Given that the liver is involved in many metabolic mechanisms,it is not surprising that chronic liver disease(CLD)could have numerous complications.Secondary osteoporosis and increased bone fragility are frequently ov...Given that the liver is involved in many metabolic mechanisms,it is not surprising that chronic liver disease(CLD)could have numerous complications.Secondary osteoporosis and increased bone fragility are frequently overlooked complications in CLD patients.Previous studies implied that up to one-third of these individuals meet diagnostic criteria for osteopenia or osteoporosis.Recent publications indicated that CLD-induced bone fragility depends on the etiology,duration,and stage of liver disease.Therefore,the increased fracture risk in CLD patients puts a severe socioeconomic burden on the health system and urgently requires more effective prevention,diagnosis,and treatment measures.The pathogenesis of CLD-induced bone loss is multifactorial and still insufficiently understood,especially considering the relative impact of increased bone resorption and reduced bone formation in these individuals.It is essential to note that inconsistent findings regarding bone mineral density measurement were previously reported in these individuals.Bone mineral density is widely used as the“golden standard”in the clinical assessment of bone fragility although it is not adequate to predict individual fracture risk.Therefore,microscale bone alterations(bone microstructure,mechanical properties,and cellular indices)were analyzed in CLD individuals.These studies further support the thesis that bone strength could be compromised in CLD individuals,implying that an individualized approach to fracture risk assessment and subsequent therapy is necessary for CLD patients.However,more well-designed studies are required to solve the bone fragility puzzle in CLD patients.展开更多
BACKGROUND Although percutaneous vertebral augmentation(PVA)is a commonly used procedure for treating vertebral compression fracture(VCF),the risk of vertebral refracture should be considered.Chronic kidney disease-mi...BACKGROUND Although percutaneous vertebral augmentation(PVA)is a commonly used procedure for treating vertebral compression fracture(VCF),the risk of vertebral refracture should be considered.Chronic kidney disease-mineral and bone disorder(CKD-MBD)is a systemic disease of mineral and bone metabolism.It is associated with an increased risk of fracture.Few studies have reported the use of PVA in patients with CKD-MBD.We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA.CASE SUMMARY A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago.According to physical examination,imaging and laboratory findings,diagnoses of T12 VCF,CKD-MBD,and chronic kidney disease stage 5 were established.He then received percutaneous vertebroplasty at T12 vertebra.Fourteen weeks later,he presented with T12 and L1 vertebral refractures caused by lumbar sprain.Once again,he was given PVA which was optimized for the refractured vertebrae.Although the short-term postoperative effect was satisfactory,he reported chronic low back pain again at the 3-month follow-up.CONCLUSION It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD.It may increase the risk of vertebral refracture.Furthermore,the PVA surgical technique needs to be optimized according to the condition of the patient.The medium-and long-term effects of PVA remain uncertain in patients with CKD-MBD.展开更多
A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear.Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely.Over the last decades,many studi...A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear.Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely.Over the last decades,many studies have described arthroscopic fixation of acute cruciate tibial avulsion fractures,but arthroscopic treatment in a late presenting patient has not been reported in the literature.This case report presents a 32-year-old female with a chronic tibial avulsion fracture of both anterior cruciate ligament and posterior cruciate ligament.Simultaneous fixation of both fractures was performed arthroscopically at week four post-injury.At one year of follow-up,the patient had demonstrated full knee range of motion and stable knee with no complaints,and achieved excellent clinical outcomes.Radiographs showed union of both fractures,and the patient had resumed high-impact exercises.展开更多
目的对伤后3个月以上的骨质疏松性椎体压缩性骨折患者行经皮椎体成形术(PVP),观察患者症状改善及并发症情况。方法对2006年5月至2008年5月行PVP术的22例患者进行随访,根据MRI表现分为骨髓水肿组(组Ⅰ)和无骨髓水肿组(组Ⅱ),手术前后给...目的对伤后3个月以上的骨质疏松性椎体压缩性骨折患者行经皮椎体成形术(PVP),观察患者症状改善及并发症情况。方法对2006年5月至2008年5月行PVP术的22例患者进行随访,根据MRI表现分为骨髓水肿组(组Ⅰ)和无骨髓水肿组(组Ⅱ),手术前后给予视觉模拟评分(VAS),比较不同骨折时间的VAS变化的差异,了解并发症的发生及患者的主观满意度。结果平均随访时间12.2个月,术前VAS评分组Ⅰ为7.77±0.73,组Ⅱ为7.44±0.88,总体为7.63±0.79。术后1 d VAS评分,组Ⅰ为3.61±0.51,组Ⅱ为3.88±0.60,总体为3.72±0.55。随访时VAS评分组Ⅰ为3.46±1.05,组Ⅱ为3.56±0.73,总体为3.50±0.91。所有患者无骨水泥渗漏造成的神经压迫等并发症,手术的主观满意度良好(约90.9%)。结论对于慢性症状性骨质疏松性椎体压缩骨折患者,PVP是一种有效、安全的疗法;MRI对于病变的评估非常重要,术前MRI出现骨髓水肿信号的患者疗效更显著。展开更多
目的分析慢性肾脏病(chronic kidney disease,CKD)患者骨密度(bone mineral density,BMD)与骨代谢生化指标的相关性,探讨BMD及骨代谢生化指标在慢性肾脏病-矿物质和骨代谢紊乱(chronic kidney disease-mineral and bone disorder,CKD-M...目的分析慢性肾脏病(chronic kidney disease,CKD)患者骨密度(bone mineral density,BMD)与骨代谢生化指标的相关性,探讨BMD及骨代谢生化指标在慢性肾脏病-矿物质和骨代谢紊乱(chronic kidney disease-mineral and bone disorder,CKD-MBD)早期评估和管理中的价值。方法选取2018年1月1日-2019年9月30日就诊于安徽医科大学第二附属医院肾脏内科的CKD3~5D期患者128例,将CKD组分为CKD3期组、CKD4期组、CKD5期非透析组(CKD5ND组)和CKD5期血液透析组(CKD5HD组)。另选取15例健康人员作为对照组。检测血钙(Ca)、血磷(P)、甲状旁腺素(PTH)、骨特异性碱性磷酸酶(BALP)和血肌酐(SCr)等实验室指标,完善腰椎及左髋关节BMD检查。比较各组间各指标的组间差异,分析腰椎及左髋关节BMD与各指标间的相关性,并利用多元线性回归法分析影响BMD的危险因素。结果①BMD状况:CKD3期组、CKD4期组、CKD5ND期组和CKD5HD期组的左髋关节BMD均低于对照组,并随着CKD分期的进展不断降低(P均<0.05);各组间腰椎BMD差异不具有统计学意义(P>0.05)。②BALP、Ca、P和LogPTH水平:CKD3期组、CKD4期组、CKD5ND期组和CKD5HD期组的BALP水平均高于对照组(P均<0.05);CKD5ND期组Ca显著低于其他组(P均<0.05),CKD5ND期组和CKD5HD期组P显著高于其他组(P<0.05),CKD5HD期组logPTH水平显著高于其他组(P<0.05)。③相关性分析:Pearson相关分析显示,左髋关节BMD与P、LogPTH、BALP呈负相关(P均<0.05);腰椎BMD与各项指标之间均无相关性(P均>0.05)。④多元线性回归分析显示,年龄、体质量指数(body mass index,BMI)、SCr和PTH是影响髋关节BMD的危险因素。结论与腰椎BMD相比,髋关节BMD是早期骨代谢异常的敏感指标,并随着CKD进展逐渐降低。髋关节BMD与P、PTH和BALP呈负相关,PTH是影响髋关节BMD的危险因素。早期联合检测髋关节BMD和骨代谢生化指标对早期评估和管理CKD-MBD具有重要的价值。展开更多
文摘Given that the liver is involved in many metabolic mechanisms,it is not surprising that chronic liver disease(CLD)could have numerous complications.Secondary osteoporosis and increased bone fragility are frequently overlooked complications in CLD patients.Previous studies implied that up to one-third of these individuals meet diagnostic criteria for osteopenia or osteoporosis.Recent publications indicated that CLD-induced bone fragility depends on the etiology,duration,and stage of liver disease.Therefore,the increased fracture risk in CLD patients puts a severe socioeconomic burden on the health system and urgently requires more effective prevention,diagnosis,and treatment measures.The pathogenesis of CLD-induced bone loss is multifactorial and still insufficiently understood,especially considering the relative impact of increased bone resorption and reduced bone formation in these individuals.It is essential to note that inconsistent findings regarding bone mineral density measurement were previously reported in these individuals.Bone mineral density is widely used as the“golden standard”in the clinical assessment of bone fragility although it is not adequate to predict individual fracture risk.Therefore,microscale bone alterations(bone microstructure,mechanical properties,and cellular indices)were analyzed in CLD individuals.These studies further support the thesis that bone strength could be compromised in CLD individuals,implying that an individualized approach to fracture risk assessment and subsequent therapy is necessary for CLD patients.However,more well-designed studies are required to solve the bone fragility puzzle in CLD patients.
文摘BACKGROUND Although percutaneous vertebral augmentation(PVA)is a commonly used procedure for treating vertebral compression fracture(VCF),the risk of vertebral refracture should be considered.Chronic kidney disease-mineral and bone disorder(CKD-MBD)is a systemic disease of mineral and bone metabolism.It is associated with an increased risk of fracture.Few studies have reported the use of PVA in patients with CKD-MBD.We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA.CASE SUMMARY A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago.According to physical examination,imaging and laboratory findings,diagnoses of T12 VCF,CKD-MBD,and chronic kidney disease stage 5 were established.He then received percutaneous vertebroplasty at T12 vertebra.Fourteen weeks later,he presented with T12 and L1 vertebral refractures caused by lumbar sprain.Once again,he was given PVA which was optimized for the refractured vertebrae.Although the short-term postoperative effect was satisfactory,he reported chronic low back pain again at the 3-month follow-up.CONCLUSION It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD.It may increase the risk of vertebral refracture.Furthermore,the PVA surgical technique needs to be optimized according to the condition of the patient.The medium-and long-term effects of PVA remain uncertain in patients with CKD-MBD.
文摘A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear.Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely.Over the last decades,many studies have described arthroscopic fixation of acute cruciate tibial avulsion fractures,but arthroscopic treatment in a late presenting patient has not been reported in the literature.This case report presents a 32-year-old female with a chronic tibial avulsion fracture of both anterior cruciate ligament and posterior cruciate ligament.Simultaneous fixation of both fractures was performed arthroscopically at week four post-injury.At one year of follow-up,the patient had demonstrated full knee range of motion and stable knee with no complaints,and achieved excellent clinical outcomes.Radiographs showed union of both fractures,and the patient had resumed high-impact exercises.
文摘目的对伤后3个月以上的骨质疏松性椎体压缩性骨折患者行经皮椎体成形术(PVP),观察患者症状改善及并发症情况。方法对2006年5月至2008年5月行PVP术的22例患者进行随访,根据MRI表现分为骨髓水肿组(组Ⅰ)和无骨髓水肿组(组Ⅱ),手术前后给予视觉模拟评分(VAS),比较不同骨折时间的VAS变化的差异,了解并发症的发生及患者的主观满意度。结果平均随访时间12.2个月,术前VAS评分组Ⅰ为7.77±0.73,组Ⅱ为7.44±0.88,总体为7.63±0.79。术后1 d VAS评分,组Ⅰ为3.61±0.51,组Ⅱ为3.88±0.60,总体为3.72±0.55。随访时VAS评分组Ⅰ为3.46±1.05,组Ⅱ为3.56±0.73,总体为3.50±0.91。所有患者无骨水泥渗漏造成的神经压迫等并发症,手术的主观满意度良好(约90.9%)。结论对于慢性症状性骨质疏松性椎体压缩骨折患者,PVP是一种有效、安全的疗法;MRI对于病变的评估非常重要,术前MRI出现骨髓水肿信号的患者疗效更显著。
文摘目的分析慢性肾脏病(chronic kidney disease,CKD)患者骨密度(bone mineral density,BMD)与骨代谢生化指标的相关性,探讨BMD及骨代谢生化指标在慢性肾脏病-矿物质和骨代谢紊乱(chronic kidney disease-mineral and bone disorder,CKD-MBD)早期评估和管理中的价值。方法选取2018年1月1日-2019年9月30日就诊于安徽医科大学第二附属医院肾脏内科的CKD3~5D期患者128例,将CKD组分为CKD3期组、CKD4期组、CKD5期非透析组(CKD5ND组)和CKD5期血液透析组(CKD5HD组)。另选取15例健康人员作为对照组。检测血钙(Ca)、血磷(P)、甲状旁腺素(PTH)、骨特异性碱性磷酸酶(BALP)和血肌酐(SCr)等实验室指标,完善腰椎及左髋关节BMD检查。比较各组间各指标的组间差异,分析腰椎及左髋关节BMD与各指标间的相关性,并利用多元线性回归法分析影响BMD的危险因素。结果①BMD状况:CKD3期组、CKD4期组、CKD5ND期组和CKD5HD期组的左髋关节BMD均低于对照组,并随着CKD分期的进展不断降低(P均<0.05);各组间腰椎BMD差异不具有统计学意义(P>0.05)。②BALP、Ca、P和LogPTH水平:CKD3期组、CKD4期组、CKD5ND期组和CKD5HD期组的BALP水平均高于对照组(P均<0.05);CKD5ND期组Ca显著低于其他组(P均<0.05),CKD5ND期组和CKD5HD期组P显著高于其他组(P<0.05),CKD5HD期组logPTH水平显著高于其他组(P<0.05)。③相关性分析:Pearson相关分析显示,左髋关节BMD与P、LogPTH、BALP呈负相关(P均<0.05);腰椎BMD与各项指标之间均无相关性(P均>0.05)。④多元线性回归分析显示,年龄、体质量指数(body mass index,BMI)、SCr和PTH是影响髋关节BMD的危险因素。结论与腰椎BMD相比,髋关节BMD是早期骨代谢异常的敏感指标,并随着CKD进展逐渐降低。髋关节BMD与P、PTH和BALP呈负相关,PTH是影响髋关节BMD的危险因素。早期联合检测髋关节BMD和骨代谢生化指标对早期评估和管理CKD-MBD具有重要的价值。
