam width, osteoblast surface, and osteoid surface. The radiological method depends on the measurement of the bone mineral density using DEXA for fractured patients with the scan performed onto the contralateral nonfractured hips and lumbar spines.

Results:

We found positive histological histomorphometric parameters of osteoporosis in 68% of patients with the femoral neck fracture, and there is a moderate correlation between histological histomorphometric analysis and DEXA in the diagnosis of osteoporosis in these patients. In our study, DEXA can detect up to 88.2% of possible cases of osteoporosis (sensitivity 88.2%), but the specificity of this diagnostic tool is 62.5% at a t-score of ≤ −2, i.e., it is sensitive but less specific. The mean difference in the t-score in femoral DEXA and lumbar DEXA is almost zero.

Conclusions:

DEXA is a noninvasive and an affordable and easy method for the diagnosis of osteoporosis but less efficient than the histological histomorphometric method of diagnosis with a low specificity. We also found that the mean difference in the t-score in femoral DEXA and lumbar DEXA is almost zero, so DEXA of one region can reflect the change in the other region and there is no need for DEXA of both regions as a routine unless indicated for a special reason. This avoids exposing the patient to unnecessary risk of radiation and reduces cost.     

经皮椎体后凸成形术治疗老年新鲜骨质疏松性椎体压缩骨折

目的探讨经皮椎体后凸成形术(PKP)治疗老年新鲜骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法采用PKP治疗86例老年新鲜OVCF患者,观察手术一般情况、术后并发症情况及疗效。结果患者均获得随访,时间1~3年。VAS评分、ODI、椎体后凸Cobb角、椎体前缘及中部高度变化等5项指标术后2 d及末次随访均较术前显著改善,差异均有统计学意义(P0.01,P0.05)。未出现骨水泥椎管内渗漏、神经或神经根损伤、肺栓塞等严重并发症。结论 PKP治疗老年新鲜OVCF疗效确切,手术出血量少,并发症少,术后患者症状和体征改善显著。     

血清戊糖素水平与骨质疏松性椎体压缩性骨折相关性研究

目的探讨血清戊糖素水平与骨质疏松性椎体压缩性骨折(osteoporosis vertebral compression fracture,OVCF)的相关性。方法对120例接受骨密度检查患者的血清戊糖素水平进行前瞻性分析;采用酶联免疫吸附试验(ELISA)测定受试者血清戊糖素水平;将受试者分为椎体骨折组(33例)及非骨折组(87例);使用亚洲版骨折风险评估(FRAX)工具评估受试者10年内骨折的概率。结果椎体骨折组(110.8 ng/m L)和非骨折组(64.3 ng/m L)血清戊糖素水平比较差异有统计学意义(P=0.04); Logistic回归分析显示血清戊糖素与OVCF显著相关。椎体骨折组的严重骨质疏松性骨折的10年概率明显高于非骨折组(P0.05),椎体骨折组的骨质疏松性骨折发生率高于非骨折组(P0.05)。戊糖素水平与FRAX结果呈正相关(r=0.35,P=0.02)。结论血清戊糖素水平升高和OVCF的发生密切相关。     

单侧椎弓根穿刺球囊扩张——椎体后凸成形术治疗骨质疏松性椎体压缩骨折并发骨水泥渗漏分析

目的 分析单侧椎弓根穿刺球囊扩张--椎体后凸成形术(BK)治疗骨质疏松性椎体压缩骨折的骨水泥渗漏情况.方法 2007-12-2010-12采用单侧椎弓根穿刺BK治疗96例椎体压缩性骨折患者.男性26例,女性70例;年龄56～87岁,平均72.6岁.其中单椎体骨折77例,双椎体骨折15例,三椎体骨折2例,四椎体骨折2例,...     

Risk factors for newly developed osteoporotic vertebral compression fractures following treatment for osteoporotic vertebral compression fractures

Background context

It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established.

老年女性股骨颈骨折妇科相关危险因素分析

目的探讨老年女性骨质疏松性股骨颈骨折的危险因素,为早期准确预测其骨质疏松股骨颈骨折提供客观依据。方法采用病例对照研究方法,选择150例年龄60岁的骨质疏松性股骨颈骨折女性患者作为骨折组,同时在周边地区随机选取150例年龄相当的无股骨颈骨折的老年女性作为对照组。通过问卷调查的方法,调查两组年龄、初潮年龄、绝经年龄、怀孕次数、生产次数、母乳喂养时间、体重指数等妇科相关情况。采用Logistic回归分析的方法对影响股骨颈骨折的因素进行分析。结果对照组与骨折组的初潮年龄、绝经年龄、怀孕次数、生产次数、母乳喂养时间、体重指数比较差异均有统计学意义(P0.05或P0.01),其中老年女性骨质疏松性股骨颈骨折的发生与初潮年龄、怀孕次数、生产次数、母乳喂养时间呈正相关(P0.05或P0.01),与绝经年龄、体重指数呈负相关(P0.01)。结论初潮晚、绝经早、孕产次数多、母乳喂养时间长、体重指数低可能是老年女性骨质疏松性股骨颈骨折的重要危险因素。     

Percutaneous balloon kyphoplasty of osteoporotic vertebral compression fractures with intravertebral cleft

Background:

Intravertebral cleft is a structural change in osteoporotic vertebral compression fractures (OVCF), which is the manifestation of ischemic vertebral osteonecrosis complicated with fracture nonunion and pseudoarthrosis and appears in the late stage of OVCF. Despite numerous studies on OVCF, few aim to evaluate the clinicoradiological characteristics and clinical significance of intravertebral cleft in OVCF. This study investigates clinicoradiological characteristics of intravertebral cleft in OVCF and the effect on the efficacy of percutaneous balloon kyphoplasty (PKP).

Materials and Methods:

PKP was performed on 139 OVCF patients without intravertebral cleft (group A) and 44 OVCF patients with intravertebral cleft (group B). The frequency distribution of the affected vertebral body, bone cement infusion volume, imaging manifestation, leakage rate and type, preoperative and postoperative height of the affected vertebral body, visual analog scale (VAS) and Oswestry disability index (ODI) score were evaluated.

Results:

Significant differences were found in the frequency distribution of the affected vertebral body and bone cement leakage type between the two groups (P < 0.05). However, differences in bone cement infusion volume and leakage rate (P > 0.05) were not detected. In both groups, the postoperative height of the affected vertebral body was significantly improved (P < 0.05). The restoration of vertebral body height in group B was more evident than that in group A (P < 0.05). The preoperative VAS and ODI scores in group B were significantly higher than those in group A (P < 0.05). After surgical treatment, pain relief and daily activity function in both groups were significantly improved (P < 0.05), and no significant difference in postoperative scores was detected between the two groups (P > 0.05).

Conclusion:

Intravertebral cleft exhibits specific clinical and imaging as well as bone cement formation characteristics. PKP can effectively restore the affected vertebral body height, alleviate pain, and improve daily activity function of patients.     

Adjacent vertebral Hounsfield unit value of acute osteoporotic vertebral fracture is a risk factor for concomitant domino osteoporotic vertebral fractures

BackgroundMost patients with acute osteoporotic vertebral fracture (AOVF) are successfully treated conservatively. However, the optimal management method and prognosis for multiple AOVFs are unclear. This study aimed to investigate the prevalence of multiple AOVFs and identify the associated risk factors.MethodsThis study enrolled 134 hospitalized patients (mean age 83 ± 7.6 years, 66% women) with AOVF treated conservatively between 2017 and 2020. The fractures were diagnosed by magnetic resonance imaging (MRI). The AOVFs were divided into two groups; single osteoporotic vertebral fractures (OVF) and domino OVFs (at least two OVFs). The adjacent vertebral Hounsfield unit values (HU) of the OVF and dual x-ray absorptiometry (DXA) of the lumbar spine or hip were used to evaluate the bone mineral density (BMD). Logistic regression analysis was performed to identify the risk factors for domino OVFs.ResultsDomino OVFs were noted in 21 (15.7%) of 134 patients. There were 10 cases of adjacent level and 11 cases of remote level. The BMI (18.5 ± 4.2 vs. 21.2 ± 4.6, p = 0.025) and adjacent vertebral HU value of OVF (57.3 ± 17.5 vs. 76.6 ± 24.1, p = 0.008) were significantly lower in the domino OVFs group than in the single OVF group. Logistic regression analysis revealed the adjacent vertebral HU value of the OVF as an independent risk factor for domino OVFs, (odds ratios (OR) 0.96, p = 0.012). The domino OVF group had a significantly higher decline in gait ability (76% vs. 48%, p = 0.017).ConclusionsThe adjacent vertebral HU value of AOVF is a useful tool for evaluating BMD for domino OVFs. The optimal treatment for osteoporosis should be considered to prevent subsequent domino OVFs.     

椎体后凸成形术治疗580例老年性骨质疏松性椎体压缩性骨折疗效的影响因素分析

目的分析椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年性骨质疏松性椎体压缩性骨折的疗效并探讨其影响疗效的因素。方法选择我院老年性骨质疏松性椎体压缩性骨折的580例患者行椎体后凸成形术,调取资料并记录与疗效相关的因素:年龄、性别、椎体压缩程度、楔形变角度、骨折椎体数量、骨折部位、单/双侧穿刺、骨水泥注入量、骨水泥椎间盘渗漏、规范抗骨质疏松治疗,并使用二分类Logistic回归探讨这些因素与疗效之间存在的关系。结果单变量因素分析椎体压缩程度[OR=2.68(2.03～3.24),P0.01]、骨折椎体数量[OR=3.54(2.87～4.12),P0.01]、骨折部位[OR=4.02(3.34～4.67),P0.01]、骨水泥注入量[OR=2.52(2.01～2.92),P0.05]、骨水泥椎间盘渗漏[OR=1.98(1.67～2.42),P0.01]、规范抗骨质疏松治疗[OR=2.70(2.31～3.22),P0.01]认为与术后疗效相关,进行多变量回归分析,经多变量Logistic回归分析(LR法),骨折椎体数量[OR=4.70(3.28～5.61),P=0.000]、骨水泥椎间盘渗漏[OR=5.12(2.07～8.26),P=0.000]、规范抗骨质疏松治疗[OR=4.40(2.93～6.71),P=0.000]与椎体后凸成形术后疗效显著相关。结论影响椎体后凸成形术疗效中,骨折椎体数量、骨水泥椎间盘渗漏、规范抗骨质疏松治疗较其他因素与疗效关系更密切。     

骨质疏松性椎体压缩骨折中生物力学变化的有限元研究进展

近年骨质疏松症的发病率逐年上升,骨质疏松性椎体压缩骨折作为其中最普遍且严重的并发症,伴骨质疏松症发病率的升高亦逐年增加,针对骨质疏松性椎体压缩骨折损伤机制和治疗的研究亦不断深入。有限元分析法通过计算机模拟人体各工况情况来分析和阐明骨质疏松性椎体压缩性骨折的损伤机制,并且可以清晰反映椎体的各个部位的受力状况。本文综述了近些年有限元分析法用于分析骨质疏松性椎体压缩骨折中生物力学研究取得的新进展,再结合新进展探讨有限元分析法出现的一些不足和未来的发展方向,以期更好为预防骨质疏松症患者发生脊柱骨折,避免在日常生活中超出脊柱稳定安全的活动范围提供指导价值。     

脊柱-骨盆矢状位参数对骨质疏松性椎体压缩骨折患者行非手术治疗后骨折愈合情况的影响

目的 探讨脊柱-骨盆矢状位参数对骨质疏松性椎体压缩骨折患者行非手术治疗后骨折愈合情况的影响.方法 纳入2016年7月-2018年7月采用非手术治疗的骨质疏松性椎体压缩骨折患者79例,治疗前均测量其骨盆入射角(pelvic inci-dence,PI)、骨盆倾斜角(pelvic tilt,PT)、腰椎前凸角(lumbar...     

经皮椎体成形术治疗老年骨质疏松性椎体压缩性骨折

2006年1月～2011年12月,我们采用经皮椎体成形术(PVP)治疗28例老年骨质疏松性椎体压缩性骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组28例,男10例,女18例,年龄71～82岁。单椎体压缩性骨折21例,多椎体压缩性骨折7例。     

骨质疏松性椎体压缩骨折经皮穿刺球囊扩张后凸成形术后再骨折的相关因素研究

目的探讨骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)行经皮穿刺球囊扩张后凸成形术(percutaneous kyphoplasty,PKP)后出现椎体再骨折的相关因素。方法回顾性研究2002年12月-2008年5月行PKP治疗的84例胸腰椎OVCF患者临床资料。其中男11例,女73例;年龄55～90岁,平均70.1岁。术后84例均获随访,随访时间24～96个月,平均38个月。其中12例于术后3～52个月出现邻近和/或间隔椎体压缩性骨折;余72例均随访24个月以上,未出现再骨折。比较再骨折组和未发生再骨折(对照组)患者的临床资料,分析导致再骨折的相关因素。结果两组患者在性别、年龄、术中穿刺方式(单、双侧穿刺)、骨折节段数目(≤3个及>3个椎体)、单椎体骨水泥注入量、术后椎体高度压缩率、术后椎体后凸角以及术前骨密度方面比较,差异均无统计学意义(P>0.05);在骨水泥向椎间盘泄露方面比较,再骨折组显著高于对照组,差异有统计学意义(χ2=5.294,P=0.032)。结论骨水泥向椎间盘泄露是PKP术后出现其他椎体再骨折的相关因素。     

中粘度与高粘度骨水泥治疗骨质疏松性椎体压缩骨折的疗效对比

目的探讨中粘度与高粘度骨水泥注入在经皮椎体成形术治疗骨质疏松性椎体压缩骨折(OVCF)的临床疗效对比。方法对2012-10-2015-03采用PVP治疗且随访时间≥1年的118例骨质疏松性椎体压缩骨折患者资料进行回顾性分析,按使用骨水泥粘度不同分为2组:中粘度组71例,男21例,女50例,平均年龄为(68.6±8.6)岁,应用中粘度骨水泥进行治疗。高粘度骨水泥组47例,男15例,女32例;平均年龄为(69.1±8.9)岁,应用高粘度骨水泥进行治疗。对两组患者的手术时间、骨水泥注入量、骨水泥渗漏率、骨折椎体高度恢复程度、后凸Cobb角矫正度数、疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)进行对比分析。结果高粘度组患者手术时间[(40.6±9.2)min]较中粘度组[(49.2±10.3)min]短,高粘度组患者骨水泥渗漏率[27.7%(13/47)]较中粘度组[36.6%(26/71)]低,差异均有统计学意义(P0.05)。骨水泥注入量、术后椎体前缘压缩改善程度及后凸Cobb角矫正度数比较,两组差异均无统计学意义(P≥0.05)。两组患者术后VAS、ODI评分均明显低于术前,差异有统计学意义(P0.05),两组患者术后3个月VAS评分低于术后24 h,术后12个月ODI评分低于术后3个月,比较差异有统计学意义(P0.05)。两组患者之间术后VAS、ODI评分比较差异无统计学意义(P≥0.05)。结论中粘度与高粘度骨水泥应用于经皮椎体成形术治疗骨质疏松性椎体压缩骨折均能获得满意的临床效果,高粘度骨水泥操作简单,注射易操控,骨水泥渗漏率低,相对中粘度骨水泥手术安全性高,值得临床推广应用。     

椎体后凸成形术治疗骨质疏松椎体压缩骨折术后非手术椎体新发骨折的相关因素分析

目的:探讨椎体后凸成形术治疗骨质疏松椎体压缩骨折术后非手术椎体新发骨折的相关因素.方法:回顾研究2005年1月～2009年12月我中心收治的102例行椎体后凸成形术治疗骨质疏松椎体压缩骨折患者的临床资料及随访结果,根据随访结果按有无新发椎体骨折出现将患者分成再骨折组及未骨折组(对照组),分析比较两组患者在一般情况(性别、年龄、骨密度、术前骨折椎体数目、骨折压缩程度、腰椎侧凸畸形及脊柱矢状面后凸角)、手术因素(强化椎体个数、手术入路、骨水泥量、骨水泥渗漏及椎体高度恢复程度)、外伤史、长期使用糖皮质激素史方面的差异.应用单因素方差分析及卡方检验分析诸因素与非手术椎体再骨折的相关性,将各相关因素引入Logistic回归分析,分析术后非手术椎体再骨折的主要因素.结果:所有患者均获2年以上随访,随访中共有20例患者先后出现非手术椎体再次骨折,再骨折率为19.6％,单因素分析显示骨密度、术前骨折椎体数目、手术强化椎体个数、骨折压缩程度、骨水泥渗漏及长期使用糖皮质激素史与术后非手术椎体骨折相关(P＜0.05);而年龄、性别、外伤史、骨水泥量、椎体高度恢复程度、腰椎侧凸畸形及脊柱矢状面后凸角与术后非手术椎体骨折无明显相关(P＞0.05).Logistic回归分析显示骨质疏松程度重(OR=0.090)、手术强化椎体数目多(0R=9.682)及长期使用糖皮质激素(0R=9.584)是术后非手术椎体再骨折的高危因素.结论:骨质疏松程度重、手术强化椎体数目多及长期使用糖皮质激素是引起术后非手术椎体新发骨折的高危因素.     

球囊扩张椎体后凸成形术对骨质疏松压缩骨折止痛和椎体高度恢复的影响

目的 评价应用经皮球囊扩张椎体后凸成形术治疗对疼痛性胸腰椎骨质疏松压缩骨折止痛效果和对椎体高度恢复的影响.方法 应用球囊扩张椎体后凸成形术治疗胸腰椎骨质疏松压缩骨折患者45例85椎(T4-L4),年龄53～86岁(平均71岁),有症状的节段均做MRI证实.手术后当天和术后随访分别进行疼痛得分VAS(visual ana...     

骨水泥椎体强化与保守治疗骨质疏松椎体压缩性骨折再骨折风险的Meta分析

目的 :对目前已发表的关于骨水泥椎体强化[包括经皮椎体成形术(PVP)和椎体后凸成形术(PKP)]与保守治疗骨质疏松椎体压缩性骨折(OVCF)的随机对照试验进行系统性评价,探讨椎体强化术后再发椎体骨折风险,为临床医疗和科研提供统计学依据。方法:通过计算机全面检索PubMed、Web of Science、Cochrane图书馆、EMBASE数据库,收集由建库至2018年4月发表的关于骨水泥椎体强化与保守治疗OVCF安全性和再发骨折的临床随机对照研究(randomized controlled trials,RCT)文献;遵循Cochrane协作网系统评价方法价纳入文献质量和可靠性,提取患者骨折椎体数、骨折平面、椎体压缩程度、骨密度以及再发椎体骨折相关数据;通过Review man 5.3软件行Meta分析,采用固定效应模型或随机效应模型合并数据,计算相对危险度(relative risk,RR)/标准化均数差(standardized mean difference,SMD)值和95%可信区间(confidence interval,CI),采用漏斗图对发表偏倚进行评估。结果:共纳入9篇文献,样本总量为853例,其中437例行椎体强化手术,416例接受保守治疗。2篇为高质量文献,5篇为中等质量文献,2篇为低质量文献。Meta分析结果显示:与保守治疗相比,骨水泥椎体强化术后患者再发椎体骨折的发生率[RR=1.13,95%CI(0.85,1.49),P=0.41]及相邻椎体再骨折发生率[RR=0.93,95%CI(0.48,1.82),P=0.84]均无统计学差异(P0.05)。结论:骨水泥椎体强化术是治疗OVCF的有效方法,不会增加再发椎体骨折的风险,再发椎体骨折可能同骨质疏松症的自然进程相关。     

经皮后凸成形术治疗骨质疏松性椎体压缩性骨折球囊压力的相关性探讨

目的探讨经皮后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩性骨折球囊压力的相关性。方法2008年1月至2017年6月骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)手术的患者209例,共269例椎体。其中女177例,男32例;平均年龄(75±8. 19)岁。根据磁共振成像(magnetic resonance imaging,MRI)信号改变分为不规则形组85例(A组,患者67例)、带状组56例(B组,患者42例)、裂隙征状组18例(C组,患者18例)和弥漫性组110例(D组,患者82例)。采用术中球囊压力及疼痛模拟视觉评分(visual analogue score,VAS)比较各组间差异。结果术中球囊破裂11例,其中A组5例,B组3例,C组1例,D组2例,各组之间比较差异无统计学意义(P0. 05)。D组与A、B、C组之间球囊压力差异比较有统计学意义(P0. 05),D组球囊压力最小; A、B、C组之间球囊压力两两比较差异无统计学意义(P0. 05);各组患者术前、术后VAS比较差异有统计学意义(P0. 001),各组间患者术前、术后VAS比较差异无统计学意义(P0. 05)。结论 PKP治疗OVCF可获得满意疗效,弥漫性骨折术中球囊压力最小,术中需根据MRI骨折分型调控球囊压力,避免球囊破裂。     

经皮球囊扩张椎体后凸成形术治疗 老年骨质疏松性椎体压缩性骨折

目的探讨经皮球囊扩张椎体后凸成形术（PKP)治疗老年骨质疏松性椎体压缩性骨折的临床 效果。方法对69例共叨个老年骨质疏松性椎体压缩性骨折的患者,均行经皮球囊扩张椎体后凸 成形术。观察指标为术前术后的疼痛视觉模拟评分（vasal analogue scale,VAS )、椎体高度的恢复及 并发症发生情况。结果 W个椎体均经皮行双侧椎弓根穿刺成功完成手术。所有患者疼痛缓解, VAS术前平均为（7. 52 10. 49)分,术后第3天平均为（2. 38 1 0. 22)分;术后1个月VAS平均为（1. 88 ±0. 12)分。术前骨折椎体前缘高度平均为（15.65 1 0. 68 ) mm,术后椎体前缘高度平均为（23.68 1 0.83) mm,术前术后差异有显著性（P < 0. 05 )。骨水泥注射量每个椎体3.5-7.5@1,平均5.5 ml。骨 水泥少量渗漏到椎间隙1个椎体,沿手术通道反流至椎弓根2个椎体,均无临床症状,渗漏率为 3.23%。结论经皮球囊扩张椎体后凸成形术（PKP)治疗老年骨质疏松性椎体压缩性骨折,能迅速 缓解疼痛,一定程度的恢复椎体高度,临床疗效确切。     

经椎体后上缘入路椎体后凸成形术治疗腰椎骨质疏松性椎体压缩骨折的临床疗效

目的:分析经椎体后上缘入路椎体后凸成形术(percutaneous kyphoplasty,PKP)的手术设计,并与经双侧椎弓根入路PKP治疗骨质疏松性腰椎椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)进行临床疗效对比.方法:回顾性分析符合纳入标准并行...