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BACKGROUND: Ligaments are important structures in maintaining the stability of the lumbar spine, and these structures are prone to degradation due to the generated mechanical stress. However, there are few studies on ligament injuries. OBJECTIVE: To determine the range of motion and stress of each ligament in the state of motion based on a three-dimensional finite element model, and to systematically explore the influence of ligament injury on the stability of the lumbar spine and its biomechanical significance. METHODS: The L4-L5 lumbar finite element model was established. All free forces on the lower surface of L5 were constrained, and a torque of 5 N·m was applied to simulate the motion states of the lumbar spine. Progressive ligament damage was simulated by changing Young’s modulus of the ligament. RESULTS AND CONCLUSION: (1) The extension range of motion of most ligament injuries increased significantly. In contrast, there was no significant change in the lateral bending range of motion. (2) The range of motion of capsular ligament injury increased significantly in flexion, extension and lateral bending. The extension range of motion increased significantly after the anterior longitudinal ligament injury. Intertransverse ligament injury resulted in a significant increase in the lateral bending range of motion. (3) After a single ligament injury, the most significant change in range of motion was observed during extension. After a single ligament injury, the stress of the remaining ligaments increased, especially the capsular ligament. The stress changes of the interspinous ligament and ligamentum flavum were the least obvious. Ligament stress changes least in lateral bending and most in torsion. (4) Ligament damage did not result in major changes in disc pressure, indicating that ligament injury leads to an increased range of motion of the lumbar spine and affects the stability of the lumbar spine. (5) Capsular ligament was stable in flexion, extension and lateral bending. The anterior longitudinal ligament showed a stable extension; the intertransverse ligament stabilizes the lateral curve. (6) Extension exercise is sensitive to a ligament injury, and the pathological changes of the ligament can be examined by extension exercise. (7) Stress compensation was given to the remaining ligaments to maintain the stability of the lumbar spine after a single ligament injury. (8) Interspinous ligament and ligamentum flavum injuries have the least impact on the peripheral ligaments, while capsular ligament injuries have the greatest impact on the peripheral ligaments. (9) The ligament injury has the least effect on the residual ligament stress during lateral bending exercise, while it has the greatest effect on the ligament stress during the twisting exercise. Patients with ligament injury should avoid twisting exercises. Ligament injuries do not affect disc pressure. [ABSTRACT FROM AUTHOR]

Objective To investigate the factors influencing interbody cage subsidence after stand-alone oblique lumbar interbody fusion (OLIF). Methods A total of 65 patients (72 lumbar vertebrae) who underwent OLIF in our hospital from Ja-nuary 2019 to January 2023 were selected and divided into subsidence group (n=19) and non-subsidence group (n=53) according to the loss of disc height. The clinical data of the two groups were collected and compared, including gender, age, body mass index, number of lumbar vertebrae requiring surgery, responsible vertebral endplate sclerosis, cage height and length, preoperative CT values of the responsible vertebral body and its upper and lower endplates, preoperative multifidus muscle cross-sectional area at responsible vertebral body, degree of multifidus muscle atrophy, and degree of preoperative articular process degeneration. Logistic regression analysis was used to explore the factors influencing cage subsidence. Results There were significant differences between the two groups in the preoperative CT values of responsible vertebral body and its upper endplate, the proportion of patients with preoperative responsible vertebral body endplate sclerosis, the preoperative multifidus muscle cross-sectional area at responsible vertebral body, the proportion of patients with preoperative severe atrophy of the multifidus muscle, the proportion of patients with cage height 14 mm, the proportion of patients with cage length 55 mm, and the proportion of patients with articular process degeneration of degree 3 (t=2.332-3.097,χ2=4.545-6.246,P

BACKGROUND: Osteoporotic vertebral compression fracture is a common fracture secondary to osteoporosis. At present, there is no effective prediction index and method for osteoporotic vertebral compression fracture. OBJECTIVE: To investigate the predictive effect of the comprehensive index of lumbar vertebral body bone strength on osteoporotic vertebral compression fracture. METHODS: 233 patients with osteoporosis were divided into a fracture group and a non-fracture group according to whether a vertebral fracture occurred. The demography, body mass index, vertebral bone mineral density and other details were collected. Lateral X-ray films of the lumbar spine were photographed. The vertebral body width, vertebral body length, sacral slope, pelvic tilt, pelvic incidence, lumbar compressive strength index and the lumbar impact strength index were measured, calculated, and analyzed by univariate and multivariate, and the receiver operating characteristic curve was analyzed. The survival analysis was conducted according to the cut-off value. RESULTS AND CONCLUSION: (1) All patients were followed up for 2-4 years, with an average of 3.1 years. During the follow-up period, 99 cases (38 cases of L1 vertebral body, 61 cases of L2 vertebral body) had fractures (fracture group), and 134 cases (52 cases of L1 vertebral body, 82 cases of L2 vertebral body) had no fractures (non-fracture group). Univariate analysis showed that there was no significant difference in age, sex, height, body mass, body mass index and fracture segment between the two groups (P > 0.05). (2) Lumbar compressive strength index and lumbar impact strength index in the fracture group were lower than those in the non-fracture group (P<0.05). Pelvic incidence and pelvic tilt in the fracture group were higher than those in the non-fracture group (P<0.05). (3) Multivariate analysis showed that lumbar compressive strength index, lumbar impact strength index and pelvic tilt were risk factors for osteoporotic vertebral compression fractures (P<0.05). (4) Receiver operating characteristic curve analysis showed that the cutoff values of vertebral bone mineral density, lumbar compressive strength index, lumbar impact strength index, pelvic tilt and pelvic incidence were 0.913 5 g/cm2, 1.932, 0.903, 21.5° and 55°, respectively; areas under the curve were 0.630, 0.800, 0.911, 0.633 and 0.568, respectively. (5) According to the survival analysis (with osteoporotic vertebral compression fracture as the end point), the average survival time of the patients with lumbar impact strength index ≥0.903 was significantly longer than that of the patients with lumbar impact strength index < 0.903 (P<0.05). (6) These findings conclude that the comprehensive index of lumbar vertebral body bone strength is more accurate than the bone mineral density of the vertebral body and spine-pelvis sagittal parameters in predicting osteoporotic vertebral compression fractures, which is helpful for early prevention and treatment of osteoporotic vertebral compression fractures. [ABSTRACT FROM AUTHOR]

Objective To compare the bone mineral density and age-related bone loss rate of thoracic and lumbar vertebrae using quantitative CT(QCT), and to explore the feasibility of measuring bone density and bone loss rate using thoracic QCT. Methods A total of 708 patients who underwent full abdominal CT scans due to trauma, acute abdominal disease, and health examination from March 2022 to March 2023 were selected. The average BMD of T10 to L3 vertebral bodies were measured using quantitative CT software. The subjects were divided into several age groups according to the age of every 10 years. The average bone density and the age-related annual rate of bone density loss of the thoracic and lumbar vertebrae for each group were computed, the correlation analysis between thoracic and lumbar BMD and age was conducted using Pearson correlation analysis. Results The peak BMD for both males and females was in the 20 to 29 years age group. After the age of 30, the bone density of the thoracic and lumbar vertebrae began to decrease to varying degrees. For females aged 80 to 89, the cumulative bone loss rate for the thoracic and lumbar vertebrae was 60.61% and 61.34%, respectively, while for males, it was 44.45% and 49.35%, respectively. The BMD of the thoracic and lumbar vertebrae in both males and females showed a negative correlation with age (P < 0.01). There was a significant positive correlation between the bone mineral density of the thoracic and lumbar vertebrae (for males, r = 0.96; for females, r = 0.98; P < 0.01). Conclusion Both thoracic and lumbar QCT accurately displayed BMD and bone loss in different age groups, and thoracic QCT could be used as a method for evaluating and monitoring bone loss. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lumbar decompression and fusion is the most effective surgical method to treat lumbar degenerative spondylolisthesis. In recent years, the sagittal balance of the spine has been widely considered the key factor to adjust the outcome of spinal surgery, and factors that can affect the sagittal balance of the spine indirectly affect the surgical effect and prognosis. OBJECTIVE: To summarize the risk factors that can affect the sagittal balance of the spine during decompression and fusion due to lumbar spondylolisthesis, and play a certain reference role in the surgical treatment of lumbar spondylolisthesis. METHODS: With “lumbar spondylolisthesis, the sagittal plane balance of the spine, surgical treatment, risk factors” as the Chinese search terms, and “lumbar spondylolisthesis, sagittal balance, risk factor” as the English search terms, PubMed, Springer, ScienceDirect, Wanfang, VIP and CNKI were searched respectively. The focus of the search was from January 2010 to January 2023, and a few classic long-term articles were included. Preliminary screening was conducted by reading the title and abstract. After excluding repetitive research in Chinese and English literature, low-quality journals and irrelevant literature, 67 articles were finally included for review. RESULTS AND CONCLUSION: (1) Degenerative lumbar spondylolisthesis is an important factor causing spinal canal stenosis and lumbar instability, and is the main cause of low back pain and intermittent claudication. Lumbar decompression, fusion and internal fixation is an effective way to treat degenerative lumbar spondylolisthesis. (2) In the past, the treatment of degenerative lumbar spondylolisthesis with decompression, fusion and fixation focused on thorough exploration and release of nerve roots, reduction of spondylolisthesis and solid internal fixation, but less attention was paid to the balance of sagittal plane of the spine. (3) With the popularization of lumbar decompression, fusion and internal fixation, complications caused by the sagittal imbalance of the spine gradually increased, resulting in poor prognosis of patients and even increased risk of secondary surgery. (4) Previous studies have only discussed the correlation between lumbar sagittal plane parameters and spinal sagittal plane balance, but have not in-depth studied the relevant factors causing spinal sagittal plane imbalance. (5) Our results show that open lumbar fixation and fusion, complete reduction of spondylolisthesis, selection of thicker pedicle screws, selection of larger fusion cages, and autologous bone transplantation are beneficial factors for maintaining sagittal balance. The higher the number of fusion segments, the higher the level of fusion segments is, which is a risk factor for sagittal plane imbalance. [ABSTRACT FROM AUTHOR]

BACKGROUND: As a leading technique in the treatment of primary stenosis by posterior spinal endoscopy through unilateral approach and bilateral decompression using single channel endoscopy, the long-term efficacy needs to be further observed. There are few reports on the scope of intraoperative resection and few relevant studies on biomechanics and finite element analysis. OBJECTIVE: A three-dimensional finite element model was established to evaluate the effects of bilateral lumbar canal decompression under a one-hole split endoscope on lumbar range of motion and intradiscal pressure, to provide suggestions for clinical operation and theoretical basis for further clinical research. METHODS: A complete L3-L5 vertebral body model was reconstructed by CT images of nine healthy volunteers, which was used as the preoperative model M1. The simulated surgical resection range of L4-L5 was performed, and 1/4, 1/3 and 1/2 of bilateral facet joints were removed respectively to obtain models M2, M3 and M4. The range of motion and the maximum Von Mises stress of the four models were compared in the six directions of forward bending, backward extension, left and right bending, and left and right rotation. RESULTS AND CONCLUSION: (1) The L3-L5 finite element model established in this study was effective, and the range of motion was within the range of previous solid studies under six motion states. (2) Compared with the M1 model, the L4-L5 lumbar spine range of motion increased with the increase of resection range in M2 with M3 and M4 models under forward bending, left and right bending and left and right rotation loading, and the difference was significant (P < 0.05). Under posterior extension loading, there was no significant difference in lumbar range of motion between M1 and M2 (P > 0.05), but there was a significant difference of M1, M3 and M4 (P < 0.05). (3) The range of motion of the L3-L4 lumbar spine had no significant change with the increase of bilateral facet arthrotomy (P > 0.05). (4) There was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M2 (P < 0.05), and there was a significant difference in the maximum value of L4-L5 Von Mises between M1 and M3, M4 (P < 0.01), and the maximum value of L4-L5 lumbar von Mises increased with the increasing range of bilateral facet joint resection. Resection of more than 1/3 was particularly obvious. (5) The maximum value of Von Mises in the L3-L4 lumbar spine was increased with the increase of the resection range under forward bending, left and right bending and left and right rotation loading and the difference was significant (P < 0.05). (6) The results exhibited that the L4-L5 lumbar motion and intervertebral disc pressure increased with the increase of the excision range. Intervertebral disc pressure at L3-L4 increased with the increased extent of excision, but the lumbar range of motion was not significantly affected. In conclusion, the stability of the operative segment may be affected by the increase in the scope of facet joint resection. Although the immediate stability of adjacent segments is not affected, it may accelerate disc degeneration. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transpedicular transdiscal lumbar screw is a new type of spinal minimally invasive internal fixation technology. Compared with traditional bilateral pedicle screws, only one screw is needed to fix one segment on one side. It has the characteristics of being more economical, less trauma and easy to operate. However, studies on the application of transpedicular transdiscal lumbar screws combined with transforaminal lumbar interbody fusion (TLIF) and fixation are still rare. OBJECTIVE: To evaluate the effect of TLIF combined with various surgery methods on stress distribution of cage, fixation, disc lower and endplate and range of motion of lumbar vertebrae by constructing three kinds of finite element models including modified TLIF (cage alone) model, modified TLIF combined with bilateral pedicle screw (cage+BPS) model and modified TLIF combined with bilateral transpedicular transdiscal lumbar screw (cage+BTPTDS) model. METHODS: The CT images of the adult lumbar spine were used to establish the three kinds of TLIF finite element models: cage alone, cage+BPS and cage+BTPTDS using software Mimics, Geomagic and SolidWorks. ANSYS Workbench was used to simulate the application of six different motion loads of human body flexion and extension, left and right bending, and left and right rotation to calculate stress distribution and the changes in the range of motion of the lumbar spine of the cage, fixation, endplate and disc of the three lumbar spine surgery models and to compare the effects of three surgical options on the biomechanical effects of the lumbar spine. RESULTS AND CONCLUSION: (1) The cage alone model, cage+BPS model and cage+BTPTDS model were constructed successfully. (2) In flexion and lateral bending conditions, the maximum stress of the cage of cage+BTPTDS model was smaller than that of the cage alone model and a little greater than that of the cage+BPS model. In the extension condition, the maximum stress of the cage of the cage+BPS model was obviously smaller than that of the other two models. When it came to rotating condition, the maximum stress of the cage in the cage+BPS model and the cage+BTPTDS model presented no obvious difference, which was both smaller than the cage alone model. (3) The maximum stress of fixation of the cage+BTPTDS model was obviously bigger than the cage+BPS model in flexion and extension conditions, close to the cage+BPS model in lateral bending conditions, and smaller than the cage+BPS model in rotation conditions. (4) The maximum stress of the lower endplate of the fusion segment of the cage+BPS model was between the two other models. (5) In terms of the range of motion, the cage+BTPTDS model presented no obvious difference with that of the cage+BPS model at flexion and extension, left and right bending, and left and right rotation. (6) It is concluded that modified TLIF combined with transpedicular transdiscal lumbar screw provides stable support for the vertebral body of the fusion segment, ensures the motion range of the lumbar spine and has a good biomechanical effect. [ABSTRACT FROM AUTHOR]

BACKGROUND: Periprosthetic osteolysis is the most common long-term complication of total joint arthroplasty. Many studies suggest that the inflammasome may play an important role during the osteolysis. Melatonin is a rhythm-regulated hormone secreted by the pineal gland with many functions including antiinflammatory, anti-oxidation, and antitumor, but its effects on osteolysis and inflammasome have yet to be explored. OBJECTIVE: To explore the effect of melatonin on the osteolysis induced by wear particles and the role of melatonin on the activation of NLRP3 inflammasome. METHODS: (1) In vivo test: Fifteen C57BL/6 mice were randomly divided into sham operation group, osteolysis group and melatonin group by random number table method, with 5 mice in each group. The osteolysis model of the osteolysis group and the melatonin group was established by injecting cobalt-chromiummolybdenum (CoCrMo) particles into the sagittal suture of the skull. After injection, the melatonin group was intraperitoneally injected with 50 mg/(kg•d) of melatonin for 14 consecutive days. After drug intervention, the mouse calvarium was collected for micro-CT analysis to observe the micro-structural changes around the sagittal suture. (2) In vitro test: Mouse bone marrow-derived macrophages and THP-1 cells (which had been induced to differentiate into macrophages) were taken and divided into seven groups: normal group, lipopolysaccharide group, lipopolysaccharide+CoCrMo group and melatonin 0.5, 1, 1.5, 2 mmol/L groups (lipopolysaccharide and CoCrMo were added to the melatonin intervention groups). After the intervention for 6 hours, the expression of related proteins (NLRP3, Caspase-1, interleukin-1β, and gasdermin D, gasdermin D-N terminal) in the inflammasome of cell lysate or cell culture supernatant was detected by western blot assay. Cytotoxicity and cell death were observed through lactate dehydrogenase release and live-dead fluorescence staining. RESULTS AND CONCLUSION: (1) In vivo test: Micro-CT scanning 3D reconstruction images showed that the bone mass around the sagittal suture of the skull of mice in the osteolysis group was significantly reduced, and the bone tissue structure was severely damaged. Compared with the osteolysis group, the bone mass around the sagittal suture of the skull in the melatonin group was significantly increased, and the destruction of tissue structure was reduced. (2) In vitro test: For mouse bone marrow-derived macrophages, lipopolysaccharide significantly up-regulated NLRP3 protein expression in cell lysate, and melatonin intervention could reduce NLRP3 protein expression in a dose-dependent manner. CoCrMo particles significantly up-regulated the protein expressions of the gasdermin D-N terminal in cell lysate and Caspase-1 and interleukin-1β in the supernatant of cell culture, while melatonin intervention could reduce the expression of these proteins in a dose-dependent manner. For THP-1 cells, the protein expressions of Caspase-1 and interleukin-1β in the supernatant of cell culture were significantly up-regulated by CoCrMo particles, and the expression of these proteins was decreased dose-dependent by melatonin intervention. Lactate dehydrogenase release and live-dead fluorescence staining showed that CoCrMo particles significantly increased the release of lactate dehydrogenase and cell death in the supernatant of mouse bone marrow-derived macrophage culture, and melatonin intervention could reduce the release of lactate dehydrogenase and cell death. (3) The results show that melatonin can inhibit particle-induced inflammasome activation and pyroptosis to suppress periprosthetic osteolysis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous literature reported that the fusion cage moved more than 2 mm from its original position, which means that the fusion cage moved backward. At present, clinical observation has found that the factors leading to the displacement of the fusion cage are complex, and the relationship between these factors and the cage retropulsion is not clear. OBJECTIVE: To explore the risk factors related to cage retropulsion after lumbar interbody fusion. METHODS: Retrospective analysis was conducted in 200 patients who underwent transforaminal lumbar interbody fusion surgery with a polyetheretherketone interbody fusion from February 2020 to February 2022. According to the distance from the posterior edge of the vertebral fusion cage to the posterior edge of the vertebral body after the operation (the second day after the removal of the drainage tube) and 1, 3, 6 and 12 months after the operation, patients were [ABSTRACT FROM AUTHOR]

BACKGROUND: Interspinous distraction fusion device BacFuse was used for the management of lumbar degenerative disease and obtained good clinical efficacy in recent years. However, the related biomechanical study was lacking. OBJECTIVE: To explore the related biomechanical characteristics of BacFuse, a novel interspinous distraction fusion device, which was used in lumbar degenerative disease. METHODS: After constructing the goat spinal models (L1-L6), they were grouped into four groups based on different simulated surgeries: the control group, the BacFuse group (L3/4), the screw-rod fixation group (L3/4) and the Topping-off group (L3/4 screw-rod fixation + L2/3 BacFuse fixation). The goat lumbar spine surgical model was assembled into a biomechanical testing system. A biomechanical machine was used for mechanical loading, simulating lumbar spine movement of flexion, extension, lateral flexion and rotation with a 4 Nm moment. A visual tracking system was used for positioning and capturing. Finally, mechanical and optical calibration was completed to calculate the range of motion of the L2/3, L3/4 and L4/5 segments. RESULTS AND CONCLUSION: (1) Compared with the control group, the range of motion of the L3/4 segment in the BacFuse group decreased 27.27%, 70%, 38.1% and 23.08% in the flexion, extension, lateral bending and rotation directions, respectively (P < 0.05). The range of motion of L3/4 segment in the screwrod fixation group decreased 72.73%, 80%, 71.43% and 73.08% in the flexion, extension, lateral bending and rotation directions, respectively (P < 0.05). (2) Compared with the control group, the range of motion of the adjacent segment L2/3 increased by 33.33%, 25% and 23.81% in the extension, lateral bending and rotation directions, respectively in the BacFuse group (P < 0.05), with no significant change in flexion. In the screw-rod fixation group, there was a 50%, 44.44%, 50% and 58.96% increase in the adjacent segment L2/3 in the flexion, extension, lateral calibration and rotation directions, respectively (P < 0.05). (3) Compared with the control group, the BacFuse group showed an increase in range of motion in proximal segment L4/5 in the extension and rotation directions by 27.3% and 17.39% (P < 0.05) respectively, with no significant change in flexion or lateral bending. In the screw-rob fixation group, the proximal segment L4/5 demonstrated 38.89%, 22.73% and 26.09% (P < 0.05) increases in range of motion in the flexion, extension and rotation directions, respectively, with no significant change in lateral bending. (4) In the Topping-off group, the range of motion of L2/3 was reduced by 37.04%, 73.08%, 56.67% and 38.46% in flexion, extension, lateral flexion and rotation, respectively, compared to the screw-rob fixation group (P < 0.05). Compared with the screw-rob fixation group, the Topping-off group showed a 20% reduction in the range of motion of the L4/5 in the flexion direction (P < 0.05), with no significant differences seen in extension, lateral bending and rotation. (5) It is concluded that the interspinous distraction fusion device BacFuse significantly reduces the range of motion of the implanted segment and provides some stability. It still retains more mobility and reduces the impact on the adjacent segment compared to screw-rob fixation, while the Topping-off tip, which can be used for intervertebral fusion fixation, significantly reduces the range of motion of the adjacent segment and reduces the risk of adjacent segment degeneration. [ABSTRACT FROM AUTHOR]

BACKGROUND: With the variation of disease treatment modes and the in-depth research on senile osteoporosis in recent years, increasing studies have confirmed that traditional Chinese medicine has a significant effect on the prevention and treatment of senile osteoporosis. OBJECTIVE: To investigate the effect of Yishen Gushu Formula on bone metabolic markers in patients with osteoporosis of kidney deficiency and blood stasis type. METHODS: 102 patients with senile osteoporosis of kidney deficiency and blood stasis type who were treated at Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from July 2020 to March 2022 were enrolled, including 32 males and 70 females, aged 71-93 years. All patients were randomly divided into two groups, with 51 patients in each group. The control group was treated with calcium carbonate D3 granules and sodium alendronate tablets, while the treatment group was treated with Yishen Gushu Formula beyond the control group. Treatments in each group lasted 3 months. Bone mineral density of the L1-4 lumbar vertebrae and left femoral neck, visual analog scale score, and serum levels of osteocalcin, osteopontin, type I collagen cross-linked C-terminal peptide and tartrate resistant acid phosphatase were measured before and 3 months after treatment. Traditional Chinese medicine syndrome score and therapeutic efficiency were also assessed. RESULTS AND CONCLUSION: After 3 months of treatment, the bone mineral density of the lumbar vertebrae (L1-4) and left femoral neck was significantly increased in both two groups (P < 0.05), and the bone mineral density of the lumbar vertebrae (L1-4) and left femoral neck was significantly higher in the treatment group than the control group (P < 0.05). The visual analog scale scores of both groups after 3 months of treatment were lower than those before treatment (P < 0.05), and the visual analog scores of the treatment group after 3 months of treatment were lower than those of the control group (P < 0.05). After 3 months of treatment, the serum levels of osteocalcin, osteopontin, type I collagen cross-linked C-terminal peptide and tartrate resistant acid phosphatase were significantly improved in both two groups, while compared with the control group, the serum levels of osteocalcin and osteopontin were significantly higher (P < 0.05) and the serum levels of type I collagen cross-linked C-terminal peptide and tartrate resistant acid phosphatase were significantly lower in the treatment group (P < 0.05). After 3 months of treatment, the Traditional Chinese medicine syndrome scores were decreased in both two groups, while the Traditional Chinese medicine syndrome scores in the treatment group were lower than those in the control group. After 3 months of treatment, no significant adverse reactions occurred in both groups. The total effective rate was 88.2% and 70.6% in the treatment and control groups respectively, and there was a significant difference between the two groups (P < 0.05). To conclude, Yishen Gushu Formula combined with anti-osteoporosis drugs can significantly improve the clinical symptoms of patients with senile osteoporosis of kidney deficiency and blood stasis type and prevent disease progression by regulating bone metabolism, increasing bone mineral density, and relieving pain. [ABSTRACT FROM AUTHOR]

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BACKGROUND: In recent years, with the development of 3D printing, surgical surgery has become personalized and accurate. 3D printed guide template technique can realize preoperative planning and intraoperative navigation, making surgery more accurate. In clinical orthopedic surgery for moderate and severe stiff scoliosis, there is still a problem that the accuracy of screw placement is not high, resulting in screw loosening and even nerve complications. There are few studies on 3D printed guide template technique to guide screw placement in surgery for severe stiff scoliosis. OBJECTIVE: To evaluate the clinical effect of the 3D printed guide template technique combined with multiple posterior derotation in the treatment of severe rigid scoliosis. METHODS: The clinical data of six patients with severe scoliosis undergoing 3D printed guide template technique of pedicle screw combined with multiple posterior derotation were retrospectively analyzed. There were 3 males and 3 females, with a mean age of (18.17±3.49) years (range, 15-23 years). The changes of parameters related to lateral bending were analyzed at postoperative 2 weeks and 18 months, and the results were obtained by statistical analysis. RESULTS AND CONCLUSION: (1) The operation time was 280-540 minutes (mean 340.83±102.20 minutes). The intraoperative blood loss was 1 000-4 000 mL (mean 2 000.00±1 073.70 mL). The fixed segments were 9-14 vertebral bodies (mean 11.83±1.72), and no screw loosening occurred during the operation. (2) All patients were followed up. At postoperative 2 weeks, the anteroposterior and lateral radiography of the whole spine showed that the cobb angle, the distance between the vertical line of C7 on the coronal plane and the median line of S1, the distance between the vertical line of C7 in the sagittal plane and the posterior edge of S1, apical vertebral translation, thoracic kyphosis, and lumbar lordosis were significantly corrected. The average correction rate of the cobb angle in the main curve was 62.22%. After 18 months of follow-up, there was no significant change in all parameters compared with 2 weeks after operation; the orthopedic effect was satisfactory, and there was no infection or internal fixation fracture. (3) There was one case of delayed wound healing; scar healing appeared after dressing change treatment; no neurological complications occurred. (4) The results show that the 3D print-guide template combined with multiple posterior rod derotation technique is safe and effective in the treatment of severe rigid scoliosis, and the correction effect is satisfactory. [ABSTRACT FROM AUTHOR]

BACKGROUND: One-hole split endoscope technique has been widely used in the treatment of lumbar degenerative diseases, but there is no relevant literature on the safety analysis of this technique in the treatment of upper lumbar disc herniation.OBJECTIVE:To observe the position relationship of nerve roots, intervertebral space and bone landmarks in the upper lumbar spine by three-dimensional lumbar CT reconstruction technology, and to provide a basis for the clinical ope ration of one-hole split endoscope surgery. METHODS: Twenty-six patients with upper lumbar disc herniation underwent a lumbar CT scan.Mimics 17.0 software was imported to measure the related imaging paramete rs of L1/2 to L3/4 segments: (1) Measurement of vertical distance:In coronal view, the distance (a) from the intersection point of the medial facet of the superior articular process and the superior endplate (N) to the apex of the articular process (S); in the coronal view, the distance (b) from the sagittal intersection (M) of N and the inferior endplate to the apex of the inferior articular process (X). (2) Measured horizontal distance: the distance (c)between the cross-section of N and the lower edge of the outlet nerve root (N2);distance (d) between the cross-section of N and the intersection point of neural tissue (N1);N1 to N2 distance (e); distance (f) between the cross-section of M and the lateral edge of the nerve tissue (M1); M to M cross-section and exit nerve root intersection (M2) distance (g); distance (h) from M1 to M2;distance (i) from M2 to N1; distance (j) from the posterior edge of the articular surface (R)to M2 in sagittal view of the superior articular process.RESULTS AND CONCLUSION: (1) With the decrease of the segment, the distances a and b gradually increased, and the distance j gradually decreased. There was no significant difference between L1/2 and L2/3 segments (P＞ 0.05). (2) With the decrease of the segment, distance d first decreased and then increased; distance f gradually decreased;distances c, e, g, h and i gradually increased;and there was no significant difference between L2/3 and L3/4 segments (P＞ 0.05). (3) Distance i was the shortest distance without pulling nerve roots in the natural state, and the area of the safety zone was between four points M1, M2, N1, and N2. The bone was removed to the upper and lower endplates by biting the bone downward and upward through S and X, respectively, to expose the intervertebral space, and the window of distance g to M2 could be opened outward to avoid injury of the outlet nerve roots. (4) In conclusion, the upper lumbar vertebrae have unique anatomical characteristics. Based on the relevant measurements of nerve roots, spinal dura and intervertebral space, the parameters of the one-hole split endoscope technique are more accurate and safe during operation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with severe lumbar degenerative disease may have their bone mineral density incorrectly raised by dual-energy X-ray absorptiometry. While lumbar cancellous bone Hounsfield unit value can assist dual-energy X-ray absorptiometry in reducing osteoporosis misdiagnosis. OBJECTIVE: To identify osteoporosis in woman patients with lumbar degenerative diseases using lumbar CT scans. METHODS: Bone mineral density test results and lumbar CT data of 192 women patients who were treated at the Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University were retrospectively reviewed. All patients were divided into a degeneration group (n=107) and a control group (n=85) according to the criteria of severity of vertebral degeneration as assessed on CT of the lumbar spine. The CT value of axial cancellous bone of L1 vertebral body was measured in the two groups. The T score and bone mineral density of the hip and L2-L4 were recorded. According to previously published studies, osteoporosis was diagnosed at L1 vertebral CT values ≤110. The prevalence of osteoporosis diagnosed by dual-energy X-ray absorptiometry and CT values was compared between the two groups. RESULTS AND CONCLUSION: (1) CT values were significantly and positively correlated with T scores and mean bone mineral density of the L2-L4 vertebrae in both groups (P < 0.001), while the correlation was higher in the control group. (2) Lumbar T scores and bone mineral density values were significantly higher in the degeneration group than those in the control group (P < 0.05) and CT values were significantly lower in the degeneration group than that in the control group (P = 0.001). Hip T scores and bone mineral density were not significantly different in the two groups. (3) The prevalence of osteoporosis diagnosed by CT thresholds was higher in all patients than that diagnosed by T values (51.0% and 42.7%). (4) The prevalence of osteoporosis diagnosed by CT values was as high as 23.6% in the 110 patients diagnosed with non-osteoporosis by dual energy X-ray absorptiometry in both groups, and was higher in the degeneration group than that in the control group (31.7% and 14.0%, respectively). (5) The prevalence of missed osteoporosis was as high as 38.6% (27/70) of non-osteoporosis patients diagnosed by dual-energy X-ray absorptiometry of the lumbar spine in the degeneration group compared to 19.6% (11/56) in the control group. (6) It is concluded that osteoporosis is common in female patients with lumbar degenerative diseases aged ≥50 years. Measurement of lumbar cancellous bone CT values may be a useful complementary method for diagnosing osteoporosis in patients with lumbar degenerative diseases, especially in patients with severe degenerative lumbar degenerative diseases where more missed osteoporosis patients can be identified. [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of high lumbar disc herniation in elderly patients with osteoporosis is increasing.The changes in lumbar overall mechanical strength and biomechanical properties of adjacent vertebrae after conventional posterior approach decompression and interbody fusion have not been clarified. Finite element analysis has great value in the field of biomechanics because of its advantages of non-invasiveness, high repeatability and accuracy. OBJECTIVE: To explore the establishment of a finite element model of senile osteoporotic L3/4 lamina decompression using finite element analysis and intervertebral fusion spine, and to evaluate the biomechanical status of the internal fixation complex of bones under bending motion in elderly patients with osteoporosis. METHODS: Mimics 21.0 was used to extract the DICOM data of the spine CT to establish the 3D bony structure of the lumbar spine (T12-L5), which was imported into Geomagic wrap 2017.The L3/4 full lamina decompression model was established after redrawing the mesh, deleting the nails, cutting the model,filling the cavity,detecting and editing the contour line,constructing curved surfaces and grids, fitting curved surfaces and other operations. Solidworks 2017 was used to construct pedicle screws, connecting rods,and intervertebral fusion cages,which were assembled into the L3/4 full lamina decompression model. Intervertebral discs and articular process cartilage and other structures were established through operations such as stretching,isometric surfaces,moving and copying entities. ANSYS Workbench 17.0 was utilized for mate rial assignment,simulating spinal ligaments,meshing,applying force and limiting boundary conditions. A complete osteoporotic L3/4 laminar decompression and intervertebral fusion spine finite element model was established. The stress,strain and dis placement cloud diagram of the L3/4 lamina decompression and intervertebral fusion full lumbar spine finite element model were observed under simulated bending conditions. RESULTS AND CONCLUSION: (1) In terms of the stress cloud diagram:The T12-L1 vertebra had the highest ave rage stress value;L2 dropped by 24%;L3 d ropped by 55%,and L4-5 dropped by about 80%. The stress concentration in the L4/5 articular process area was the highest, followed by L2/3,and lighter in L1/2 and T12/L1. The stress concentration at the junction of the screw and the connecting rod was obvious,followed by the screw at the entrance and exit of the pedicle. (2)In terms of strain and displacement cloud map:The strain degree of L4/5 and L2/3 articular process was the highest;the strain degree of T12/L1 and L1/2 was the second,and the L3/4 segmental fusion cage, pedicle screw and connecting rod had no any visible deformation.The intervertebral discs of all segments showed great deformation. (3) It is concluded that the cooperative operation of multiple software can successfully construct a finite element model of the spine with L3/4 lamina decompression and intervertebral fusion in elderly patients with osteoporosis. Elderly patients after lumbar spine surgery can tolerate forward flexion,confirming that L3/4 laminar decompression and intervertebral fusion can maintain the shape of the spine and ensure the stability of the spine,but it is necessary to be alert to the occurrence of thoracolumbar stress fractures and adjacent spondylopathy. [ABSTRACT FROM AUTHOR]

BACKGROUND: As a routine method after lumbar spine surgery, a drainage tube is convenient for postoperative bleeding drainage and management, and there is still no consensus on the choice of postoperative removal time for short-segment lumbar spine surgery with less risk. OBJECTIVE: To explore the effect of different drainage times on early clinical efficacy after short-segment lumbar fusion. METHODS: A prospective randomized controlled study was performed on 220 patients in the Affiliated Hospital of Southwest Medical University who underwent posterior lumbar interbody fusion for lumbar degenerative diseases from March 2017 to April 2021. According to the different drainage times, the patients were randomly divided into removal on the second day after operation (group A), removal on the third day after operation (group B), and removal after the observation method 24-hour drainage volume < 30 mL (group C). The perioperative indicators and follow-up results of the three groups of patients were observed and compared. RESULTS AND CONCLUSION: (1) Because 7 patients were lost to follow-up, 2 patients were excluded, and 211 patients were finally included (72 patients in group A, 71 patients in group B, and 68 patients in group C). (2) The average drainage time of group C was 2.91 days. The postoperative drainage volume in group A was significantly less than that in groups B and C, and the difference was statistically significant (P < 0.05). On day 3 after operation, the hematocrit value of group C was lower than that of group A and group B, and the difference was statistically significant (P < 0.05). Postoperative activity time and hospital stay in group A were shorter than those in groups B and C, and the difference was statistically significant (P < 0.05). (3) Four patients in group A, two patients in group B and three patients in group C received an allogeneic blood transfusion. There was no significant difference among the groups (P > 0.05). (4) In terms of postoperative complications, there were no statistical differences in postoperative wound leakage and surgical site infection in all three groups (P > 0.05). (5) All patients were followed up for more than 12 months. Visual analog scale score and Oswestry dysfunction index of the three groups of patients before discharge and at the last follow-up were significantly improved compared with those before surgery (P < 0.05). There was no statistical significance among the groups (P > 0.05). (6) It is indicated that the removal of the drainage tube on the second day after a posterior lumbar fusion can effectively reduce the time to get out of bed and hospital stay, without increasing the postoperative blood loss and the risk of complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: The majority of studies on developmental dysplasia of the hip focus on hip malformations, but there are few reports on the effects of acetabular dysplasia on the spine. OBJECTIVE: To investigate the compensation of spinopelvic parameters in coronal and sagittal views in patients with developmental dysplasia of the hip, and to explore the correlation between acetabular development and spinopelvic parameters. METHODS: A total of 101 patients with developmental dysplasia of the hip admitted to the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2018 to June 2022 were selected as the trial group, and 114 healthy subjects were selected as the control group during the same period. The spinopelvic parameters of the subjects were measured through the full-length X-ray films of the coronal and sagittal spines: lumbar lordosis, anterior pelvic tilt, thoracolumbar kyphosis, Cobb angle, and the distance between the C7 plumb line and the center sacral vertical line, sacral slope, pelvic incidence, and thoracic kyphosis. The differences in spinopelvic parameters were compared between the two groups. In addition, the differences in spinopelvic parameters in patients with unilateral, bilateral and different Crowe classifications of developmental dysplasia of the hip were compared. Pearson correlation analysis was used to explore the correlation between Sharp angle and spinopelvic parameters. RESULTS AND CONCLUSION: (1) In the sagittal view, the lumbar lordosis in the trial group was significantly lower than that in the control group (P < 0.05). The pelvic tilt and kyphosis angle of the thoracolumbar segment in the trial group were significantly greater than those in the control group (P < 0.05). In the coronary position, the Cobb angle and the distance between the C7 plumb line and center sacral vertical line in the trial group were significantly greater than those in the control group (P < 0.05). There was no significant difference in the remaining spinopelvic parameters between the two groups (P > 0.05). (2) The lumbar lordosis of patients with bilateral developmental dysplasia of the hip was significantly lower than that of patients with unilateral developmental dysplasia of the hip (P < 0.05). The pelvic tilt, thoracolumbar kyphosis, Cobb angle and the distance between the C7 plumb line and center sacral vertical line in bilateral developmental dysplasia of the hip patients were significantly greater than those in unilateral developmental dysplasia of the hip patients (P < 0.05). (3) The lumbar lordosis decreased with the increase of Crowe classification severity (P < 0.05). The pelvic tilt increased with the severity of the Crowe classification (P < 0.05). (4) Pearson correlation analysis showed that Sharp angle was negatively correlated with lumbar lordosis (P < 0.05), while Sharp angle was positively correlated with anterior pelvic tilt, Cobb angle, C7 plumb line and center sacral vertical line (P < 0.05). (5) It is concluded that the pelvic tilt, thoracolumbar kyphosis, Cobb angle and the distance between the C7 plumb line and center sacral vertical line increase, while lumbar lordosis decreases in developmental dysplasia of the hip patients. The degree of acetabular dysplasia was significantly correlated with lumbar lordosis, pelvic tilt, Cobb angle, C7 plumb line and center sacral vertical line. [ABSTRACT FROM AUTHOR]

the implantation of a working cannula, which requires only partial bone removal, and there are no studies on the effects of two types of intraoperative foraminoplasty and laminoplasty on the mechanical properties of the local structure of the lumbar spine. OBJECTIVE: To compare the effect of foraminoplasty and laminoplasty on the biomechanical properties of disc and isthmus of the responsible segment. METHODS: The lumbosacral CT images of a healthy male volunteer were taken, and a finite element model M0 of the L3 to sacral vertebrae was established, on which the primary and secondary foraminoplasty models M1 and M2 of the L5/S1 and the laminoplasty model M3 were built. The same load was applied to compare the intervertebral motion range, disc Von Mises stress and equivalent stress characteristics of L5 vertebral isthmus with each model. RESULTS AND CONCLUSION: (1) Compared with M0, M1 and M2 motion range in L5/S1 segment did not change significantly in all directions; M2 overall motion range increased by 8.60% in flexion; M3 increased by 8.23% and 8.26% in L5/S1 right bending and right torsion, and 5.39% and 5.67% in overall motion range in flexion and right bending, with no significant changes in motion range in the rest of working conditions. (2) Compared with M0, M1 showed no significant change in the extremes of Von Mises stress at L5/S1 disc; M2 increased 11.06%, 12.50%, 18.32%, and 15.48% in flexion, extension, left torsion, and right torsion; M3 increased 12.22%, 19.54%, 10.05%, and 9.97% in flexion, extension, left torsion, and right torsion, and the rest working conditions and L4/5 disc maximum Von Mises stress did not change significantly. (3) Compared to M0, the maximum Von Mises stress in the left isthmus of L5 of M1 increased by 12.43% in left bending, 18.38%, 13.29%, 13.62%, and 40.00% in the right isthmus in extension, right bending, left torsion, and right torsion. The maximum Von Mises stress in the left isthmus of L5 of M2 increased by 38.87%, 42.63%, 16.95%, and 19.35%, and that in the right isthmus increased by 12.58%, 33.70%, 12.92%, and 17.42% in flexion, extension, left bending, and left torsion. The maximum Von Mises stress in the left isthmus of L5 of M3 increased 67.07%, 78.14%, 32.33%, 62.94%, and 89.99% in flexion, extension, left and right bending, and right torsion. (4) The results suggest that foraminoplasty and laminoplasty have a small effect on spinal motion range; there is a mild increase in the extreme values of disc Von Mises stress in the segments operated by interbody laminoplasty and secondary foraminoplasty; there is no significant change in the extreme values of disc Von Mises stress in adjacent segments, and there is a significant increase in the Von Mises stress in the ipsilateral isthmus operated by the interbody laminoplasty model. [ABSTRACT FROM AUTHOR]

BACKGROUND: Osteoporotic vertebral compression fracture is the most common complication of osteoporosis. Percutaneous kyphoplasty is an effective treatment for osteoporotic vertebral compression fractures. Its operative approaches include unilateral and bilateral pedicle approaches. The two approaches have their advantages and disadvantages. OBJECTIVE: To explore the clinical effect and value of the unipedicular and bipedicular approaches to percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture. METHODS: 383 patients with osteoporotic vertebral compression fractures of the thoracic and lumbar spine were operated on from March 2014 to April 2020 via bipedicular approach (bipedicular group, 208 cases) and unipedicular approach (unipedicular group, 175 cases) percutaneous kyphoplasty. All patients were followed-up using the Oswestry dysfunction index, visual analog scale score and X-ray inspection preoperatively and postoperatively. The operation time, blood loss, amount of bone cement injected, frequency of X-ray exposure, Cobb angle of vertebral kyphosis, vertebral body leading edge height, intermediate height, cement leakage rate, and incidence of adjacent vertebral body re-fracture were measured and compared between the two groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: Clarifying the exact relationship between specific physiological periods and postmenopausal low bone mineral density in women can be a key to predicting low bone mineral density in postmenopausal women and provide a reference value for preventing the occurrence of low bone mineral density. OBJECTIVE: To investigate the association between different special periods and postmenopausal low bone mineral density in women. METHODS: A total of 15 560 samples were collected from the NHANES database (published from 2017 to 2020), and 1 563 participants were screened out. Their bone mineral density values were acquired to calculate the T-score. Those with osteoporosis and osteopenia were enrolled in observation group, while those with normal bone mass acted as controls. Three linear regression models were established to evaluate the effects of age at menarche, age at menopause, gravidity and parity on postmenopausal low bone mineral density. Finally, the results of multivariate logistic regression analyses were used to verify the relationship among gravidity, parity and low bone mineral density. RESULTS AND CONCLUSION: The incidence of postmenopausal low bone mineral density was 1.62 times higher in participants aged > 13 years at menarche than those aged < 12 years at menarche. Relative to menopausal age under 45, the odds ratio value for postmenopausal low bone mineral density was 0.72 for those between 45-55 years of age at menopause and 0.51 for those over 55 years of age at menopause. Gravidity was negatively correlated with the T scores of the femur and greater trochanter but showed no correlation with the T score of the lumbar spine. Parity was not related to the T scores of the femur and lumbar spine but only negatively related to the T score of the greater trochanter. The later the age of menarche, the earlier the age of menopause, the more pregnancies, the greater the likelihood of postmenopausal lower bone mineral density. Gravidity has the most significant effect on the bone mineral density of the femur and greater trochanter. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recent studies have found that there may be an intrinsic association between platelet count and bone mineral density. However, previous studies have reached different conclusions on the intrinsic association between the two. OBJECTIVE: To study the correlation between lumbar spine bone density and platelet count in middle-aged and elderly people. METHODS: A total of 2 571 men and 2 929 women were recruited from the NHANES database. Weighted multiple linear regression models and smooth curve fitting were used to evaluate the association between lumbar bone mineral density and platelet count. RESULTS AND CONCLUSION: (1) The weighted multiple linear regression model results showed that lumbar bone mineral density was negatively correlated with platelet count in the total population. There was still a negative correlation between lumbar bone density and platelet count after grouping into four groups. When stratified by sex, there was still a negative correlation in men, β=-0.000 2, 95% confidence interval (CI): (-0.000 3, < -0.000 1). When stratified by race, only the three models for Americans of other races showed a positive correlation [model 1: β=0.000 2, 95% CI: (< 0.000 1, 0.000 4); Model 2: β=0.000 1, 95% CI: (-0.000 1, 0.000 3); Model 3: β=0.000 1, 95% CI: (-0.000 1, 0.000 3)], while the three models of Hispanic, non-Hispanic white and non-Hispanic black showed a negative correlation. (2) The smooth curve fitting was used to solve the nonlinear relationship between platelet count and lumbar bone mineral density. It was found that there were two inflection points between platelet count and lumbar bone mineral density within the normal range in men. The piecewise linear regression model was used to identify the two inflection points, which were 141×109 /L and 246×109 /L. (3) To conclude, there is a negative correlation between lumbar bone mineral density and platelet count in middle-aged and elderly men. There is a positive correlation between lumbar bone mineral density and platelet count in men when platelet count is < 141×109 /L in the normal range, a negative correlation when platelet count is (141-246)×109 /L, and a positive correlation when platelet count is > 246×109 /L. There may be a positive correlation between lumbar bone density and platelet count in women. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is still a big controversy about the interaction between knee osteoarthritis and osteoporosis. Patients with knee osteoarthritis often present with changes in bone mineral density (BMD). The relationship between the BMD of the knee joint and the BMD of the lumbar spine and hip is unclear. OBJECTIVE: To investigate the distribution and correlation of BMD in the lumbar spine, femoral neck, and knee joint of patients with knee osteoarthritis. METHODS: 150 postmenopausal women with primary knee osteoarthritis were selected to measure the BMD of the lumbar spine, femoral neck, and ipsilateral knee joint. Then the knee joint was divided into six regions of interest (ROI), which were marked as R1-R6, with R1 representing the medial side of proximal tibia, R2 representing the lateral side of proximal tibia, R3 representing the proximal tibia (R3=R1+R2), R4 representing the medial side of distal femur, R5 representing the lateral side of distal femur and R6 representing the distal femur (R6=R5+R4). According to the K-L classification, all the patients were divided into grade 0 group (33 cases), grade I-II group (61 cases), and grade III group (56 cases). The BMD of each ROI was compared with the BMD of the lumbar spine and femoral neck, and then the BMD of different ROIs was compared in pairs. The correlation between the BMD of each ROI and the BMD of the lumbar spine and femoral neck was analyzed. RESULTS AND CONCLUSION: (1) The BMD of R2, R4, R5, and R6 in the grade III group was lower than that in the grade 0 group (P < 0.05). The BMD of the femoral neck, R2, and R3 in the grade III group was lower than that in the grade I-II group (P < 0.05). (2) The BMD of each ROI of the knee joint in the three groups was ranked as R5 > R6 > R4 > (R1, R2, and R3). The BMD of R1 was lower than that of R2 in the grade 0 group (P < 0.05). (3) In grade 0 patients, the BMD of R2, R5, and R6 was positively correlated with the BMD of the lumbar spine and femoral neck (P < 0.05), while the BMD of R1 and R3 was only positively correlated with the BMD of the lumbar spine (P < 0.05). In grade I-II patients, the BMD of each ROI of the knee joint was positively correlated with the BMD of the lumbar spine and femoral neck (P < 0.05). In grade III patients, the BMD of R1 and R3 was positively correlated with the BMD of the lumbar spine and femoral neck (P < 0.05), while the BMD of R2, R4, R5, and R6 was only positively correlated with the BMD of the femoral neck (P < 0.05). (4) All these findings suggest that there are differences in the BMD of different ROIs of the knee joint, and the BMD of the lateral side of distal femur is the highest. With the progression of knee osteoarthritis, the BMD of the femoral neck and the BMD of the knee joint except the medial side of proximal tibia are on the decline, and the BMD of different parts of the knee joint is correlated with the BMD of the lumbar spine and ipsilateral femoral neck. [ABSTRACT FROM AUTHOR]

BACKGROUND: Compared with the common segment of lumbar disc herniation, upper lumbar disc herniation is rare, but the structure of the high spinal canal is complex, so the clinical manifestations are often serious and varied. Analysis of related imaging parameters can provide a deep understanding of the disease characteristics, and provide ideas for early diagnosis and treatment and postoperative prevention of recurrence. OBJECTIVE: To analyze the characteristics of sagittal imaging parameters in patients with upper lumbar disc herniation, and to explore the possible influence of different parameters on the incidence of upper lumbar disc herniation. METHODS: A total of 46 upper lumbar disc herniation patients hospitalized from January 2019 to January 2022 were collected as the observation group, including 9 cases of disc herniation at the L1-L2 level, 10 cases at the L2-L3 level, and 27 cases at the L3-L4 level. According to the 1 ∶ 1 ratio, 46 patients with L4-L5 lumbar disc herniation during the same period were selected as the control group. Sagittal imaging parameters of the two groups were measured on the anteroposterior and lateral lumbar X-ray films in standing position, including: pelvic tilt, pelvic incidence, sacral slope, lumbar lordosis, thoracolumbar kyphosis, and wedging angle of the vertebrae. Multivariate Logistic regression analysis was used to determine the correlation between the above parameters and the incidence of upper lumbar disc herniation, and receiver operating characteristic curve was used to analyze the influence of risk factors for meaningful results. RESULTS AND CONCLUSION: (1) Pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis of the observation group were significantly less than those in the control group (P < 0.05). Thoracolumbar kyphosis and wedging angle of the vertebrae in the observation group were larger than those in the control group (P < 0.05). (2) Multivariate Logistic regression analysis showed that high thoracolumbar kyphosis (OR=1.963, 95%CI:1.341-2.874, P=0.001) and high wedging angle of the vertebrae (OR=1.635, 95%CI:1.069-2.499, P=0.023) affected the incidence of upper lumbar disc herniation. Although the differences of pelvic tilt, pelvic incidence, sacral slope, lumbar lordosis and other indicators between the two groups were statistically significant, they could not be used as independent risk factors. (3) Receiver operating characteristic curve analysis showed that thoracolumbar kyphosis and wedging angle of the vertebrae had certain warning significance for the occurrence of upper lumbar disc herniation, and the cutoff values of thoracolumbar kyphosis and wedging angle of the vertebrae were 10.45° and 6.45°, respectively. (4) It is concluded that the anteroposterior and lateral lumbar radiography can better evaluate the sagittal related parameters in patients with upper lumbar disc herniation. The pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis of patients with upper lumbar disc herniation are significantly lower than those of patients with conventional lumbar disc herniation, and the physiological curvature of the lumbar spine decreases or disappears, presenting a relatively straight state as a whole. Thoracolumbar kyphosis and wedging angle of the vertebrae are relatively high, and thoracolumbar kyphosis > 10.45° and wedging angle of the vertebrae > 6.45° are the high-risk alert values of upper lumbar disc herniation. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Objective.To investigate the risk factors for osteoporotic vertebral compression fractures (OVCFs) in patients with chronic hepatitis B (CHB) and magnetic resonance imaging (MRI) findings of paraver- tebral muscles in the lumbar spine. Methods.Six hundred and twenty-seven patients with CHB from April 2019 to April 2023 were selected. They were divided into OVCFs group (n = 124) and Non-OVCFs group (n = 503) based on T2-weighted MRI. Risk factors for OVCFs were analyzed after propensity score matching. R software was used to create column line plots. A risk stratification system was established by recursive segmentation.Cox model was used to analyze the association between MRI performance and OVCFs. Results.The OVCFs group (n = 73) and Non- OVCFs group (n = 73) were balanced at baseline after matching (P > 0.05). Multifactorial analysis showed that osteocalcin (OST) HR = 2.742 (1.653 - 4.572), β-collagen crosslinking (β-CTX) HR = 2.590 (1.984 - 3.391), type 1 procollagen amino-terminal extension peptide (P1NP) HR = 2.291 (1.672 - 2.860), sagittal Cobb's angle HR = 5.143 (3.375 - 6.622), and kyphosis HR = 1.772 (1.491- 2.095) were risk factors for OVCFs. Bone mineral density HR = 0.682 (0.551 -0.834), history of vitamin/calcium supplementation HR = 0.671 (0.563 - 0.792), and history of exercise HR = 0.890 (0.674 - 0.923) were protective factors. AUC = 0.926 (0.854 - 0.997) after column line plot validation. The mean error of calibration curve was 0.012. OVCFs were divided into very low risk group (< 105, n = 50), low risk group (105 ≤ score < 204, n = 52), medium risk group (204 ≤ score < 341, n = 26) and high risk group (≥ 341, n = 18). There was an association between net muscle content, fat infiltration area and risk of OVCFs in L3/4, L4/5 erector spinae and multifidus muscles in each subgroup (Ptrend < 0.05). However, there was no interaction between the subgroups (Pinteraction > 0.05). Conclusion.OST ≥ 15 ng/mL, β-CTX ≥ 0.5 ng/mL, P1NP ≥ 40 ng/mL, sagittal Cobb angle ≥ 55°, bone mineral density < -3.0, kyphosis deformity, not taking vitamin/calcium supplements, and lack of exercise are risk factors for OVCFs in CHB. With increased risk of OVCFs, CHB patients showed degenerative changes in the erector spinae and multifidus muscles at the L3/4 and L4/5 levels. [ABSTRACT FROM AUTHOR]

BACKGROUND: Low back pain and anterior knee pain are very common in clinical work, and they often occur together. Although the concept of knee-spine syndrome has been clearly put forward, which is a significant correlation between lumbar lordosis loss and knee flexion, there are few studies on the mutual compensation between knee and lumbar spine. In particular, there is no report on the research methods and equipment used between the two. OBJECTIVE: To summarize the relevant literature related to knee-spine syndrome, analyze the measurement methods and equipment in each study, and give tips for the further development of knee-spine syndrome. METHODS: The relevant articles in PubMed database and CNKI database were searched by computer. The Chinese and English search terms were “knee-spine syndrome, low back pain, biomechanics, balance parameters, knee, spine”. Finally, 46 articles were included for review and analysis. RESULTS AND CONCLUSION: (1) There is a correlation between the sagittal balance of the lumbar spine and the flexion angle of the knee joint. When the knee joint has a flexion contracture deformity, the center of gravity of the body moves forward, and the human body will re-establish a new balance system, that is, the loss of lumbar curvature and lumbar lordosis. (2) The innovation of science and technology is an important driving force for the in-depth development of knee-spine syndrome. The technical means for the measurement and research of knee-spine syndrome include X-ray plain film, EOS system, SpinalMouse, finite element analysis, and gait analysis to build a multi-dimensional measurement and exploration system from lines of force, stress, kinematics, computer simulation analysis, etc., which will gradually reveal the mutual compensatory connection between the knee joint and the spine. (3) In-depth research on knee-spine syndrome is of great significance to explore the internal changes and mutual compensation relationship of human kinematics and morphology. The human body is a continuous integral movement unit, can provide guidance and theoretical basis for diagnosis and treatment of knee joint and lumbar spine diseases in clinical work by exploring the compensatory mechanism of the knee and waist. [ABSTRACT FROM AUTHOR]

BACKGROUND: The high prevalence of osteoporotic vertebral compression fractures leads to a significant socioeconomic and medical burden, and there are controversies about the optimal timing and treatment methods. Percutaneous balloon kyphoplasty can reduce complications, relieve pain, and enhance structural integrity of the vertebral body. OBJECTIVE: To investigate the influence of spinal-pelvic sagittal balance on the therapeutic effects of percutaneous balloon kyphoplasty on osteoporotic vertebral compression fractures. METHODS: The medical records of 74 patients admitted to Hefei First People's Hospital from August 2018 to January 2020 for percutaneous balloon kyphoplasty were retrospectively analyzed, and the included patients were equally divided into the good outcome and poor outcome groups (n=37 per group) according to the postoperative recovery. The visual analog scale scores, Japanese Orthopaedic Association scores, and imaging data of the two groups were compared at baseline and during the postoperative period. RESULTS AND CONCLUSION: (1) Cement leakage occurred in three patients in the poor outcome group and four patients in the good outcome group postoperatively, respectively. (2) Visual analog scores in both groups at 1 month postoperatively were similar to baseline (P > 0.05), while the scores were improved significantly at 12 months postoperatively, with the good outcome group significantly better than the poor outcome group (P < 0.05). (3) There was no significant difference in the loss rate of injured vertebral height, Cobb angle, angle of pelvic incidence, pelvic tilt, sacral slope, angle of lumbar anterior convexity, sagittal deviation and thoracic lordosis angle between the both groups (P > 0.05) at baseline, while the loss rate of injured vertebral height, Cobb angle, and sagittal deviation in both groups were significantly improved at 1 month postoperatively (P < 0.05). The rate of height loss of the injured spine, Cobb angle, sagittal deviation, thoracic lordosis angle, pelvic tilt, sacral slope were significantly increased in the poor outcome group compared with the good outcome group (P < 0.05), while the angle of pelvic incidence and angle of lumbar anterior convexity were significantly decreased in the poor outcome group compared with the good outcome group at 12 months postoperatively (P < 0.05). (4) Pearson correlation analysis revealed that Japanese Orthopaedic Association scores were negatively correlated with sagittal deviation, thoracic lordosis angle, pelvic tilt, sacral slope, angle of pelvic incidence (P < 0.05), while were positively correlated with the angle of lumbar anterior convexity (P < 0.05). In addition, the visual analog scale scores were positively correlated with sagittal deviation, thoracic lordosis angle, sacral slope, and angle of pelvic incidence (P < 0.05), while were negatively correlated with the angle of lumbar anterior convexity and pelvic tilt (P < 0.05). (5) These results suggest that percutaneous balloon kyphoplasty can correct deformity, stabilize fracture, and relieve pain, thereby benefiting most of the patients with osteoporotic vertebral compression fractures. Moreover, spine-pelvic sagittal plane balance can affect the clinical efficacy. [ABSTRACT FROM AUTHOR]

Objective To investigate the magnetic resonance imaging (MRI) features of lumbar lesions in patients in the acute stage of ankylosing spondylitis (AS), as well as the distribution, involvement, and pathological features of lumbar lesions in the acute stage of AS based on Berlin score. Methods A total of 70 patients with AS who were admitted to Department of Rheumatology, Shanxian Central Hospital, from 2019 to 2022 were enrolled, and related data were collected, including general information, human leukocyte antigen-B27 (HLA-B27) on admission, and lumbar MRI findings. The MRI findings, distribution characte-ristics, and extent of involvement of lumbar lesions were analyzed. The vertebral units were divided into three segments, i.e., T12-L2 as the upper segment, L2-L4 as the middle segment, and L4-S1 as the lower segment, and Berlin score was determined for the affected vertebral units and was compared between different segments of vertebral units. The Pearson or Spearman correlation analysis was used to investigate the correlation between age, course of disease, HLA-B27, and Berlin score. Results Of all patients, there were 52 cases (74.3%) of vertebral corner inflammatory lesion, mainly involving the anterior horn of vertebral body; there were 18 cases (25.7%) of discitis, mainly with diffuse involvement. There was a significant difference in the ove-rall distribution of Berlin score between vertebral units in different segments (χ2=20.425,P0.05), and there was a weak positive correlation between HLA-B27 on admission and Berlin score (r=0.240,P

BACKGROUND: Lumbar degenerative disease is a common disease in middle-aged and elderly patients. Traditional lumbar spine surgery is more traumatic and takes a long time to recover after surgery. In recent years, spinal endoscopic technology has achieved great development, and endoscopic transforaminal lumbar interbody fusion, as a new treatment for lumbar degenerative diseases, is worth promoting in patients with indications for lumbar degenerative diseases because of the advantages of less trauma, shorter recovery time, less postoperative pain, and less bleeding. OBJECTIVE: To review the research progress of endoscopic transforaminal lumbar interbody fusion in lumbar degenerative diseases, review the occurrence, development, advantages, limitations, and development trend of endoscopic transforaminal lumbar interbody fusion. METHODS: The first author used a computer to search PubMed, Web of Science and Wanfang databases for the literature published from 2010 to 2022. Key words were “endoscopic lumbar fusion, lumbar degenerative disease, minimally invasive spine” in Chinese and English. Duplicate, poor quality and irrelevant articles were excluded for review analysis. RESULTS AND CONCLUSION: (1) Degenerative diseases of the lumbar spine are the pathological basis of disc herniation, spinal stenosis, and vertebral slippage, and are the main cause of discogenic lower back pain. Endoscopic transforaminal lumbar interbody fusion is a novel technique for the treatment of degenerative diseases of the lumbar spine. (2) In recent years, endoscopic lumbar spine surgery has evolved from simple decompression to simultaneous decompression and fusion, with satisfactory short-term results. Microscopic fusion and flexible anesthesia are the greatest highlights of this technique, which has the advantages of less surgical trauma, less bleeding, shorter hospital stay, less postoperative pain, faster recovery, and preservation of the posterior spinal structures, but because of the need for repeated intraoperative fluoroscopy, the relatively high radiation exposure to the surgeon and the patient, as well as the higher requirements for the surgeon’s operating skills. (3) The use of endoscopic transvertebral foramina for the treatment of degenerative lumbar spine disease is now considered to be a potentially effective novel treatment compared to conventional surgery. In previous studies of endoscopic transforaminal lumbar interbody fusion, there were some shortcomings in the use of large amounts of saline to flush the surgical site intraoperatively causing occult blood loss, and these occult blood losses could not be calculated, which was not included in the relevant literature. Second, because fewer hospitals can perform endoscopic transforaminal lumbar interbody fusion and lack the support of large samples and long-term follow-up evidence, its long-term efficacy still needs further study. [ABSTRACT FROM AUTHOR]

BACKGROUND: As a physical therapy method with remarkable curative effect for spinal diseases, spinal manipulation has been widely used by scholars at home and abroad and gradually developed into standardization and systematization. Its mechanism of action and safety have always been the focus of medical attention. Three-dimensional finite element method is an effective tool for numerical simulation of human mechanical behavior. It has certain research value and clinical significance to clarify the biomechanical effect of manipulation on spinal structure through technical analysis. OBJECTIVE: To review the development of three-dimensional finite element method and its application in biomechanics of cervical, thoracolumbar and lumbar manipulations. METHODS: The first author used “finite element, biomechanics, spine, cervical vertebrae, thoracolumbar, lumbar vertebra, manipulation” as English search terms, and used computer to search PubMed and Web of Science databases from establishment to April 2022. There were a total of 495 related articles. The “finite element analysis, spine, cervical spine, thoracic and lumbar spine, lumbar spine, massage, manipulation, biomechanics” were used as the Chinese search terms. A total of 593 related articles from the establishment of the database to April 2022 were checked in CNKI, Wanfang, and VIP databases using computers, and 80 of them were selected for review according to the inclusion criteria. RESULTS AND CONCLUSION: (1) Through the three-dimensional finite element method to analyze the stress and strain of the spine structure under the action of massage manipulation, the stress value and displacement value of each part of the model can be obtained, which can objectively, intuitively and accurately reflect the vertebral body, intervertebral disc, ligament, muscle, blood vessel, nerve, etc. The mechanical effect status of the components provides strong evidence for explaining the mechanism of spinal manipulation, improving the safety and effectiveness of manipulation, greatly promoting the development of clinical manipulation techniques, and has a good development potential. (2) The three-dimensional finite element method has made an important progress in the study of the biomechanics of spinal manipulation. The simulation of paravertebral soft tissue components of the spinal model has been continuously improved. The basic research of cervical and lumbar massage manipulations has continued to deepen, and the biomechanical analysis of massage manipulations has developed from solid mechanics to fluid mechanics. (3) However, there are still problems such as insufficient representation of the imaging sources of the spine model and the material setting data of each component in the current application. The simulation and loading of spinal manipulation manipulations are too simple, and many basic researches on thoracic manipulation manipulations have not been carried out. The researchers need to further improve, so that the three-dimensional finite element method can better meet the needs of clinical and scientific research of spinal manipulation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Compared with pedicle screws, cortical bone trajectory screws can improve the holding force, but they have longer learning curve and high misplacement rate. Orthopedic robots can overcome the above limitations and improve the accuracy and safety of screw placement. OBJECTIVE: To compare the accuracy and safety of robot-assisted with those of free-hand cortical bone trajectory screw placement in senile osteoporotic patients with lumbar spinal surgery. METHODS: From June 2015 to March 2021, data of patients aged ≥65 years old with osteoporosis, who underwent lumbar cortical bone trajectory screw instrumentation in Beijing Jishuitan Hospital, were retrospectively analyzed. A total of 64 patients were included in the study. In the robot group (n=23), 92 TiRobot-assisted cortical bone trajectory screws were implanted. In the free-hand group (n=41), 164 cortical bone trajectory screws were implanted. The modified Gertzbein-Robbins scale was used to assess the accuracy of screw placement and the incidence of proximal facet joint violation. Operative time, intraoperative blood loss, postoperative hospital stay, and complications were observed. RESULTS AND CONCLUSION: (1) In the robot group, the proportion of clinically acceptable screws (97.8%) was significantly higher than the 87.2% in the freehand group (P < 0.001). (2) There was no statistically significant difference in the rate of cephalic facet joint violation between the robot and free-hand groups (P = 0.157). (3) There was no statistically significant difference in the blood loss, postoperative hospital stay, or wound infection between the two groups. (4) These findings indicate that in osteoporotic patients with lumbar spine surgery, robot-assisted placement of cortical bone trajectory screw is more accurate and safe compared with free-hand placement. [ABSTRACT FROM AUTHOR]

BACKGROUND: Oblique-pulling manipulation has a reliable curative effect on lumbar synovial incarceration, and it has been widely used in the clinic. However, the related research on the treatment of lumbar synovial incarceration by oblique-pulling manipulation is still relatively lacking. OBJECTIVE: To analyze the biomechanical mechanism and effect of oblique-pulling manipulation in the treatment of lumbar synovial incarceration by threedimensional finite element method, and provide theoretical basis for the treatment of lumbar synovial incarceration by oblique-pulling manipulation. METHODS: The CT data of patients with lumbar synovial incarceration were collected, and the three-dimensional finite element model of L4-5 motor unit of spine was established by using Mimics and Ansys software. The operation process of the oblique-pulling manipulation in the left lateral position was simulated, and the influence of the oblique-pulling manipulation on the biomechanics, morphological changes and facet joint contact area of each tissue structure of L4-5 segment of lumbar spine was analyzed. RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of lumbar L4-5 segment was established, and the validity of the model was verified. (2) Before and after the oblique-pulling manipulation was applied, the stress of left facet joint cartilage increased from 2.959 MPa to 14.35 MPa; the strain increased from 0.078 34 to 0.345 1, and the contact area of articular cartilage increased from 20.806 2 mm² to 94.872 7 mm². On the other hand, the stress of the right facet joint cartilage decreased from 3.127 MPa to 0 MPa; the strain decreased from 0.081 96 to 0, and the articular cartilage contact surface decreased from 16.705 3 mm2 to 0 mm² on the right. (3) It is concluded that oblique-pulling manipulation has a good effect on patients with lumbar synovial incarceration. It can change the stress and strain of the articular process and the contact area of the upper and lower articular processes, fully release and open the articular process, and achieve the therapeutic purpose of reducing the articular process and relieving the synovial incarceration. [ABSTRACT FROM AUTHOR]

Objective To explore the use of a novel inflammatory composite scoring system with a column chart model to predict the risk of postoperative delirium in patients with lumbar spine fractures. Methods 251 patients with lumbar spine fracture who had been admitted to our hospital and had undergone surgical treatment from June 2020 to December 2022 were selected as study subjects, and then divided into a postoperative delirium group （n = 55） and a delirium-free group （n = 196） according to the patients' conditions. The clinical data of the two groups were recorded and subjected to univariate analysis. ROC curve was used to analyze the predictive value of the indexes for postoperative delirium in the patients; logistic regression was used to analyse the independent risk factors for postoperative delirium and construct a columnar graph model; the calibration curves were used for the internal validation of the model; the consistency index （C-index） was calculated; and the decision curve was used to evaluate the predictive efficiency of the model. Results The differences between the two groups in terms of age, surgical duration, intraoperative bleeding, and inflammatory response markers NLR, PLR, and CAR were statistically significant （P < 0.05）. The AUCs of age, surgical time, intraoperative bleeding, NLR, PLR, and CAR were 0.788, 0.714, 0.797, 0.824, 0.839, and 0.811, respectively; and the AUC of the constructed N.P.Cs scoring scale was 0.963. Age, intraoperative bleeding, and N.P.Cs were independent risk factors affecting postoperative delirium in patients with lumbar spine fractures. The calibration curve of the column-line diagram prediction model was close to the original and ideal curves, with a C-index of 0.847 （95% CI:0.811 ~ 0.903）; the threshold value of the column-line diagram prediction model was greater than 0.17, providing a net clinical benefit. Conclusion Age, intraoperative bleeding, and N.P.Cs are independent risk factors for postoperative delirium in patients with lumbar spine fractures. The column chart prediction model based on this construction can provide guidance for the prevention and treatment of postoperative delirium in patients with lumbar spine fractures. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical effect of nerve stem electrical stimulation therapy in the treatment lumbar disc herniation (LDH) at 4-5 levels. Methods From January 2020 to October 2021,A total of 140 patients with LDH (three cases dropped out during the study and 137 cases actually completed the study) in the Department of Acupuncture and Moxibustion of the hospital were randomly divided into the observation group (69 cases) and the control group (68 cases). The observation group was treated with direct nerve trunk stimulation, while the control group was treated with warm acupuncture. The patients in both groups were treated continuously for two courses. The improved version of Japanese Orthopedic Association and Visual Analgesia Scale were used to evaluate the efficacy of the two groups. The the difference in marked response rate between the two groups of patients was compared. Results After treatment, the scores of the modified Japanese Orthopedic Association and Visual Analgesia Scale in the two groups were significantly improved, and the cure rate and effective rate in the observation group were significantly higher than those in the control group, with statistical significances (P＜0. 05). Conclusion Nerve stem electrical stimulation therapy is effective in the treatment of LDH at 4-5 levels, and has high clinical application value. [ABSTRACT FROM AUTHOR]

BACKGROUND: Our group, together with the Institute of Robotics of Shanghai University and Shanghai Hepu Medical Technology Co., Ltd. developed this Frame-type Parallel Orthopedic Robot in the hope of contributing to the development of domestic orthopedic surgical robots. OBJECTIVE: To test the feasibility of the frame-type parallel orthopedic robot-assisted lumbar spine surgery by animal lumbar spine experiments and to verify its operational performance and the accuracy of the assisted nail placement. METHODS: A total of twelve goat lumbar vertebrae were randomized into two groups. In the experimental group (6 vertebrae, 60 nail paths), the screw path was planned according to 3D CT data using the surgical robot and Kirschner wire placement was assisted by frame-type parallel orthopedic robot. The control group (6 vertebrae, 60 nail paths) was manually implanted with Kirschner wire under the 2D X-ray data. The screw path planning time, Kirschner wire placement time and X-ray exposure time were recorded. CT images of both groups were collected after the experiment. The accuracy and the excellent and good rate of Kirschner wire placement were assessed according to the modified Gertzbein-Robbins criteria. RESULTS AND CONCLUSION: (1) The screw path planning time of the experimental group was longer than that of the control group (P < 0.001). There were no statistically significant differences in Kirschner wire placement time and X-ray exposure time between the experimental group and the control group (P > 0.05). (2) According to the CT scan of the specimens after the experiment, the success rate and the excellent and good rate of the experimental group were 100% and 96.7%, and those of the control group were 98.3% and 85.0%. The excellent and good rate of the experimental group was significantly higher than that of the control group (P < 0.05). (3) This demonstrates that frame-type parallel orthopedic robot-guided placement of pedicle screws has a higher accuracy rate compared with intraoperative C-arm fluoroscopy-guided freehand screw placement, which can effectively improve surgical safety. [ABSTRACT FROM AUTHOR]

BACKGROUND: The cannulated lag screw technique has many advantages in the treatment of spondylolysis, but there is still the risk of fracture and loosening of the internal fixation. OBJECTIVE: To analyze the biomechanical stability of cannulated lag screw treatment of spondylolysis by establishing L4-S normal model, spondylolysis model and cannulated lag screw treatment model of spondylolysis through three-dimensional finite element software. METHODS: One male healthy young soldier volunteer was selected. 3D CT scan was performed on the volunteer’s lumbar spine and sacral spine. The imaging data were obtained and saved in Dicom format. CT data were imported into Mimics research 21.0 software to initially establish a geometric model, and deviation analysis was carried out. The obtained model was output in STEP format. Three groups of models of normal L4-S segment, L5 bilateral isthmus and cannulated lag screw in the treatment of spondylolysis were established after imported into Solidworks 21.0 software. They were represented by A, B and C respectively. The biomechanical characteristics of the three groups of models were compared under five motion states, such as axial compression, flexion, extension, left bending, and left rotation. RESULTS AND CONCLUSION: (1) Compared with models A and C, model B had the largest overall maximum displacement under the five working conditions of axial compression, flexion, extension, left bending, and left rotation. However, the overall maximum displacement of models A and C was not significantly different. (2) After removing the internal fixation in the model C, the maximum stress trend was similar to the model A. The stress of the model B was significantly higher than that of the models A and C during left bending and left rotation. (3) The overall maximum rotation angle of the three groups of models showed that the maximum rotation angle of the model B under the five working conditions was significantly larger than that of the models A and C. The models A and C were similar. The range of motion of the L4 vertebral body in the three groups did not change significantly. The range of motion of the L5 vertebral body in the model B was significantly higher than that in the models A and C, and it was more obvious in the left rotation and left bending. (4) These findings indicate that under the condition of physiological movement of the spine, the change trend of cannulated lag screw in the treatment of lumbar spondylolysis model is the same as that of normal model, which obtains good biomechanical stability and retains the normal mechanical characteristics of the spine, but excessive extension and rotation should be avoided immediately after operation. BACKGROUND: The cannulated lag screw technique has many advantages in the treatment of spondylolysis, but there is still the risk of fracture and loosening of the internal fixation. OBJECTIVE: To analyze the biomechanical stability of cannulated lag screw treatment of spondylolysis by establishing L4-S normal model, spondylolysis model and cannulated lag screw treatment model of spondylolysis through three-dimensional finite element software. METHODS: One male healthy young soldier volunteer was selected. 3D CT scan was performed on the volunteer’s lumbar spine and sacral spine. The imaging data were obtained and saved in Dicom format. CT data were imported into Mimics research 21.0 software to initially establish a geometric model, and deviation analysis was carried out. The obtained model was output in STEP format. Three groups of models of normal L4-S segment, L5 bilateral isthmus and cannulated lag screw in the treatment of spondylolysis were established after imported into Solidworks 21.0 software. They were represented by A, B and C respectively. The biomechanical characteristics of the three groups of models were compared under five motion states, such as axial compression, flexion, extension, left bending, and left rotation. RESULTS AND CONCLUSION: (1) Compared with models A and C, model B had the largest overall maximum displacement under the five working conditions of axial compression, flexion, extension, left bending, and left rotation. However, the overall maximum displacement of models A and C was not significantly different. (2) After removing the internal fixation in the model C, the maximum stress trend was similar to the model A. The stress of the model B was significantly higher than that of the models A and C during left bending and left rotation. (3) The overall maximum rotation angle of the three groups of models showed that the maximum rotation angle of the model B under the five working conditions was significantly larger than that of the models A and C. The models A and C were similar. The range of motion of the L4 vertebral body in the three groups did not change significantly. The range of motion of the L5 vertebral body in the model B was significantly higher than that in the models A and C, and it was more obvious in the left rotation and left bending. (4) These findings indicate that under the condition of physiological movement of the spine, the change trend of cannulated lag screw in the treatment of lumbar spondylolysis model is the same as that of normal model, which obtains good biomechanical stability and retains the normal mechanical characteristics of the spine, but excessive extension and rotation should be avoided immediately after operation. [ABSTRACT FROM AUTHOR]

BACKGROUND: The biomechanical research on a single cortical bone track screw has been reported in many articles at home and abroad. There are not many reports on the biomechanical research on the entire motion unit of the vertebral body, cage, and screw rod, especially the stress distribution of the motor unit and the stability of the internal fixation device by the fixation method of cortical bone trajectory combined with pedicle screw. OBJECTIVE: To summarize and analyze the biomechanical differences between traditional pedicle screw fixation and cortical bone trajectory combined with pedicle screw fixation in osteoporotic vertebral bodies. METHODS: The CT scan data of one osteoporosis volunteer (bone mineral density T value < -0.25 SD) were obtained, and the L3-S1 vertebral functional unit osteoporosis finite element model was established to simulate the fixation of traditional trajectory screws and cortical bone trajectory combined with pedicle screws after verification of validity. The stress distribution and stability of the two internal fixation methods on the motion unit were compared according to the force and activity of the vertebral body motion unit in the flexion, extension, lateral flexion and rotation states, respectively. RESULTS AND CONCLUSION: (1) The results of finite element verification showed that the model could well simulate the physiological activity of lumbar vertebrae in osteoporosis patients. (2) In the flexion and extension states, the maximum stress of the internal fixator was similar to that of the traditional trajectory screw group, but the maximum stress of the nail rod system in the cortical bone trajectory combined with pedicle screw group was greater than that in the traditional trajectory screw group in the lateral flexion and rotation states. In lateral flexion, the cortical bone trajectory combined with pedicle screw group increased by 11.5% compared with traditional trajectory screw group, and in rotation, the cortical bone trajectory combined with pedicle screw group increased by 25.2% compared with traditional trajectory screw group. The maximum equivalent stress of cage in cortical bone trajectory combined with pedicle screw group was greater than that in traditional trajectory screw group, and the maximum equivalent stress of cage in cortical bone trajectory combined with pedicle screw group was 17% higher than that in traditional trajectory screw group during lateral flexion and 15% higher than that in rotation. (3) Two groups of model after in static load, bending forward, stretch, lateral flexion and rotation condition, intervertebral range of motion, two kinds of internal fixation devices can provide similar stability. (4) In general, both fixation methods can enhance the fixation strength of the lumbar fusion segment and provide similar stability, but cortical bone trajectory combined with pedicle screw internal fixation can further enhance the mechanical strength of the fusion segment and provide a better fusion stress environment. [ABSTRACT FROM AUTHOR]

: In patients undergoing interbody fusion surgery, the proportion of patients with osteoporosis is increasing. Osteoporosis has an impact on the fixation effect of screw rod system, such as extraction of pedicle screw, failure of interbody fusion surgery, and so on. The use of bone cement screw channel augmentation surgery has effectively improved this problem. OBJECTIVE: To compare biomechanical changes of lumbar spine strengthened with different bone cement nail channels under the condition of low bone mineral density by finite element method. METHODS: A finite element model of L4-5 vertebral body functional unit was established according to the extracted CT images. All vertebral body bone materials were set as osteoporotic state. Models of non-cemented screw channel augmentation, all-bone cement screw channel augmentation, L4 vertebral body bone cement screw channel augmentation, unilateral bone cement screw channel augmentation, and cross bone cement screw channel augmentation were established. The lower surface of the L5 segment was fixed. The upper surface of the L4 segment was subjected to a vertical downward load of 500 N and a moment of 7.5 N•m. The von-Mises stresses of the screw rod system, vertebral body screw channel and bone cement mass were detected. RESULTS AND CONCLUSION: (1) Compared with the non-cemented screw channel fixation group, the effect of the bone cement augmentation groups on the von-Mises stress of the screw-rod system was very small. (2) The von-Mises stress of the bone-cemented screw channel in each group was generally smaller than that of the non-cemented screw channel group; the more significant one was the all-bone cement screw channel augmentation group. All-bone cement screw channel augmentation group had a similar effect to the cross bone cement augmentation group. The decrease of von-Mises stress in the unilateral bone cement screw channel augmentation group was lower than that of the cross bone cement augmentation group. The L4 vertebral bone cement screw channel augmentation group had no obvious effect on the reduction of the screw channel von-Mises stress, and the screw channel von-Mises stress was higher than that of the non-cemented screw channel fixation group during scoliosis and rotation. (3) Under various motion states, the von-Mises stress of bone cement in all-bone cement screw channel augmentation group was the minimum value. The von-Mises stress of bone cement in the unilateral bone cement screw channel augmentation group and the cross bone cement screw channel augmentation group was slightly greater than that of the all-bone cement screw channel augmentation group. (4) These results showed that the bone cement screw channel augmentation technology effectively reduces the stress concentration effect of the screw rod fixation system on the vertebral screw channel, optimizes the stress distribution of the internal fixation system, and reduces the risk of screw loosening relative to the vertebral body. The effects of different bone cement screw channel augmentation methods are different, but the overall trend is the reduction of screw channel stress. Among them, the most effective fixation methods are all-bone cement screw channel augmentation and cross bone cement screw channel augmentation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of TRB3 gene knockout on skeletal muscle atrophy and fibrosis in diabetic mice.Methods: Thirty TRB3 knockout(TRB3-/-) mice and 30 C57/BL6J mice were randomly divided into 4 groups, including TRB3 knockout diabetes model group(group A), normal TRB3 knockout control group(group B), normal control group(group C) and diabetes model group(group D). Normal control group mice were fed standard rat feed, and diabetic mice were injected intraperitoneally with low dose of streptozotocin to establish diabetic mice model. The forelimb grip strength test, suspension grid test and muscle function test were performed. Meanwhile, the levels of bone microstructure, anti-type I collagen and anti-type III collagen, atrophy gene MuRF1 and atrophy gene atrophy 1 were determined. Results: The hand grip strength of group A, B and D was significantly lower than that of group C, and the hand grip strength of group D was the lowest(P＜0.05). The inverted hanging time of mice in groups A, B and D was significantly lower than that in group C, and the inverted hanging time of mice in group D was the shortest(P＜0.05). CSA value of muscle function in groups A, B and D was significantly lower than that in group C, and CSA value of muscle function in group D was the lowest(P＜0.05). The bone microstructure indexes BMD, BV/TV, Tb.N and Tb.Th in groups A, B and D were significantly lower than those in group C, and the lowest values were in group D(P＜0.05). The values of Tb.Sp and SMI in group C were significantly higher than those in group C, and the values in group D were the highest(P＜0.05). The levels of anti-type I collagen and anti-type III collagen in groups A, B and D were significantly higher than those in group C, and the levels of anti-type I collagen and anti-type III collagen in group D were the highest(P＜0.05).The levels of atrophy gene MuRF1 and Atrogin-1 in groups A, B and D were significantly higher than those in group C, and the levels of Mu RF1 and Atrogin-1 in group D were the highest(P＜0.05). Conclusion: TRB3 gene knockout significantly reduced skeletal muscle atrophy and fibrosis and increased bone strength in diabetic mice. [ABSTRACT FROM AUTHOR]

Objective To explore the distribution of iliac vessels in the anterior lower lumbar spine using CT angiography, and to provide vascular anatomical references for anterior lower lumbar surgery. Methods Select 100 male and 100 female patients who underwent abdominal CT angiography at Guizhou Provincial People′s Hospital from June 2016 to November 2018 for observation and measurement research;（1）Observe and record the distribution of the bifurcation points of the abdominal aorta and the confluence points of the common iliac vein;（2）Measure the distance from the vertex of the angle between the left common iliac vein and the right common iliac artery to the upper edge of the L5-S1 intervertebral space, and the distance between the left common iliac vein and the inner edge of the right common iliac artery at the upper and lower edges of the L5-S1 intervertebral space. Results （1）64% of the L4 vertebral body is flat at the bifurcation point of the abdominal aorta. The confluence point of the common iliac vein accounts for 42% of the L4 vertebral body and 40% of the L4-5 intervertebral space.（2）Abdominal aortic bifurcation angle：（51.01 ± 9.24）° for males, （50.51 ± 7.92）° for females;The confluence angle of the common iliac vein is（58.82 ± 11.81）° for males and（62.47 ± 12.46）° for females;The angle between the left common iliac vein and the right common iliac artery is（64.92 ± 12.07）° for males and（68.73 ± 13.87）° for females. （3）When the confluence point of the common iliac vein is level with the L4 vertebral body, L4 5 intervertebral space, and L5 vertebral body：① The distance from the vertex of the angle between the left common iliac vein and the right common iliac artery to the upper edge of the L5-S1 intervertebral space is（26.51 ± 8.11）mm, （16.18 ± 6.70）mm, and（7.82 ± 4.26）mm, respectively;② The distances between the left common iliac vein and the medial edge of the right common iliac artery from the L5-S1 intervertebral space are（32.52 ± 9.95）mm, （28.63 ± 11.48）mm, and（16.27 ± 7.71）mm, respectively The distance between the left common iliac vein and the inner edge of the right common iliac artery at the lower edge of the L5-S1intervertebral space is（43.88 ± 9.86）mm, （41.55 ± 11.05） mm, and（33.17 ± 9.40） mm, respectively. ④ The area of the "iliac vascular triangle" is （486.32 ± 246.26）mm2, （263.94 ± 178.47）mm2, and（85.49 ± 71.45）mm2, respectively The surgical windows for the L5-S1 intervertebral space are（496.98 ± 114.48）mm2, （488.89 ± 127.69）mm2, and（344.32 ± 166.63）mm2, respectively. Conclusion （1）There are significant anatomical changes at the bifurcation point of the abdominal aorta and the confluence point of the common iliac vein;The bifurcation point of the abdominal aorta is mostly flat on the L4 vertebral body, and the confluence point of the common iliac vein is mostly flat on the L4 vertebral body and the L4-5 intervertebral space.（2）When the confluence point of the common iliac vein is level with the L4 vertebral body, there is sufficient vascular safety zone in front of the lower lumbar spine for surgical operation;When the confluence point of the common iliac vein is located in the L4-5 intervertebral space, there is a certain vascular safety zone in front of the lower lumbar spine for surgical operation;When the confluence point of the common iliac vein is flat on the L5 vertebral body, the safety zone of the anterior blood vessels of the lower lumbar spine cannot meet the surgical requirements at this time.（3）When the confluence point of the common iliac vein is level with the L4 vertebral body and the L4-5 intervertebral space, there is sufficient surgical vascular safety zone in the anterior L5-S1 intervertebral space, but the vascular safety zone is gradually reduced. Preoperative CT angiography examination to clarify the vascular safety zone is helpful for surgical safety. [ABSTRACT FROM AUTHOR]

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BACKGROUND: As the central axis of the human body, the spine is the pillar of the body and has functions such as weight-bearing, shock absorption, protection and movement. When spinal disorders occur, it often leads to serious consequences such as appearance deformity, back pain, lower extremity pain and even paralysis. The application of finite element method in spine surgery can carry out modeling and mechanical analysis of spine diseases, and provide a research method for the pathogenesis, treatment plan and prognosis of spine diseases. OBJECTIVE: To review the application status of finite element analysis method in various types of spinal diseases. METHODS: The articles about finite element analysis and spinal diseases published in PubMed, CNKI and Wanfang databases were searched by computer. The articles were published from 2012 to 2022. The search terms were: “finite element method, spine, scoliosis, spinal fracture, intervertebral disk degeneration, osteoporosis, biomechanics, review” in Chinese and English. Finally, 53 articles were included for review. RESULTS AND CONCLUSION: (1) Finite element analysis method is to use mathematical approximation to simulate the real physical system (geometry and load conditions). Using simple interacting elements (i.e., cells), a finite number of unknowns can be used to approximate a real system with infinite unknowns. (2) Finite element analysis has become a powerful tool in the field of spine surgery, enabling surgeons to more intuitively understand the biology of the spine under physiological and pathological conditions. (3) The construction of a patient’s personalized finite element model can be used for patient condition assessment and preoperative and intraoperative planning, so as to avoid nerve, muscle and vascular damage. (4) Since the finite element analysis method is only a digital simulation of real conditions, it cannot accurately simulate the actual situation in the body, and there are many features that cannot be represented by the finite element method. (5) At present, most spine models are studied with adult spine stiffness properties, which lack the material properties of young spines, which can reduce the accuracy of research on developmental spine diseases. Spine models of different age groups should be established to study the material properties of spines of different age groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lumbar spinal stenosis is the most common degenerative disease of the spine in the elderly, and its symptoms and postoperative efficacy are related to both local sequence and overall balance. However, the reasonable range of spinal-pelvic sagittal parameters in this population is unknown. OBJECTIVE: To determine and validate the acceptable interval of sagittal lumbo-pelvic parameters for lumbar spinal stenosis patients. METHODS: A total of 376 patients with lumbar spinal stenosis who were admitted to Peking University People's Hospital from June 2016 to December 2019 were selected. According to the scoring principle of propensity matching and the ratio of (2-3):1, they were divided into a derivation cohort group (n=276) and a validation cohort group (n=100). Imaging examinations were performed preoperatively and at the final postoperative follow-up to obtain sagittal spinopelvic parameters, containing thoracolumbar kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt and sagittal vertical axis. | Pelvic incidence - lumbar lordosis |, pelvic tilt and sagittal vertical axis were seen as the main parameters. Quality-of-life was evaluated by the Oswestry disability index, which contained four quarters orderly: mild, sub-mild, sub-severe and severe dysfunction. The reasonable threshold of parameters corresponding to Oswestry disability index was determined by both linear regression and logistic regression. Cases in the validation cohort were used to verify the results concluded from derivation cohort. RESULTS AND CONCLUSION: (1) Oswestry disability index got improvement in the final follow-up. At baseline, Oswestry disability index was positively correlated to | pelvic incidence - lumbar lordosis | (P=0.011) while at final Oswestry disability index was positively correlated to | pelvic incidence - lumbar lordosis | and pelvic tilt (P=0.029, P=0.008) but not correlated to sagittal vertical axis in the derivation cohort. (2) Mild, sub-mild, sub-severe and severe dysfunctions of Oswestry disability index were 15-35, 36-39, 40-43, and 44-50 preoperatively, but 0-4, 5-8, 9-12, and 13-40 in the final follow-up, respectively in the derivation cohort. Multiple regression analysis showed that the independent factor affecting preoperative Oswestry disability index was | pelvic incidence - lumbar lordosis |, with Oswestry disability index =0.19×| pelvic incidence - lumbar lordosis |+36.9 and the mean threshold of preoperative | pelvic incidence - lumbar lordosis | was 10.7°. At final, pelvic tilt was the influencing factor of Oswestry disability index and | pelvic incidence - lumbar lordosis | was the influencing factor of pelvic tilt with Oswestry disability index =0.21× pelvic tilt +3.16 and pelvic tilt =0.60×| pelvic incidence - lumbar lordosis |+12.22. (3) The mean threshold of postoperative | pelvic incidence - lumbar lordosis | was 16.0° and pelvic tilt was 23.1° by both linear regression and logistic regression. (4) In validation cohort, Oswestry disability index in patients less than the threshold of | pelvic incidence - lumbar lordosis | was superior to cases with over-larged | pelvic incidence - lumbar lordosis | (P=0.046). (5) It is concluded that | pelvic incidence - lumbar lordosis |=16.0° was probably the reasonable sagittal range for lumbar spinal stenosis with posterior surgery and we should be tolerate to spino-pelvic matching for this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Volume of disc herniation is an important measurement index for quantitative evaluation of disc herniation degree. Previously, the volume of cervical disc herniation that was completely absorbed after cervical microendoscopic laminoplasty was found unable to be confirmed by volume quantitative measurement. The reason was related to the fact that some tissues posterior to the vertebral body that could not be absorbed were included during measurement. OBJECTIVE: To compare and analyze the effect of inclusion and removal of the posterior vertebral structure on the volume measurement of herniated lumbar intervertebral discs, and to preliminarily observe the early changes of the volume of herniated intervertebral discs after lumbar microendoscopic laminoplasty. METHODS: Totally 98 patients with lumbar disc herniation (191 intervertebral discs) in First Affiliated Hospital of Zhengzhou University were enrolled. Lumbar spine MRI images of patients before and 1 week after lumbar microendoscopic laminoplasty were collected. The volumes were measured using PACS software. There were two measurement methods: one group included the posterior vertebral structure and the other group removed the posterior vertebral structure. The reduction rate, reduction ratio, unchanged ratio, enlargement ratio, and enlargement rate of the herniated lumbar intervertebral discs before and after the operation under the two measurement methods, and the absorption ratio and absorption rate of the herniated lumbar intervertebral disc under two measurement methods at 1 week after operation were compared. RESULTS AND CONCLUSION: (1) In the inclusion group, 123 disc herniations with reduced volume after lumbar microendoscopic laminoplasty (reduction ratio of 64.4%, maximum reduction rate of 34.17%); 45 disc herniations were unchanged in volume, ratio of 23.6%; 23 disc herniations showed increase in volume, increase ratio of 12%, and maximum increase rate of 59.9%. In the exclusion group, 143 disc herniations were reduced in volume after lumbar microendoscopic laminoplasty (reduction ratio of 74.9%, maximum reduction rate of 51.47%), 28 disc herniations were shown unchanged in volume, constant ratio of 14.7%, and 20 disc herniations increased in volume, increase ratio of 10.5%, maximum increase rate of 60.26%. (2) The absorption ratio and absorption rate of herniated lumbar intervertebral disc were lower in the inclusion group than that in the exclusion group (P < 0.01). (3) It is concluded that the measurement method of disc herniation volume by exclusion of posterior vertebral structure is closer to the actual state with a high accuracy. Lumbar microendoscopic laminoplasty can induce the herniated lumbar disc to spontaneously absorb in the early stage postoperatively. [ABSTRACT FROM AUTHOR]

BACKGROUND: A novel one-hole split endoscope technique has been used in the treatment of lumbar spondylolisthesis, but there is no literature on the safety, feasibility and effectiveness of this technique. OBJECTIVE: The relationship between bone markers and L4, L5 nerves and intervertebral space position is observed by lumbar CT three-dimensional reconstruction to evaluate the safety of intervertebral fusion with one-hole split endoscopic L4/5 spondylolisthesis. METHODS: Totally 26 patients with grade I L4/5 spondylolisthesis (spondylolisthesis group) and 26 volunteers (normal group) underwent lumbar CT scanning. Data were input into Mimics 17.0 software to measure the following parameters: (1) vertical distance. a, b: The intersection of the medial edge of the articular surface at the coronal position of the upper endplate of L5 and the upper articular process of L5 (N) to the highest point of the posterior edge of the mastoid process (R) and the tip of the superior articular process of L5 (S); c: point of intersection between L4 inferior articular process tip (X) and N on sagittal plane and L4 inferior endplate (M). (2) Horizontal distance. d: intersection point between R and N and lower edge of L4 outlet nerve root (N1); e: intersection point of transverse section from R to M with lower edge of L4 outlet nerve root (M1); f: intersection point of N to N cross section and lateral edge of nerve tissue (N2); g: N1 to N2; h: M1 to M2; i: N2 to M1; j: Posterior edge of articular surface (R1) in sagittal position of superior articular process from M1 to L5. (3) Nine patients underwent a one-hole split splinterbody endoscopic interbody fusion with bone grafting. The outcomes were evaluated by visual analogue scale for lumbar and leg pain, Japanese Orthopaedic Association Evaluation score, Oswestry Disability Index, and 36-item Short-Form scale. RESULTS AND CONCLUSION: (1) There was no significant difference between b and c in the spondylolission group (P > 0.05), indicating that only equal amounts of upper and lower articular processes and/or laminae were removed to expose the L4/5 disc. (2) There were statistically significant differences in d and e between the two groups (P < 0.05), so surgery should be planned according to pathological changes. (3) There were no significant differences in f, g and i between the two groups (P > 0.05), indicating that the degenerative spondylolisthesis did not change the position relationship between walking and outlet nerve, and it was safe to implant the fusion device in the constant transverse workspace of both groups. (4) Visual analogue scale score, Japanese Orthopaedic Association Evaluation score, Oswestry Disability Index and 36-item Short-Form scale score of nine patients with lumbar spondylolisthesis were significantly improved at the last follow-up compared with the data before operation and 6 months after operation (P < 0.05). (5) Safe fenestrating range: S down (11.78±2.34) mm to N, X up to L4 lower endplate to expose the upper and lower margins of the intervertebral disc. Opening the window outward to M1 would not damage L4 nerve; decompress inwards to prevent damage to N and its adjacent L5 nerves. Understanding the technical features of the novel one-hole split endoscope technique can help improve surgical safety and efficacy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Screw loosening is a common complication of lumbar transpedicle screw fixation in patients with osteoporosis. It is a difficult problem for clinicians to accurately choose the right time to strengthen pedicle screw fixation. OBJECTIVE: To investigate the correlation between hand feel and screw torque in the process of lumbar pedicle screw insertion, and initially screen the visual simulation score of hand feeling and the range of torque for bone cement reinforcement. METHODS: A total of 34 patients with degenerative diseases of lumbar spine who underwent lumbar internal fixation fusion in Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine from January to December 2020 were included. During the operation, the operator’s hand feeling, visual simulation score of hand feeling and the maximum screw torque value were recorded, and the screw loosening was evaluated periodically after the operation. All 188 screws were divided into groups with small, average, large and laborious hand resistance according to hand feeling. Hand score and torque value among the four groups were compared, and the correlation between torque value and hand feeling was analyzed. RESULTS AND CONCLUSION: (1) The hand feeling resistance group of screw insertion was reinforced with bone cement. The feeling score and torque value of this group were significantly lower than those in the other three groups (P ≤ 0.001, P ≤ 0.05), and the torque value was strongly positively correlated with the feeling of screw insertion. (2) The results showed that hand feeling score and torque value of pedicle screw could assist the surgeon to judge the stability of screw. When hand feeling score ≤ 3 and torque value ≤ 1.3 N·m, the possibility of screw loosening after operation was greater, and bone cement fixation was recommended. [ABSTRACT FROM AUTHOR]

To investigate the effects of Tofacitinib citrate tablets combined with Xianling Gubao capsule on serum inflammatory cytokines, bone strength and bone metabolism levels in patients with rheumatoid arthritis (RA) complicated with osteoporosis. 80 patients with RA complicated with osteoporosis who were diagnosed and treated in Lianyungang Hospital Affiliated to Xuzhou Medical University from August 2021 to August 2022 were included.The patients were divided into the control group (Tripterygium wilfordii polyglycosides tablets combined with Xianling Gubao capsule) and the experimental group (Tofacitinib citrate tablets combined with Xianling Gubao capsule) according to the random number table method, with 40 cases each. The efficacy, inflammatory cytokines, bone strength and bone metabolism indexes were compared in the two groups, and the incidence of adverse reactions was observed in the two groups. The total clinical effective rate in the experimental group was higher than that in the control group (P<0.05). Macrophage colony-stimulating factor (M-CSF), interleukin-1β(IL-1β) and cyclooxygenase-2 (COX-2) in the experimental group after treatment were lower than those in the control group (P<0.05). The cross sectional area (CSA), cross sectional moment of inertia (CSMI), cross sectional coefficient (Z) and cortical thickness (CT) in the experimental group after treatment were higher than those in the control group (P<0.05). After treatment, the N-terminal intermediate molecule of osteocalcin (N-MID), the amino terminal extension peptide(T-PINP), osteocalcin (BGP) and carboxyterminal propeptide of type I procollagen (PICP) in the experimental group were higher than those in the control group at the same period, and the β-collagen degradation products (β-CTX) was lower than that in the control group at the same period (P<0.05). Lumbar spine BMD and femoral neck BMD increased after treatment in both groups compared with before treatment, and were higher in the experimental group than in the control group during the same period (P<0.05). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid arthritis patient condition (DAS28) scores decreased in both treatment groups, and were lower in the experimental group than in the control group during the same period (P<0.05). There was no significant difference in the incidence of adverse reactions in the two groups (P>0.05). Tofacitinib citrate tablets combined with Xianling Gubao capsule is applied to the patients with RA with osteoporosis, which can effectively regulate the bone metabolism level, enhance bone strength and reduce the serum inflammatory cytokines level. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coping with osteoporosis is an important part of China's response to population aging. Early prevention, early detection and early intervention of osteoporosis were considered to play a very important role in improving prognosis. OBJECTIVE: To analyze the relevant factors affecting the difference in bone mineral density of bilateral proximal femur and to explore the methods to improve the diagnostic performance of dual-energy X-ray absorptiometry. METHODS: The clinical data of 207 subjects who underwent dual-energy X-ray absorptiometry bone mineral density examination in Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January to July 2021 were retrospectively analyzed. After grouping, differences between groups and related factors leading to differences were analyzed. Multivariate Logistic Regression Equation was utilized for correction. Receiver operating characteristic curve was used to predict performance. RESULTS AND CONCLUSION: (1) There was no significant correlation between the differences in the bone mineral density of the bilateral femoral necks (higher than the least significant change) and left-right handedness, sleep orientation preference (all P > 0.05). (2) For postmenopausal women and men over the age of 50 years, when the left femoral neck T value was -0.9 or -1.0 (the difference between the bone mineral density value and the bone mineral density value when the T value was -1.1 was greater than the least significant change), the right-side examination could significantly improve the diagnosis rate of osteopenia (P < 0.001). Multivariate logistic regression analysis showed that it was an independent influencing factor after correcting traditional factors, OR=0.001, 95%CI (0.000-0.326), P=0.03; receiver operating characteristic curve predicted its efficacy in altering the diagnosis: area under the curve=0.765, 95%CI (0.536- 0.993), P=0.018. (3) It is concluded that for postmenopausal women and men over 50 years old, when the T value of the left femoral neck was -0.9 or -1.0 (the difference between the bone mineral density value and the bone mineral density value when the T value was -1.1 was greater than the least significant change), the dual-energy X-ray absorptiometry bone density test of the lumbar spine and bilateral proximal femur could significantly improve the diagnosis rate of bone loss compared with the lumbar and left side examination. [ABSTRACT FROM AUTHOR]