骨水泥强化椎弓根螺钉固定对骨质疏松患者有利无弊？

背景：在对伴骨质疏松的腰椎疾病患者进行椎弓根螺钉固定手术时,椎体添加骨水泥可有效增加内固定稳定性,但对相邻节段的影响尚不明确. 目的：观察伴骨质疏松的腰椎疾病患者进行椎体骨水泥强化内固定后,早中期随访中骨水泥强化对相邻节段的影响. 方法：以87例伴骨质疏松的腰椎疾病患者为研究对象,均行椎弓根螺钉系统固定＋后路椎管减压术,并分为3组：常规螺钉组,常规螺钉＋骨水泥组,可灌注骨水泥螺钉＋骨水泥组.样本平均随访6-18个月,平均随访为9个月.测量术前、术后3 d、末次随访的Oswestry功能障碍指数评分、固定节段上位相邻椎间隙高度、固定节段上位相邻椎体变形指数、固定节段椎体上缘终板及相邻上位椎体下缘终板凹陷角度、固定节段Cobb角. 结果与结论：①常规螺钉组、常规螺钉＋骨水泥组、可灌注骨水泥螺钉＋骨水泥组3组内末次随访功能障碍指数评分均较前明显减小（P〈0.05）,组间两两对比无显著差异（P〉0.05）.表明骨质疏松患者脊柱后路固定时,是否添加骨水泥及不同添加方式,对早中期主观疗效影响无显著差异,且均可明显改善患者生活质量.②常规螺钉＋骨水泥组、可灌注骨水泥螺钉＋骨水泥组2组末次随访对术后3 d固定节段Cobb角变化小于常规螺钉组（P 〈0.05）,常规螺钉＋骨水泥组、可灌注骨水泥螺钉＋骨水泥组2组组间差异无统计学意义（P 〉0.05）.表明添加骨水泥辅助的内固定稳定性明显优于未添加骨水泥常规手术.③常规螺钉＋骨水泥组、可灌注骨水泥螺钉＋骨水泥组2组术后3 d出现上终板凹陷角度增大;末次随访观察到相邻上位椎体下终板凹陷角度、椎体矩形指数及相邻椎间隙均减小,且前两项指标的改变程度明显大于常规螺钉组.表明添加骨水泥辅助内固定对相邻椎间盘退变程度无显著影响,但明显改变了相邻椎体终板及椎体的形态,增加了相邻椎体发生骨折的风险.     

Patellar Height After Total Knee Arthroplasty: Comparison of 3 Methods

Background

Total knee arthroplasty (TKA) is the gold standard procedure for knee osteoarthritis. However, there have been conflicting reports concerning whether TKA is associated with modifications in patellar height. This controversy might be partially explained by the diversity of methods used to measure patellar height. Therefore, we aimed at assessing the reproducibility of 3 radiological indices commonly used to evaluate patellar height—Insall-Salvati (IS), Blackburne-Peel (BP), and Caton-Deschamps (CD) ratios. Additionally, we aimed at evaluating the short-term differences between preoperative and postoperative patellar heights as measured by those 3 methods.

Simultaneous dental implant placement and endoscope-guided internal sinus floor elevation: 2-year post-loading outcomes

Aims: To determine whether endoscope‐guided sinus elevation procedures can be consistently used to create sufficient bone support for stable implant placement and long‐term implant success. Material and methods: Sixty‐two implants were surgically placed into 30 patients (14 men and 16 women) following internal sinus elevation without the use of graft material. Panoramic radiographs were made pre‐, post‐operative and after 24 months in order to evaluate the peri‐implant bone and maxillary sinuses. Resonance frequency analysis (RFA) was used to evaluate implant stability immediately upon placement and just before prosthesis delivery. Results: The average pre‐operative height of the maxillary alveolar bone was 8.4±2.2 mm at the premolar and 7.3±3.1 mm at the molar regions. The average bone gain was 3.5±1.8 and 4.5±1.9 mm in the premolar and molar sites, respectively. Clinical parameters and the RFA (4 and 12 weeks post‐operative) outcomes show sufficient stability (ISQ=60) of the inserted implants. Three implants failed during the healing period of 12 weeks. The overall implant success rate was 94%. After loading, no further implant failure was observed. The overall success rate after beginning of implant loading was 100%. Conclusions: Sinus floor elevation is a well‐established procedure for augmentation of the atrophic maxillary posterior region. The minimally invasive internal sinus floor elevation procedure visually guided by an endoscope helped to prevent, diagnose and manage complications such as sinus membrane perforation. The clinical outcomes of this study show that endoscope‐controlled internal sinus floor elevation combined with implant placement results in low intra operative trauma, good implant stability upon placement, low incidence of post‐operative symptoms and high success rates after 24 months of loading.     

Crown-root ratio of permanent teeth in cleft lip and palate patients

Objectives:To determine root lengths of fully developed permanent teeth of cleft lip and palate (CLP) patients and to define their crown-root (C/R) ratios.Method:Crown height and root length of permanent teeth were measured from panoramic radiographs of 44 CLP patients and 37 controls. A total of 1397 teeth were measured, and C/R ratios were calculated.Results:Higher C/R ratios were found in CLP patients; this was statistically significant for both maxillary and mandibular incisors and canines. Bilateral CLP subjects showed higher C/R ratios in general than unilateral CLP subjects. Roots of maxillary incisors, canines, and some other teeth were significantly shorter in CLP patients than in controls.Conclusions:CLP patients should be considered to have unfavorable C/R ratios, which could be the result of short root lengths for some teeth.     

Heterogeneous effects of obesity on mental health: Evidence from Mexico

Obesity can spread more easily if it is not perceived negatively. This issue may be more pronounced among the poor, a conjecture that we test in this paper. We start with general evidence on the concave relationship between income and obesity, both across countries and within Mexico, a country characterized by very unequal development levels and the highest obesity rate in the world. We suggest a general model that explains this stylized fact from a simple necessary condition, namely, the complementarity between nonfood consumption and health concerns. Then, we test the direct effect of overweight on mental health among Mexican women. We find a positive effect of obesity in the low consumption group and a depressing effect among the rich. This result is robust to the inclusion of a range of confounders (childhood conditions, lifestyle variables, food expenditure, and household shocks) and after instrumenting individual fatness by the variation in genetic predisposition. The complementarity between living standards and weight concerns may reflect different norms, different labor market penalties, or simply different returns to healthy time across the social spectrum.     

Association of quadriceps angle with plantar pressure distribution,navicular height and calcaneo-tibial angle

ObjectiveThe aim of study was to analyze the association between Quadriceps Angle (QA) and plantar pressure, navicular height (NH), and calcaneo-tibial angle (CTA).MethodsA total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19–33)) participated in this cross sectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamic plantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneus and the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground was measured while the subject was standing on both feet for NH. QA was measured while the subject was standing in a relaxed posture where both feet bearing equal weight.ResultsThere were significant negative correlations between QA and maximum force (MxF) under the 4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral (FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head (MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 and MH5 were found to be significantly negatively correlated with QA. A significant correlation was also found between QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regression analysis showed that NH was appeared as the major contributor for the QA (β = −0.49, p < 0.001) in the dynamic condition, followed by BT-FTI (β = 0.37, p < 0.001) and MH5-MxF (β = −0.21, p < 0.037).ConclusionThese findings may imply that the NH which can at least be controlled by appropriate shoe inserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity may be altered.Level of evidenceLevel III, Diagnostic Study.