目的 探讨青少年特发性脊柱侧凸(adolescent Idiopathic Scoliosis,AIS)患者行后路融合术后发生尿潴留(postoperative urinary retention,POUR)的影响因素.方法 选择2015年1月至2020年12月在我院接受后路融合术的137例AIS患者作为研究对象,记录患者性别、年龄、主弯Cobb角、融合节段数、手术时间、估算失血量(estimated blood loss,EBL)、标准化失血量(normalized blood loss,NBL)、拔导尿管日吗啡等效阿片剂量(简称"吗啡当量剂量")、累积吗啡当量剂量等资料,观察术后POUR发生率及影响POUR的风险因素.结果 137例患者中,33例发生POUR,POUR发生率为24.09％.单因素分析显示,POUR和非POUR组患者的年龄、术中输液量、EBL、NBL、手术时间、活动状态、步行距离、拔导尿管日吗啡当量剂量、累积吗啡当量剂量、术后拔导尿管时间相比,差异有统计学意义(P<0.05).多因素Logistic回归分析显示,拔导尿管日吗啡当量剂量和术后拔导尿管时间是POUR的风险因素(P<0.05),累积吗啡当量剂量和行动距离是POUR的保护性因素(P<0.05).结论 AIS患者后路融合术后的POUR发生率较高,等待拔除导尿管直至患者合理恢复活动,给予合理麻醉用量,可能是减少POUR的有效策略.

目的 探究蛇床子素对绝经后骨质疏松症(postmenopausal osteoporosis,PMO)模型大鼠骨代谢生化指标及磷脂酰肌醇3-激酶/蛋白激酶B(PI3K/AKT)通路的影响.方法 选取90只雌性大鼠,采用随机数字表法将大鼠分为:健康对照组、模型组、雌二醇组和蛇床子素低、中、高剂量组,每组15只.除健康对照组外各组摘除双侧卵巢制成PMO大鼠模型;雌二醇组采用0.21 mg/kg雌二醇灌胃,低、中、高剂量蛇床子素组分别采用10、20、40 mg/kg的蛇床子素灌胃;完成12周治疗后,检测血清抗酒石酸酸性磷酸酶-5b(TRAP-5b)、骨钙素(OC)和血碱性磷酸酶(ALP),以及尿液钙、磷、肌酐、脱氧吡啶啉(D-Pry)含量水平.分别于治疗8、12周后测定全身骨密度,于治疗12周后检测左侧股骨和腰椎骨密度及右侧股骨和第4腰椎生物力学性能;采用蛋白质印记法检测PI3K/AKT通路相关蛋白相对表达水平.结果 相比健康对照组,模型组TRAP-5b、尿钙/尿肌酐、尿磷/尿肌酐、D-Pry水平均显著升高(P<0.05),OC、ALP、全身骨密度、离体股骨密度、离体椎骨密度、股骨弹性模量和最大载荷、腰椎骨股骨和腰椎骨弹性模量和最大载荷、磷酸化蛋白激酶B/蛋白激酶B(p-AKT/AKT)和磷酸化磷脂酰肌醇3/磷脂酰肌醇3(p-PI3K/PI3K)水平均显著降低(P<0.05).相比雌二醇组,低、中、高剂量组TRAP-5b、尿钙/尿肌酐、尿磷/尿肌酐、D-Pry水平均显著升高(P<0.05),OC、ALP、全身骨密度、离体股骨密度、离体椎骨密度、股骨和腰椎骨弹性模量和最大载荷、p-AKT/AKT和p-PI3K/PI3K水平均显著降低(P<0.05).相比模型组,低、中、高剂量组TRAP-5b、尿钙/尿肌酐、尿磷/尿肌酐、D-Pry水平均显著降低,且随着使用剂量增加逐渐降低(P<0.05),OC、ALP、全身骨密度、离体股骨密度、离体椎骨密度、股骨弹性模量和最大载荷、腰椎骨股骨和腰椎骨弹性模量和最大载荷、p-AKT/AKT和p-PI3K/PI3K水平均显著升高,且随着使用剂量的增加逐渐升高(P<0.05).结论 蛇床子素可呈剂量依赖性地改善PMO大鼠骨代谢,增加骨密度,其作用机制与激活PI3K/AKT信号通路有关.

目的 探讨miR-21对骨质疏松小鼠骨髓基质细胞(BMSCs)增殖的影响.方法 采用双侧卵巢切除法构建骨质疏松小鼠模型(VOX),分离、培养、纯化小鼠BMSCs并采用siPORT NeoFX转染pre-miR-21、pre-miR-negative control(pre-miR-NC)、ant-miR-21、ant-miR-negative control(ant-miR-NC)并进行RT-PCR验证,MTT法检测小鼠BMSCs增殖情况、茜素红与碱性磷酸酶染色法检测小鼠BMSCs成骨能力、Western-blotting检测细胞增殖、成骨分化相关蛋白水平.结果 骨质疏松症小鼠BMSCs中miR-21相对表达水平低于Ctrl组(P<0.05),OVX-pre-miR-21组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均高于OVX-pre-miR-NC组(P<0.05),OVX-pre-miR-NC组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于Ctrl-pre-miR-NC(P<0.05);OVX-ant-miR-21组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于OVX-ant-miR-NC组(P<0.05),OVX-ant-miR-NC组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于Ctrl-ant-miR-NC(P<0.05).结论 提高miR-21表达水平可促进骨质疏松小鼠BMSCs增殖能力与成骨分化能力.

目的 探讨骨松宝颗粒联合注射用唑来膦酸治疗早中期股骨头坏死的临床疗效.方法 选取2018年4月—2020年1月在南阳市中心医院接受诊疗的108例股骨头坏死患者,采用双色球法将患者分为对照组和治疗组,每组各54例.对照组患者静脉滴注注射用唑来膦酸,4 mg加入0.9％氯化钠溶液100 mL中,于30 min内完成滴注,治疗1次.治疗组在对照组的基础上口服骨松宝颗粒,1袋/次,3次/d,以30 d为1个疗程,连续治疗12个月.观察两组临床疗效,比较两组视觉疼痛模拟评分(VAS)、Harris髋关节功能评分、骨代谢指标、血液流变学指标.结果 治疗后,治疗组的优良率(72.22％)明显高于对照组(51.85％)(P<0.05).与治疗前相比,两组VAS评分下降,Harris髋关节功能评分升高(P<0.05);与对照组治疗后相比,治疗组VAS评分更低,Harris髋关节功能评分更高(P<0.05).与治疗前相比,两组全血黏度、红细胞压积、纤维蛋白原均下降(P<0.05);与对照组治疗后相比,治疗组全血黏度、红细胞压积、纤维蛋白原更低(P<0.05).与治疗前相比,两组治疗后骨钙素(OC)下降,25-羟基维生素D3[25(OH)D3]升高(P<0.05);与对照组治疗后相比,治疗组OC更低,25(OH)D3更高(P<0.05).结论 骨松宝颗粒联合注射用唑来膦酸治疗早中期股骨头坏死患者可促进症状改善,调节血液流变学指标和骨代谢,具有较好的临床应用价值.

[目的]比较颈前路零切迹椎间融合(Zero-P)固定系统与常规笼架-钢板系统用于前路颈椎间切除融合术治疗双节段颈椎病的临床效果.[方法]回顾性分析2016年5月～2019年3月手术治疗的双节段颈椎病患者120例,其中,62例采用零切迹固定系统,58例采用常规笼架-钢板系统.比较两组患者围手术期、随访和影像资料.[结果] Zero-P组手术时间、术中出血量、住院时间和术后早期并发症均显著优于笼架钢板组(P＜0.05).所有患者均获12个月以上随访,Zero-P组术后恢复颈椎完全负重活动时间显著早于笼架钢板组(P＜0.05).与术前相比,末次随访时两组患者VAS评分显著下降(P＜0.05),而JOA评分和SF-36评分显著增加(P＜0.05);术前两组间VAS、JOA和SF-36评分的差异均无统计学意义(P＞0.05),末次随访时Zero-P组VAS、JOA和SF-36评分均显著优于笼架钢板组(P＜0.05).影像方面,术前两组间颈椎前凸Cobb角和椎间隙高度差异均无统计学意义(P＞0.05),而末次随访时,Zero-P组的上述参数的改善显著优于笼架钢板组(P＜0.05);此外,Zero-P组骨性融合时间显著早于笼架钢板组(P＜0.05).[结论]对于双节段颈椎病,颈前路零切迹椎间融合器明显优于常规钢板椎间融合器.

[目的]比较开放复位内固定与闭合复位外固定治疗桡骨远端C2、C3型骨折的临床效果.[方法]回顾性分析2015年5月～2019年6月本院收治的C2、C3型桡骨远端骨折患者120例,依据术前医患沟通结果,62例采用开放内固定治疗,58例采用闭合复位外固定术治疗.比较两组患者的围手术期、随访和影像资料.[结果]两组均顺利完成手术.内固定组患者的手术时间及术中出血量均明显多于外固定组,而内固定组的术中透视次数、住院时间显著少于外固定组(P＜0.05).所有患者随访12～29个月,平均(14.52±3.41)个月.内固定组恢复完全负重活动时间显著少于外固定组[(26.89±4.97)周vs(38.54±5.37)周,P＜0.05].随术后时间推移,两组患者VAS评分和Gartland-Werley评分均显著减少(P＜0.05),而两组腕背伸-掌屈和尺偏-桡偏活动度均显著增加(P＜0.05);相应时间点,内固定组的上述指标均优于外固定组(P＜0.05).影像方面,末次随访时,内固定组掌倾角[(11.13±2.82)°vs(7.53±2.78)°,P＜0.05]、尺偏角[(23.47±2.63)°vs(16.45±2.84)°,P＜0.05]及桡骨高度[(13.73±1.86)mm vs(10.76±1.85)mm,P＜0.05]均显著优于外固定组.术后影像显示,内固定组关节面复位质量显著优于外固定组(P＜0.05).内固定组骨折愈合时间显著早于外固定组(P＜0.05).[结论]开放复位内固定治疗桡骨远端C2、C3型骨折的临床效果显著优于闭合复位外固定.

目的:比较切开复位空心钉内固定与闭合复位经皮克氏针内固定治疗GeddaⅠ型Bennett骨折的临床疗效和安全性.方法:回顾性分析49例GeddaⅠ型Bennett骨折患者的病例资料,接受切开复位空心钉内固定治疗者24例(空心钉组),接受闭合复位经皮克氏针内固定治疗者25例(克氏针组).比较2组患者的骨折愈合时间、术后并发症发生率,以及术后3个月、术后1年的上肢功能障碍(disabilities of the arm,shoulder and hand,DASH)评分和患手疼痛视觉模拟量表(visual analogue scale,VAS)评分.结果:2组患者骨折愈合时间、术后3个月和术后1年患手疼痛VAS评分、术后1年DASH评分比较,组间差异均无统计学意义[(6.23±3.25)周,(5.56±2.27)周,t=0.816,P=0.419;(3.34±2.23)分,(2.25±2.55)分,t=1.562,P=0.125;(1.21±1.03)分,(1.08±1.98)分,t=0.284,P=0.778;(8.21±2.32)分,(9.30±3.74)分,t=1.206,P=0.234];术后3个月空心钉组的DASH评分低于克氏针组[(15.32±3.23)分,(25.25±7.81)分,t=5.740,P=0.000].空心钉组术后并发局部皮肤感觉异常2例(1例为麻木,1例为刺痛),均未行特殊处理,末次随访时症状有所改善.克氏针组术后并发克氏针松动、复位丢失2例,再次行闭合复位克氏针内固定手术后骨折愈合;并发针道感染1例,抗感染治疗后感染控制,骨折愈合后去除克氏针.均无骨折延迟愈合、不愈合、畸形愈合及神经、血管损伤等并发症发生.2组患者并发症发生率的差异无统计学意义(χ2=0.000,P=1.000).结论:切开复位空心钉内固定与闭合复位经皮克氏针内固定治疗GeddaⅠ型Bennett骨折,二者在缓解患手疼痛、促进骨折愈合方面疗效相当,且安全性相当,但前者在促进术后早期上肢功能恢复方面有优势.

目的 探讨手术固定后踝骨折块的疗效.方法 采用手术固定治疗60例后踝骨折患者.记录骨折愈合时间、扶拐时间、下地完全负重时间及术后并发症发生情况.术后6个月采用Biard-Jackson踝关节评分评价临床疗效.结果 患者均获得6个月随访.骨折愈合时间7～11(9.5±0.8)周,扶拐时间8～13(11.2±0.8)周,下地完全负重时间9～15(12.9±0.7)周.随访期间1例畸形愈合,1例下肢深静脉血栓,1例活动受限.术后6个月采用Biard-Jackson踝关节评分评价临床疗效:优13例,良25例,可19例,差3例,优良率为63.33％(38/60).结论 手术固定后踝骨折块治疗后踝骨折,疗效显著,可有效改善患者踝关节功能.

目的 探讨经皮椎间孔镜下髓核摘除术( percutaneous transforaminal endoscopic discectomy,PTED)治疗脱垂型腰椎间盘突出症的临床疗效.方法 纳入2017年1月-2018年5月于本院行PTED手术治疗的65例脱垂型腰椎间盘突出症患者,重度脱垂30例,轻度35例,随访2年以上.对患者术后随访期间的临床疗效进行评价.结果 所有患者均完成手术,手术时间(82. 33 ±13. 21) min、住院时间 (5. 05±1. 25) d,透视次数(26. 22±± 6. 35) 次;术后7 d、3个月、1年的ODI指数、腰部VAS、下肢VAS评分均显著降低,JOA评分均显著上升,差异有统计学意义(P<0. 05);术后1年,按改良Macnab 标准评价综合疗效:优32例,良28例,可4例,差1例,优良率92. 31% ;术后1例髓核残留,1例复发,无继发神经损伤、深部感染等并发症发生.结论 PTED术治疗脱垂型腰椎间盘突出症可获得优良的近远期疗效,需注意术前仔细的影像学评估进行个性化手术设计,术中良好的椎间孔成形以及止血等步骤.

目的:探讨锁定加压钢板结合Herbert螺钉内固定治疗桡骨远端骨折合并同侧舟骨骨折的临床疗效和安全性.方法:2010年1月至2018年12月,采用锁定加压钢板结合Herbert螺钉内固定治疗桡骨远端骨折合并同侧舟骨骨折患者18例,男14例、女4例;年龄28～52岁,中位数35岁;均为闭合性骨折.骨折AO分型,A3型桡骨远端骨折合并B1型舟骨骨折4例,B2型桡骨远端骨折合并B1型舟骨骨折3例,B2型桡骨远端骨折合并B2型舟骨骨折1例,C2型桡骨远端骨折合并B1型舟骨骨折4例,C3型桡骨远端骨折合并B1型舟骨骨折5例,C3型桡骨远端骨折合并B2型舟骨骨折1例.受伤至手术时间3～10 d,中位数5 d.术中先采用切开复位锁定加压钢板内固定桡骨远端骨折,再根据舟骨骨折情况,采用闭合复位或切开复位Herbert螺钉内固定舟骨骨折.随访观察骨折愈合、腕关节功能恢复及并发症发生情况.结果:18例患者均获随访,随访时间11～24个月,中位数16个月;切口均甲级愈合;骨折均愈合,桡骨远端骨折愈合时间8～16周(中位数11周),舟骨骨折愈合时间3～8个月(中位数4个月).末次随访时,腕关节主动屈伸活动范围为120° ～180°,中位数138°;Mayo腕关节评分(88.44±7.98)分,优10例、良6例、可2例.均无桡神经浅支、头静脉损伤及骨折延迟愈合、不愈合和舟骨坏死等并发症发生.结论:锁定加压钢板结合Herbert螺钉内固定治疗桡骨远端骨折合并同侧舟骨骨折,骨折愈合好,有利于腕关节功能恢复,并发症少.

目的:比较切开复位空心螺钉内固定与切开复位克氏针内固定治疗尺骨茎突基底部骨折的临床疗效和安全性.方法:回顾性分析104例尺骨茎突基底部骨折患者的病例资料,其中采用切开复位空心螺钉内固定治疗42例(空心螺钉内固定组),采用切开复位克氏针内固定治疗62例(克氏针内固定组).比较2组患者的骨折愈合率、Cooney腕关节评分、腕关节旋转疼痛发生率及并发症发生率.结果:所有患者均获得随访,随访时间12～36个月,中位数18个月.切口均甲级愈合.术后12个月,空心螺钉内固定组骨折愈合率、Cooney腕关节评分均高于克氏针内固定组[χ2=6.674,P=0.010;(91.27±6.52)分,(85.32±4.62)分,t=2.530,P=0.014];2组患者腕关节旋转疼痛发生率比较,差异无统计学意义(χ2=3.296,P=0.069).克氏针内固定组5例发生克氏针退针;其中3例克氏针松动导致腕部疼痛明显,提前取出克氏针后腕部疼痛显著减轻;2例腕部疼痛较轻,未予以特殊处理,术后12个月常规取出克氏针后腕部疼痛消失.空心螺钉内固定组患者未发生螺钉松动.2组患者均未发生神经血管损伤、骨折复位丢失等并发症.2组患者并发症发生率比较,差异无统计学意义(χ2=3.558,P=0.059).结论:采用切开复位空心螺钉内固定治疗尺骨茎突基底部骨折相较于切开复位克氏针内固定,更有利于骨折愈合和腕关节功能恢复,二者的安全性相当.

本研究以我院脊柱外科 2016-11-2017-11,收治的 64 名慢性颈痛患者为研究对象,现进行分组对照研究,探讨悬吊运动疗法的临床疗效, 具体报告如下. 1 资料与方法 1.1 一般资料 采用随机数字表法,将此 64 例患者分为观察组 (32 例) 和对照组(32例). 观察组中,男 14 例,女 18 例;年龄 21-52 岁,平均(33.1±2.1)岁;平均病程(4.2±0.8)个月. 对照组中,男 17例, 女 15 例; 年龄 22-51 岁, 平均(32.4±1.9)岁,平均病程(4.1±0.6)个月. 两组患者的性别、年龄、病程等一般资料比较, 差异无统计学意义 (P>0.05).

目的:研究miR-139-5p对骨肉瘤细胞增殖、迁移和侵袭的影响,并探讨其机制.方法:运用qRT-PCR检测软骨肉瘤细胞中miR-139-5p、GPR56的mRNA表达;Westem blot检测细胞中GPR56的蛋白表达;将miR-139-5p组(转染miR-139-5p mimics)、miR-NC组(转染miR-NC)、si-NC组(转染si-NC)、si-GPR56组(转染si-GPR56)、miR-139-5p+ pcDNA3.1组(miR-139-5p mimics和pcDNA3.1共转染)、miR-139-5p+ pcDNA3.1-GPR56组(miR-139-5p mimics和pcDNA3.1-GPR56共转染),均以脂质体法转染至U-2OS细胞;MTT法检测各组细胞的增殖;Transwell检测各组细胞的迁移、侵袭.结果:与人正常成骨细胞hFOB1.19相比,人骨肉瘤细胞U-2OS中miR-139-5p表达显著降低,GPR56表达显著升高(P＜0.05).过表达miR-139-5p、敲减GPR56均可明显抑制U-2OS细胞增殖、迁移、侵袭;GPR56是miR-139-5p的靶点.过表达GPR56可逆转miR-139-5p对U-2OS细胞增殖、迁移、侵袭的抑制作用.结论:miR-139-5p可抑制骨肉瘤细胞增殖、迁移、侵袭,其机制可能与靶向GPR56有关,将可为骨肉瘤的治疗提供新靶点.

目的:观察带线锚钉内固定治疗第五跖骨基底部撕脱骨折的临床疗效及安全性.方法:2016年1月至2018年5月,采用带线锚钉内固定治疗第五跖骨基底部撕脱骨折患者24例.男15例,女9例.年龄23～40岁,中位数27.5岁.左侧14例,右侧10例.新鲜骨折18例,陈旧骨折6例.按照第五跖骨基底分区标准,均为Ⅰ区骨折.受伤至手术时间3～98 d,中位数6 d.采用视觉模拟量表(visual analogue scale,VAS)评价患足疼痛情况,采用美国足与踝关节协会(American Orthopedic Foot and Ankle Soci-ety,AOFAS)趾、跖趾关节、趾间关节功能评分标准评价疗效,随访观察骨折愈合及并发症发生情况.结果:所有患者均获随访,随访时间12～18个月,中位数12个月.切口均甲级愈合.骨折均获得骨性愈合,愈合时间6～12周,中位数6周.患足疼痛VAS评分,术后12周(2.08±1.56)分、术后12个月(1.08±1.14)分.AOFAS评分,术后12周(88.33±5.34)分、术后12个月(92.25±3.94)分.至末次随访时,所有患者均未出现内固定物松动或断裂、骨折再移位等并发症.结论:带线锚钉内固定治疗第五跖骨基底部撕脱骨折,骨折愈合率高,可减轻患足疼痛、恢复患足功能,且并发症较少.

目的 探讨影响脊柱转移瘤患者术后生存期的影响因素.方法 选择2010-01-2016-01在我院接受手术治疗的脊柱转移瘤患者127例作为研究对象,采用Kaplan-Meier曲线计算患者生存期,不同因素中位生存期比较采用Log-Rank分析,采用Cox比例风险模型进行多因素分析.结果 127例患者术后中位生存期为9.5个月,95％CI:4.8～16.3个月.单因素分析显示:性别、原发肿瘤类型、放疗、Tomita评分、术前运动功能、术后运动功能、原发肿瘤确诊至脊柱转移时间、术后并发症和原发肿瘤分化程度与脊柱转移瘤患者术后生存期显著相关(P＜0.05),年龄、受累椎体位置、手术类型、受累椎体数量与脊柱转移瘤患者术后生存期无相关性(P＞0.05).多因素分析显示,术前Tomita评分和术后运动功能为影响脊柱转移瘤患者术后生存期的独立影响因素(P＜0.05).结论 术前Tomita评分和术后运动状态是脊柱转移瘤患者术后生存期的独立影响因素.

髋部骨折以老年人群居多,主要由骨质疏松引起,包含股骨粗隆间骨折及股骨颈骨折。目前,临床多通过关节置换术、内固定术治疗髋部骨折,在改善临床症状等方面具有一定价值,研究指出,经手术治疗1年后髋部骨折患者病死率为10%-45%,约有33.33%患者独立生活能力较患病前差[1]。加以老年患者多并发心脑血管疾病,术中麻醉方案、手术创伤、并发症均对心血管功能存在不利影响,严重者可出现心力衰竭、心肌梗死等疾病,给临床治疗带来一

Objective To compare the curative effect of long-segment or short-segment fixation and fusion after decompression in adult patients with degenerative scoliosis (DS). Methods According to different fusion segments,89 patients with DS treated by posterior decompression and pedicle screw fixation and fusion were divided into the long-segment group and the short-segment group. The operation indicators, complications, scores of visual analogue scale (VAS) before and after operation, Oswestry dysfunction index (ODI)and changes in Cobb angle of scoliosis were compared between the two groups. Results The operation time, intraoperative blood loss, fusion segment and length of hospital stay of the long-segment group were significantly longer or more than those of the short-segment group (P<0.05). VAS score of the long-segment group at the end of the follow-up was significantly higher than that of the short-segment group [(2.13±0.64)vs (1.12±0.57)],while the ODI score was significantly lower than that of the short-segment group [(8.07±1.04)vs (14.26±1.68)] (P<0.05). The Cobb angle of scoliosis and its correction rate in the long-segment group at the end of the follow-up were significantly larger or higher than those in the short-segment group(P<0.05).Conclusion Long-segment and short-segment fusion have their own advantages and disadvantages in the treatment of DS.The former has obvious advantages in improving the Cobb angle of scoliosis and spinal function, while the trauma of the latter is smaller,complications are fewer and safety is higher.

骨质疏松性椎体压缩骨折（osteoporotic vertebral compressionfractures,OVCF）是中老年骨质疏松人群的见终末期事件, 经皮椎体成形术（percutaneous vertebroplasty,PVP）是最早应用于OVCF 的骨水泥强化技术,其创伤小、镇痛效果好,但在实际应用中,有部分患者术后缓解欠佳、残留较明显的腰骶部疼痛, 据报道其发生率约占1.8%-15.6%之间[1].

Objective To explore the risk factors for re-fracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF),and to evaluate the value of bone mineral density (BMD) as a prognostic indicator for re-fracture.Methods A prospective cohort study including 208 patients,who had osteoporotic vertebral compression fractures and had PKP performed in our hospital.BMD was measured and other general clinical data were also collected and analyzed.All patients were followed up for more than 2 years.The occurrence of re-fracture or death was defined as the end-point event.Kaplan-Meier analysis and multivariate Cox regression model were used for the analysis of risk factors.Receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of BMD.Results Among all the 208 patients,37 (17.8％) were re-fractured in 2 years.Cox regression analysis showed that BMD,gender,and initial double segment fractures were independent and important predictors for re-fracture.Using BMD as a forecast standard,the ROC area under the curve (AUC) was 0.787,and diagnose critical point was-3.0SD.The sensitivity and specificity were 83.2％ and 66.8％,respectively.Kaplan-Meier analysis revealed that patients with BMD-T level ≤-3.0SD had a higher re-fracture rate than patients with BMD-T level ＞-3.0SD.Conclusion BMD level was an effective and suitable predictor for re-fracture in patients with OVCF after PKP,and the high risk of re-fracture after PKP should be considered especially when patients' BMD-T level ≤-3.0SD.

BACKGROUND: Aseptic loosening occurs after long-term total hip replacement, which directly affects the service life and prospective efficacy of artificial joints. The particles produced by artificial joint wear lead to the surrounding bone dissolved, further cause loosening, among which, polyethylene particles because of acetabular liner wear stand out. OBJECTIVE: To systematically assess the acetabular liner wear, loosening and osteolysis caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty. METHODS: A computer-based research of Medline, EMbase, CBM, CNKI, CqVip, WanFang databases before December 2015 and Cochrane (3rd issue, 2011) was performed in accordance with the retrieval strategy made by Cochrane collaboration. A manual retrieval of related bone journals and conference papers was conducted. Eleven randomized controlled trials about the wear caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty were enrolled based on inclusion criteria, followed by a Meta-analysis using RevMan 5.0 software. RESULTS AND CONCLUSION: (1) Eleven randomized controlled trials involving 952 patients were included. (2) Meta-analysis showed that the acetabular liner wear rate of cross-linked polyethylene was significantly lower than that of conventional polyethylene at 5 years postoperatively [MD=-0.07, CI(-0.09, -0.05), I2=93%, P < 0.00001]; the large heterogeneity was decreased [MD=-0.06, 95%CI (-0.07, -0.04), I2=39%, P < 0.00001] after three research removed through sensitivity analysis. (3) The osteolysis rate in the cross-linked polyethylene group was significantly lower than that in the conventional polyethylene group [RR=0.39, 95%CI (0.27, 0.57), I2=0%, P < 0.00001]. (4) These results suggest that the cross-linked polyethylene liners exhibit reduced radiological wear and osteolysis, but the mean follow-up of 5 years (1.8 to 8.0) cannot meet the long-term requirements. Therefore, multi-central, large sample size and high-quality randomized controlled trials are needed to testify the efficacy and safety of cross-linked polyethylene.BACKGROUND: Aseptic loosening occurs after long-term total hip replacement, which directly affects the service life and prospective efficacy of artificial joints. The particles produced by artificial joint wear lead to the surrounding bone dissolved, further cause loosening, among which, polyethylene particles because of acetabular liner wear stand out. OBJECTIVE: To systematically assess the acetabular liner wear, loosening and osteolysis caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty. METHODS: A computer-based research of Medline, EMbase, CBM, CNKI, CqVip, WanFang databases before December 2015 and Cochrane (3rd issue, 2011) was performed in accordance with the retrieval strategy made by Cochrane collaboration. A manual retrieval of related bone journals and conference papers was conducted. Eleven randomized controlled trials about the wear caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty were enrolled based on inclusion criteria, followed by a Meta-analysis using RevMan 5.0 software. RESULTS AND CONCLUSION: (1) Eleven randomized controlled trials involving 952 patients were included. (2) Meta-analysis showed that the acetabular liner wear rate of cross-linked polyethylene was significantly lower than that of conventional polyethylene at 5 years postoperatively [MD=-0.07, CI(-0.09, -0.05), I2=93%, P < 0.00001]; the large heterogeneity was decreased [MD=-0.06, 95%CI (-0.07, -0.04), I2=39%, P < 0.00001] after three research removed through sensitivity analysis. (3) The osteolysis rate in the cross-linked polyethylene group was significantly lower than that in the conventional polyethylene group [RR=0.39, 95%CI (0.27, 0.57), I2=0%, P < 0.00001]. (4) These results suggest that the cross-linked polyethylene liners exhibit reduced radiological wear and osteolysis, but the mean follow-up of 5 years (1.8 to 8.0) cannot meet the long-term requirements. Therefore, multi-central, large sample size and high-quality randomized controlled trials are needed to testify the efficacy and safety of cross-linked polyethylene.