OBJECTIVE: Pedicle screw fixation for spine arthrodesis is a useful procedure for the treatment of spinal disorders. However, instrument failure often occurs, and pedicle screw loosening is the initial step of a range of complications. The authors recently used a modified transpedicular polymethylmethacrylate (PMMA) screw augmentation technique to overcome pedicle screw loosening. Here, they report on the laboratory testing of pedicle screws inserted using this modified technique. METHODS: To evaluate pullout strengths three cadaveric spinal columns were used. Three pedicle screw insertion methods were utilized to compare pullout strength; the three methods used were; control (C), traditional transpedicular PMMA augmentation technique (T), and the modified transpedicular augmentation technique (M). After control screws had been pulled out, loosening with instrument was made. Screw augmentations were executed and screw pullout strength was rechecked. RESULTS: Pedicle screws augmented using the modified technique for pedicle screw loosening had higher pullout strengths than the control (1106.2+/-458.0 N vs. 741.2+/-269.5 N; p=0.001). Traditional transpedicular augmentation achieved a mean pullout strength similar to that of the control group (657.5+/-172.3 N vs. 724.5+/-234.4 N; p=0.537). The modified technique had higher strength than the traditional PMMA augmentation technique (1070.8+/-358.6 N vs. 652.2+/-185.5 N; p=0.023). CONCLUSION: The modified PMMA transpedicular screw augmentation technique is a straightforward, effective surgical procedure for treating pedicle screw loosening, and exhibits greater pullout strength than traditional PMMA transpedicular augmentation. However, long-term clinical evaluation is required.
Arthrodesis ; Cadaver ; Osteoporosis ; Polymethyl Methacrylate* ; Postoperative Complications ; Prosthesis Failure ; Spine

Helicobacter pylori (HP) is an infectious pathogen which can easily infringe gastric mucosa. If the body is infected by HP, it can release cytokines, such as TNF-alpha, IL-1 and IL-6. These cytokines can regulate the absorption and transformation of bone, promote the formation of osteoclast, and then cause localized or systemic osteoporosis. HP infection may decrease the level of estrogen and vitamin B12, which is considered as a risk factor for osteoporosis. Helicobacter pylori infection is related with the occurrence of gastritis, peptic ulcer and gastric malignancies, and these diseases and treatments are associated with osteoporosis. Meanwhile the application of proton pump inhibitor (PPI) can influence absorption of calcium, decrease the level of serum calcium and increase the risk of fracture. Gastrostomy may cause bone metabolism disorders.
Helicobacter Infections ; complications ; drug therapy ; Helicobacter pylori ; Humans ; Osteoporosis ; etiology

OBJECTIVE: To investigate the incidence of lower extremity deep vein thrombosis (DVT) before surgery in patients with spinal fracture and analyze its risk factors. METHODS: The clinical data of 1 046 patients with spinal fracture who underwent surgery from October 2017 to December 2020 were retrospectively analyzed, including patient's age, gender, body mass index (BMI), smoking history, complications, the time from injury to diagnosis of DVT, blood index results on admission. The complications included hypertension, osteoporosis, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), anemia, obesity, hypokalemia, hyponatremia, hypoproteinemia, renal insufficiency, spinal cord injury;blood index results on admission included hematocrit (HCT), creatinine (Cre), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein(LDL), D-dimer(D-D), fibrin/fibrinogen degradation products(FDP), and C-reactive protein(CRP). The patients were divided into group according to whether DVT was diagnosed by the lower extremity venous ultrasonography after admission to pre-operation. The patients with DVT were set as the DVT group, and the patients without DVT were set as the non-DVT group. First, the above-mentioned possible risk factors were analyzed by univariate analysis, and then the risk factors of DVT before spinal fracture surgery were analyzed by multivariate Logistic regression. RESULTS: Among 1 046 patients with spinal fracture, 137 had DVT before operation and 909 had no DVT. There were significant differences in age, the incidence of preoperative osteoporosis, diabetes, anemia, hypoalbuminemia, the levels of LDL, plasma D-D, FDP, and CRP between the two groups (P<0.05). Multivariate Logistic regression analysis showed that osteoporosis (OR=3.116, 95%CI:1.816-5.346, P<0.001), hypoproteinemia (OR=2.508, 95%CI:1.583-3.974, P<0.001), preoperative serum LDL>4.645 mmol/L(OR=2.586, 95%CI:1.394-4.798, P<0.001), plasma D-D>558.00 ng/ml (OR=23.916, 95%CI:15.108-37.860, P<0.001), FDP>13.81 µg/ml(OR=3.873, 95%CI:2.614-5.739, P<0.001) and age were independent risk factors for the occurrence of DVT before spinal fracture surgery, and the incidence of DVT in patients aged 36-50, 51-65 and over 65 years was 2.49, 2.59 and 4.02 times of those aged 18-35 years, respectively. CONCLUSION The incidence of preoperative DVT in patients with spinal fracture is 13.10%(137/1 046). Preoperative complicating osteoporosis, hypoalbuminemia, serum LDL>4.645 mmol/L, plasma D-D> 558.00 ng/ml, FDP> 13.81 µg/ml and age are risk factors for DVT. And the older the patient, the higher the risk of DVT.
Fractures, Bone/complications* ; Humans ; Hypoalbuminemia/complications* ; Incidence ; Osteoporosis/complications* ; Prevalence ; Retrospective Studies ; Risk Factors ; Spinal Fractures/surgery* ; Venous Thromboembolism

PURPOSE: To compare the functional and radiological outcomes of volar plating to that of external fixation for treating unstable osteoporotic distal radius fracture. MATERIALS AND METHODS: From March 2006 to March 2008, 36 patients with osteoporosis over 60-year old were selected for this study. They were divided into two groups; group I (open reduction and internal fixation with volar fixed angle plate) and group II (closed reduction and external fixation). Clinical outcomes and radiologic outcomes were evaluated. RESULTS: There was no statistical difference between group I and group II in range of motion and DASH score, BMD score. However, the grip strength and PRWE score were found to be higher in group II (p<0.05). In radiologic evaluation, group I showed higher radial inclination, volar tilting angle (p<0.05). CONCLUSION: Internal fixation using Volar-fixed Angle Plate seems to give more stable fixation for distal articular fragments compared to external fixation. it could allow early postoperative exercise and could result in low incidence of postoperative complication such as pin track infections and joint stiffness. Therefore, the internal fixation could be more desirable treatment method to manage unstable distal radius fracture.
Hand Strength ; Humans ; Incidence ; Joints ; Osteoporosis ; Postoperative Complications ; Radius ; Radius Fractures ; Range of Motion, Articular ; Track and Field

OBJECTIVE: The authors report the microsurgical anterolateral tunnel approach for the treatment of the cervical disc diseases and its postoperative surgical results. METHODS: All surgical procedures followed the method of classical microsurgical anterior discectomy. Small tunnel(7-8mm) was made on the disc space reaching to the posterior longitudinal ligament. The disc materials and bony spurs were removed through this tunnel. Thirty-one patients of cervical disc herniation(24 cases with pure disc herniation, 7 cases with combined cervical spondylosis) were evaluated on the symptoms, conformation in plain X-ray, C-T, and MRI. The follow up time was over 2 years . RESULTS: Postoperatively the result(following the out come scale) was excellent and good in Twenty-nine patients. One with fair result showed remnant disc particle and spur and another one is combined with cord contusion. One patient with lesion in C 3-4 space and two cervicothoracic junction showed excellent result. Two patients with osteoporosis also showed good results. Cervical spine curvature and disc space height were not changed on the plain X-ray and MRI in all patients. Twenty-nine patients were discharged within 3 days after surgery without any postoperative complications. CONCLUSIONS: The microsurgical anterolateral tunnel approach could be indicated for the treatment of patients with cervical disc diseases and with difficulty in achieving interbody fusion(the higher cervical level and cervicothoracic junction, osteoporosis etc.).
Contusions ; Diskectomy ; Follow-Up Studies ; Humans ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Osteoporosis ; Postoperative Complications ; Spine

STUDY DESIGN: Retrospective study. PURPOSE: To compare intraoperative endplate injury cases and no injury cases in consecutive series and to identify predisposing factors for intraoperative endplate injury. OVERVIEW OF LITERATURE: Unintended endplate violation and subsequent cage subsidence is an intraoperative complication of extreme lateral interbody fusion (XLIF). It is still unknown whether it is derived from inexperienced surgical technique or patients' inherent problems. METHODS: Consecutive patients (n=102; mean age, 69.0±0.8 years) underwent XLIF at 201 levels at a single institute. Preoperative and immediately postoperative radiographs were compared and cases with intraoperative endplate injury were identified. Various parameters were reviewed in each patient and compared between the injury and no injury groups. RESULTS: Twenty one levels (10.4%) had signs of intraoperative endplate injury. The injury group had a significantly higher rate of females (p=0.002), lower bone mineral density (BMD) (p=0.02), higher rate of polyetheretherketone as cage material (p=0.04), and taller cage height (p=0.03) compared with the no injury group. Multivariate analysis indicated that a T-score of BMD as a negative (odds ratio, 0.52; 95% confidence interval, 0.27–0.93; p=0.03) and cage height as a positive (odds ratio, 1.84; 95% confidence interval, 1.01–3.17; p=0.03) were predisposing factors for intraoperative endplate injury. CONCLUSIONS: Intraoperative endplate injury is correlated significantly with reduced BMD and taller cage height. Precise evaluation of bone quality and treatment for osteoporosis might be important and care should be taken not to choose excessively taller cage.
Bone Density ; Bone-Implant Interface ; Causality* ; Female ; Humans ; Intraoperative Complications ; Multivariate Analysis ; Osteoporosis ; Retrospective Studies ; Spine

In the treatment of malleolar fracture, anatomical reduction and rigid internal fixation are essential to prevent the complications such as infection, malunion or nonunion, traumatic arthritis, skin necrosis and joint contracture. But it is often difficult to obtain rigid fixation for medial malleolar fracture because of its comminution or thin cortex with osteoporosis. Generally, two operative methods are available for medial malleolar fracture, which are malleolar lag screw fixation and tension band wiring. The purpose of this paper is to analyze which operative method is better for anatomical reduction and rigid fixation and has less postoperative complications for medial malleolar fractures. From March 1992 through March 1995, 88 patients had undergone surgical intervention for medial malleolar fractures. The patients were divided into 2 groups according to operative method for medial malleolar fracture. For one group, malleolar lag screw together with or without a K-wire was used in 48 patients, and for the other group, tension band wiring was used in 40 patients. The average follow-up periods were 14 months in screw fixation group and 13 months in tension band wiring group. The average union time were 15.4 weeks (8-17 weeks) in screw fixation group and 12.2 weeks (6-15 weeks) in tension band wiring group. 27 cases (56%) showed excellent result in screw fixation group and 30 cases (75%) in tension band wiring group. In the patient over 50 years old, 2 (15%) in 13 cases showed excellent result of screw fixation group, while 5 (45%) in 11 cases of tension band wiring group. We concluded that tension band wiring is a better method for medial malleolar fracture to obtain early union and to prevent postoperative complications, especially in the elderly patient.
Aged ; Arthritis ; Contracture ; Follow-Up Studies ; Humans ; Joints ; Middle Aged ; Necrosis ; Osteoporosis ; Postoperative Complications ; Skin

Degenerative scoliosis is one of the important reasons of low back pain in middle-aged and elderly. The surgical treatment has been gradually paid more attention to in recent years. Pain and the quality of life are the key points of the surgical treatment. In addition to neurogenic compression,clinical symptoms and health-related quality of life are also closely related to the three-dimensional deformity of spine. Researchers try to employ different classifications of degenerative scoliosis to guide personalizedly surgical treatment. In the future,osteoporosis and complications may be the research highlights in the surgical treatment of degenerative scoliosis.
Aged ; Humans ; Low Back Pain ; etiology ; Middle Aged ; Osteoporosis ; etiology ; Quality of Life ; Scoliosis ; complications ; surgery ; Spine

PURPOSE: The purpose of this study was to compare the clinical results in the treatment of femoral intertrochanteric fractures with dynamic compression hip screws (DHS) in patients with or without osteoporosis. MATERIALS AND METHODS: Between March 2003 and February 2006, the clinical results in the treatment of intertrochanteric fractures of the femur with DHS in patients with severe osteoporosis (T score<-4.0 at the femoral neck by DXA; 56 patients [group 1]) and in non-osteoporotic patients (T score>-2.5; 46 patients [group 2]) were reviewed. We retrospectively compared the mortality rate, the incidence of postoperative complications or fixation failures, and the patterns between the two groups. RESULTS: The mortality rate in group 1 was 30.4% at postoperative 1 year and 21.4% at 6 months. The mortality rate at 1 year was 21.8% in group 2 (p<0.05). There were no differences in fracture patterns according to the AO/OTA classification between the two groups. However, the incidence of fixation failures were 19.6% in group 1 vs. 13.0% in group 2 (p<0.05). CONCLUSION: There was a higher postoperative mortality rate at 1 year (30.4% vs. 21.4%), and the incidence of fixation failures (19.6% vs. 13.0%) in the treatment of osteoporotic intertrochanteric fractures by DHS in osteoporotic compared to non-osteoporotic fractures.
Femur ; Femur Neck ; Hip ; Hip Fractures ; Humans ; Incidence ; Osteoporosis ; Postoperative Complications ; Retrospective Studies

Osteoporosis is charactered by body bone mass reduce and bone microstructure degration. With the improvement of biology-psychology-social medical model, it have found a certain relation between osteoporosis and psychology. Psychology have an influence on BMD, contents of bone transition index, bone cytokine consistency and fragility fracture rate. Meantime, life of quality of the patients have been affected by osteoporosis, leading to their psychology situation have an according changes.
Bone Density ; Fractures, Bone ; epidemiology ; Humans ; Mental Disorders ; complications ; metabolism ; Osteoporosis ; etiology ; psychology ; Quality of Life