Background: To evaluate bone-mineral-density-BMD determined by dual-energy X-ray absorptiometry-DEXA and bone turnover markers in chronic-kidney-disease-CKD patients. Method: An observational-clinical study of all pat...Background: To evaluate bone-mineral-density-BMD determined by dual-energy X-ray absorptiometry-DEXA and bone turnover markers in chronic-kidney-disease-CKD patients. Method: An observational-clinical study of all patients who were scanned by DEXA-scan in 2018. All patients with low-bone-density or osteoporosis-based on World-Health-Organization-WHO definition were included. Results: 505 patients with abnormal-BMD, 87.3% were in early-stage CKD-stage I - II, 8.5% were in CKD-stage III - V and 4.2% did not have renal tests. 95 (18.8%) were male with a mean age of 57.0 years and 410 (81.2%) were females with a mean age of 55.8 years. Patients of ≥65 years had lower T-score than those who were younger than 65 years-old. Among CKD patients, those with late-CKD (stage III - V) had less BMD-measurements and lower T-score than those with early-CKD (stage I - II). A significant positive correlation exists between parathyroid hormone-PTH-level and the lower T-score. Female had a worse T-score at the lumbar-region whereas male had a worse T-score at the femoral-region. There was no significant difference between males and females for the T-score at hip-region. Conclusion: We observed a distribution of abnormal BMD among different age, sex and CKD groups. Measurements of BMD by DEXA might be a useful test to diagnose osteoporosis in CKD patients. Femoral and total hip areas were more affected, however DEXA might not be able to detect osteoporosis in the lumbar area of CKD patients. T-scores are lower in patients with more severe CKD and lower in elderly patients. PTH level is associated proportionally to the degree of bone loss. Early intervention and proper management must be implemented early among CKD patients with multidisciplinary team approach strategy. More studies are needed to determine if DEXA techniques are enough to distinguish the quantity of bone loss between different stages of CKD.展开更多
BACKGROUND A high degree of vigilance is warranted for a spinal infection,particularly in a patient who has undergone an invasive procedure such as a spinal injection.The average delay in diagnosing a spinal infection...BACKGROUND A high degree of vigilance is warranted for a spinal infection,particularly in a patient who has undergone an invasive procedure such as a spinal injection.The average delay in diagnosing a spinal infection is 2-4 mo.In our patient,the diagnosis of a spinal infection was delayed by 1.5 mo.CASE SUMMARY A 60-year-old male patient with a 1-year history of right-sided lumbar radicular pain failed conservative treatment.Six weeks to prior to surgery he received a spinal injection,which was followed by increasing lumbar radicular pain,weight loss and chills.This went unnoticed and surgery took place with right-sided L4-L5 combined microdiscectomy and foraminotomy via a posterior approach.The day after surgery,the patient developed left-sided lumbar radicular pain.Blood cultures grew Staphylococcus aureus(S.aureus).Magnetic resonance imaging showed inflammatory aberrations,revealing septic arthritis of the left-sided L4/L5 facet joint as the probable cause.Revision surgery took place and S.aureus was isolated from bacteriological samples.The patient received postoperative antibiotic treatment,which completely eradicated the infection.CONCLUSION The development of postoperative lower back pain and/or lumbar radicular pain can be a sign of a spinal infection.A thorough clinical and laboratory work-up is essential in the preoperative evaluation of patients with spinal pain.展开更多
目的评价在腰椎侧方椎管狭窄分型(classification of lateral region of the lumbar spinal canal,CLLSC)指导下,局麻下经皮内镜椎间孔入路减压(full endoscopic transforaminal decompression,FETD)治疗老年腰椎管狭窄症(lumbar spinal...目的评价在腰椎侧方椎管狭窄分型(classification of lateral region of the lumbar spinal canal,CLLSC)指导下,局麻下经皮内镜椎间孔入路减压(full endoscopic transforaminal decompression,FETD)治疗老年腰椎管狭窄症(lumbar spinal stenosis,LSS)的安全性、有效性和可靠性。方法回顾性分析2015年6月—2017年7月收治并符合选择标准的63例老年LSS患者临床资料,均采用FETD治疗。其中男37例,女26例;中位年龄76岁[四分位数间距(interquartile range,IQR),73~80岁]。中位病程55个月(IQR,16~120个月)。LSS根据Schizas分级:B级17例,C级46例。使用CLLSC分型进行狭窄部位分区评价,采用组内相关系数(intra-class correlation coefficients,ICC)检测CLLSC分型的观察者内部和观察者间的信度。主刀医师术后再行狭窄部位分区评定,验证术前与术后CLLSC分型的匹配度。术前及术后1 d、3个月、6个月和末次随访时,采用疼痛视觉模拟评分(VAS)评价腰痛及腿痛改善情况,Oswestry功能障碍指数(ODI)评价患者活动功能变化;采用改良Macnab量表进行患者对手术效果的自我评价。结果所有患者均顺利完成手术,中位手术时间75 min(IQR,65~85 min),中位住院时间48 h(IQR,48~72 h),中位下床活动时间24 h(IQR,24~24 h)。63例均获随访,中位随访时间18个月(IQR,13~20个月)。基于术前CLLSC分型共有72个狭窄区,分布于1区16个,2区6个,3区3个,4区2个,5区7个,1+2区34个,3+4区2个,4+5区2个。4例(6.3%)患者发生围术期并发症,其中2例术中出现硬膜囊撕裂,1例出现术前症状部位麻木明显加重,1例出现术后尿潴留。术后各时间点腿痛VAS评分及ODI评分均较术前显著改善(P<0.05);手术前后各时间点下腰痛VAS评分比较差异均无统计学意义(P>0.05)。末次随访时根据改良Macnab量表评价,优19例、良37例、可6例、差1例,优良率88.9%。一致性分析发现,在老年人群中,CLLSC分型具有良好的组内一致性,平均ICC为0.78;也具有较展开更多
文摘Background: To evaluate bone-mineral-density-BMD determined by dual-energy X-ray absorptiometry-DEXA and bone turnover markers in chronic-kidney-disease-CKD patients. Method: An observational-clinical study of all patients who were scanned by DEXA-scan in 2018. All patients with low-bone-density or osteoporosis-based on World-Health-Organization-WHO definition were included. Results: 505 patients with abnormal-BMD, 87.3% were in early-stage CKD-stage I - II, 8.5% were in CKD-stage III - V and 4.2% did not have renal tests. 95 (18.8%) were male with a mean age of 57.0 years and 410 (81.2%) were females with a mean age of 55.8 years. Patients of ≥65 years had lower T-score than those who were younger than 65 years-old. Among CKD patients, those with late-CKD (stage III - V) had less BMD-measurements and lower T-score than those with early-CKD (stage I - II). A significant positive correlation exists between parathyroid hormone-PTH-level and the lower T-score. Female had a worse T-score at the lumbar-region whereas male had a worse T-score at the femoral-region. There was no significant difference between males and females for the T-score at hip-region. Conclusion: We observed a distribution of abnormal BMD among different age, sex and CKD groups. Measurements of BMD by DEXA might be a useful test to diagnose osteoporosis in CKD patients. Femoral and total hip areas were more affected, however DEXA might not be able to detect osteoporosis in the lumbar area of CKD patients. T-scores are lower in patients with more severe CKD and lower in elderly patients. PTH level is associated proportionally to the degree of bone loss. Early intervention and proper management must be implemented early among CKD patients with multidisciplinary team approach strategy. More studies are needed to determine if DEXA techniques are enough to distinguish the quantity of bone loss between different stages of CKD.
文摘BACKGROUND A high degree of vigilance is warranted for a spinal infection,particularly in a patient who has undergone an invasive procedure such as a spinal injection.The average delay in diagnosing a spinal infection is 2-4 mo.In our patient,the diagnosis of a spinal infection was delayed by 1.5 mo.CASE SUMMARY A 60-year-old male patient with a 1-year history of right-sided lumbar radicular pain failed conservative treatment.Six weeks to prior to surgery he received a spinal injection,which was followed by increasing lumbar radicular pain,weight loss and chills.This went unnoticed and surgery took place with right-sided L4-L5 combined microdiscectomy and foraminotomy via a posterior approach.The day after surgery,the patient developed left-sided lumbar radicular pain.Blood cultures grew Staphylococcus aureus(S.aureus).Magnetic resonance imaging showed inflammatory aberrations,revealing septic arthritis of the left-sided L4/L5 facet joint as the probable cause.Revision surgery took place and S.aureus was isolated from bacteriological samples.The patient received postoperative antibiotic treatment,which completely eradicated the infection.CONCLUSION The development of postoperative lower back pain and/or lumbar radicular pain can be a sign of a spinal infection.A thorough clinical and laboratory work-up is essential in the preoperative evaluation of patients with spinal pain.
