Objective:To investigate the efficacy and safety of anterior cervical mini-incision vertebroplasty in the treatment of vertebral metastases. Methods:From July 2009 to March 2013, seven cases of vertebral metastases were treated by using vertebroplasty through an anterior cervical paratracheal mini-incision guided by C-arm X-ray in Beijing friendship hospital, Capital medical university. Among them, three were male and four were female, aged 51 to 74 years with an average age of 61.7 years. Preoperative and postoperative Visual Analog Scale (VAS) scores and analgesic medication usage were evaluated, and postoperative pain relief was assessed using the World Health Organization (WHO) criteria. Results:All seven surgeries were successful without any occurrences of complications such as nerve or vascular injury, pulmonary embolism, or hematoma. The average cement injection volume was 1.8ml, and postoperative X-rays and CT scans indicated satisfactory cement filling, with two cases showing paravertebral cement leakage, but without clinical symptoms. One week postoperatively, the VAS score decreased from a preoperative average of 8.86 to 2.14, with complete pain relief in three cases, leading to the cessation of analgesic drugs, and partial pain relief in four cases, resulting in a reduction or downgrade of analgesic medications. Follow-ups ranged from 3 to 28 months, with one patient dying at 3 months postoperatively, one at 4 months, two at 6 months, one at 8 months, and one at 17 months, while one patient survived 28 months postoperatively. Postoperatively, all patients showed no worsening of local pain symptoms, and the surgical efficacy remained stable. Conclusion:Anterior cervical mini-incision vertebroplasty is a precise and effective method for pain relief in the treatment of vertebral metastases, providing a safe approach that reduces the risk of damaging critical cervical tissues during the puncture procedure and postoperative hematoma formation. Level of Evidence lll; Retrospective Study.

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.

The aim of this study was to identify the clinical factors associated with serum trough concentrations of vancomycin crystalline degradation product (CDP-1) and to determine the impact of CDP-1 on chemiluminescence microparticle immunoassay (CMIA) results among patients with chronic kidney disease (CKD). In this retrospective observational study, patients with CKD who were receiving vancomycin intravenously were included if steady-state serum trough levels of vancomycin were available. Patients were allocated to three groups on the basis of their estimated creatinine clearance (eCrCl) on the day of trough level monitoring: G1 (60 < eCrCl ≤ 90 mL/min), G2 (30 < eCrCl ≤ 60 mL/min), and G3 (eCrCl ≤ 30 mL/min). CDP-1 serum concentrations were determined via ultra-high performance liquid chromatography‒tandem mass spectrometry (UPLC‒MS/MS). Vancomycin serum concentrations measured via CMIA were compared with those measured via UPLC‒MS/MS. Multiple linear regression analyses were performed to identify factors associated with the CDP-1 concentration and the ratio of vancomycin concentration determined via CMIA to vancomycin concentration via UPLC‒MS/MS (VCMIA/VUPLC-MS/MS). Among the 167 patients included, 49 (29.34

BACKGROUND:Degenerative lumbar spine pathologies are a major cause of chronic low back pain and radiculopathy. In recent years, unilateral biportal endoscopic (UBE) technology has been applied more in the treatment of lumbar disc herniation. However, there are few studies on UBE postoperative infection. We conducted a retrospective analysis of patient information from our medical center to summarize the diagnosis and treatment of surgical site infections following UBE. METHODS:Data of patients who underwent UBE for lumbar disc herniation between October 2020 and October 2024 were reviewed, and basic patient information and potential risk factors for infection were statistically analyzed using Fisher exact test. RESULTS:Four hundred thirty-six patients were reviewed. Postoperative infections occurred in 3 patients. A statistically significant association was observed between diabetes mellitus and infection development (P < 0.05). All the patients had a good prognosis following treatment. CONCLUSIONS:Diabetes mellitus is a notable risk factor for postoperative infections after UBE. Early diagnosis, targeted antibiotic therapy, and timely surgical intervention using appropriate techniques are essential for achieving optimal treatment outcomes.

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.

目的 探讨腰椎手术Wiltse入路的解剖学基础,提高该入路的稳定性和可操作性.方法 成人标本20具,通过解剖观察双侧竖脊肌腱膜与多裂肌的关系;最长肌与竖脊肌腱膜的关系;多裂肌和最长肌间隙是否清晰,是否存在稳定的解剖标志;竖脊肌腱膜表面及其深面是否还存在其它结构可作为多裂肌和最长肌之间隙的解剖标志.结果 多裂肌虽有少许纤维与竖脊肌腱膜相连接,仍可视为在竖脊肌腱膜上无起点;在腰部,最长肌在竖脊肌腱膜形成起点,起点的内缘自内上向外下斜行,并发出筋膜向深部延伸副突、横突,由此形成多裂肌与最长肌之间的分隔;在所有20具标本的左右两侧,以此隔膜为解剖标志向深部钝性分离,直接、顺利到达关节突;在竖脊肌腱膜表面未发现任何可作为多裂肌和竖脊肌间隙标志的解剖结构,剥离竖脊肌腱膜后在最长肌和多裂肌表面亦未发现可定位二者间隙的解剖标志;在多裂肌和最长肌间隙内,最长肌的内侧面可见清晰的节段神经及伴随血管.结论 竖脊肌腱膜在最长肌内侧向深部的延续是腰椎手术Wiltse入路准确进入多裂肌和最长肌间隙的可靠解剖标志.

目的 观察经皮椎体成形术(Percutaneous vertebroplasty,PVP)治疗脊柱转移瘤的临床疗效.方法 回顾性分析自2016-01-2020-01采用PVP治疗的34例脊柱转移瘤,比较术前、术后3个月、术后12个月疼痛VAS评分、ODI指数、QOL评分、椎体前缘压缩率、伤椎Cobb角.结果 34例均顺利完成手术并获得至少12个月的随访.切口均一期愈合,2例出现椎体前方侧漏,4例出现椎体侧方渗漏,3例出现椎间隙侧漏.未出现骨水泥渗入椎管、脊髓神经损伤与压迫、局部感染、骨水泥过敏、循环系统异常及肺栓塞等并发症.术后3个月与术后12个月疼痛VAS评分、ODI指数较术前降低,QOL评分较术前增加,差异有统计学意义(P＜0.05);术后12个月疼痛VAS评分、ODI指数较术后3个月增高,QOL评分较术后3个月降低,差异有统计学意义(P＜0.05);术后3个月与术后12个月的椎体前缘压缩率、伤椎Cobb角与术前比较差异无统计学意义(P＞0.05).结论 PVP是治疗脊柱转移瘤的有效方法,可有效缓解疼痛,提高患者生活质量.

Objective To evaluate the effects of different intervention measures to prevent falls in elderly osteoporotic patients. Methods A randomized controlled trial was conducted in our outpatient ward from August 2014 to September 2015. A total of 420 patients over 60 years of age were assigned to four groups. NA VitD group took 800 mg calcium and 800 IU non‐active vitamin D. P‐NA VitD group took 800 mg calcium, 800 IU non‐active vitamin D, and received physical exercise. A VitD group took 800 mg calcium and 0.5 μg active vitamin D. P‐A VitD took 800 mg calcium, 0.5 μg active vitamin D, and received physical exercise. Physical exercise includes guidance in improving muscle strength and balance ability. Short physical performance battery (SPPB), grip strength, modified falls efficacy scale (MFES), blood calcium, and 25‐hydroxyl vitamin D were measured before interventions and at 3, 6, and 12 months after interventions. Bone mineral density (BMD) was detected before interventions and at 12 months after interventions. The incidence of falls and fractures, adverse events, and drug reactions were recorded for 12 months. Results A total of 420 patients were allocated in the four groups: 98 cases into the NA VitD group (11 males, 87 females), 97 cases into the P‐NA VitD group (13 males, 84 females), 99 cases in the A VitD group (15 males, 84 females), and 98 cases into the P‐A VitD group (11 males, 87 females). At 6 months after interventions, the SPPB of A VitD group significantly increased from 6.9 ± 1.9 to 8.0 ± 2.4 (P < 0.05), and the SPPB of A VitD group significantly increased from 7.2 ± 2.1 to 8.6 ± 1.7 (P < 0.05). At 6 months after interventions, MFES of P‐NA VitD group 7.0 ± 1.6 to 7.6 ± 1.6 (P < 0.05), and MFES of P‐A VitD group significantly increased from 6.7 ± 1.6 to 7.5 ± 1.6 (P < 0.05). At 12 months after interventions, SPPB of all groups, grip strength, and MFES of P‐NA VitD group, A VitD group, P‐A VitD group were significantly improved (P < 0.05). The BMD of lumbar vertebrae of A VitD group significantly increased from 0.742 ± 0.042 to 0.776 ± 0.039, and P‐A VitD group significantly increased from 0.743 ± 0.048 to 0.783 ± 0.042 (P < 0.05). No serious adverse events occurred during the 12 months of follow‐up. Conclusion Active vitamin D is better than non‐active vitamin D to improve physical ability and the BMD of lumbar vertebrae and reduce the risk of falls.

目的 分析绝经后骨质疏松症(PMO)骨转换标志物变化情况,选择较合适的检测指标,为早期防治PMO提供帮助.方法 回顾性分析2018年1月至2020年1月该院骨科50～70岁69例绝经后女性资料,根据双能X线骨密度仪检查患者腰椎和股骨近端骨密度的结果,分为PMO组(44例)和骨质正常组(25例).记录患者年龄、身高、体重及既往病史等,采用化学发光免疫分析仪检测并比较两组25羟维生素D3[25(OH)D3]、骨钙素(OC)和甲状旁腺素(PTH).分析绝经后女性骨转换标志物与骨密度相关性.结果 两组腰椎、股骨颈骨密度比较,差异有统计学意义(P<0.05).与骨质正常组比较,PMO组25(OH)D3水平更低[(22.57±10.48)ng/mLvs.(16.46±7.93)ng/mL],PTH水平更高[(35.89±13.71)mmol/L vs.(44.75±16.76)mmol/L],差异有统计学意义(P<0.05).25(OH)D3与腰椎骨密度呈正相关(P<0.05).结论 25(OH)D3和PTH水平监测对PMO防治有价值.

目的 观察SD大鼠足底皮下注射甲基丙烯酸甲酯单体(methylmethacrylate,MMA)后爪体积、自发痛和机械痛敏等指标变化,以及布比卡因和传导机械痛的P2X3受体选择性的抑制剂A-317491对疼痛的抑制、翻转效应.探讨MMA对外周神经痛行为学的影响.方法 建立SD大鼠MMA疼痛模型.将不同浓度的MMA注射至大鼠足底皮下,在注射前和注射后不同时间点观察自发痛现象,并测定爪体积和机械痛敏的变化.用布比卡因和A-317491对MMA给药部位进行局部阻滞,以鉴别MMA对痛敏的影响是否是通过作用于外周神经发挥作用.结果 ①大鼠足底皮下注射2～50μL/ml浓度范围的MMA后引起机械痛敏明显下降.②200μL/ml浓度的MMA可引起注射侧足明显水肿、爪体积增大.500μL/ml以上浓度的MMA可诱发明显的持续1h的自发缩足反射、舔足等自发痛表现.③2μL/ml～50μL/ml浓度范围的MMA可诱发机械痛敏降低现象,而且也发生在对称的非注射侧部位.④0.2％布比卡因和A-317491能显著抑制和翻转MMA降低机械痛敏的作用.结论 2μL/ml～50μL/ml浓度范围的MMA可诱发机械痛敏降低现象.MMA不会因提高椎体内感觉神经痛阈.

INTRODUCTION:The pregnancy and lactation-associated osteoporosis (PLO) is a rare disease whose precise pathophysiological mechanisms remain mostly unknown.CASE REPORT:We reported here a case of PLO that occurred in the early postpartum period and led to multiple compression fractures. Combination therapy with alendronate, calcium carbonate, and vitamin D was used to treat the patient and a marked but gradual increase in the density of bone mineral was observed. Moreover, no further fractures have occurred.CONCLUSION:PLO is a very rare type of osteoporosis associated with severe chronic back pain. Increased bone resorption significantly increases the risk of bone fractures in women with PLO. Early diagnosis, stopping breastfeeding, treatment of calcium and vitamin D, bisphosphonates, or other antiosteoporosis medicine and regular follow-ups of these cases are particularly important in the prevention of fractures and to increase the quality of life of patients.

Necroptosis is a non-Caspase dependent regulated cell death mechanism.The process of its initiation,execution and inhibition are complex involving the expression and regulation of a series of relative molecules,such as receptor interacting protein kinase (RIPK1),receptor interacting protein kinase 3 (RIPK3) and mixed lineage kinase domain like kinase (MLKL).It plays an important role in orthopedic diseases caused by inflammatory reactions following acute and chronic injury.With the in-depth study of the regulation mechanism of necroptosis,the discovery of a specific inhibitor (Necrostatin-1,Nec-1) provides an effective clinical treatment strategy for orthopedic diseases caused by necroptosis.This article systematically reviews the regulation mechanism of necroptosis and its research progress and prospects in orthopedic diseases.

目的 了解绝经后女性人群的骨质疏松风险及跌倒风险状况,探讨两者之间的关系,指导综合防治骨质疏松症及预防跌倒导致的骨质疏松性骨折.方法 采取前瞻性研究选取2015年1月至2017年2月首都医科大学附属北京友谊医院骨科就诊且符合纳入标准的绝经后女性,采集基本信息.采用亚洲人骨质疏松自我筛查工具(OSTA)指数评估骨质疏松风险,采用修订版跌倒效能量表(MFES)及社区老年人跌倒风险评估工具(FROP-Com)评估跌倒恐惧心理和跌倒发生的风险,采用简易躯体能力测试工具(SPPB)评价躯体综合能力.依据OSTA指数评分将研究人群分为三组,即骨质疏松低风险组、中风险组、高风险组,比较不同骨质疏松风险组人群的跌倒效能差异性、跌倒风险差异性及躯体综合能力差异性.同时分析骨质疏松高风险发生情况与MFES、FROP-Com、SPPB评分之间的关系.结果 共收集符合纳入标准且数据完整的绝经后女性231例,年龄50～85岁,平均年龄为(67.6±8.6)岁,平均绝经年龄为(49.0±3.8)岁.其中骨质疏松低风险组89例(38.5％)、中风险组100例(43.3％)、高风险组42例(18.2％).骨质疏松高风险组的跌倒恐惧心理及跌倒发生风险均高于中风险组和低风险组(P<0.05),中风险组和低风险组之间差异无统计学意义(P>0.05);骨质疏松高风险组的躯体能力评分低于中风险组和低风险组(P<0.05),中风险组和低风险组之间差异无统计学意义(P>0.05).MFES评分、SPPB评分与骨质疏松高风险呈负相关,且差异具有统计学意义(P<0.05);FROP-Com评分与骨质疏松高风险呈正相关,但差异无统计学意义(P>0.05).结论 在绝经后女性人群中,高骨质疏松风险和高跌倒风险往往同时存在,需要早期全面评估并发现高危人群,积极防治骨质疏松症的同时联合心理干预、预防跌倒、肌力训练等措施,降低跌倒发生的风险,最终降低骨质疏松性骨折发生的风险.

Objective: To evaluate the release of Necrostatin-1 (Nec-1) in bone cement mixed by different proportions of calcium phosphate cement (CPC) and polymethyl methacrylate (PMMA) in vitro, and to optimize the mixture proportion of CPC-PMMA. Methods: CPC and PMMA powder are mixed at the ratio of 0:1, 1:1, 2:1, and 3:1, with 5.18 mg of Nec-1 as 4 groups (0:1 group, 1:1 group, 2:1 group, 3:1 group). The mixed bone cement samples are produced by same standard (height of 12 mm and an inner diameter of 6 mm). All the bone cement samples are tested by X-ray diffraction, compression test, solidification time, electron microscope scanning and the detection of Nec-1 release in vitro. The activity of releasing Nec-1 was deteted by culturing with MC3T3-E1 cells and then necrotic apoptosis cells were tested via Flow cytometry. Results: Nec-1, CPC and PMMA do not affect each other's material generation after the analysis of their mixture structure. With the increase of the proportion of CPC, the compressive strength of CPC-PMMA bone cement mixed with Nec-1 is gradually reduced and the time of solidification is prolonged. The distance between the PMMA particles in 0:1 group, 1:1 group, 2:1 group, and 3:1 group are about 0 mu m, 100200 mu m, 100-400 mu m, 100-400 mu m, respectively. By comparing the cumulative release of Nec-1 in the four groups, the release of 0:1 group is at the lowest level, and the rank of release rate is 3:1 group > 2:1 group > 1:1 group. It is clear that the release of Nec-1 is fast in 5 days in each group, become slower from 5 to 19 days and continuously decelerate after 19 days. The amount of Nec-1 release reaches the highest point at 19 days. The cumulative release concentration of Nec-1 of 0:1 group, 1:1 group, 2:1 group and 3:1 group in 59 days are 13.72 um/L, 286.66 um/L, 405.96 um/L and 553.77 um/L, respectively. The cumulative release percentages are respectively 0.34%, 7.17%, 10.15% and 13.84%. Through testing the necrotic apoptosis cells via Flow cytometry, the releasing Nec-1 still remains activity. Conclusions: This study has verified that CPC-PMMA bone cement mixture has a better comprehensive performance than simple PMMA bone cement, and established a methodology for detection of Nec-1 release in bone cement in vitro. In this study, Nec-1-CPC-PMMA bone cement mixture with the CPC to PMMA ratio of 3:1 showed the optimal compressive strength and coagulation time. And the mixture can release Nec-1 stably and the releasing Nec-1 maintains activity, thus this configuration would be an ideal choice for the preparation of a new type of Nec-1-CPC-PMMA bone cement.

随着我国人口老龄化加重,骨质疏松已经成为影响巨大的社会性问题[1].老年人骨折中约有80％是由骨质疏松引起,最常见的是椎体压缩骨折和髋部骨折.每年用于治疗骨质疏松性骨折的费用达数十亿元.我国还是肾脏疾病的高发地区,根据慢性肾脏病(chronic kidney disease,CKD)和肾功能损害流行病调查统计,我国现有CKD患者超过1.3亿.慢性肾脏病矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)是CKD患者较为常见的并发症之一.其主要临床表现为心血管硬化及钙化、维生素D代谢异常、骨代谢异常、继发性甲状旁腺功能亢进等.骨代谢异常和维生素D代谢异常会导致患者出现继发性骨质疏松症,随之而来的疼痛、骨折等会严重影响患者生活质量.现就CKD-MBD与骨质疏松性骨折相关问题的研究现状综述如下.

目的 探讨经皮骶骨成形术治疗肿瘤晚期骶骨转移瘤患者的止痛效果及安全性.方法 2009年2月至2015年6月期间,我科使用C型臂X线机引导下对38例肿瘤晚期患者49处骶骨转移灶行经皮骶骨成形术,通过分析术前术后视觉模拟评分(visual analogue scale,VAS)、止痛药物服用情况、术后疼痛缓解程度以及并发症评价临床效果.结果 49处骶骨转移灶手术穿刺全部成功,无穿刺部位血肿、神经损伤、肺栓塞等并发症,患者当天即可下地活动,术后1周左右出院.单处病灶手术中位时间29 min(25~35 min),平均骨水泥的注射量为(3.05±0.67)mL,7处病灶发生骨水泥渗漏,渗漏率为14.3%,但均未引起临床症状.所有患者随访3个月以上,术后24 h VAS评分由术前(7.61±0.97)分降至(1.74±1.99)分,术后1个月降至(1.61±1.82)分,术后3个月降至(1.50±1.78)分.术后不同时间点VAS评分与术前比较,差异均有统计学意义(P<0.05);术后24 h与术后1个月、术后3个月比较,差异具有统计学意义(P<0.05).术后1周时治疗有效率为92.1%,24例完全不需止痛药(63.2%),9例止痛药级别降低(23.7%),3例止痛药服用剂量减少(7.9%),2例(5.3%)维持原级别及剂量.3个月内死亡4例.结论 采用经皮骶骨成形术治疗肿瘤晚期骶骨转移瘤患者创伤小、安全性高,可快速缓解疼痛,提高患者生存质量.

Objective To evaluate the efficacy and safety of vitamin D (plain vitamin D or active vitamin D) plus calcium carbonate in elderly osteoporotic patients.Methods Two hundred forty patients over 60 years with osteoporosis were randomly divided into two groups:vitamin D 800 IU/d plus calcium 800 mg/d group (plain D group) and calcitriol 0.5 μg plus calcium 800 mg/d group (plain D group).Participants underwent physical performance tests at onset and after 6 and 12 months:the time of short physical performance battery (SPPB) acted as primary end-point.Fall risk was measured by modified falls efficacy scale (MFES) scores,grip strength estimated by hand-held dynamometer,bone mineral density (BMD) obtained from dual energy X-ray absorptiometry (DXA),and the presence of fall and new fracture were evaluated as well.Results There were 103 patients (man 17,women 86) in plain D group and 105 patients (man 18,women 87) in active D group for follow-up.A significant improvement in the performance of SPPB [plain D group (7.45±2.45),active D group (7.80±2.21)],grip strength [plain D group (21.04±5.66) kg,active D group (21.96±6.12) kg] and MFES [plain D group (7.09±1.62),active D group (7.19±1.63)] tests was observed after 6 months and further increased by the end of the therapeutic intervention in both groups.Active vitamin D showed better improvement than plain vitamin D (P＜0.05).The grip strength was significantly enhanced in two groups during the 12 months of treatment,but no significant differences were found between these two groups.The changes of BMD at spine and hip were not significant either,except that lumbar BMD [(0.790±0.105) g/cm2] were increased during 12 months of treatment with active vitamin D.No severe adverse events related to these medications were found throughout the study.Conclusions Treatment with vitamin D plus calcium for 12 months in elderly osteoporotic patients effectively reduced fall risk through increasing physical performance and muscle strength.Active vitamin D had better effects than plain vitamin D in improving physical function,reducing falls risk and increasing spine BMD.

A sandwich vertebra is formed after multiple osteoporotic vertebral fractures treated by percutaneous vertebroplasty, which has a risk of developing new fractures. The purpose of our study was to (i) investigate the occurrence of new fractures in sandwich vertebra after cement augmentation procedures and to (ii) evaluate the clinical outcomes after prophylactic vertebral reinforcement applied with resorbable bone cement.From June 2011 to 2014, we analysed 55 patients with at least one sandwich vertebrae and treated with percutaneous vertebroplasty. Eighteen patients were treated by prophylactic vertebroplasty with a resorbable bone cement to strengthen the sandwich vertebrae as the prevention group. The others were the non-prevention group. All patients were examined by spinal radiographs within 1 day, 6 months, 12 months, 24 months and thereafter.The incidence of sandwich vertebra is 8.25% (55/667) in our study. Most sandwich vertebrae (69.01%, 49/71) are distributed in the thoracic-lumbar junction. There are 24 sandwich vertebrae (18 patients) and 47 sandwich vertebrae (37 patients) in either prevention group or non-prevention group, respectively. No significant difference is found between age, sex, body mass index, bone mineral density, cement disk leakage, sandwich vertebrae distribution or Cobb angle in the two groups. In the follow-up, 8 out of 37 (21.6%) patients (with eight sandwich vertebrae) developed new fractures in non-prevention' group, whereas no new fractures were detected in the prevention group. Neither Cobb angle nor vertebral compression rate showed significant change in the prevention group during the follow-up. However, in the non-prevention group, we found that Cobb angle increased and vertebral height lost significantly (P<0.05).Prophylactic vertebroplasty procedure applied with resorbable bone cement could decrease the rate of new fractures of sandwich vertebrae.

聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)骨水泥首次于1987年由Galibert等报道用来治疗椎体血管瘤,并将此技术称之为经皮椎体成形术(percutaneous vertebroplasty,PVP ).随着此项技术的发展,在此基础上发展的经皮椎体后凸成形术(percutaneous kyphoplasty,PKP )也不仅用于治疗血管瘤,而且还用于治疗骨质疏松性椎体压缩骨折、椎体转移瘤等,并且达到很好的临床治疗效果.PVP和PKP已经成为治疗椎体压缩骨折的最佳手术方式.但由于手术采用的PMMA骨水泥自身的缺点,临床上一些并发症也逐渐出现.比如,PMMA骨水泥黏度低易造成骨水泥渗漏,造成严重的并发症,据文献报道,骨水泥渗漏约占全部临床并发症的66%[1,2].PMMA骨水泥的自身强度大,其压缩和拉伸应力分别为97 MPa、27 MPa[3],易引起邻近椎体骨折.PMMA骨水泥聚化时温度可高达100℃ ~110℃,可造成骨水泥周围组织坏死,甚至造成周围神经的损伤,同样,PMMA 骨水泥释放的甲基丙烯酸甲酯(methyl methacrylate,MMA)单体毒性也会造成骨水泥周围发生骨坏死.

Objective To compare the vertebral refracture after percutaneous vertebralplasty ( PVP) and percutaneous kyphoplasty ( PKP ) in the treatment of osteoporotic vertebral compression fractures ( OVCFs ) . Methods We recruited 809 patients treated in Beijing Friendship Hospital affiliated to the Capital Medical Univer-sity with osteoporotic vertebral compression fractures from June 2008 to January 2015 and complete follow-up data in this study.The 809 patients were divided into two groups ( PVP group:536 cases; PKP group: 273 cases) .We evaluated the patients'age, sex, bone mineral density values, postoperative radiographic follow-up information in this study.Vertebral heights were measured preoperatively and 24 hours, 12 months postoperatively.We compare the collapsed vertebral differences between the two groups, including: refracture incidence, the height of the verte-bral body recovery rate and vertebral height loss ratio caused by the recurrence of fracture.Results Twenty nine pa-tients in the PVP group ( surgical treatment of 43 vertebral body, of which 35 vertebral refracture) had vertebral col-lapse again, with incidence of refracture 5.41%, while the number was 34 in PKP group ( surgical treatment of 45 vertebral body, with 39 vertebral refracture, 12.45% incidence of refracture ) .For the incidence of vertebral re-fracture and vertebral height loss ratio of operation, PKP group were higher than those in PVP group ( P<0.05 ) . Conclusions Recurrence of fracture risk of the vertebral augmentation operation correlated to surgery mode .PKP group had higher incidence of vertebral refracture than PVP group .