1
|
Yang Y, Liao F, Xing X, Liao N, Wang D, Yin X, Liu Y, Guo J, Li L, Wang H, Li C, Zheng Y. The reduced cortical bone density in vertebral bodies: risk for osteoporotic fractures? Insights from CT analysis. J Orthop Surg Res 2024; 19:486. [PMID: 39152470 PMCID: PMC11329995 DOI: 10.1186/s13018-024-04896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/03/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND There is a corresponding increase in the prevalence of osteoporosis and related fractures with the aging population on the rise. Furthermore, osteoporotic vertebral compression fractures (OVCF) may contribute to higher patient mortality rates. It is essential to conduct research on risk factors for OVCF and provide a theoretical basis for preventing such fractures. METHODS We retrospectively recruited patients who had spine CT for OVCF or back pain. Demographic and CT data were collected. Quantitative computed tomography (QCT) software analyzed the CT data, using subcutaneous fat and paraspinal muscles as reference standards for BMD processing. BMD of cortical and cancellous bones in each patient's vertebral body was determined. RESULTS In this study, 144 patients were divided into non-OVCF (96) and OVCF (48) groups. Non-OVCF patients had higher cortical BMD of 382.5 ± 52.4 to 444.6 ± 70.1 mg/cm3, with T12 having the lowest BMD (p < 0.001, T12 vs. L2). Cancellous BMD ranged from 128.5 ± 58.4 to 140.9 ± 58.9 mg/cm3, with L3 having the lowest BMD. OVCF patients had lower cortical BMD of 365.0 ± 78.9 to 429.3 ± 156.7 mg/cm3, with a further decrease in T12 BMD. Cancellous BMD ranged from 71.68 ± 52.07 to 123.9 ± 126.2 mg/cm3, with L3 still having the lowest BMD. Fractured vertebrae in OVCF patients (T12, L1, and L2) had lower cortical bone density compared to their corresponding vertebrae without fractures (p < 0.05). CONCLUSIONS T12 had the lowest cortical BMD and L3 had the lowest cancellous BMD in OVCF patients, with T12 also having the highest incidence of osteoporotic fractures. These findings suggest that reduction in cortical BMD has a greater impact on OVCF than reduction in cancellous BMD, along with biomechanical factors.
Collapse
Affiliation(s)
- Yong Yang
- Department of Orthopaedics, Fourth Medical Center of PLA General Hospital, Beijing, PR China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 10048, PR China
- Department of Orthopedics, General Hospital of Western Theater Command, Rongdu Avenue No. 270, Chengdu, 610083, PR China
| | - Feng Liao
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, PR China
| | - Xingbo Xing
- Department of Radiology, Fourth Medical Center of PLA General Hospital, Beijing, 10048, PR China
| | - Nianxi Liao
- Yizhun medical AI Co.Ltd, No.7, Zhichun road, Haidian district, Beijing, 100088, PR China
| | - Dawei Wang
- Department of Orthopaedics, Fourth Medical Center of PLA General Hospital, Beijing, PR China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 10048, PR China
| | - Xin Yin
- Department of Orthopaedics, Fourth Medical Center of PLA General Hospital, Beijing, PR China
| | - Yihao Liu
- Department of Orthopaedics, Fourth Medical Center of PLA General Hospital, Beijing, PR China
| | - Jidong Guo
- Department of Orthopaedics, Fourth Medical Center of PLA General Hospital, Beijing, PR China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 10048, PR China
| | - Li Li
- Department of Orthopaedics, Fourth Medical Center of PLA General Hospital, Beijing, PR China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 10048, PR China
| | - Huadong Wang
- Department of Orthopaedics, Fourth Medical Center of PLA General Hospital, Beijing, PR China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 10048, PR China.
| | - Chunyan Li
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Xicheng District, Beijing, 100035, PR China.
| | - Yang Zheng
- Department of Orthopaedics, Fourth Medical Center of PLA General Hospital, Beijing, PR China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, 10048, PR China.
- Department of Orthopedics, General Hospital of Western Theater Command, Rongdu Avenue No. 270, Chengdu, 610083, PR China.
| |
Collapse
|
2
|
Tomé-Bermejo F, Bartolomé Gómez JF. Anatomical and biomechanical factors of osteoporotic vertebral fracture and the occurrence of cascade fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00112-7. [PMID: 38925424 DOI: 10.1016/j.recot.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
Osteoporosis weakens the structural strength of bone to such an extent that normal daily activity may exceed the capacity of the vertebra to bear this load. Vertebral fracture and deformity is a hallmark of osteoporosis. The detriment of trabecular bone properties alone cannot explain the occurrence of osteoporotic vertebral fracture. The ability of the spine to bear and resist loads depends on the structural capacity of the vertebrae, but also on loading conditions arising from activities of daily living or low-energy trauma. This review describes the mechanical properties of the vertebral bone, the structural load-bearing capacity of the various elements forming the spine, the neuromuscular control of the trunk, as well as the biomechanics of the loads to which the spine is subjected in relation to the presence of osteoporosis and the risk of vertebral fracture. A better understanding of biomechanical factors may help to explain both the high incidence of osteoporotic vertebral fractures and their mechanism of production. Consideration of these issues may be important in the development of prevention and management strategies.
Collapse
Affiliation(s)
- F Tomé-Bermejo
- Hospital Universitario General de Villalba. Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - J F Bartolomé Gómez
- Instituto de Ciencia de Materiales de Madrid. Consejo Superior de Investigaciones Científicas, Madrid, España
| |
Collapse
|
3
|
Wang F, Sun R, Zhang SD, Wu XT. Comparison of thoracolumbar versus non-thoracolumbar osteoporotic vertebral compression fractures in risk factors, vertebral compression degree and pre-hospital back pain. J Orthop Surg Res 2023; 18:643. [PMID: 37649026 PMCID: PMC10469467 DOI: 10.1186/s13018-023-04140-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Thoracolumbar spine is at high risk of osteoporotic vertebral compression fractures (OVCF). This study aimed to identify the differences in risk factors, vertebral compression degree and back pain characteristics of thoracolumbar OVCF (TL-OVCF) and non-thoracolumbar OVCF (nTL-OVCF). METHODS OVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, spine trauma, bone mineral density, duration of pre-hospital back pain, extent of vertebral marrow edema, and degree of vertebral compression of patients with nTL-OVCF were summarized and compared to those with TL-OVCF. RESULTS A total of 944 patients with acute single-segment OVCF were included. There were 708 (75.0%) TL-OVCF located in T11-L2 and 236 (25.0%) nTL-OVCF in lower lumbar (L3-L5) and middle thoracic (T5-T10) spine. The female-male ratio was 4.1 in nTL-OVCF and differed not significantly from TL-OVCF. The middle thoracic OVCF were older and had higher comorbidity of coronary heart disease (21.3%) and cerebral infarction (36.3%) than TL-OVCF (12.1% and 20.6%). In nTL-OVCF the ratio of apparent spine trauma (44.9%) and pre-hospital back pain ≤ 1 week (47.5%) was lower than in TL-OVCF (66.9% and 62.6%). The T-score value of lumbar spine was - 2.99 ± 1.11, - 3.24 ± 1.14, - 3.05 ± 1.40 in < 70, 70-80, > 80 years old TL-OVCF and differed not significantly from nTL-OVCF. The lower lumbar OVCF had more cranial type of vertebral marrow edema (21.8%) and fewer concurrent lumbodorsal fasciitis (30.8%) than TL-OVCF (16.8% and 43.4%). In TL-OVCF the anterior-posterior vertebral height ratio was lower with back pain for > 4 weeks than for ≤ 1, 1-2, and 2-4 weeks. In nTL-OVCF the degree of vertebral compression differed not significantly with pre-hospital back pain for ≤ 1, 1-2, 2-4, and > 4 weeks. CONCLUSIONS Thoracolumbar spine has 2-folds higher risk of OVCF than non-thoracolumbar spine. Non-thoracolumbar OVCF are not associated with female gender, apparent spine trauma or poor bone mineral density, but tend to maintain the degree of vertebral compression and cause longer duration of pre-hospital back pain.
Collapse
Affiliation(s)
- Feng Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
- Surgery Research Center, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
| | - Rui Sun
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
- Surgery Research Center, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
| | - Shao-Dong Zhang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China.
- Surgery Research Center, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China.
| | - Xiao-Tao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
- Surgery Research Center, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China
| |
Collapse
|
4
|
A Computer-Assisted Approach Regarding the Optimization of the Geometrical Planning of Medial Opening Wedge High Tibial Osteotomy. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure often used to eliminate the effects of knee osteoarthritis, a disease that is becoming more widespread worldwide. Optimizing the geometric planning of this operation is a very important preparatory step for the success of the intervention and rapid postoperative recovery. This optimization is performed in two main directions. The first direction evaluates the intraoperative behavior of the tibia during the osteotomy by optimizing four geometric parameters that characterize geometric planning. The second direction aims at a postoperative evaluation of the flat tibia-osteosynthesis assembly taking into account the optimal position on the medial–lateral articular line through which the corrected mechanical axis of the tongue passes and implicitly offloads the transfer from the medial area to the side of the knee. The research methods used are exclusively computer-assisted such as: computer-aided design (hereinafter CAD) for geometric modeling of the tibia taking into account the real bone structure, the finite element method (hereinafter FEM) for performing numerical analyses and design of the experiment (hereinafter DOE) for the design of the research. The results obtained are eloquent and clearly presented and can be important elements for orthopedic doctors at the geometric planning stage of the OWHTO.
Collapse
|
5
|
Georgeanu VA, Atasiei T, Predescu V, Gheorghiu N, Feier AM, Russu OM. Transfemoral Approach in Revision Hip Arthroplasty; a Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up. Medicina (B Aires) 2022; 58:medicina58020237. [PMID: 35208559 PMCID: PMC8879778 DOI: 10.3390/medicina58020237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: One of the most difficult aspects of hip revision is to remove the stem from the femoral canal with or without cement while maintaining the maximal amount of bone stock to obtain the best possible press-fit of the revision prosthesis. The transfemoral approach ensures direct access to the medullary canal so that the content removal is completed under direct control, while protecting the bone. This type of approach is particularly efficient for special conditions, such as deformation of the proximal femoral region, broken stems, or the presence of cement over a long distance distal to the prosthesis. The aim of this study was to evaluate the main advantages of transtrochanteric approach in hip revisions. Materials and Methods: Our series included 36 revisions performed using the transfemoral approach. We have analyzed the following postoperative radiological aspects: the length of the fixation zone distal to the osteotomized bone fragment (OBF), the gap between the OBF and the diaphysis, stem subsidence over time, and OBF consolidation. Results: The results were very good, both in terms of the rate of intraoperative complications and postoperative evolution. The fixation zone length was 4.2 cm on average (range: 2 to 5.8 cm). The distal gap between the OBF and the diaphysis was 1.2 cm on average (range: 0 to 2.3 cm). Stem subsidence was noted in four cases (11.1%). In all cases, stem subsidence occurred between three and six months and was 6 to 8 mm without affecting hip stability. OBF consolidation was radiologically confirmed for all cases at one year follow-up. Clinical assessment based on the Harris Hip Score showed an overall improvement from 43.2 preoperatively to 79.7 at 12 months and 83 at two years, respectively. The most important rate of progress was between 6 months and 12 months. Conclusions: The transtrochanteric approach has been shown to be very efficient for hip revisions. Understanding the hip biomechanics, applying a less aggressive surgical technique, and using efficient fixation methods such as cables significantly improved the results.
Collapse
Affiliation(s)
- Vlad Alexandru Georgeanu
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (T.A.); (N.G.)
- Clinic of Orthopaedics and Trauma Surgery, “St. Pantelimon” Hospital, 021659 Bucharest, Romania
- Correspondence: ; Tel.: +40-722-821-344
| | - Tudor Atasiei
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (T.A.); (N.G.)
- Clinic of Orthopaedics and Trauma Surgery, “St. Pantelimon” Hospital, 021659 Bucharest, Romania
| | | | - Nicolae Gheorghiu
- Department of General Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (T.A.); (N.G.)
- Department of Orthopaedics and Traumatology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Andrei Marian Feier
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (A.M.F.); (O.M.R.)
- Department of General Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540139 Tîrgu Mureș, Romania
| | - Octav Marius Russu
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (A.M.F.); (O.M.R.)
- Department of General Medicine, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, 540139 Tîrgu Mureș, Romania
| |
Collapse
|