Inflammatory osteolysis arises from pro-inflammatory cytokine-driven osteoclast activation and disrupted bone remodeling equilibrium. The IRE1-XBP1s axis, a major unfolded protein response pathway, regulates cellular homeostasis, but its role in inflammatory osteoclastogenesis remained unexplored. Single-cell RNA-seq showed increased osteoclast precursor cells and activated IRE1-XBP1s in LPS-induced osteolysis. Inhibition of this axis reduced osteoclastogenesis and bone loss in vitro and in vivo. RNA-seq indicated that blocking IRE1-XBP1s suppressed Slc6a4 transcription, with gene set enrichment analysis confirming its role in 5-HT transport. Dual-luciferase assays and ChIP-PCR demonstrated XBP1s' direct transcriptional regulation targeting the Slc6a4 promoter. The 5-HT transporter inhibitor escitalopram also inhibited osteoclastogenesis, highlighting the IRE1-XBP1s-Slc6a4 axis's importance. Notably, untargeted metabolomics suggested 5-HT inhibited intracellular 3-methyladenine (3MA) metabolism, a compound previously considered unnatural. HPLC-MS confirmed the presence of 3MA metabolism in inflammatory osteoclasts, and 3MA supplementation attenuated 5-HT-induced autophagy and osteoclast differentiation. Blocking the IRE1-XBP1s-Slc6a4 axis reduced pro-osteoclastogenic effects in inflammatory bone disease patient-derived PBMCs. This study demonstrates that IRE1-XBP1s inhibition alleviates inflammatory osteoclastogenesis and osteolysis via a 5-HT-dependent anti-autophagy mechanism, proposing this pathway as a therapeutic target for inflammatory bone loss.

Iron overload and related oxidative damage are seen in many rare diseases, due to mutation of iron homeostasis-related genes. As a core regulator on cellular antioxidant reaction, Nrf2 can also decrease systemic and cellular iron levels by regulating iron-related genes and pathways, making Nrf2 activators very good candidates for the treatment of iron overload disorders. Successful examples include the clinical use of omaveloxolone for Friedreich's Ataxia and dimethyl fumarate for relapsing-remitting multiple sclerosis. Despite these uses, the therapeutic potentials of Nrf2 activators for iron overload disorders may be overlooked in clinical practice. Therefore, this study talks about the potential use, possible mechanisms, and precautions of Nrf2 activators in treating rare iron overload diseases. In addition, a combination therapy with Nrf2 activators and iron chelators is proposed for clinical reference, aiming to facilitate the clinical use of Nrf2 activators for more iron overload disorders.

OBJECTIVE:To investigate the feasibility of prepsoas oblique lumbar interbody fusion (OLIF) at L5-S1 level and propose a new practical framework for approach selection of OLIF51. METHODS:The feasibility of left-sided and right-sided prepsoas approaches was graded as easy, advanced, and difficult depending on retraction distance and perivascular adipose tissue in the radiographic study. The classification results were summarized, and the OLIF51 approach selection framework was proposed to guide the subsequent clinical research. The clinical outcomes and incidence of complications were compared between two groups in which the inpatients underwent OLIF51 from 2019 to 2022. RESULTS:Among the 200 consecutive randomized outpatients who met the inclusion criteria, the easy, advanced, and difficult cases of left-sided prepsoas were 19, 158, and 23, respectively, with right-sided prepsoas (40, 160, 0). Guided by the proposed framework, 65 inpatients who underwent left-sided prepsoas OLIF51 were enrolled in group A and 71 inpatients who underwent right-sided prepsoas OLIF51 were enrolled in group B. There was no significant difference in demographic and preoperative follow-up results. The operation time for OLIF51 alone was shorter in group B than in group A. Operations were successfully completed in all patients of group B. In group A, sufficient exposure was not achieved in four patients (6.2%). Ligation of the iliolumbar vein was needed for adequate exposure in 16 (24.6%) patients from group A and 14 (19.7%) from group B. Postoperative clinical outcomes were improved and not significantly different between the two groups. CONCLUSIONS:Prepsoas OLIF51 is feasible, which can serve as alternative approaches for anterior interbody fusion of L5-S1 according to preoperative imaging evaluation. Although there is no difference in the therapeutic effect between the two groups, the right-sided prepsoas approach was preferred with its greater feasibility and advantages.

Objective: To investigate the improvement of spinopelvic parameters and therapeutic efficacy in the treatment of complex degenerative lumbar spondylolisthesis (CDLS) after oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF). Methods: From January 2018 to December 2020, 71 patients with CDLS underwent OLIF or TLIF at the same hospital: 31 in the OLIF group and 40 in the TLIF group. The spinopelvic parameters, perioperative data, and clinical outcomes were elected and compared between the 2 groups. Results: There were no statistic differences in demographic perioperative complication rates and preoperative spinopelvic parameters between the two groups. OLIF group showed lower serum C-reactive protein in the early postoperative stage, shorter length of stay, less estimated blood loss and larger slippage correction rate (88.05 vs. 62.37%) (all P < 0.05). There was no significant difference in the visual analog scale and Oswestry disability index scores before operation and three and six months after surgery, but OLIF group was better in the long-term with visual analog scale and Oswestry disability index (1.7/13.2 vs. 2.3/16.5). And it was significantly different in the lumbar lordosis angle, segmental lordosis angle, pelvic tilt, sacral slope (46.0 degrees/9.3 degrees/18.2 degrees/35.9 degrees vs. 40.4 degrees/7.2 degrees/23.9 degrees/31.1 degrees), and sagittal vertical axis (21.6 vs. 31.7mm) after surgery between OLIF and TLIF groups (all P < 0.05). Conclusions: In the therapy of CDLS, OLIF can better reduce pelvic tilt, L1 axis S1 distance, and sagittal vertical axis, and increase lumbar lordosis angle and sacral slope, showing advantages over TLIF in improving and maintaining spinopelvic parameters. Although there was no difference in complication rates between OLIF and TLIF, OLIF was more minimally invasive, had less tissue damage, had faster recovery, and had better long-term outcomes.

Purpose To investigate the improvement of spinopelvic parameters and therapeutic efficacy in the treatment of complex degenerative lumbar spondylolisthesis (CDLS) after OLIF and TLIF. Methods From January 2018 to December 2020, 71 patients with CDLS underwent OLIF or TLIF at the same hospital: 31 in the OLIF group and 40 in the TLIF group. The spinopelvic parameters, perioperative data and clinical outcomes were elected and compared between the two groups. Results There were no statistic differences in demographic, perioperative complication rates and preoperative spinopelvic parameters between the two groups. OLIF group showed lower serum C-reactive protein (CRP) in the early postoperative stage, shorter length of stay (LOS), less estimated blood loss (EBL) and larger slippage correction rate (SCR, 88.05 vs 62.37%) (all P＜0.05). There was no significant difference in the VAS and ODI scores before operation and three and six months after surgery, but OLIF group was better in the long-term with VAS and ODI (1.7/13.2vs 2.3/16.5). And it was significantly different in the lumbar lordosis angle (LLA), segmental lordosis angle (SLA), pelvic tilt (PT), sacral slope (SS)( 46.0°/9.3°/18.2°/35.9° vs 40.4°/7.2°/23.9°/31.1°) and sagittal vertical axis (SVA, 21.6 vs 31.7mm) after surgery between OLIF and TLIF groups (all P＜0.05). Conclusion In the therapy of CDLS, OLIF can better reduce PT, LASD and SVA, and increase LLA and SS, showing advantages over TLIF in improving and maintaining spinopelvic parameters. Although there was no difference in complication rates between OLIF and TLIF, OLIF was more minimally invasive, had less tissue damage, had faster recovery, and had better long-term outcomes.

Bone homeostasis is maintained by osteoclast-mediated bone resorption and osteoblast-mediated bone formation. A dramatic decrease in estrogen levels in postmenopausal women leads to osteoclast overactivation, impaired bone homeostasis, and subsequent bone loss. Changes in the gut microbiome affect bone mineral density. However, the role of the gut microbiome in estrogen deficiency-induced bone loss and its underlying mechanism remain unknown. In this study, we found that the abundance of Clostridium sporogenes (C. spor.) and its derived metabolite, indole propionic acid (IPA), were decreased in ovariectomized (OVX) mice. In vitro assays suggested that IPA suppressed osteoclast differentiation and function. At the molecular level, IPA suppressed receptor activator of nuclear factor kappa-Β ligand (RANKL)-induced pregnane X receptor (PXR) ubiquitination and degradation, leading to increased binding of remaining PXR with P65. In vivo daily IPA administration or repeated C. spor. colonization protected against OVX-induced bone loss. To protect live bacteria from the harsh gastric environment and delay the emptying of orally administered C. spor. from the intestine, a C. spor.-encapsulated silk fibroin (SF) hydrogel system was developed, which achieved bone protection in OVX mice comparable to that achieved with repeated germ transplantation or daily IPA administration. Overall, we found that gut C. spor.-derived IPA was involved in estrogen deficiency-induced osteoclast overactivation by regulating the PXR/P65 complex. The C. spor.-encapsulated SF hydrogel system is a promising tool for combating postmenopausal osteoporosis without the disadvantages of repeated germ transplantation.

Quantification for Western Blot and Schematic representation

Ferroptosis is characterized by iron accumulation and lipid peroxidation. However, a clinical dose of Fe3O4 nanoparticles could not cause effective ferroptosis in tumors, and the mechanism is yet to be completely understood. In this study, using RNA-seq data, we found that tumor cells could feedback-activate the antioxidant system by upregulating Nrf-2 expression, thus avoiding ferroptosis caused by Fe3O4 nanoparticles. We also found that DHJS (a probe for ROS generation) can antagonize Nrf-2 expression when it synergizes with Fe3O4 nanoparticles, thus inducing ferroptosis in tumor cells. Considering these findings, we created a biomimetic hybrid cell membrane camouflaged by PLGA-loaded Fe3O4 and DHJS to treat osteosarcoma. The hybrid cell membrane endowed the core nanoparticle with the extension of blood circulation life and enhanced homologous targeting ability. In addition, DHJS and Fe3O4 in nanoparticles prompted synergistically lethal ferroptosis in cancer cells and induced macrophage M1 polarization as well as the infiltration of CD8(+) T cells and dendritic cells in tumors. In summary, this study provides novel mechanistic insights and practical strategies for ferroptosis induction of Fe3O4 nanoparticles. Meanwhile, the synthesized biomimetic nanoparticles exhibited synergistic ferroptosis/immunotherapy against osteosarcoma.

Background Although clinicians and patients with extremity bone and soft tissue (EBST) are increasingly interested in limb salvage surgery (LSS), because of the minimal damage to physical appearance and function, however, there is still a lack of large-scale population studies on whether LSS improves the prognosis of patients. Purpose The aim of this study was to compare the survival of patients with EBST sarcomas after receiving LSS and amputation. Methods To conduct the population-based study, we identified 6,717 patients with a histologically diagnosed bone sarcoma and 24,378 patients with a histologically diagnosed soft tissue sarcoma from the Surveillance, Epidemiology, and End Results database. We analyzed overall survival (OS), cancer-specific survival (CSS), and non-sarcoma survival (NSS) using the Kaplan–Meier method, log-rank test or Gray test, Cox regression model, propensity score-matched analysis, and landmark analysis. Results LSS could improve the prognosis in patients with most EBST subtypes, except for Ewing sarcomas and MPNST. However, in the subgroup without distant metastases, limb salvage increased CSS only for patients with osteosarcoma, Ewing sarcoma, and leiomyosarcoma, as well as NSS for patients with chondrosarcoma and synovial sarcoma. Landmark analysis further demonstrated that sarcoma survivors surviving <10 years could benefit from LSS but not for long-term survivors ≥10 years. Moreover, for patients with distant metastases, LSS could improve survival of osteosarcoma patients but worsen CSS among patients with MPNST. Landmark analysis further demonstrated that LSS improved survival among osteosarcomas patients with distant metastases only within 1 year after surgery. Moreover, patients receiving LSS and those receiving amputation had a high risk of dying from different non-sarcoma diseases during the postoperative follow-up. Conclusions The impact of limb salvage on the prognosis of patients depends on the pathological subtype and stage of EBST sarcomas.

BACKGROUND CONTEXT: In the context of the population growing and aging worldwide, the epidemiology, and burden of vertebral fracture have not been comprehensively analyzed. PURPOSE: To delineate the global number and rate of incidence, prevalence and burden of vertebral fracture in 2019, and the temporal trends from 1990 to 2019 by location, age, sex, and the socio-demographic index (SDI). STUDY DESIGN/SETTING: A cross-sectional study using data from the Global Burden of Disease Study 2019 (GBD study 2019). PATIENT SAMPLE: Patients with vertebral fracture documented in medical records or registrations and included in the GBD study 2019 from different countries worldwide. OUTCOME MEASURES: Age standardized incidence rate (ASIR), age standardized prevalence rate (ASPR), and age standardized years lived with disability (YLDs). METHODS: The GBD study 2019 was used to obtain data for this analysis. The incidence, prevalence and disability were analyzed by location, year, sex, age, and SDI. DisMod-MR 2.1, a Bayesian meta-regression tool, was used to produce the estimates for each value after adjustment for age, sex, and other variables. Estimated annual percentage change (EAPC) was calculated to represent the temporal trends from 1990 to 2019. Spearman's rank order correlation was used to determine the correlation between SDI and the incidence and burden of vertebral fracture. This work was supported by the Key Research and Development Program of Hubei Province of China (No. 2020BCB049), and no conflicts of interest-associated biases existed in this study. RESULTS: Globally, there were 8.6 million (95% uncertainty interval [UI], 6,6-11,3 million) incident cases, 5.3 million (95% UI, 4.6-6.2 million) prevalent cases, and 0.55 million (95% UI, 0.37-0.77 million) YLDs of vertebral fracture. Compared with 1990, the number of incident cases and YLDs in 2019 increased by 38% (95% UI, 23%-48%) and 75% (95% UI, 65%-85%), respectively, while the ASIR (EAPC, -0.28; 95% CI, -0.41 to -0.14), ASPR (EAPC, -0.12; 95% CI, -0.22 to -0.02) and age standardized YLD rate (ASYR) (EAPC, -0.13; 95% CI, -0.23 to -0.04) decreased during this period. High ASIR, ASPR and ASYR were commonly seen in high-SDI countries, such as high-income North America, Australia, Central and Eastern Europe. In the country level, positive correlations were observed between SDI and ASIR (rho, 0.596; p<.001) and ASYR (rho, 0.413; p<.001). Males had higher ASIR and ASYR worldwide in each year from 1990 to 2019. However, the incidence, and YLD rates in females surpassed that in males after 65 years of age. Increasing trends were observed for both incidence and YLD rates with age. Falls were the leading cause for vertebral fracture across all ages. CONCLUSIONS: The past thirty years have seen increasing numbers but decreasing rates of global incidence, prevalence, and disability of vertebral fractures, resulting from the growing population worldwide. With population aging, efforts are still in urgent need to address vertebral fracture related health outcomes. (C) 2021 Elsevier Inc. All rights reserved.

Objective We aim to explore the global spatial prevalence and temporal trends of the burden of low bone mineral density (LBMD) worldwide, due to a lack of related studies. Design Cross-sectional study. Methods We used data from the Global Burden of Disease Study 2019 to conduct this study. LBMD in the GBD study includes both osteopenia and osteoporosis. The estimation for the prevalence, measured by the summary exposure value (SEV), and burden of LBMD was made in DisMod-MR 2.1, a Bayesian meta-regression tool. Correlation analysis was performed using the Spearman rank order correlation methods. The temporal trends were represented by the estimated annual percentage change (EAPC). Results In 2019, there were 438 thousand deaths and 16.6 million DALYs attributable to LBMD, increasing by 111.1% and 93.8% respectively, compared to that in 1990. From 1990 to 2019, the prevalence of LBMD has decreased worldwide, but has increased in high-income North America. Some countries, such as the United States, Australia, Canada, and China had increased disability and mortality rates of LBMD with time. Countries with low socio-demographic index (SDI) had higher incidence and mortality rate than those with high SDI. The prevalence of LBMD was lower in males, but the attributable disability and mortality were higher in males in all years from 1990 to 2019. Conclusion With population aging, countries worldwide, especially those with low-SDI, will face increasing challenges in reducing the burden attributable to LBMD and osteoporosis. The treatment of osteoporosis has been overlooked in men for a long time. Effective measures are warranted to control the prevalence and burden of LBMD.

cytohesin-2 is a guanine nucleotide exchange factor to activate ARF1 and ARF6, which are involved in various biological processes, including signal transduction, cell differentiation, cell structure organization, and survival. Nevertheless, there is a lack of evidence revealing the role of cytohesin-2 in osteoclast differentiation and in the development of osteoporosis. In this study, we find cytohesin-2 and ARF1 positively regulate osteoclast differentiation and function. Blocking the cytohesin-2 /ARF1 axis with SecinH3 or by genetic silencing of cytohesin-2 inhibits osteoclast formation and function in vitro. In vivo treatment with SecinH3 ameliorates ovariectomy-induced osteoporosis. Mechanistically, RNA-sequencing combined with molecular biological methodologies reveal that the regulatory function of cythohesin-2/ARF1 axis in osteoclast differentiation is mainly dependent on activating the JNK pathway. Further, in addition to the common viewpoint that JNK is activated by IRE1 via its kinase activity, we found that JNK can act upstream and regulate the endoribonuclease activity of IRE1 to promote XBP1 splicing. Both SecinH3 and silencing of cytohesin-2 inhibit JNK activation and IRE1 endoribonuclease activity, leading to the suppression of osteoclast differentiation. Taken together, our findings add new insights into the regulation between JNK and IRE1, and reveal that inhibiting the cytohesin-2/ARF1/JNK/IRE1 axis might represent a potential new strategy for the treatment of post-menopause osteoporosis.

Methionine adenosyltransferase II alpha (MAT2A) is the key enzyme to transform methionine and adenosine-triphosphate (ATP) to S-adenosylmethionine (SAM), a general methyl-group donor in vitro. MAT2A has been reported to participate in the NF-κB pathway and maintain the methylated modification, which also affects osteoclastogenesis. In this study, we found the expression of MAT2A was increased upon RANKL stimulation. Pharmacological inhibition of MAT2A by its selective inhibitor AG-270 or genetic silencing by MAT2A-shRNA suppressed osteoclast formation and function in vitro. In vivo treatment with the inhibitor AG-270 also prevented OVX-induced bone loss. Further study revealed that the inhibition of MAT2A affected osteoclast differentiation mainly by suppressing crucial transcription factors and reactive oxygen species induced by RANKL. A quasi-targeted metabolomics assay performed by LC-MS/MS indicated that SAM was reduced by MAT2A knockdown, and the administration of SAM partly rescued the effects of MAT2A inhibition on osteoclastogenesis. These findings revealed that MAT2A is crucial for osteoclastogenesis and might be a potential target for the treatment of osteoporosis attributed to osteoclast dysfunction.

目的 探讨前路病灶清除自体髂骨植骨融合内固定术联合抗结核药物治疗下颈椎结核.方法 回顾性分析2010年1月—2017年12月本院收治的25例下颈椎结核患者,所有患者术前采用抗结核药物治疗2周以上,均采用一期前路病灶清除自体髂骨植骨融合内固定术治疗,术后继续规范抗结核药物治疗12～18个月.随访观察记录颈部疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、局部后凸Cobb角、C2～7 Cobb角、红细胞沉降率(ESR)、C反应蛋白(CRP)及植骨融合情况.结果 所有患者随访18～45个月,平均30个月.所有患者术后临床症状均明显改善,末次随访时颈部疼痛VAS评分为(2.1±1.5)分,JOA评分为(15.3±1.5)分,下颈椎局部后凸Cobb角为-6.2°±3.5°,C2～7 Cobb角为-10.0°±4.5°,ESR为(8.1±4.2)mm/h,CRP为(3.8±2.2)mg/L;均较术前明显改善,差异有统计学意义(P<0.05).末次随访时所有患者病灶区域植骨均完全融合,无内固定松动断裂.结论 前路病灶清除自体髂骨植骨融合内固定术联合抗结核药物能有效治疗下颈椎结核.

Study Design. A case-control study. Objectives. The aim of this study was to evaluate the outcomes of two modified laminoplasties (LPs) based on a novel paraspinal approach for treating multilevel cervical spondylotic myelopathy. Summary of Background Data. No laminoplasty through a natural intermuscular plane mimicking Wiltse approach to minimize intraoperative injury to extensor muscles has ever been developed and studied. Methods. Ninety-two patients were enrolled, including patients treated with either modified LP and patients treated with concurrent conventional LP. Operation time, blood loss, and complications were recorded. Clinical outcomes were evaluated by VAS, JOA scores, and recovery rate. Cervical sagittal alignment was measured on cervical radiographs. Spinal canal expansion was assessed on CT scans. Cross-sectional area (CSA) and atrophy rate (AR) of cervical deep extensors were evaluated on MRI. Results. The average follow-up duration was 33.05, 31.55, 33.02, and 32.52 months, respectively in each group. Compared to concurrent conventional procedure, unilateral muscle-preserving procedure displayed similar, whereas bilateral muscle-preserving procedure showed significantly increased operation time and blood loss; each modified procedure resulted in comparable and satisfied perioperative clinical scores, spinal canal expansion while achieving significantly lower axial pain incidence, better cervical lordosis maintenance, and better deep extensor preservation. AR of deep extensors on the open side was significantly lower than that on the hinge side. Bilateral paraspinal approach demonstrated significantly better muscle-preservation on the open side and increased operation duration, with similar clinical scores, axial pain incidence, cervical lordosis maintenance, and spinal canal expansion compared to unilateral paraspinal approach. Loss of cervical lordosis was strongly correlated with AR of deep extensors. Conclusion. Paraspinal approach is a good manner to protect deep extensor muscles; the two modified LPs have similar effects on clinical outcomes.

BACKGROUND:Regional lymph node metastasis (RLNM) has been reported to be a prognostic factor for poor survival outcomes of bone sarcoma. However, studies about risk factors for RLNM of bone sarcoma are extremely rare, and the outcome of such patients remains to be explored. We aimed to identify risk factors for RLNM of bone sarcoma and conduct survival analysis for patients with bone sarcoma with RLNM.METHODS:A total of 10,641 patients confirmed of malignant bone sarcomas from 1983 to 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database, with 311 being regional lymph node positive. Logistic regression analysis was used to identify risk factors for RLNM, while the Cox proportional hazards model and the Fine and Gray's regression model were used for survival analysis.RESULTS:The proportion of RLNM was 6.0% in Ewing sarcoma, 2.5% in osteosarcoma and 1.1% in chondrosarcoma. Other bone tumors together had a RLNM rate of 4.2%. Risk factors identified by the logistic regression analysis for RLNM were male patients, primary tumor site, tumor type and size. The multivariate Cox regression analysis suggested age, race, distant metastasis, tumor type and surgical treatment to be prognostic factors for the overall survival of patients with RLNM. Taking non-cancer-specific death as a competing risk, however, we found only age between 30-60 years [sub-distribution hazard ratio (SHR), 1.528, 95% CI, 1.028-2.271; P=0.02], distant metastasis (SHR, 2.418, 95% CI, 1.682-3.474; P<0.001) and surgery treatment (SHR, 0.493, 95% CI, 0.339-0.718; P<0.001) remained significant for the cancer-specific survival in the Fine and Gray's regression model.CONCLUSIONS:Predictive factors for RLNM of bone sarcoma are sex, tumor site, type and size. In the presence of RKNM, only age, distant metastasis and surgery treatment are prognostic factors for the outcome of patients with bone sarcoma.

Study Design. Retrospective analysis. Objective. The aim of this study was to develop and validate a competing-risk-based prognostic model and a nomogram for predicting the three- and five-year probability of cancer-specific death (CSD) in patients with spinal and pelvic chondrosarcoma. Summary of Background Data. The issue of competing risk has rarely been addressed and discussed in survival analysis of bone sarcoma. In addition, the Fine and Gray model, a more accurate method for survival analysis in the context of competing risk, has also been less reported in prognostic study of chondrosarcoma. Methods. A total of 623 patients with spinal or pelvic chondrosarcoma were identified from the SEER database and were divided into a training and a validation cohort. These two cohorts were used to develop and validate a prognostic model to predict the 3- and 5-year probability of CSD, considering non-CSD as competing risk. The C-index, calibration plot, and decision curve analysis were used to assess the predictive performance and clinical utility of the model. Results. Older age (subdistribution hazards ratio [SHR]: 1.02, 95% confidence interval [CI]: 1.01 similar to 1.03; P = 0.013), high grade (SHR: 2.68, 95% CI: 1.80 similar to 3.99; P < 0.001), regional involvement (SHR: 1.66, 95% CI: 1.06 similar to 2.58; P = 0.026), distant metastasis (SHR: 5.18, 95% CI: 3.11 similar to 8.62; P < 0.001) and radical resection (SHR: 0.38, 95% CI: 0.24 similar to 0.60; P < 0.001) were significantly associated with the incidence of CSD. These factors were used to build a competing-risk-based model and a nomogram to predict CSD. The C-index, calibration plot, and decision curve analysis indicated that the nomogram performs well in predicting CSD and is suitable for clinical use. Conclusion. A competing-risk based prognostic model is developed to predict the probability of CSD of patients with spinal and pelvic chondrosarcoma. This nomogram performs well and is suitable for clinical use.

目的 评估同一体位斜外侧腰椎椎间融合术(OLIF)联合后路导航辅助下经皮椎弓根螺钉固定治疗腰椎退行性疾病的可行性、安全性及临床疗效.方法 回顾性分析2015年8月～2019年2月于本院行同一体位OLIF联合后路经导航辅助下皮椎弓根螺钉固定治疗的腰椎退行性疾病患者22例.统计手术时间、术中出血量、术中椎弓根螺钉置钉时间,利用腰痛及下肢痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评估临床疗效.术后CT三维重建评估侧卧位经皮置钉的准确性及椎间融合率.结果 所有患者均获得随访,随访时间12～24个月,平均(15.6±4.8)个月.所有患者均顺利完成手术,手术时间(96.2±15.2) min,术中出血量(62.4±19.3) mL,总置钉时间(33.0±3.6) min.术后随访腰痛VAS评分、下肢痛VAS评分及ODI指数均较术前明显改善,差异具有统计学意义(P＜0.05).置钉准确率94.3％,术后1年椎间融合率为100％.结论 同一体位OLIF联合后路导航辅助下经皮椎弓根螺钉固定手术可以避免术中变换体位,精简手术过程,节约手术时间,具有良好的可行性、安全性及临床疗效.