Trabecular Bone Score Reference Values for Children and Adolescents According to Age,Sex, and Ancestry

Trabecular bone score (TBS) is used for fracture prediction in adults, but its utility in children is limited by absence of appropriate reference values. We aimed to develop reference ranges for TBS by age, sex, and population ancestry for youth ages 5 to 20 years. We also investigated the association between height, body mass index (BMI), and TBS, agreement between TBS and lumbar spine areal bone mineral density (aBMD) and bone mineral apparent density (BMAD) Z-scores, tracking of TBS Z-scores over time, and precision of TBS measurements. We performed secondary analysis of spine dual-energy X-ray absorptiometry (DXA) scans from the Bone Mineral Density in Childhood Study (BMDCS), a mixed longitudinal cohort of healthy children (n = 2014) evaluated at five US centers. TBS was derived using a dedicated TBS algorithm accounting for tissue thickness rather than BMI. TBS increased only during ages corresponding to pubertal development with an earlier increase in females than males. There were no differences in TBS between African Americans and non-African Americans. We provide sex-specific TBS reference ranges and LMS values for calculation of TBS Z-scores by age and means and SD for calculation of Z-scores by pubertal stage. TBS Z-scores were positively associated with height Z-scores at some ages. TBS Z-scores explained only 27% and 17% of the variance of spine aBMD and BMAD Z-scores. Tracking of TBS Z-scores over 6 years was lower (r = 0.47) than for aBMD or BMAD Z-scores (r = 0.74 to 0.79), and precision error of TBS (2.87%) was greater than for aBMD (0.85%) and BMAD (1.22%). In sum, TBS Z-scores provide information distinct from spine aBMD and BMAD Z-scores. Our robust reference ranges for TBS in a well-characterized pediatric cohort and precision error estimates provide essential tools for clinical assessment using TBS and determination of its value in predicting bone fragility in childhood and adolescence. © 2022 American Society for Bone and Mineral Research (ASBMR).     

Skeletal clinical characteristics of osteogenesis imperfecta caused by haploinsufficiency mutations in COL1A1

COL1A1 haploinsufficiency mutations lead to the mildest form of osteogenesis imperfecta (OI), OI type I. The skeletal clinical characteristics resulting from such mutations have not been characterized in detail. In this study we assessed 86 patients (36 male, 50 female; mean age 13.3 years; range, 0.6 to 54 years) with COL1A1 haploinsufficiency mutations, of whom 70 were aged 21 years or less (“pediatric” patients). Birth history was positive for fracture or long‐bone deformity in 12% of patients. The average rate of long‐bone fracture (femur, tibia/fibula, humerus, radius/ulna) in pediatric patients was 0.62 fractures per year, one‐half of which affected the tibia/fibula. Long‐bone fracture rate was negatively associated with age and lumbar spine areal bone mineral density. Vertebral compression fractures were observed in 71% of the 58 pediatric patients who had lateral spine radiographs. The median number of vertebral fractures was higher for females (median 4; range, 0 to 14) than for males (median 1; range, 0 to 8) (p = 0.03). Lumbar spine areal bone mineral density was negatively associated with the severity of vertebral compression fractures, as reflected in the spine deformity index. Scoliosis was present in about 30% of pediatric patients but the Cobb angle was <30 degrees in all cases. The average final height Z‐score was –1.1, representing a deficit of 8 to 10 cm compared to the general population. In summary, OI patients with COL1A1 haploinsufficiency mutations have high rates of significant skeletal involvement. Systematic follow‐up of growing patients with COL1A1 haploinsufficiency mutations including radiographic screening for vertebral compression fractures and scoliosis is warranted.     

Back Pain-Inducing Test,a Novel and Sensitive Screening Test for Painful Osteoporotic Vertebral Fractures: A Prospective Clinical Study

To detect painful vertebral fractures (VFs) in back pain populations at risk of osteoporosis, we designed a physical examination test (the Back Pain-Inducing Test [BPIT]) that included three movements: lying supine, rolling over, and sitting up. If back pain is induced during any of these movements, the result is defined as positive, thereby establishing a presumptive diagnosis of painful VFs. Pain severity is quantified using a self-reported numerical rating scale (NRS). The presence or absence of painful VFs is verified by whole-spine magnetic resonance imaging (MRI), the gold standard for final diagnosis. According to the standards for reporting diagnostic accuracy, a real-world, prospective, and observational study was performed on 510 back pain patients (enrolled from a single institute) at risk of osteoporosis. The sensitivity, specificity, and accuracy of the BPIT for identifying painful VFs were 99.1% (95% CI, 97.5% to 99.8%), 67.9% (95% CI, 60.4% to 74.5%), and 89.0%, respectively. The positive and negative predictive values were 86.6% (95% CI, 82.9% to 89.6%) and 97.4% (95% CI, 92.6% to 99.3%), respectively. Cutoff NRS scores for lying supine, rolling over, and sitting up were 3, 0, and 2, respectively. The corresponding area under the receiver operating characteristic curves (AUROCs) of each movement was 0.898 (95% CI, 0.868 to 0.922), 0.884 (95% CI, 0.854 to 0.911), and 0.910 (95% CI, 0.882 to 0.933), respectively. Although the high prevalence of VFs in the enrolled cohort partially limits the external validity of the predictive value in the general population, we conclude that the BPIT is potentially effective for detecting painful VFs in back pain populations at risk of osteoporosis. This test may be used as a stratification tool in decision-making on subsequent imaging procedures: a negative BPIT rules out painful VFs and indicates that an MRI should be spared, whereas a positive BPIT means that an MRI is necessary and is likely to identify painful VFs. © 2019 American Society for Bone and Mineral Research.     

椎动脉型颈椎病中医多途径治疗的临床观察

目的：观察中医多途径综合治疗椎动脉型颈椎病的临床疗效。方法：将180例椎动脉型颈椎病患者随机分治疗组120例和对照组60例。治疗组采用中药辨证施治配合牵引、针灸、推拿、针刀、导引、高压氧治疗;对照组采用单纯中药治疗。均连续治疗23天,观察治疗前后的主要症状与体征,有效者临床症状改善时间。结果：治疗组治疗后临床症状包括眩晕、头痛、记忆、颈部酸痛、颈部活动、颈部肌肉痉挛、颈椎棘突旁压痛和旋颈试验与对照组比较,差异有统计学意义（P〈0.05）;治疗组中有效者临床症状改善时间较对照明显缩短（P〈0.01）。结论：中医多途径综合疗法能明显改善椎动脉型颈椎病主症及体征,且疗效确切,起效迅速。     

手法治疗轻度特发性脊柱侧凸畸形机理分析

采用手法整复机械牵引治疗Ｃｏｂｂ角小于３０°的特发性脊柱侧凸畸形２４例。结果治愈１５例，显效５例，好转３例，无效１例，总有效率达９５％。分析认为，本病以腰背部肌力失衡、椎间盘膨隆、椎体旋转和继发性筋膜孪缩等为病因。治疗时应采用相应的手法，并提出了三步治疗的原则和方法。     

牵引压弹斜扳三步法治疗腰椎间盘突出症临床观察及机理分析

采用牵引、压弹、斜扳三步法治疗腰椎间盘突出症９４例．以自拟三期疗效标准评定，优良率达９４％。观察发现Ⅰ期疗效优者，Ⅱ、Ⅲ期疗效亦优；反之则差。因此，主张Ⅰ期疗效差者，应及时进行手术治疗，以免延误病情。分析认为该疗法的机理在于：①可拉宽椎间隙，增加椎管内容积；②可松解神经根粘连，使突出物还纳或位移；③可纠正脊柱后关节紊乱，恢复其正常的生理平衡；④可放松脊旁肌肉．改善受压组织的血液供应。     

The Application of the Principles and Procedures of PNF for the Care of Lumbar Spinal Instabilities

Abstract

Proprioceptive Neuromuscular Facilitation (PNF) is a dynamic manual approach to the evaluation and treatment of the neuromusculoskeletal system. This treatment approach has broad application for patients with both neurological and orthopedic problems. The authors have developed a systematic protocol using the philosophy and procedures of PNF integrated with other manual therapy procedures for the care of lumbar instabilities. This article will present the history, philosophy, basic principles, and procedures of PNF and their use in the treatment of lumbar spine instabilities.     

环锯法颈椎前路手术治疗脊髓型颈椎病

采用环锯法颈椎前路手术治疗１１例脊髓型颈椎病患者，根据北医三院疗效标准，术后病人均获得随访，结果优良率达８１．８％，有效率达１００％。该法是在传统环锯法基础上作了改进，要求做到解剖熟悉，手法轻巧，切忌粗暴；另外，术前要明确诊断；认为一经确诊应尽早手术，彻底减压，椎间融合，方能保证良效。     

低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术治疗颈椎间盘突出症的效果

目的 评价低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术治疗颈椎间盘突出症的效果.方法 具有头痛、头晕、颈肩臂痛等症状的颈椎病患者56例,年龄33～61岁,采用随机数字表法,将患者随机分为2组(n=28):胶原酶盘外溶解术组(C组)和低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术组(R组).两组手术均在CT引导下进行,术后6个月采用改良划线法评价疗效.结果 C组患者头痛、头晕和颈肩臂痛缓解率分别为86％、79％和93％,R组分别为96％、93％和100％,差异均有统计学意义(P＜0.05).结论 低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术治疗颈椎间盘突出症的效果优于单独应用胶原酶盘外溶解术.     

Differential Diagnosis and Treatment of Chronic Neck and Upper Trapezius Pain and Upper Extremity Paresthesia: A Case Study Involving the Management of an Elevated First Rib and Uncovertebral Joint Dysfunction

Abstract

Diagnosis and effective treatment of patients presenting with cervicobrachial symptoms are often challenging due to the large number of potential pain sources and the high degree of convergence of sensory afference in the cervical region. A 42-year-old female presented in the clinic with a six-month history of neck pain, upper trapezius pain, and upper extremity paresthesia. A careful history, specific functional examination, and selected special tests led to diagnosis-specific orthopedic manual therapy management of this patient. The patient fully recovered within 6 physical therapy treatment sessions, which included management of an elevated first rib, double-crush phenomenon, uncovertebral joint dysfunction, and careful ergonomic intervention with home instructions. Although controlled trials are needed to evaluate the effectiveness of these techniques and allow generalizability of such interventions, the recovery of this patient suggests the efficacy of manual techniques and ergonomic intervention in the management of uncovertebral joint dysfunction and thoracic outlet syndrome associated with a double-crush phenomenon.