RESUMO
STUDY DESIGN: Cross-sectional study using radiological measurements. PURPOSE: To analyze the relationship between type 2 diabetes mellitus (DM) and bone mineral density (BMD) in postmenopausal women and to assess risk factors of osteoporotic vertebral compression fracture (OVCF) in postmenopausal diabetic women. OVERVIEW OF LITERATURE: Type 2 DM has negative effects on the quality of bone. Patients with type 2 DM have increased risk of hip and other fractures, but their vertebral fracture risk is controversial. There is a positive correlation between body mass index (BMI) and BMD. At the same time, obesity is the most important risk factor for type 2 DM. METHODS: Consecutive patients whose BMD had been checked using dual-energy X-ray absorptiometry at Gwangmyung Sungae Hospital were recruited. Patients were divided into two groups according to the presence of type 2 DM. Risk factors of OVCF including age, BMI, current smoking status, current alcohol consumption, and presence of osteoporosis were analyzed separately in the type 2 DM group and control group. RESULTS: A total of 1,130 patients were enrolled in this study. The mean age was 63.2 years. BMI was positively correlated with lumbar BMD in the control group (r =0.284) and in the diabetic group (r =0.302). In subgroup analysis, BMI and age were significant risk factors of OVCF in the type 2 DM group. In multiple linear regression analysis, type 2 DM (ß =0.035; 95% confidence interval [CI], 0.005-0.065; p=0.024) and BMI (ß =0.015; 95% CI, 0.012-0.018; p<0.001) were positively correlated with lumbar BMD, and age was negatively correlated with BMD (ß =-0.006; 95% CI, -0.007 to -0.004; p<0.001). CONCLUSIONS: BMI was positively correlated with lumbar BMD and was higher in type 2 diabetic patients. Age was negatively correlated with lumbar BMD.
RESUMO
STUDY DESIGN: Retrospective evaluation. PURPOSE: To determine the prevalence of mid-range dynamic instability in patients with degenerative spondylolisthesis (DS) and to evaluate the clinical implication of mid-range instability (MI). OVERVIEW OF LITERATURE: Instability is identified by measuring vertebral body anterior-posterior translation on static end-range flexion and extension lateral radiographs. Mid-range kinematics could evince occult dynamic instability in which motion is not appreciated at the terminal-range of motion. METHODS: In this study, 30 patients with DS with checked standing dynamic radiographs of the lumbar spine in Gwangmyeong Sungae Orthopedic Clinic were recruited. Standing lateral radiographs were evaluated in extension, 45° of flexion (mid-range) and 90° of flexion (terminal-range) of the lumbar spine. Instability was defined as sagittal translation greater than 3 mm from the extension position. Patients were divided into three groups: a control group, an MI group, and a terminal-range instability (TI) group. Radiographic outcome (stenosis grade) and clinical outcome were compared between the three groups. RESULTS: The average sagittal translation of the lumbar spine was 5.2 mm in extension, 6.6 mm in mid-range, and 7.2 mm in endrange. MI was observed in eight patients (26.2%) and TI was seen in 12 patients (40%). Of eight patients with MI, three patients did not have instability at terminal-range (occult patients) and five patients had instability at terminal-range (typical patients). Body weight and body mass index (BMI) was significantly higher in the MI group as compared to the control group. BMI was positively correlated with slippage to mid-range. There was no significant difference in stenosis grade, Visual Analog Scale, and Oswestry Disability Index. In the TI group, there was no significant difference in radiographic clinical parameters as compared to the control group. CONCLUSIONS: MI was demonstrated in 25% of DS patients. Mid-range motion was increased with BMI. Mid-range lateral radiography can reveal occult instability in patients with DS, particularly in obese patients.
RESUMO
PURPOSE: The purpose of this study was to compare the insertion sites of the posterior horn between discoid and non-discoid lateral meniscus using magnetic resonance imaging (MRI). METHODS: Two hundred and twenty-seven patients who had MRI scans before surgery and underwent arthroscopy were enroled in this study. A coronal view showing the narrowest width of the midbody of the lateral meniscus was chosen to measure the widths of the entire tibial plateau and the midbody of the lateral meniscus. Considering the ratio of the meniscal width to the tibial plateau width, the patients were divided into non-discoid, incomplete discoid, and complete discoid groups. On a coronal view accurately showing the insertion of the posterior horn of the lateral meniscus, a distance between the peak of the lateral tibial eminence and the centre of the insertion of the posterior horn, and a width of the lateral tibial plateau between the lateral edge of the tibial plateau and the peak of the lateral tibial eminence were measured. RESULTS: The insertion centre of the posterior horn was located more medially in the incomplete and complete discoid groups than in the non-discoid group (p = 0.003, 0.010, respectively). When individual differences in the knee size were corrected, the insertion centre of the posterior horn in the incomplete discoid and complete discoid groups was located more medially than in the non-discoid group (p = 0.009, 0.003, respectively). CONCLUSION: The insertion centre of the posterior horn of the lateral meniscus is located more medially to the apex of the lateral tibial eminence in the discoid group than in the non-discoid group. This finding needs to be considered for an accurate position of the posterior horn of lateral meniscus during the lateral meniscal allograft transplantation. LEVEL OF EVIDENCE: IV.