Objective To evaluate the clinical effect of arthroscopic treatment of femoroacetabular impingement syndrome(FAI) for patients over 50 years old,and explore the occurrence regularity and treating rules for such a disease.Methods The clinical data of 71 patients(78 hips with FAI) over 50 years old who underwent arthroscopic treatment for FAI in our department between May 2012 and May 2017 were studied retrospectively.Physical examination,X-ray and CT 3D scans were made preoperatively for explicit diagnosis.The follow-up period ranged from 6 to 66 months,with an average of 31.78 ± 18.07 months.Every patient had a joint space greater than 2 mm,and a grade Ⅰ or Ⅱ hip osteoarthrosis according to the Trnnis scale.Under the hip arthroscopy the synovial hyperplasia was cleaned,the damaged labrum and cartilage were repaired,and the femoroacetabular hyperplasia and the impingement factors were removed to restore the normal shape of femoroacetabular.The joint clearance,changes ofthe alpha angle when at Dunn position and centre edge(CE) angle at normotopia on the X-ray,the intraoperative injuries of cartilages and glenoid labrum and surgical satisfaction and complications were measured and recorded.The modified Harris hip score(mHHS) and visual analogue scale(VAS) were used to evaluate the hip function recovery and pain relief of patients.Results The average age of the patients was 55.15 ± 5.02 years old,ranging from 50 to 69.Among the 23 males and 48 females,there were 33 left hips with FAI and 45 right hips with FAI.The average preoperative joint clearance was 4.81 ± 0.87 mm,and all incisions were healed by first intention after the treatment.The average α angle of the patients decreased from 50.11 ± 4.75 to 42.72 ± 4.7 degrees after the treatment,with the α angle of 7 patients(8.97％) bigger than 55 degree,and that of 40 patients(51.28％) smaller than 50 degree.The average CE angle decreased from 36.54 ± 9.14 degrees to 35.19 ± 8.55 degrees after the treatment,with that of 27 patients(34.62％) bigger than 40 degrees.Before the treatment,the main clinical manifestations were hip pain and swelling,including 36 cases(46.15％) with hip joint lock,70 (89.74％) with groin tenderness.Moreover,75 cases(96.15％) were positive in hip adduction internal rotation test(FADIR) and 64 cases(83.33％) were positive in the hip abduction and external rotation impingement test.However,the pain was relieved or disappeared after the treatment.The average VAS score decreased significantly from preoperative 4.42 ± 1.42 points to 1.31 ± 1.28 at the last follow-up,while the average mHHS score increased significantly from preoperative(52.4 ± 19.38) points to(81.72 ± 10.82) during the last follow-up,and the difference was statistically significant (P＜0.01).Significant improvement was observed in the mHHs and VAS scores of 89％ patients(P＜0.01).1 patient(1.28％) underwent hip replacement during the follow-up period.No serious complications occurred.Conclusion In most cases,arthroscopic treatment of FAI in old patients(over 50 years old),who were with osteoarthrosis and hip labrum injury,can significantly improve the joint function and relieve pain.It is a treatment with safety.

OBJECTIVE:To compare the efficacy and safety of terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures through a Meta-analysis. METHODS:By searching PubMed,Cochrane Library,EMbase,CNKI,WanFang and VIP databases,18 randomized controlled studies on terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures were included according to inclusion and exclusion criteria.Endnote X9 software was used to manage the literature and Revman 5.3 software was used to perform a Meta-analysis on the extracted data.The incidences of vertebral fracture,non-vertebral fracture and adverse reaction in postmenopausal osteoporosis patients treated with terlipatide and bisphosphate were analyzed. RESULTS:A total of 18 randomized controlled studies were included,of which 10 were of medium and high quality and 8 were of low quality.Meta-analysis results showed that the fracture incidence in the teriparatide group[risk ratio(RR)=0.56,95%confidence interval(CI):0.48-0.66,P＜0.000 01]was lower than that in the bisphosphonate group,and teriparatide was superior to alendronate in preventing fractures in postmenopausal women with osteoporosis(RR=0.50,95%CI:0.35-0.69,P＜0.000 1)and other bisphosphonates(RR=0.58,95%CI:0.49-0.70,P＜0.000 01).During the follow-up over 18 months,teriparatide was superior to bisphosphonates in preventing fractures in postmenopausal women with osteoporosis(RR=0.56,95%CI:0.48-0.69,P＜0.000 01).In addition,we found that teriparatide was superior to bisphosphonates in preventing vertebral fractures(RR=0.48,95%CI:0.37-0.62,P＜0.000 01)and non-vertebral fractures(RR=0.63,95%CI:0.51-0.78,P＜0.000 1)in postmenopausal women with osteoporosis.Teriparatide was superior to bisphosphonates in increasing lumbar bone density[odds ratio=4.16,95%CI:2.96-5.36,P＜0.000 1)and femoral neck bone density(odds ratio=1.02,95%CI:0.04-2.01,P=0.04).There was no significant difference in adverse reactions between teriparatide and bisphosphonates(RR=0.95,95%CI:0.85,1.06,P=0.37). CONCLUSION:Teriparatide is superior to bisphosphonates in preventing vertebral and non-vertebral fractures in postmenopausal women with osteoporosis,but the safety and adverse drug reactions of teriparatide and bisphosphonates are basically similar.Teriparatide is superior to bisphosphonate in preventing fracture and improving lumbar and femoral neck bone density regardless of short-term(＜18 months)or long-term(≥18 months)use.

BACKGROUND:Studies have exhibited that symmetrical distribution and effective dose of bone cement can reduce postoperative vertebral refractures and help improve outcomes,but obtaining better distribution and dose of bone cement during percutaneous vertebroplasty remains an issue for surgeons. OBJECTIVE:To investigate the risk factors of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture,and to analyze the correlation between these factors and recurrent fractures of the operative vertebral body and adjacent vertebral bodies after percutaneous vertebroplasty. METHODS:111 patients who underwent unilateral approach percutaneous vertebroplasty in Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2021 were screened and divided into fracture group(n=17)and non-fracture group(n=94)according to whether refracture was observed during follow-up.The following variables were reviewed in both groups:Gender,age,body mass index,operation time,menopause age,bone cement distribution index,bone density T value,bone cement dose,location of bone cement distribution,percutaneous vertebroplasty stage,past history,adverse reactions and disc cement leakage of patients.These variables were analyzed by univariate analysis.The statistically significant factors were replaced by a binary Logistic regression model to analyze the correlation with vertebral refracture after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis demonstrated that after percutaneous vertebroplasty,vertebral refracture was associated with disc cement leakage(P=0.000),cement dose(P=0.049),and cement distribution location(P=0.017).(2)Binary Logistic regression revealed that bone cement leakage(P=0.000),cement dose(P=0.031),and location of cement distribution(P=0.015)were risk factors for recurrent fracture of the operative vertebral body and adjacent vertebral body after percutaneous vertebroplasty.Compared with cement distribution types I,II,and III,the risk of recurrent fracture in the operative and adjacent vertebrae was higher in cement distribution types IV and V(OR=36.340,P=0.016;OR=27.755,P=0.017).(3)It is concluded that recurrent fractures of the surgically operated vertebral body and adjacent vertebral bodies are caused by the interaction of multiple risk factors.Bone cement distribution and bone cement leakage were independent risk factors.Recurrent fractures of the operative vertebra and adjacent vertebrae are more likely when the cement is distributed in type IV and type V.Surgeons should fully assess these risk factors before surgery and develop targeted prevention and treatment strategies to help reduce the risk of future refractures.