BACKGROUND:For the treatment of osteoporosis, clinicians general y focus on improving bone mineral density and reducing the incidence of fractures, but often ignore the ease of osteoporotic chronic pain.
OBJECTIVE:To review the research progress in osteoporotic chronic pain from domestic and overseas literature in recent years in order to provide reference for basic and clinical research.
METHODDatabases of PubMed and Wanfang database were retrieved with key words of“osteoporosis;chronic pain;treatment of osteoporotic;vertebral compression fracture”in English and Chinese to search papers published from March 1999 to March 2014. Articles related to characteristics, pathogenesis and drug treatment of osteoporotic chronic pain as wel as surgical treatment of osteoporotic vertebral compression fractures. Final y 49 articles were summarized according to inclusion criteria.
RESULTS AND CONCLUSION:The pathogenesis of osteoporotic chronic pain includes congestion mechanism and mechanisms of cytokines and lactic acid accumulation, but its exact cytological and biochemical mechanisms are not very clear. Commonly used drugs in the treatment of osteoporotic chronic pain include calcitonin and bisphosphonates. Calcitonin plays an analgesic effect by inhibiting bone resorption to indirectly reduce the hydrogen ion concentration, suppress prostaglandin synthesis, improve animal pain threshold, and increase the plasma concentration of beta-endorphin. The main pharmacological action of bisphosphonate is to inhibit osteoclast formation and activity, inhibit bone absorption, improve osteoporotic bone pain, improve bone mineral density, increase bone strength, and prevent osteoporotic fracture. Benign and malignancy tumor of the spine and osteoporotic spinal compression fractures can be treated with percutaneous vertebroplasty or percutaneous kyphoplasty. After treatment, the vertebral height can be restored completely or partial y, the kyphosis is corrected, the vertebral stability is increased and pain is relieved. Combination of various treatments is effective for the treatment of osteoporotic chronic pain, and meanwhile, the prevention and treatment of osteoporotic fractures has a positive role in prevention and treatment of osteoporotic chronic pain.

When the central nervous system is stimulated, the opioid neuropeptide?-endorphine (?-EP) is liberated into the blood stream. The result of this work showedthat the antigen-presenting capability (APCP) of normal human monocytes (Mon) wasmarkedly enhanced (P0. 05), sug-gesting that the effect of ?-EP was mediated through the opioid receptors on the Mon.

[Objective]To discuss surgical approaches,results and complications of ossification of posterior longitudinal ligament(OPLL)of cervical spine.[Method]The clinic data of 48 patients from 2000 with cervical OPLL were reviewed and analyzed.Eighteen of them were decompressed from an anterior approach and 30 from a posterior approach.The improvement rate according to JOA scoring system were evaluated,some relevant imaging examination data including X-rays,CT and MRI were also measured,which were taken preand post-operatively.Surgical complications were also recorded.[Result]Of 48 patients,23 had cervical stenosis,the mean occupancy rate was 41.4%,and 19 had the abnormal signal in spinal cord.The mean postoperative improvement rate was 68.3% in patients treated by anterior decompression and 51.3% in those treated by posterior decompression.There were 2 patients with dural tear,5 with segmental nerve root palsy and 2 with hematoma after operation.[Conclusion]Suitable operation methods should be chosen according to the location,extent and occupancy ratio of OPLL,which is important for avoiding complications and improving surgical results.

[Objective] To discuss the prognostic factors for cervical OPLL treated by anterior decompression.[Method]A total of 48 patients with cervical OPLL,who underwent anterior decompression,were followed up for 1～4 years,with an average of 2.1 years.The patients were classified into a good-prognosis group and a poor-prognosis group according to the JOA neruologic scoring system.Age,sex,JOA score,duration of symptoms,diabetes mellitus,Pavolv ratio,occupying rate,type of ossification,CT double-layer sign,hyperintense areas,level of segments,and treatment of ossification were testified using multiple logistic regression analysis.[Result]Treatment of ossification was the only statistically significant factor predicting clinical results in this study.[Conclusion]It is the most important to resect the ossification and decompress the spinal cord thoroughly in the process of antarior decompression for cervical OPLL.

Objective To report a newly designed method of cervical subtotal corpectomy with the posterior vertebral wall retention. Methods 89 cases of cervical spondylotic myelopathy(CSM) or cervical injury were treated with subtotal corpectomy with the posterior vertebral wall retention from March 2001 to March 2004. 61 males and 28 females, aged from 25 to 76 years(mean, 47 years) were included, which involved 62 cases of multiple level in CSM with or without radiculopathy, 14 fractures of cervical vertebral body with or without cervical dislocation, 13 cervical instability with or without cervical disc disease. Subtotal corpectomy with 2 mm retention in posterior wall of the vertebral body were performed, in which 23 cases' level were C4,55 C5 and 11 C6. Extensive decompression through intervertebral body space was performed and bone fusion with autogenous iliac bone graft or titanium mesh supplemented with anterior locking plates were used, the bone graft or mesh were impacted into the decompression slot between the upper to lower endplate as well as the preserved lateral and posterior wall stably. Bone fusion were assessed with roentgenogram during the 3rd, 6th, 12th month follow-up and neurological function was recorded. Results The average operation time is 100 min, ranged from 55-130 min, the blood loss were 120 ml, ranged from 30 to 300 ml. Neither plate or screw migration, nor bone graft loosening or subsidence were found in 77 patients with over 6 months follow-up. Bone fusion happened in all patients, and Frankel score improved 1.0 level averagely after operation. 3 patients with hoarseness recovered 2 weeks later. Conclusion Subtotal corpectomy with posterior wall of vertebrae retention was a feasible anterior decompression procedure with advantage of safety, completely decompression and reliable bone fusion. This method included double level of CSM, and cervical fracture as well as two level of local ossification of posterior longitudinal ligament.

Objective To evaluate the clinical value of percutaneous renal artery angiography and embolization of the renal artery pseudoaneurysms. Methods A retrospective analysis was made on 15 cases of postoperative urethral bleeding following urinary calculi surgery from January 2012 to February 2014, which were diagnosed of renal artery pseudoaneurysms via the renal artery angiography.Superselective catheter placement was carried out into the proximal of parent artery and the pseudoaneurysm was embolized by using a coil and gelatin sponge. Results Renal artery angiography clearly displayed pseudoaneurysms in the 15 cases, which were located in interlobular artery in 11 cases, arcuate artery in 3 cases, and minor interlobular artery in 1 case.Urethral bleeding was stopped after using gelatin sponge and spring coil embolization.Among them urethral bleeding recurred in 1 case after two days, and a second embolization was conducted.After the embolization, transient renal colic happened in 2 cases and a fever of 37.8-39.3 ℃lasting for 3-8 d was seen in 7 cases.Follow-ups for 3-24 months ( mean, 15 months) showed no renal dysfunction and urinary tract bleeding. Conclusion The transcatheter embolization and angiography can diagnose and treat renal artery pseudoaneurysms, with safe and effective outcomes.

Objective To investigate the preoperative diagnosis,surgical treatment and results of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).Methods We retrospectively analyzed the clinical data of 9 patients with ALCAPA who had undergone surgical treatment in Shanxi Children's Hospital from June 2010 to March 2014.Results There were 3 males and 6 females,aged from 4 months to 4 years old and 6 months,average age (1.14 ± 1.33)years,body weight from 5.6 to 18.0 kg,average weight(8.06 ± 3.99) kg.Echocardiography and spiral CT angiography were performed in all patients,one of which underwent cardiac catheter angiography.The cases of mitral regurgitation were mild in 2 cases,mild to moderate in 5 cases,and moderate to severe in 2 cases.Electrocardiogram showed abnormal Q wave,ST segment change and T wave inversion in lead Ⅰ,AVL and V4-6 in 9 cases.The X-ray sign was significant heart enlargement(C/T ratio 0.56-0.73,mean 0.61 ± 0.05).Echocardiography indicated ALCAPA,significant enlargement of left ventricle and decreased myocardial contractility(ejection fraction less than 50％).End diastolic diameter of left ventricle were more than 35 mm in 8 cases and aneurysm formation of left ventricular apex in 1 case.One case was confirmed ALCAPA by catheter angiography.Six cases had radioactive nuclide myocardial imaging,which showed different degree of myocardial infarction.All patients underwent reimplantation of left coronary artery into the aorta,mitral valvoplasty in 7 patients.One case died for low cardiac output syndrome.Others recovered and discharged.Postoperative complications included low cardiac output syndrome in 2 cases,pneumonia in 3 cases and supraventricular tachycardia in 1 case.During a followup of 3 months to 2 years,well development,good heart function,mitral valve regurgitation and ejection fraction improved in all case.Conclusion Echocardiography has important value in diagnosis of ALCAPA,which are confirmed by spiral CT angiography and catheter angiography.Preoperative nuclide examination for determinant of survival myocardium is helpful for surgery and prognosis.Reimplantation of left coronary artery into the aorta is the most ideal surgical procedure.

Objective To report the clinical outcome of L3～L5 fractures treated with USS short segmental pedicel screw system. Methods From 1994 to 2004, 57 cases of lower lumbar fractures were treated, of which 21 cases were treated with USS pedicel screw system. There were 12 cases of L3 fracture, 8 cases of L4 fracture and 1 cases of L5 fracture. The intervertebral height and lumbar lordosis were evaluated both before and after operation, the spinal impingement of bone was evaluated on CT scan, the neurofunction was evaluated with Frankle system and the clinical outcomes were evaluated with Charles system. Results The operation time ranged from 90 min to 150 min, averaging 120 min. The bleeding volume ranged from 100 ml to 600 ml, averaging 350 ml. The Frankle scores increased from 3.7 to 4.5 after operation. The intervertebral height of the fractured vertebral body increased from preoperative 30%to 60%to postoperative 70%to 100%(averaging 87%). The lumbar lordosis angel increased from preoperative 35.2?8.3o to postoperative 38.3?10.2o. The mobilization time was 3d to 2w, and the time for resuming work was 3 to 6w. The 3 to 30 months follow ups (averaging 15m) showed that the clinical outcomes were excellent in 9 cases, good in 9 cases, fair in 2 in and poor in 1. Conclusion The advantages of treating the lower lumbar fractures with short segmental USS pedicel screw system are effective restoration of intervertebral body height, lumbar lordosis and spinal volume, prevention of long term lumbago and lumbar stenosis, as well as early mobilization and return to work.

Objective To investigate the expressions of epidermal growth factor receptor (EGFR), cyclooxygenase-2 (COX-2) and P63 protein in non-small cell lung cancer (NSCLC) and their relationship with TNM staging and lymph node metastasis of NSCLC. Methods Seventy-eight paraffin-embedded specimens of NSCLC from 1998-2005 were collected in this study. Inclusion criteria included no chemotherapy or radiotherapy before operation. Pathological diagnosis was made after operation: 43 squamous carcinoma and 35 adenocarcinoma, 45 with lymph node metastasis and 33 without, 13 in stage Ⅰ, 19 in stage Ⅱ, 28 in stage Ⅲ and 18 in stage Ⅳ. The expressions of EGFR, COX-2 and P63 were determined by immunohistochemical staining (S-P). Results The expression rates of EGFR, COX-2 and P63 were 65.4% (51/78), 61.5% (48/78) and 56.4% (44/78) respectively in 78 cases of NSCLC. Significant difference in the expressions of COX-2 and P63 was found between squamous carcinoma and adenocarcinoma (P0.05). The positive rate of EGFR and COX-2 protein expressions in NSCLC of stage Ⅲ-Ⅳ and NSCLC with lymph node metastasis was significantly higher than that in stage Ⅰ-Ⅱ and NSCLC without lymph node metastasis (P0.05). Conclusion Over-expressions of EGFR and COX-2 may play an important role in invasion and metastasis of NSCLC. COX-2 and P63 may be valuable markers in differentiating pulmonary squamous cell carcinoma from pulmonary adenocarcinoma.

Objective To investigate incidence,diagnosis and treatment strategy of delayed esophageal complications after anterior cervical spine surgery.Methods The clinical data of 2316 patients who had undergone anterior cervical spine surgery from January 2001 to December 2011 were analyzed.The delayed esophageal complications were defined as esophageal perforation,esophago-tracheal fistula,esophago-cutaneous fistula,diverticulum of esophagus,esophagopleural fistula and esophageal stenosis that occurred 2 weeks after spine surgery.Results Delayed esophageal complications occurred in 4 patients,and the incidence was 0.17％.Esophageal perforation occurred in 2 patients; the incidence was 0.09％.Case 1 was a 31-year-old man who was found to have esophageal diverticulum and perforation 7 years after anterior cervical spine surgery.Then he underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 2 was a 46-year-old man who was found to have esophageal diverticulum 3 years after cervical spine surgery.He also underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 3 was a 58-year-old woman who was found to have esophageal diverticulum 5 years after cervical spine surgery.She underwent removal of implant,excision of diverticulum,and repair of esophagus with sternocleidomastoid muscle flap.Case 4 was a 56-year-old woman who was found to have esophageal perforation 3 years after cervical spine surgery.She underwent removal of implant and repair of esophagus with sternocleidomastoid muscle flap.All 4 patients recovered after operation.Conclusion The incidence of delayed esophageal complications after anterior cervical spine surgery is low,and the diagnosis is difficult.X-ray,digestive tract radiography,and gastrointestinal endoscopy are the main diagnostic tools.Surgical treatment is the main and effective management.