I. What are the characteristics of low back pain caused by osteoporosis?
Pain is the most common and dominant symptom of OP. Low back pain is most common when changing position such as turning over, getting in and out of bed, sitting and standing up. In external forces or non-traumatic spinal compression fractures, wedge and multivertebral deformities, causing low back pain, not unlike persistent pain such as lumbar muscle strain and malignancy.
What are the risks of osteoporotic fractures for patients?
Fractures are the most important complication of OP. In the grand scheme of things, its risk is greater in women than the sum of breast cancer, endometrial cancer and myocardial infarction, and in men far greater than prostate cancer. Osteoporotic fractures occur in more than 1 million people each year in the United States. The prevalence rate in China is as high as 50% in women over 50 years old and over 20% in men over 70 years old. The number of patients with osteoporosis has reached 86 million. The harm is not only in the patients themselves, but also on the family, society and medical expenses.
How to treat patients with osteoporosis?
In the clinical treatment of orthopedics, osteoporosis is a common disease that is easy to be ignored, and even after the fracture of an osteoporotic patient, the attention of the orthopedic surgeon is mainly focused on the choice of fracture treatment method, and often the cause of the fracture – Often, the cause of the fracture, osteoporosis, is not diagnosed and not treated as necessary.
To prevent “bone failure” and fractures, the orthopedic surgeon is often the first and often the only physician seen by the patient with an osteoporotic fracture, and therefore must be aware of the need to take effective measures to prevent the patient from re-fracturing.
To date, there is a lack of ideal and reliable methods for the treatment of severe osteoporotic fractures with very poor bone quality. Therefore, the timely identification and treatment of patients with osteoporosis and the necessary treatment and monitoring of those at risk for fracture (those with multiple fracture risk factors or whose BMD values are already below the threshold bone mass for fracture at a particular site) is an ideal way to effectively reduce the incidence of osteoporotic fractures. “Just as cardiologists do not wait for severe heart failure to start treating heart disease, we should take the necessary steps to prevent “bone failure” and prevent fractures from occurring.
According to the World Orthopaedic Osteoporosis Organization, “Unless contraindicated, any patient who has had a fragility fracture and osteoporosis should be treated with medication to reduce the risk of re-fracture.”
Data from several studies in Europe and North America indicate that a fracture at any site after age 50 predicts an increased risk of vertebral fracture; those with a history of hip fracture have a 50% risk of hip re-fracture; women with a history of wrist fracture have a significantly increased risk of hip fracture, and men with a history of wrist fracture are suggestive of a precursor to fracture at another site.
At the 6th Congress of the European Federation of Bone and Trauma Associations held in Helsinki, Finland, in 2003, it was suggested that the responsibilities of orthopaedic surgeons are: to identify and diagnose patients with osteoporosis; to determine and assess the degree of osteoporosis in elderly patients who have suffered a fragility fracture; to treat both fractures and osteoporosis; to treat osteoporosis in patients who have suffered a fracture and are able to prevent a re-fracture; and for fracture treatment and injury protection for people at risk can reduce the risk of fracture.
The prevention and treatment of osteoporosis can be carried out in various ways, including the intake of basic nutrients such as protein, vitamin D, calcium and other trace elements in appropriate amounts; sunlight and outdoor exercise; correction of bad habits such as smoking, alcohol abuse and partial eating; treatment of the etiology of secondary osteoporosis and prevention of bone loss; and the application of anti-osteoporosis drugs for patients with diagnosed osteoporosis or existing fragility fractures is beneficial It is very necessary.
Generally, patients are bedridden for 1.5 to 2 months and treated with medication; vertebroplasty is performed for severe fractures.
It is clear from the following studies that the neglect of osteoporosis treatment by orthopedic surgeons may be a common problem worldwide.
The National Osteoporosis Risk Assessment Organization (NORA) study showed that about half of the 200,000 randomly selected menopausal women in the United States were not found to have low bone mass, with a subsequent increased risk of potential fracture in these individuals. Among the 39.6% of menopausal women with reduced bone mass, the incidence of fracture was 1.8 times that of women with normal bone mass; and among women with confirmed osteoporosis, the incidence of fracture was four times that of women with normal bone mass.
In 1998, a survey of British orthopaedic surgeons found that 44% of orthopaedic surgeons never checked the bone density of patients with hip fractures, and only half of them did so occasionally, and none of them used bone density as a routine test for patients with hip fractures.
In 2002, only 10% of male hip fracture patients were also examined for bone density. Of the 1162 women over 55 years of age who had a Colles fracture, only 2.8% had had a bone density test within 6 months.
A Dutch scholar followed 1654 patients with osteoporotic fractures for 1 year in 2003 and found that only 15% of those with fractures received anti-osteoporosis treatment.
Kaufman noted that orthopaedic surgeons may not be aware of the presence of osteoporosis and have not been taking effective treatment. Diagnosing and evaluating osteoporosis and treating it in patients who have had a fragility fracture is the best way to prevent another fracture.
Third, how to determine if you have osteoporosis?
Women over 50 years old with pain in the lower back and other areas, the most basic X-ray or unstable X-ray absorptiometry suggests osteoporosis for the purpose of clear diagnosis.
Fourth, what should I pay attention to when suffering from osteoporosis?
1, usually pay attention to avoid falls to prevent the occurrence of fractures, do not sleep on a soft bed, wear suitable shoes, clothing and pants, choose the ground flat, dry, well-lit places for activities and exercise. Hold the handrail when going up or down the stairs, and keep your balance with the help of a cane or walker. When changing position, move slowly and have a bedside commode at night. Have someone to accompany and support you when you go out for examination and treatment.
2.Rational diet. First of all, it is advisable to ensure adequate calcium intake, the daily calcium intake of elderly patients with osteoporosis should be 1000-1500 mg. It is advisable to choose foods rich in calcium, such as low-fat or fat-free milk, yogurt, dark green vegetables, beans and soy products, shrimp skin, etc. It is not advisable to eat too much protein and too salty food, and control the intake of sugar to prevent calcium loss; eat more fruits and vegetables containing vitamin C to promote calcium absorption. Avoid smoking, drinking alcohol and drinking strong tea. Urinary stones are easily formed after taking oral calcium, so you should drink more water. Anti-inflammatory and analgesic drugs such as fenbuterol and fotarine have a certain stimulating effect on the stomach, so it is advisable to take them after meals or when eating, and pay attention to whether there is stomach pain, black stool and other manifestations.
3, sports exercise. Exercise can not only stimulate the increase of calcium and phosphorus in the bones and maintain bone mass, but also increase the strength of muscle stretching and contraction, joint coordination, balance and flexibility. You can develop a scientific personal exercise plan according to your condition, ability and hobbies. Choose suitable exercise programs for elderly patients, such as walking, jogging, dancing, tai chi, etc. Generally, exercise 3-4 times a week, 30-60 minutes each time. Try to get more sunshine in order to increase the production of endogenous vitamin D and effectively prevent further development of osteoporosis.
4.Chinese medicine treatment
(1) Kidney Yang deficiency type: clinical manifestations include soreness and pain in the waist and knees, coldness, especially in the lower extremities, with depression, dark complexion, long and clear urine, frequent urination at night, or prolonged bowel movements, and diarrhea on the fifth shift. Treatment should be to warm the kidney yang, can take the Chinese medicine Jin Kui Kidney Qi Pill.
(2) Liver and kidney yin deficiency type: soreness of the back, fatigue and weakness, insomnia and dreaminess, dryness of the throat and mouth, feverishness of the five hearts, night sweating and tinnitus. Treatment should be to nourish the liver and kidney, and can take Liu Wei Di Huang Wan.
(3) Qi stagnation and blood stasis type: back pain, restricted movement, or deformation of joints of the limbs, accompanied by anxious temperament, dullness of the ribs, and painful movement. Treatment should be to activate the blood and move the qi, and relieve pain by taking Blood Mansions and Stasis Capsules. (4) Qi and Blood deficiency type: soreness and pain in the lower back, weakness in the limbs, sore joints, palpitations and insomnia, weakness and spontaneous sweating, and a pale complexion. The treatment should be to strengthen the spleen, benefit the qi and replenish the blood, which can be V. Can taking Ginseng and Spleen Pill medicine cure osteoporosis?
Treatment OP only play a role in preventing fractures, after fracture or severe osteoporosis to use vertebroplasty, while taking drugs, can best treat OP.
VI. Can calcium supplementation cure osteoporosis?
Calcium is the most abundant element in bones, and calcium supplementation is a necessary measure for the prevention and treatment of osteoporosis, but for the treatment of osteoporosis, calcium supplementation alone is absolutely insufficient. The currently accepted treatment plan for osteoporosis is based on calcium and vitamin D, plus at least one anti-osteoporosis drug.
VII. What are the commonly used anti-osteoporosis drugs?
The commonly used anti-osteoporosis drugs include: (1) bisphosphonates (Fosamax, TENCO, etc.); (2) calcitonin (MIGA, Ecalcitonin, etc.); (3) selective estrogen receptor modulators (EVET); (4) hormone replacement therapy (HRT); and (5) recombinant human parathyroid hormone (PTH). As mentioned earlier, the treatment regimen is usually one of calcium and vitamin D and anti-osteoporosis drugs, which need to be used under the supervision of a specialist.
How can I know if the treatment for osteoporosis is working?
The treatment of osteoporosis is a long-term process, and the measurement of bone density is the main method to judge the effectiveness of treatment, and it often takes six months after the treatment to see the obvious effect. Of course, the occurrence of fractures is also an intuitive way to determine the efficacy of osteoporosis treatment, but it is only suitable for use in population studies.
IX. Why are osteoporotic fractures not suitable for open surgery?
The treatment of osteoporotic fractures is difficult, with the majority of patients being of advanced age. The health status and many coexisting conditions increase the risk of anesthesia and surgery; the incidence of postoperative systemic complications is significantly higher than in younger people; the reduction of local bone quality and strength increases the risk of failure of internal fixation or artificial implants, and improvement of bone quality and strength is difficult to achieve in the short term. Therefore, orthopaedic surgeons must repeatedly weigh and evaluate invasive and non-surgical treatments and treatment outcomes in order to make a reasonable choice.
What is vertebroplasty?
Percutaneous vertebroplasty (PVP) is a new minimally invasive spine procedure developed in Europe and the United States in recent years. It is currently used for vertebral compression fractures in osteoporosis and for primary or metastatic invasive tumors of the vertebral body, and is effective in reducing pain, increasing vertebral strength, improving systemic symptoms, and even improving, to some extent, kyphosis. kyphosis deformity of the spine. Moreover, it has the characteristics of low complications and good long-term results of surgery. The main bone cement material used for surgery is polymethylmethacrylate (PMMA), and new materials are being developed. However, strict clinical evaluation of the materials is not yet complete. Nevertheless, percutaneous vertebroplasty still shows a broad application prospect and vitality.
XI. What are the advantages of vertebroplasty?
Safe, minimally invasive efficacy: more than 90~95% excellent rate, pain can be relieved immediately.
12.Is there any risk in vertebroplasty?
Any surgery has the possibility of complications. opthroplasty has few complications, and patients are most concerned about spinal cord and nerve injury, which is theoretically very unlikely, and pulmonary embolism complications should not occur according to the operation protocol. Posterior convexoplasty is safe under general anesthesia, with even less leakage and pulmonary embolism. It is usually possible to go down in 48 hours.
XIII. What is the effect of vertebroplasty?
The effect of PVP on pain relief for osteoporotic fractures and tumors is very satisfactory, mostly above 90%; for compression fractures (65% of people have 83% vertebral compression) the application of PKP has good effect on pain relief and can also significantly restore the height of the compressed vertebral body and correct the posterior deformity.
XIV, which patients can do vertebroplasty?
Indications
(a), benign lesions of the vertebral body: ① vertebral body hemangioma, 100% effective after surgery. ② vertebral osteoporosis and its complications, PVP is suitable for patients with loss of mobility and presence of severe back pain.
b), malignant tumors of the vertebral body, to stabilize the spine, relieve pain and prevent further compression of the vertebral body.
c), fractures and tumors in other parts of the spine, such as the ilium.
(d), PVP can also be used to carry bone growth hormone or other anti-tumor drugs with good effect.
XV. Why can bone cement injection stop pain?
Mechanism of action.
(a) Enhance the strength of vertebral body and restore the stiffness of the motion segment.
(b) The microfracture in the vertebral body is stable, but some axial forces and sensory nerves are not destroyed.
(c), can restore the height of the vertebral body, correct the posterior convexity deformity.
Can PVP be done in osteoporosis with age-related diseases?
Unless extremely serious heart failure or coagulation dysfunction can be applied to PVP minimally invasive technique.
XVII. What should I pay attention to after the surgery?
XVIII. Is it too late to start treatment now that a fracture has occurred?
It is never too late to mend. This is also true for osteoporosis. Even in very severe cases, starting treatment at any time will be effective. Aggressive treatment can prevent and reduce the occurrence of re-fractures, which not only reduces pain and improves quality of life, but also prevents patients from incurring medical expenses due to re-fractures and greatly reduces medical costs in general.
The patient should be able to move to the ground 4 hours after PVP or 48 hours after PKP. At the same time, leg raising and low back function exercises should be performed early to prevent venous thrombosis and pulmonary and urinary complications. Lowering to the ground can be done under the protection of a lumbar bib or under the guidance of a physician. The original long-term pain can be quickly eliminated. Self-care life and increase the enjoyment of life.
Case example.
Wang, female, 80 years old, 8 years after thyroid tumor surgery, lower limb discomfort of lumbar pain for 2 years, physical examination: decreased pain in the right saddle area, dull pain in the right calf, and decreased muscle strength on the right side. vertebroplasty was performed on April 2, 2002, and the symptoms disappeared immediately after the operation, and now she has resumed normal life and is learning calligraphy at the university for the elderly.
Zhou, female, 81 years old, trauma caused low back pain for more than 5 years. Examination: posterior spinal protrusion increased, thoracic 3, 4, 9, 10 percussion pain, walking affected. l3, l4 vertebrae severe compression fracture, severe osteoporosis. On June 3, 2003, L3 and L4 vertebroplasty was performed. He walked on the ground one day after surgery and has resumed normal life.
Qiu, male, 74 years old, had low back pain for 2 months. Physical examination: posterior protrusion deformity of thoracolumbar segment with obvious percussion pain. On 2002.7.31, T10 vertebroplasty was performed, and the symptoms disappeared immediately after surgery, and he was discharged on his own 1 day after surgery.