ABSTRACT
Objective To explore the demographic factors and the risk of the pedicle screw insertion of the narrow pedi?cles. Methods Thoracolumbar spine thin?section CT image data of 312 adults from September 2014 to September 2015 were ana?lyzed. The pedicle width,medial and lateral cortical thickness, spongy bone thickness, spongy bone thickness/cortical thickness, e angle and screw path length of each pedicle were measured. The incidence and the distribution characteristics of the narrow pedi?cle were analyzed. Anatomic parameters and age, gender and stature were compared between the narrow pedicle group and non?narrow pedicle. The risk of the pedicle screw insertion of the narrow pedicle was assessed. Results Among the 3 081 pedicles, 74 narrow pedicles were determined as their pedicles width were less than 5 mm, and the proportion of narrow pedicle was 2.40%. Among the 312 subjects, 26 subjects were found having narrow pedicles, and the proportion of individuals with narrow pedicles in the population was 8.33% (26/312). The incidences of narrow pedicle in thoracolumbar spine were T10 0.32%, T11 0.32%, T12 0.98%, L1 7.54%, L2 2.92%. The spongy bone thickness, spongy bone thickness/cortical thickness of narrow pedicle were lower than non?narrow pedicle. However, there were no significant differences of medial and lateral cortical thickness, e angle and screw path length between the narrow pedicle and non?narrow pedicle. Difference of the mean age between the two subjects groups had no statistical significance. The percentage of female in narrow pedicle subjects group was 84.6%(22/26), which was higher than that in non?narrow pedicle subjects group (49.7%, 142/286). The mean stature of the male and female of stenosis pedicle group subjects were 163.8±1.3 cm and 152.5±4.3 cm, which were shorter than those of non?narrow subjects pedicle group (169.5±5.6 cm, 160.1±6.6 cm). The percentage of the cortical bone breakthrough by the pedicle screws of narrow pedicle group was (84.6%, 27/32), which was higher than that of non?narrow pedicle group (14.7%, 33/224). Conclusion L1 is the most common segment of thoracolumbar spine that narrow pedicle exist, which is the result of reduction of the spongy bone thickness. Narrow pedicle mostly appears in short stature female. There is high risk of cortical bone breakthrough by insertion of the posterior pedicle screws in the narrow pedicle.
ABSTRACT
Osteoarthritis (OA) is a common chronic arthritis, mainly suffering the middle and elderly patients, and it is the main cause of arthralgia and articular functional disturbance. Studies have suggested that osteophyte formation was closely con?nected with the development of OA due to the stabilization of suffered joints and arthralgia induced by osteophytes. In tissue con?stitution and pathology, osteophyte is made up of bone, cartilage and connective tissue, stemming from MSCs. With the develop?ment of osteophytes, the proportion of bone increases while the proportion of cartilage and connective tissue decreases. What's more, in promotion factors of osteophytes, osteophyte formation was induced by the biomechanical and biochemical factors and their both effect. The biomechanical factors result from imbalance of articular biomechanics induced by cartilaginous degeneration and ligament trauma. And the biochemical factors result from alteration of articular microenvironment induced by metabolic disor?der of chondrocytes and synovitis. Furthermore, the both effects that the biomechanical factors induces biochemical alterations al?so co?promote osteophyte formation. And studies on the mechanism indicated that osteophyte formation was regulated by several signaling pathways and cytokines. TGF?β superfamily and Hedgehog signaling pathway were involved in modulating osteophyte formation. TGF?βand BMPs modulated the initiation and late stage of osteophyte formation respectively. And Hedgehog signaling pathway regulated the osteophyte formation with modulating the hypertrophy of chondral osteophytes. This paper emphatically re?views the development and mechanism of osteophytes in OA for deeply understanding the OA and bringing new ideas and methods for the precaution and treatment of OA.