Objectives:. To analyze the correlation among subcutaneous lumbar spine index (SLSI), paraspinal muscle parameters, and lumbar bone mineral density (BMD), and to evaluate their predictive value on lumbar BMD for patients with lumbar spondylolisthesis. Materials and methods:. A total of 216 patients with lumbar spondylolisthesis were included. All of them were divided into groups of normal bone mass, osteopenia, and osteoporosis (OP) according to BMD of L1–4 measured by dual-energy X-ray absorptiometry (DXA). SLSI was obtained by computed tomography, and paraspinal muscle parameters were calculated by the Image J software. The differences between SLSI and paraspinal muscle parameters were compared in 3 groups. Correlation analysis and multiple linear regression were used to analyze the relationship between parameters and lumbar BMD. Results:. SLSI and paraspinal muscle parameters were analyzed among 3 groups. There was a significant difference in cross-sectional areas (CSAs) of psoas major (PS) and quadratus lumborum (QL), PS index, relative cross-sectional areas (rCSAs) of PS and QL, fatty infiltration (FI) of multifidus (MF) and erector spinae (ES) between normal bone mass group and osteopenia group, normal bone mass group and OP group (p < 0.05). Correlation analysis among body mass index (BMI), SLSI, paraspinal muscle parameters, and BMD was adopted for all included patients. There were positive correlations among BMI, CSAs of PS and QL, PS index, rCSAs of PS and QL, and lumbar BMD (p < 0.05). There were negative correlations among MF index, FI of PS, MF and ES, and lumbar BMD (p < 0.05). The regression equation of lumbar BMD: BMD = −3.461 + 0.063 × BMI + 0.943 × rCSA of PS − 3.871 × FI of ES (R2 = 0.111). Conclusions:. For patients with lumbar spondylolisthesis, smaller CSAs of flexor muscle group and more FI of paraspinal muscles are related to less bone mass and lower lumbar BMD. Combined with BMI, rCSA of PS and FI of ES have predictive value on lumbar BMD. For patients with both lumbar spondylolisthesis and OP, those who have higher SLSI are estimated to have less bone mass.

BACKGROUND: With the increasing use of polymethyl methacrylate (PMMA) for vertebral augmentation, the complications caused by PMMA have also increased. In order to avoid the complications, metal stents combined with artificial bone are currently used in clinical practice for vertebral augmentation. We conducted finite element analysis on the biomechanical differences between metal stents combined with artificial bone versus PMMA on adjacent vertebrae and intervertebral discs in order to find whether metal stents combined with artificial bone have more advantages. METHODS: Finite element models of a functional spinal unit from T11 to L1 were created based on computed tomography data. The T12 vertebra was augmented using 3 different materials: 1 metal stent with artificial bone, 2 metal stents with artificial bone, and PMMA. The model assumed fixation of the lower endplate of L1. A 350 N follower load was applied at the center of the upper endplate of T11, with flexion, extension, lateral bending, and axial rotation under a 7.5 Nm moment. RESULTS: Compared to the PMMA augmentation model, the maximum von Mises stress within the augmented vertebra significantly increased with metal stents combined with artificial bone. Meanwhile, the augmentation materials in the vertebral body among the three models showed no significant difference. Furthermore, compared to the PMMA augmentation model, metal stents combined with artificial bone models exhibited reduced stress on adjacent vertebrae and intervertebral discs during flexion- extension and lateral bending. No significant biomechanical differences were observed between 1 or 2 metal stents combined with artificial bone models. CONCLUSIONS: Metal stents combined with artificial bone and PMMA can enhance the strength and rigidity of the augmented vertebra, aiding reconstruction of vertebral function. Metal stents combined with artificial bone offer biomechanical advantages over PMMA for adjacent vertebrae and intervertebral discs.

Bone defects caused by trauma, tumor resection, and surgery present significant clinical challenges, often resulting in complications such as delayed union, nonunion, and even long-term functional impairment. Current treatments, including autografts and allografts, are limited by donor site morbidity, immune rejection, and pathogen transmission, highlighting the need for developing reliable synthetic alternatives. To address these challenges, we report a binary composite hydrogel combining gelatin methacryloyl (GelMA) and κ-Carrageenan, reinforced with calcium phosphate cements (CPC). GelMA ensures rapid gelation and biocompatibility, κ-carrageenan improves injectability, and CPC enhances mechanical strength and osteogenic activity, collectively creating a robust and versatile hydrogel system. Furthermore, the hydrogel’s injectable, adaptive, and self-healing characteristics enable it to conform to irregular bone defect sites, providing mechanical support and osteogenic stimulation. It also releases bioactive components to accelerate bone regeneration. With exceptional toughness and resilience, this hydrogel recovers its shape after deformation, positioning it as a promising candidate for clinical bone defect repair applications.

Background Osteonecrosis of the femoral head (ONFH) is a refractory orthopedic disease with a high disability rate. Long-term administration of steroids is the most common pathogenic factor for non-traumatic ONFH. Early diagnosis of steroid-induced osteonecrosis of the femoral head (SONFH) is difficult and mainly depends on imaging.Objectives The objectives of this review were to examine the pathological mechanisms of SONFH, summarize related markers of SONFH, and identify areas for future studies.Methods We reviewed studies on pathological mechanisms and related markers of SONFH and discussed the relationship between them, as well as clinical applications and the outlook of potential markers.Results The pathological mechanisms of SONFH included decreased osteogenesis, lipid accumulation, increased intraosseous pressure, and microcirculation disruption. Differential proteomics and genomics play crucial roles in the occurrence, progression, and outcome of SONFH, providing novel insights into SONFH. Additionally, the biological functions of mesenchymal stem cells (MSCs) and exosomes (Exos) in SONFH have attracted increasing attention.Conclusions The pathological mechanisms of SONFH are complex. The related markers mentioned in the current review can predict the occurrence and progression of SONFH, which will help provide effective early clinical prevention and treatment strategies for SONFH.

The senescence-associated secretory phenotype (SASP) is a generic term for the secretion of cytokines, such as pro-inflammatory factors and proteases. It is a crucial feature of senescent cells. SASP factors induce tissue remodeling and immune cell recruitment. Previous studies have focused on the beneficial role of SASP during embryonic development, wound healing, tissue healing in general, immunoregulation properties, and cancer. However, some recent studies have identified several negative effects of SASP on fracture healing. Senolytics is a drug that selectively eliminates senescent cells. Senolytics can inhibit the function of senescent cells and SASP, which has been found to have positive effects on a variety of aging-related diseases. At the same time, recent data suggest that removing senescent cells may promote fracture healing. Here, we reviewed the latest research progress about SASP and illustrated the inflammatory response and the influence of SASP on fracture healing. This review aims to understand the role of SASP in fracture healing, aiming to provide an important clinical prevention and treatment strategy for fracture. Clinical trials of some senolytics agents are underway and are expected to clarify the effectiveness of their targeted therapy in the clinic in the future. Meanwhile, the adverse effects of this treatment method still need further study.

OBJECTIVE Lumbar disc herniation (LDH) is rare in young adults. The present study aimed to evaluate the clinical outcomes of full-endoscopic lumbar discectomy (FELD) for LDH in young adults and to determine the risk factors that predict unfavorable outcomes of FELD for LDH in young adults. METHODS A retrospective two-center cohort study was performed between January 2015 and October 2021 at the authors’ institutions. Clinical outcomes were assessed using the visual analog scale (VAS) for low-back pain and leg pain and the Oswestry Disability Index (ODI). The modified Macnab criteria were used to evaluate clinical efficacy at the last follow-up, and the global outcomes were classified into 4 groups, namely excellent, good, fair, and poor. The fair and poor groups were defined as unfavorable outcomes. RESULTS One hundred ninety-nine patients were analyzed in this study (mean age 18.5 years, mean BMI 25.1 kg/m2, male/female sex ratio 2.8). The duration from the onset of symptoms to the operation was in general prolonged with age. The VAS and ODI scores significantly improved after surgery. A total of 17 of 195 single-segment cases had unfavorable outcomes based on the modified Macnab criteria. Lateral disc herniation (OR 3.72, 95% CI 1.14–12.12, p = 0.029) and high preoperative VAS score (OR 1.98, 95% CI 1.13–3.46, p = 0.017) were identified as risk factors for unfavorable outcomes after FELD. CONCLUSIONS FELD for LDH in young adults is safe and effective. Preoperative VAS score and lateral disc herniation are risk factors of nonfavorable outcomes after surgery and may be a useful index for surgical procedure selection.

BACKGROUND: The high incidence of nonunion in osteoporosis vertebral compression fractures (OVCFs) among the elderly population is a significant concern. But the hypothesis about etiopathogenesis of the intravertebral cleft (IVC) is not convincing. This study aims to investigate the association between spinopelvic parameters and IVC. METHODS: Patients with single segment IVC or healed vertebral compression fracture (HVCF) were retrospectively recruited for the study. Patients with IVC were assigned to the IVC group, the others were assigned to the HVCF group. We estimated whether IVC or HVCF locates the vertebra inflection point on lumbar lateral radiography. Distance between the sagittal line passing through the anterosuperior corner of S1and the center of the vertebra of healed fracture or with IVC (DSVA) and sacral slope (SS) were measured on lumbar lateral plain films. Intergroup spinopelvic parameters were analyzed. analysis to identify independent variables associated with IVC incidence. The receiver operating characteristics (ROC) curve was generated to identify the optimal cut-off point for statistically significant variables. RESULTS: Sixty-five patients were included in the study. Thirty patients (mean age: 74 +/- 7.16 years) had single-level IVC, and 35 patients (mean age: 67.71 +/- 7.30 years) had single-level HVCF. Age, body mass index (BMI), and DSVA were statistically different between the groups (all P < 0.05). The occurrence of IVC was related to the DSVA in the multivariate logistic regression analysis (OR [ 0.73, P < 0.05). CONCLUSIONS: According to the results of this study, large DSVA was a risk factor for IVC formation in patients with OVCFs. Patients with global spinal malalignment should be actively observed during conservative treatment.

A novel interspinous distraction fusion (ISDF) device has been used to treat lumbar degenerative diseases. As a minimally invasive technique, ISDF differs from the traditional interspinous process distraction devices. Currently, biomechanical studies on ISDF are rare. To investigate the biomechanical properties of the ISDF device (BacFuse) which is used to treat lumbar degenerative diseases. Three-dimensional L3-L5 models were created. The models were divided into four groups: intact (M1), local decompression alone (M2), internal fixation alone (M3) and local decompression combined with internal fixation (M4), based on different surgical procedures. Local laminectomy was performed to resect the lower part of the L4 lamina and the upper part of the L5 lamina at the right lamina of L4/5 in the M2 and M4 groups. After meshing the models elements, Abaqus were used to perform the finite element (FE) analysis. The intervertebral range of motion (ROM) was measured during flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation under a follower load of 400 N with a 7.5Nm moment. The distributions of disc and facet joint stresses were observed and recorded. Spinal vertebral stress was compared, and internal fixation device stress was observed. The ROM of L4/5 in M2 increased in flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation compared with that in M1. In all motion directions, the ROM at L4/5 decreased, and the ROM at L3/4 increased after implantation of the ISDF device in M3 and M4 groups. The disc stress and facet joint stresses in the instrumented segment decreased after implantation of the ISDF device. The spinous process loaded a certain amount of stress in M3 and M4 groups. The spikes of the internal fixation device were loaded with the maximum stress. BacFuse exhibited a reduction in intervertebral ROM, as well as decreased stress on the intervertebral disc and facet joint, while also demonstrating a discernible impact on the upper adjacent segment.

目的 分析13例接受局麻下经皮椎体强化术(percutaneous vertebral augmentation,PVA)的患者发生短暂性截瘫的临床特点.方法 对北京友谊医院 13 例PVA短暂性截瘫患者进行分析,收集包括手术、椎体节段、麻醉剂量、手术时间、截瘫恢复时间和随访在内的临床数据.结果 13 例患者中男 5 例、女 8 例;年龄 62～83 岁、平均 73.3 岁.每个椎体注射的平均麻醉剂量为 5.84 mL,患者平均需要 217.3 min才能完全恢复感觉和运动,麻醉剂量与完全恢复所需时间无关.患者术前疼痛视觉模拟评分(Visual Analog Scale,VAS)7.462±0.183(n=13)、术后1个月1.615±0.213(n=13)、术后3个月1.538±0.447(n=13)、术后 6 个月1.273±0.273(n=11),术后均较术前明显改善(P＜0.000 1).术前Oswestry 功能障碍指数(Oswestry Dis-ability Index,ODI)(69.540±1.323)%(n= 13)、术后 1 个月(12.310±1.517)%(n= 13)、术后 3 个月(12.460±2.980)%(n=13)、术后6个月(7.000±0.884)%(n=11),术后均较术前有明显改善(P＜0.000 1).结论 局麻下经皮椎体强化术中短暂性截瘫的临床特点与蛛网膜下腔麻醉恢复期相似.

目的 探讨骨折风险评估工具(Fracture Risk Assessment Tool,FRAX)对绝经后女性骨折风险的预测价值.方法 回顾性分析 750 名北京地区绝经后女性的FRAX评分,收集每位受试者股骨颈骨密度(bone mineral density,BMD)及FRAX算法中需要的危险因素,并随访收集 10 年内是否新发骨折,计算年龄及体质量指数(body mass index,BMI),用FRAX工具计算10 年内骨质疏松引起主要部位骨折(脊柱、前臂、肩部骨折)概率(the 10-year probability of major osteoporotic fractures,PMOF)和 10 年内髋骨骨折概率(the 10-year probability of hip osteoporotic fractures,PHF).分析FRAX预测值与年龄、BMI、股骨颈BMD的相关性,建立二分类Logistic回归方程研究 10 年内新发骨折的显著危险因素,并建立模型得到预测值,以 10 年内是否新发骨折为标准绘制受试者工作曲线(receiver operating characteristic curve,ROC),计算FRAX预测值、BMD及模型预测值曲线下面积(area under curve,AUC),以AUC评估FRAX工具的预测价值.结果 研究对象平均年龄为(62.49±6.59)岁,平均体质量为(63.03±9.63)kg,平均身高为(156.11±5.10)cm,平均股骨颈BMD(T值)为-1.12±0.95.危险因素与FRAX预测值的相关性分析显示,除吸烟和饮酒外,余危险因素与PMOF的差异均有统计学意义(P＜0.05);除饮酒和风湿性关节炎外,余危险因素与PHF的差异均有统计学意义(P＜0.05).年龄、BMI和股骨颈BMD与FRAX评分的相关性分析显示,年龄与PMOF和PHF呈正相关,差异有统计学意义(P＜0.05),而BMI、股骨颈BMD与PMOF和PHF均 呈负相关,差异有统计学意义(P＜0.05).以 10 年内是否新发骨折为因变量生成Logistic回归方程评估危险因素,得出骨折史、吸烟、股骨颈BMD、体重、身高对女性骨折风险的影响较大并得到预测模型.ROC曲线分析PMOF、PHF、股骨颈BMD和回归模型预测 10 年内骨折的AUC分别为 0.616、0.600、0.573 和 0.670(P＜0.05),但诊断能力较低.结论 FRAX可应用于北京地区绝经后女性骨折风险评估,但预测准确性有待提高.绝经后女性如果有骨折史,应尽早行FRAX及DXA评估,并尽快得到医疗建议.

The study of damage expansion process of the surrounding rock mass under blasting is of great significance to the blast resistance design of a chamber. In order to explore the damage propagation law of the surrounding rock mass around a chamber under the action of different blasting sources, a numerical calculation model including top explosion, vault side explosion, side wall explosion, bottom side explosion and bottom explosion was established by using the finite element simulation software ANSYS/LS-DYNA. The RHT model was used to analyze the damage propagation process of the chamber surrounding rock mass at different positions. On this basis, 10 vibration velocity monitoring points were set equidistantly from the blast source to the chamber boundary in the model, and the vibration velocity attenuation law from the blast source center to the chamber boundary was studied. The results show the damage point first appears at the shortest distance from the blast source, and is then formed subsequently. The damage zone expands gradually along the boundary of the chamber and finally forms the damage zone. Compared with the decay law of the blasting vibration velocity, the blasting vibration wave is fully reflected in the surrounding rock mass, which makes the blasting vibration velocity appear an amplification effect. At the same time, the damage evolution from the blast source to the surrounding rock mass corresponds to the change law of the peak vibration velocity, which can be used to determine if damage happens.

为解决裂隙围岩隧道爆破掘进施工过程中断面轮廓控制不足、超欠挖严重的问题,以某隧道为例,通过分析掌子面爆破开挖过程中导致轮廓控制不足的主要因素,对炮孔装药结构、装药密度和光爆层厚度等进行了优化.现场爆破效果表明:采用优化后的爆破参数进行开挖,可有效控制爆破开挖断面轮廓,抑制拱顶岩体大面积离层,避免掌子面底部"根底"现象;隧道平均线性超挖量大幅降低80％,平均炮孔利用率提高至93.2％,有效降低了裂隙围岩隧道爆破开挖对围岩的损伤,改善了爆破效果.

目的 探讨紫草素(SK)对糖皮质激素性骨质疏松症的潜在治疗作用和调控机制.方法 按照1 mg/kg剂量给予雄性C57BL/6小鼠肌注地塞米松(DEX)诱导构建糖皮质激素性骨质疏松症(GIOP)模型,micro-CT检测骨微结构,免疫组织化学检测骨小梁osterix(OSX)和osteocalcin(OCN)表达;蛋白质印迹法(Western blot)检测骨组织中Wnt/β-连环蛋白(β-catenin)信号相关蛋白表达.培养小鼠骨髓间充质干细胞(BMSCs),用DEX(1 mol/L)、SK(50、100、200 mol/L)处理BMSCs;细胞计数试剂盒(CCK-8)检测细胞活性;茜素红染色法检测成骨矿化能力;用Wnt信号抑制剂XAV939评估紫草素通过Wnt/β-catenin信号通路治疗GIOP.两组间比较采用t检验,多组间比较采用单因素方差分析.结果 Micro-CT结果显示,对照组、DEX组和DEX+SK组小鼠骨体积分数分别为(24.66±16.31)％、(14.76±3.99)％、(21.04±9.73)％,组间比较差异有统计学意义(F=10.03,P＜0.05);皮质骨厚度分别为(0.60±0.01)、(0.30±0.01)、(0.52±0.01)mm,组间比较差异有统计学意义(F=11.13,P＜0.05);骨小梁数量分别为(2.92±0.38)、(1.34±0.10)、(2.66±0.27)/mm,组间比较差异有统计学意义(F=12.54,P＜0.05);骨小梁厚度分别为(0.210±0.002)、(0.100±0.001)、(0.190±0.001)mm,组间比较差异有统计学意义(F=13.48,P＜0.05);骨小梁间隙分别为(0.280±0.003)、(0.530±0.003)、(0.340±0.004)mm,组间差异有统计学意义(F=21.80,P＜0.05);免疫组织化学结果显示,与对照组比较、DEX组OSX和OCN表达下调;与DEX组比较,DEX+SK组OSX和OCN表达上调,差异有统计学意义(F=60.42,56.38,P＜0.05).Western blot结果显示DEX组小鼠Wnt1和磷酸化糖原合成激酶3β(p-GSK-3β)蛋白表达下降,而DEX+SK组小鼠Wnt1和p-GSK-3β蛋白表达上调.CCK-8结果显示,与对照组[(97.33±1.61)％]比较,DEX组细胞活性受到抑制[(47.30±3.98)％],与DEX组比较,DEX+SK(50 mol/L)组、DEX+SK(100 mol/L)组和DEX+SK(200 mol/L)组细胞活性上调,差异有统计学意义(t=36.87、5.16、30.93、50.89,P＜0.05);对照组、DEX组、DEX+SK组中成骨矿化结节吸光度(A)值分别为 0.440±0.004、0.150±0.001、0.370±0.003,组间差异有统计学意义(F=158.00,P＜0.05);与DEX+SK组比较,DEX+SK+XAV939组BMSCs中OSX和OCN蛋白表达显著下调;与DEX+SK 组(0.430±0.002)比较,DEX+SK+XAV939 组(0.200±0.002)成骨矿化下降,差异有统计学意义(t=7.97,P＜0.05).结论 紫草素通过激活Wnt/-catenin信号改善GIOP小鼠骨量.

Abstract With the development of surgical techniques, the surgical treatment of hip fractures is no longer a prob-lem, but perioperative management is still a challenge. Postoperative delirium is one of the common complications of hip fracture, with an incidence of 40% -60%, significantly increasing the risk of death in patients. By reviewing the relevant literature, this paper first introduces the definition and mechanism of delirium, and discusses the man-agement of delirium from the preoperative, intraoperative, and postoperative aspects according to the currently estab-lished hypothesis, and summarizes the currently feasible therapeutic measures. The purpose is to improve orthopedic surgeons, awareness of the risk of postoperative delirium and provide a theoretical basis for perioperative management.

Robust data on osteoporosis in the Asia Pacific region could improve healthcare decision-making. Osteoporosis affects 10–30% of women aged 40 + , and up to 10% of men in 7 developed economies in Asia Pacific. Fractures affect 500–1000 adults aged 50 + per 100,000 person-years. Policymakers and clinicians must address this problem. Osteoporosis and associated fractures result in considerable morbidity, loss of productivity, early mortality, and increased healthcare expenses. Many countries in the Asia Pacific (AP) region, especially middle- and higher-income economies, are faced with aging and increasingly sedentary populations. It is critical to consolidate and analyze the available information on the prevalence and incidence of the disease in these countries. We systematically reviewed articles and gray literature for Australia, China, Hong Kong, Japan, Singapore, South Korea, and Taiwan. We searched PubMed, ScienceDirect, JSTOR, Cochrane, Google Scholar, and other databases for data published 2009–2018. We included articles with prevalence or incidence estimates for adults with osteoporosis or related fractures. All locations had data available, but of widely varying quantity and quality. Most estimates for osteoporosis prevalence ranged from 10 to 30% for women ages 40 and older, and up to 10% for men. Osteoporotic fracture incidence typically ranged between 500 and 1000 per 100,000 person-years among adults aged 50 and older. Both outcomes typically increased with age and were more common among women. Osteoporosis and associated fractures affect significant portions of the adult population in developed economies in the AP region. Governments and healthcare systems must consider how best to prevent and diagnose osteoporosis, and manage affected individuals, to reduce healthcare costs and mortality associated with fractures.

Objective:To evaluate the efficacy of percutaneous curved kyphoplasty (PCKP) for the treatment of osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective cohort study was conducted to analyze the clinical data of 70 patients with OVCF admitted to Third People′s Hospital of Datong from May 2020 to December 2021, including 32 males and 38 females, aged 60-89 years [(73.0±8.7)years]. The patients were treated with PCKP (PCKP group, n=20) or percutaneous vertebroplasty (PVP) (PVP group, n=50). The operation time, intraoperative blood loss, length of hospital stay, excellent rate of bone cement distribution at postoperative 1 day, and leakage rate of bone cement were compared between the two groups. In addition, anterior height ratio of the injured vertebrae, upper and lower Cobb angle, visual analogue scale (VAS), and Oswestry dysfunction index (ODI) were measured preoperatively and at postoperative 24 hours and 3 months. Results:All patients were followed up for 3-4 months [(3.0±0.6)months]. There were no significant differences in the operation time, intraoperative blood loss, and length of hospital stay between the two groups (all P>0.05). At postoperative 1 day, the excellent rate of bone cement distribution was 100% in PCKP group (excellent in 13 patients, good in seven, poor in zero), significantly higher than 82% in PVP group (excellent 21 patients, good in 20, and poor in nine). The leakage rate of bone cement was 0%(0/20) in PCKP group, lower than 20% (10/50) in PVP group ( P<0.05). There were no significant differences in the anterior height ratio of injured vertebrae, upper Cobb angle, lower Cobb angle, VAS and ODI between the two groups before operation (all P>0.05). At postoperative 1 day, PCKP group showed significantly higher anterior height ratio of injured vertebrae and significantly lower upper Cobb angle, lower Cobb angle, VAS, and ODI than those in PVP group ( P<0.05 or 0.01). At postoperative 3 months, PCKP group still showed significantly higher anterior height ratio of injured vertebrae and significantly lower upper Cobb angle and lower Cobb angle than those in PVP group ( P<0.05 or 0.01), but there was no significant difference in VAS and ODI between the two groups (all P>0.05). In PCKP group, the anterior height ratio of the injured vertebrae was significantly increased and the upper Cobb angle, lower Cobb angle, VAS, and ODI index were significantly decreased at postoperative 1 day and 3 months when compared with those before operation (all P<0.05). In PVP group, there were no significant changes in the anterior height ratio of the injured vertebrae, upper Cobb angle, and lower Cobb angle at postoperative 1 day and 3 months when compared with those before operation (all P>0.05), but the VAS and ODI were significantly lowered at postoperative 1 day and 3 months when compared with those before operation (all P<0.05). Conclusion:Compared with PVP, PCKP has better diffusion effect of bone cement in the injured vertebrae and lower incidence of bone cement leakage in the treatment of OVCF, which can effectively promote height recovery of the injured vertebrae, relieve the pain early, and improve spinal function.

Objective:To analyze the clinical efficacy of inter-spinal distraction fusion and fixation and Posterior lumbar interbody fusion in the treatment of lumbar disc herniation with stenosis, and to evaluate the health economics of the two surgical methods.Methods:Retrospectivly analyzed the clinical data of 400 patients with lumbar disc herniation with stenosis, who were enrolled in Beijing Friendship Hospital, Capital Medical University from Jan. 2015 to Jan. 2019, including 190 male cases and 210 female cases, aged from 50 to 87 years old, with the average age of 67.97. All patients were divided into two groups according to different surgical methods. Among them, 200 patients used interspinous process fusion and distraction fixation (ISDFF group), the other 200 cases used posterior lumbar decompression and pedicle internal fixation (PLIF group). All patients completed the follow-up time of more than 1 year after operation. The basic information of patients′ age, gender, total number of days in hospital, intraoperative bleeding, operation time, surgical incision length and other basic information were observed. The Oswestry dysfunction index (ODI), the Japanese Orthopaedic Association Score (JOA) and the visual analog scale (VAS) were used to evaluate the relief of symptoms before and after the two groups of patients. Total medical expenses, anesthesia expenses, surgical expenses and other expenses were analysed. The software of SPSS 20.0 were conducted to analyze data.Results:The patients in the ISDFF group were (70.84±8.93) years old, and the PLIF group was (65.10±10.23) years old ( t=5.98, P=0.008). The operation time in the ISDFF group was (59.21±16.22) min, and the operation time in the PLIF group was (81.31±17.24) min( t=13.20, P<0.001). The bleeding volume of the ISDFF group was (33.24±11.31) mL, and the bleeding volume of the PLIF group was (67.30±17.61) mL ( t=23.02, P<0.001). The length of the surgical incision in the ISDFF group was (8.27±2.53) cm, and the length of the surgical incision in the PLIF group was (11.15±1.91) cm ( t=11.848, P<0.001). The total hospitalization time in the ISDFF group was (15.15±0.54) days, and the total hospitalization time in the PLIF group was (19.86±0.97) days( t=4.26, P<0.001). There was no significant difference in preoperative ODI, JOA and VAS between the two groups ( P>0.05). Symptoms of postoperative patients were significantly improved compared with preoperative. There were statistical differences in ODI, JOA and VAS between the two groups before and after operation ( P<0.05). However, ODI, JOA and VAS were no statistical difference between the two groups after operation. Complications occurred in 5 cases of the two groups of patients, including two cases of superficial infection in the PLIF group, two cases of dural tear in the PLIF group, one case of spinous process fracture in the ISDFF group. The total hospitalization fee for ISDFF was (57 450±8 670) (yuan), and the total hospitalization fee for PLIF was (75 770±1 640) (yuan), with statistical differences ( t=9.92, P<0.001). The cost of ISDFF operation was 1864±38.19 (yuan), and the cost of PLIF operation was 2352±41.39 (yuan) ( t=8.65, P<0.001). ISDFF antibacterial drug usage fee was 635.5±64.69 (yuan), PLIF antibacterial drug usage fee was 1449±307.1 (yuan) ( t=2.59, P<0.001). The one-time medical material cost during the ISDFF operation was (38 990±300) (yuan), and the one-time medical material cost during the PLIF operation was (52 110±150) (yuan) ( t=5.88, P<0.001). The excellent and good rate of ISDFF group was 92%, and that of PLIF group was 86%. In this study, the total cost of hospitalization was used as an indicator to measure the cost, and further cost-effectiveness evaluation was made. For every good patient, the cost of the ISDFF group was 62 450 yuan, and the cost of the PLIF group was 88, 100 yuan. Conclusions:ISDFF is beneficial to reduce the cost of medical insurance in China, which is in line with the direction of national reform to reduce medical expenditure. It is a surgical method worthy of wide promotion and has a good application prospect.

目的 评估Otago运动训练对老年骨质疏松症患者躯体平衡功能和跌倒风险的影响.方法 将113例年龄>60岁可独立行走的骨质疏松症患者采用数字表法随机分为运动训练+抗骨质疏松组(试验组)和抗骨质疏松组(对照组).分别在干预前、干预后6个月、12个月行简易躯体能力测试(short physical per-formance battery,SPPB)和跌倒效能量表评分(modified falls efficacy scale,MFES)检测.在干预前和干预12个月应用双能X线骨密度仪行骨密度(bone mineral density,BMD)检查.两组分别记录12个月内的跌倒和是否跌倒导致骨折的次数.结果 干预前试验组和对照组SPPB[试验组(7.01±1.35)分,对照组(6.93±1.04)分]和MFES评分[试验组(6.62±1.32)分,对照组(6.54±2.06)分]差异无统计学意义(P>0.05).对照组干预前和干预后6个月SPPB[干预前(6.93±1.04)分,干预后6个月(7.37±1.25)分]和MFES[干预前(6.54±2.06)分,干预后6个月(6.81±1.27)分]评分差异无统计学意义(P>0.05);12个月[SPPB(7.83±1.38)分,MFES(7.76±1.74)分]和干预前比较,差异有统计学意义(P<0.05).试验组干预后6个月及12个月SPPB[6个月(7.89±1.96)分,12个月(8.91±1.17)分]和MFES[6个月(7.64±1.03)分,12个月(8.53±1.21)分]评分均显著提高(P<0.05),且在6个月和12个月时SPPB和MFES评分高于对照组(P<0.05).两组BMD值在干预后12个月[对照组腰椎BMD(0.786±0.130)g/cm2,髋部BMD(0.782±0.115)g/cm2;试验组腰椎BMD(0.798±0.113)g/cm2,髋部BMD(0.773±0.104)g/cm2]较干预前[对照组腰椎BMD(0.738±0.102)g/cm2,髋部BMD(0.741±0.103)g/cm2;试验组腰椎BMD(0.745±0.087)g/cm2,髋部BMD(0.747±0.122)g/cm2]均明显升高(P<0.05),但组间比较差异无统计学意义(P>0.05).结论 Otago运动训练12个月能够提高老年骨质疏松症患者平衡能力并减少跌倒的发生.

Objective:To study the efficacy and safety of bone-filling mesh container plasty in the treatment of posterior wall fracture of vertebra caused by spinal metastases.Methods:This study is a retrospective analysis of 65 patients with pathological fractures of the vertebra caused by vertebral metastases treated with bone-filling mesh container plasty from January 2015 to December 2019. There were 21 males and 44 females, 70.3±10.8 (46-90) (years). According to primary tumor, there were 25 cases of lung cancer, 14 cases of breast cancer, 11 cases of digestive system cancer, 13 cases of urinary system cancer, 1 case of lymphoma and 1 case of ovarian cancer. In the segment of vertebral metastases, there were 2 cases of T 2 vertebra, 1 case of T 5 vertebra, 1 case of T 6 vertebra, 2 cases of T 8 vertebra, 1 case of T 9 vertebra, 5 cases of T 10 vertebra, 4 cases of T 11 vertebra, 15 cases of T 12 vertebra, 12 cases of L 1 vertebra, 8 cases of L 2 vertebra, 8 cases of L 3 vertebra, 4 cases of L 4 vertebra, and 2 cases of L 5 vertebra. According to the CT images of the patient's vertebra before operation, the area of the damaged posterior wall of the vertebra is measured as s, and the area of the posterior wall of the intact vertebra is measured as S. The ratio of posterior wall damage is calculated as R= s/ S, and the value of R represents the degree of damage to the posterior wall of the vertebra. According to the size of the R value, the patients were divided into four groups, typeⅠ( R≤25%, 21 cases), typeⅡ(25%< R≤50%, 22 cases), typeⅢ (50%< R≤75%, 14 cases), typeⅣ( R>75%, 8 cases). The visual analog scale (VAS), Oswestry disability index (ODI) and activity of daily living (ADL) before and 1 day after surgery, 1 month after surgery, and 3 months after surgery were analyzed and compared to evaluate the efficacy of bone-filling mesh container plasty. Pairwise comparisons were performed to verify whether there is a difference in efficacy, bone cement leakage and postoperative complications. Results:All 65 patients were followed up for 3-6 months, with an average of 3.8 months. The VAS scores before surgery, postoperative day 1, postoperative 1, 3 months were 7.32±0.99, 4.14±1.06, 4.11±0.97, and 4.34±1.11, respectively, with a statistically significant difference ( F=149.20, P<0.001). ODI of preoperative, postoperative day 1, postoperative 1, and 3 months were 69.45%±4.15%, 36.65%±3.72%, 36.84%± 3.38%, 37.78%±3.45%, respectively, with a statistically significant difference ( F=840.88, P<0.001). ADL score of preoperative, postoperative day 1, postoperative 1, and 3 months were 71.31±12.81, 79.85±9.14, 78.92±8.95, and 78.31±8.67, respectively, with a statistically significant difference ( F=149.20, P<0.001). There was no significant difference in VAS, ODI and ADL scores between types I and IV (all P>0.05), but with the increase of R value, the leakage rate of intraspinal bone cement would increase correspondingly. Eleven cases occurred bone cement leakage with the rate of 17%. The leakage rate of type I and II was 0, type III was 7.1% (1/14), and type IV was 37.5% (3/8). All patients did not have systemic complications such as allergies, shock, decreased oxygen saturation, etc., and there were no bleeding, infection, nerve root symptoms or cement insertion syndrome after surgery. Conclusion:Bone-filling mesh container plasty can significantly improve the pain symptoms of patients with spinal metastases and recovery functions. The degree of damage to the posterior vertebra has no effect on the efficacy of the surgery. As the degree of damage to the posterior wall of the vertebra increases, the risk of complications of bone cement leakage in the spinal canal will increase.