The relationship between the accumulation of fat in visceral or subcutaneous tissue and bone mineral density (BMD) remains unclear. Our primary objective in this study was to illuminate this relationship by conducting an investigation on a vast scale, encompassing a nationally representative population in the United States. A weighted multiple linear regression model was established to evaluate the relationship between visceral fat, subcutaneous fat, and BMD. Additionally, the exploration of the potential nonlinear relationship was conducted employing the methodology of smooth curve fitting. In order to determine potential inflection points, a two-stage linear regression model was utilized. A total of 10,455 participants between the ages of 20 and 59 were included in this study. Various weighted multiple linear regression models revealed a negative correlation between lumbar BMD and visceral mass index (VMI) and subcutaneous mass index (SMI). However, the association between VMI and lumbar BMD displayed a U-shaped pattern upon employing the smooth curve fitting, and the inflection point of 0.304 kg/m2was determined using a two-stage linear regression model. Our findings indicated a negative association between subcutaneous fat and BMD. A U-shaped relationship was observed between visceral fat and BMD.
Purpose Proximal humerus fractures (PHFs) are common. With the development of locking plates, open reduction and internal fixation (ORIF) of the proximal humerus can provide excellent clinical outcomes. The quality of fracture reduction is crucial in the locking plate fixation of proximal humeral fractures. The purpose of this study was to determine the impact of 3-dimensional (3D) printing technology and computer virtual technology assisted preoperative simulation on the reduction quality and clinical outcomes of 3-part and 4-part proximal humeral fractures. Method A retrospective comparative analysis of 3-part and 4-part PHFs undergoing open reduction internal fixation was performed. Patients were divided into 2 groups according to whether computer virtual technology and 3D printed technology were used for preoperative simulation: the simulation group and the conventional group. Operative time, intraoperative bleeding, hospital stay, quality of fracture reduction, Constant scores, American Society for Shoulder and Elbow Surgery (ASES) scores, shoulder range of motion, complications, and revision surgeries were assessed. Results This study included 67 patients (58.3%) in the conventional group and 48 patients (41.7%) in the simulation group. The patient demographics and fracture characteristics were comparable in these groups. Compared with the conventional group, the simulation group had shorter operation time and less intraoperative bleeding (P < 0.001, both). Immediate postoperative assessment of fracture reduction showed a higher incidence of greater tuberosity cranialization of < 5 mm, neck-shaft angle of 120° to 150°, and head shaft displacement of < 5 mm in the simulation group. The incidence of good reduction was 2.6 times higher in the simulation group than in the conventional group (95% CI, 1.2–5.8). At the final follow-up, the chance of forward flexion > 120° (OR 5.8, 95% CI 1.8–18.0) and mean constant score of > 65 (OR 3.4, 95% CI 1.5–7.4) was higher in the simulation group than the conventional group, as well as a lower incidence of complications in the simulation group was obtained (OR 0.2, 95% CI 0.1–0.6). Conclusions This study identified that preoperative simulation assisted by computer virtual technology and 3D printed technology can improve reduction quality and clinical outcomes in treatment of 3-part and 4-part PHFs.
Objective: To explore the applicability of bone reamer and trephine for foraminoscopy in percutaneous endoscopic lumbar discectomy(PELD), and to provide a theoretical basis for foraminoplasty options in clinical practice. Methods:This study was a prospective cohort study. Sixty-three consecutive patients who underwentPELD for lumbar disc herniation between May 2021 and July 2022 were analysed. Foraminoplasty were performed by bone reamer or trephine. The amount of bone resected and the area enlarged during foraminoplasty by both tools were measured by 3D slicer as well as Digimizer software, and the numbers of fluoroscopic views were recorded. Results: The bone reamer resected less bone in the Superior Articular Process (SAP) than the trephine (t=17.507, P<0.001),and the area enlarged by the bone reamer was smaller than that of the trephine (t=10.042, P=0.002). The overall numbers of fluoroscopic views were significantly more in the bone reamer group than in the trephine group (t=19.003, P<0.001). In the bone reamer group, when the area of preoperative foraminoplasty zone was no less than 54.55 mm², the mean number of fluoroscopic views significantly decreased.(t=14.443,P=0.001). Conclusion:Bone reamer was safer and trephine was more efficient for foraminoscopy in PELD. An area of preoperative foraminoplasty zone of 54.55 mm²can be used as a critical value: bone reamer reduced the risk for cases above the value, while trephine improved the efficiency for cases less than the value.
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