莆田地区畲族的骨密度与骨生化指标以及睾酮雌二醇之间的关系

目的 探讨莆田地区畲族健康人群骨密度与骨生化指标、睾酮以及雌二醇之间的关系,并与汉族人群比较,为本地区骨质疏松防治提供依据。方法 选择本地区畲族聚集地40岁以上健康成年人,其中畲族532人,汉族563人,应用美国Osteometer Medi Tech公司生产的DTX-200骨密度吸收仪检测骨密度,以及用罗氏公司的骨生化指标仪器及试剂盒,测量骨密度以及25羟维生素D（25（OH）D3）、骨钙素（BGP）、雌二醇（E2）、睾酮（T）、甲状旁腺激素（PTH）、1型前胶原氨基末端肽（P1NP）、碱性磷酸酶（ALP）。把上述检测的数据结果输入电脑,应用SPSS17.0软件包进行数据分析。结果 不管畲族和汉族的骨密度均随着年龄的增大而下降,同年龄段男性均高于女性。畲族女性除在40～49岁年龄段稍高于汉族外,其他年龄组汉族女性均高于畲族。而畲族男性在60～69岁年龄段稍高于汉族男性,其他年龄组汉族男性均高于畲族,但汉族与畲族间都没有显著性差异（P>0.05）。汉族的25(OH)D3明显高于畲族,尤其女性在40～60岁年龄段、男性在50～69岁年龄段为正相关（P<0.05）;汉族的BGP高于畲族(P<0.05),汉族男的E2指标均高于畲族男,且40～59年龄段尤为明显（P<0.05）。P1NP在汉族男女性高于畲族男女性（P<0.05）。经皮尔森相关分析,骨密度与E2、25OHD3、T成正相关,而与PTH、BGP、ALP成负相关,与ALP无相关。结论 本研究25（OH）D3、BGP、P1NP、E2测定可以作为汉族、畲族健康人群早期检测指标,畲族的25（OH）D3水平普遍偏低,可能与他们的生活方式或者维生素D基因有关,值得进一步研究。骨密度与25（OH）D3、E2、T有明显正相关,而与PTH、PINP、BCG负相关,与ALP无明显相关。     

绝经后女性骨密度与骨代谢生化指标的相关性分析

目的分析绝经后女性骨密度(bone mineral density,BMD)与骨代谢生化指标的相关性。方法选取西南医科大学附属医院2017年1月至2018年12月收治的绝经后女性患者151例。根据骨密度T值将患者分为骨质疏松组(83例)、骨量低下组(47例)和骨量正常组(21例),比较三组患者骨代谢生化指标的差异,并对各项指标与BMD进行相关性分析。结果骨质疏松组甲状旁腺素(PTH)、Ⅰ型前胶原氨基末端前肽(P1NP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)显著高于骨量低下组和骨量正常组(P0. 05),骨量低下组显著高于骨量正常组(P0. 05)。骨质疏松组体质量指数(bone mass index,BMI)、25(OH) D_3显著低于骨量低下组和骨量正常组(P0. 05),骨量低下组显著低于骨量正常组(P0. 05)。血钙、血磷、骨钙素(BGP)、血清的骨特异性碱性磷酸酶(BALP)在三组之间比较,差异无明显统计学意义(P0. 05)。Spearman相关分析显示,PTH、P1NP、β-CTX与骨密度呈负相关(r=-0. 538,-0. 520,-0. 462,P 0. 05),25(OH) D_3与骨密度呈正相关(r=0. 517,P0. 05),血钙、血磷、BALP、BGP与骨密度无相关性(P0. 05)。结论血清25(OH) D_3、PTH、P1NP、β-CTX与骨密度存在显著相关性,骨代谢生化指标监测有助于绝经后女性骨质疏松的早期诊断。     

扩张性心肌病患者骨代谢指标状况及其临床意义

目的探究扩张性心肌病(dilated cardiomyopathy,DCM)患者骨代谢指标水平状况及其临床意义。方法选取2016年3月至2018年3月在我院诊治的DCM患者48例作为研究对象并归入DCM组,选择同期在我院接受健康体检的成年人30名归入健康组,测定和比较两组的血清骨钙素(BGP)、钙(ICa)、骨特异性碱性磷酸酶(BALP)、甲状旁腺激素(PTH)、25羟基维生素D_3[25(OH) D_3]等骨代谢指标水平,以及大粗隆、股骨颈、腰椎等部位的骨密度(BMD),分析骨代谢指标BGP、ICa、BALP、PTH和25(OH) D_3分别与患者年龄、DCM病程、BMI、肌酸激酶同工酶、肌钙蛋白I和心功能分级等因素的相关性。结果(1) DCM组的BGP、ICa、25(OH) D_3等水平均低于健康组,BALP、PTH水平均高于健康组,差异均有统计学意义(P均0.05)。(2) DCM组大粗隆部位的BMD与健康组比较,差异无统计学意义(P0.05); DCM组的股骨颈及腰椎部位的BMD均低于健康组,差异均有统计学意义(P均0.05)。(3) BGP、ICa和25(OH) D_3分别与年龄、DCM病程及心功能分级呈负相关,BGP与肌酸激酶同工酶、肌钙蛋白Ⅰ呈负相关; BALP与年龄、DCM病程、肌酸激酶同工酶、肌钙蛋白Ⅰ及心功能分级呈正相关,PTH与心功能分级呈正相关(P均0.05)。结论 DCM患者的血清BGP、ICa、BALP、PTH、25(OH) D_3等骨代谢相关指标水平有明显波动,且骨代谢相关指标水平与DCM患者年龄、病程、肌酸激酶同工酶、肌钙蛋白Ⅰ及心功能分级等相关,DCM可能是造成骨代谢指标水平发生异常的重要原因。     

666例维汉老年男性骨代谢水平、骨密度测定分析

目的 探讨汉族和维吾尔族老年男性骨代谢水平的特点,了解一定年龄范围内男性骨质疏松的特点.方法 选择符合研究对象的666名老年汉族和维吾尔族男性,测量骨密度(BMD)、骨碱性磷酸酶(BAP)、骨钙素(BGP)、抗酒石酸酸性磷酸酶(TRACP-5b)、25羟基维生素D3(25-( OH) VD3),按BMD值分为正常组、骨量减少组和骨质疏松组并进行比较.结果 OP患病率随年龄增加而增加,与年龄呈正相关.单因素方差分析,维吾尔族、汉族老年男性在年龄、BGP、TRACP-5b中差异有统计学意义(P＜0.05).统计学两两比较:汉族老年男性骨质疏松组TRACP-5b高于正常组及骨量减少组,骨质疏松组BGP骨量明显高于正常组(P＜0.05);维吾尔族骨量减少组的25-( OH) VD2、25-(OH)VD3与正常组存在差异,维吾尔族老年男性骨质疏松组年龄明显高于正常组.同组比较中:正常组、骨质疏松组中,维吾尔族25-(OH)VD2、25-(OH)VD3水平明显低于汉族(P＜0.05),正常组中维吾尔族老年男性BAP、BGP水平高于汉族老年男性(P＜0.05);同组中,维吾尔族年龄均低于汉族年龄(P＜0.05).结论 BGP、TRACP-5b在汉族老年男性中可以较早的反应骨代谢水平的差异性,可以作为骨质疏松症的早期检测指标;维吾尔族老年男性和汉族老年男性在维生素D代谢上可能存在着差异并影响到骨代谢.     

血清25羟维生素D_3的缺乏对慢性肾脏病的影响

目的探讨血清25羟维生素D_3[25(OH)D_3]与慢性肾脏病(CKD)的关系。方法选取2014年1月-2016年1月深圳市龙岗区第五人民医院肾内科确诊的120例CKD患者,根据估算肾小球滤过率(eGFR)分成1~5期,另选取健康人群30例(对照组),分别测定各组的血清25(OH)D_3水平及相关实验室指标,并分析其相关性。结果对照组和CKD各期患者的血肌酐(Scr)、eGFR、白蛋白、甲状旁腺素(PTH)、血红蛋白(Hb)、25(OH)D_3水平差异具有统计学意义(P0.05);CKD患者随着分期增加,Scr、PTH水平逐渐增加,eGFR、Hb、25(OH)D_3水平逐渐降低;各组间血钙、血磷差异均无统计学意义(P0.05)。CKD 4期、5期患者25(OH)D_3水平不足患者占比显著高于对照组以及CKD 1期、2期、3期患者(P0.05);CKD 5期患者25(OH)D_3水平不足患者占比显著高于CKD 4期患者(P0.05)。CKD患者25(OH)D_3与Scr、白蛋白、PTH呈显著的负相关(P0.05);与eGFR、Hb呈显著的正相关(P0.05)。结论CKD患者的25(OH)D_3水平较健康人群低,并且与CKD患者肾功能损害程度关系密切。     

甲状腺功能异常患者血生化、骨代谢及骨密度特点的临床研究

目的观察甲状腺功能减退症及甲状腺功能亢进症对骨密度以及骨代谢相关指标的影响。方法纳入甲状腺功能减退症女性37例为甲减组,甲状腺功能亢进症女性41例为甲亢组,健康体检女性人员40例为对照组。观察3组甲状腺功能指标血游离三碘甲状腺原氨酸(FT_3)、游离甲状腺激素(FT_4)和高敏感促甲状腺激素(TSH);骨代谢指标血Ca~(2+)、血P~(3+)、1,25-(OH)_2D_3、甲状旁腺激素(PTH)、碱性磷酸酶(ALP)、血清Ⅰ型胶原羧基端吡啶并啉交联肽(ICTP)以及血清骨钙蛋白(BGP)以及左侧股骨颈、正位腰椎1-4(L_(1-4))的骨密度情况。结果甲亢组血清FT_3、FT_4、ALP、BGP、ICTP水平高于对照组(P0.05),甲亢组血清TSH水平低于对照组(P0.05)。甲减组血清TSH水平高于对照组(P0.05),而血清FT_3、FT_4、ALP、BGP、ICTP水平显著低于对照组(P0.05)。甲亢及甲减组L1-4及左股骨颈骨密度显著低于对照组(P0.05)。3组受试者PTH、CT、Ca~(2+)、P~(3+)、1,25-(OH)_2D_3比较无统计学意义(P0.05)。结论甲亢及甲减都可以引起骨量丢失,骨密度降低;主要通过影响骨转化来实现的;应该重视甲状腺功能异常引起的骨密度及骨代谢异常。     

甲状腺功能异常对男性骨密度影响的研究

目的探讨甲状腺功能异常对50～80岁男性骨密度的影响,为这类患者的骨质疏松症防治提供理论基础。方法纳入162名50～80岁男性,根据甲状腺功能分为正常对照组(90名),甲亢组(38例),甲减组(34例)。检测记录三组受试者血清FT3、FT4、TSH、Ca、P、1,25-(OH)_2D_3、ALP以及BGP水平。测量三组受试者正位腰椎1～4与左侧髋关节骨密度。结果甲减组血清FT3、FT4、ALP、BGP水平低于对照组(P0.05),而甲亢组高于对照组(P0.05);甲减组血清TSH高于对照组(P0.05),而甲亢组低于对照组(P0.05);甲亢及甲减组腰椎和髋关节BMD低于对照组(P0.05)。三组受试者血清Ca、P、1,25-(OH)_2D_3差异无统计学意义(P0.05)。相关性结果表明血清BGP和ALP与FT3、FT4间存在统计学正相关,与TSH呈负相关(P0.05);骨密度T值评分与FT3、FT4间存在统计学负相关(P0.05)。Logistic回归结果显示甲减和甲亢均对骨密度有负向影响(P0.05)。结论甲状腺功能异常对50～80岁男性骨密度有负面影响,应重视甲状腺功能异常患者骨密度的改变,这对于骨质疏松症的防治具有重要意义。     

1084例女性TRACP、CTX-1、BALP、BGP、钙磷代谢指标 与BMD相关性

目的研究女性抗酒石酸酸性磷酸酶（TRACP)、I型胶原交联C-末端肽（CTX4)、骨碱性磷酸酶（BALP)、骨钙素 (BGP)、25著维生素D3(25( OH) D3)、甲状旁腺素（PTH)、降钙素（CT)与股骨颈BMD的相关性。方法采用Discovery WA型 骨密度仪检测股骨颈BMD,采用酶标免疫分析仪检测TRACP、CTX4、BALP、BGP、25 ( OH) D3、PTH、CT。将1084例受试者检 测结果按5岁为年龄段分组,应用SPSS 13. 0分析软件进行统计分析。结果25 (OH) D3、PTH、CT在35 ~ 50岁年龄段各组间 不存在差异;50岁以后25 (OH) D3开始下降,与丽D呈正相关;CT降低出现在65 ~ 79岁年龄段,与丽D显著正相关。35 ~ 45岁年龄段TRACP、CTX4与BMD呈负相关,而BALP、BGP与BMD呈正相关;50 -60岁年龄段BALP、BGP明显升高, TRACP、CTX4、BALP、BGP均与BMD呈负相关;65岁以后BALP、BGP开始下降,BALP、BGP与骨密度呈正相关,TRACP、CTX- 1与骨密度呈负相关。结论TRACP、CTX4、BALP、BGP、25 ( OH) D3、PTH、CT监测骨代谢水平为骨质疏松诊断、鉴别诊断提 供了分子生物学依据。     

北京地区中老年人FRAX骨折风险评估与BMD、骨代谢相关生化指标间的相关回归研究

目的探讨北京南郊地区中老年人FRAX评估未来10年全身骨折风险PMOF、骨密度BMD、骨代谢相关指标指标25(OH)D3、PTH、N-MID等在年龄、性别、体质指数之间的差异及变化趋势,研究PMOF、骨密度与各骨代谢相关生化指标之间的相关性。方法收集接受DXA桡骨远端骨密度(BMD)检查的体检人群1133例,代入FRAX骨折风险评估工具计算全身主要部位骨折概率(PMOF),收集相应骨代谢生化指标:25-羟维生素D3[25(OH)D_3],血清骨钙素N端中分子片段(N-MID),甲状旁腺素(PTH)、血钙(Ca)、血磷(P)、血清碱性磷酸酶(ALP)等。分析比较各指标随年龄的变化趋势,比较各年龄组各指标性别间差异;分析比较不同性别、各年龄组中各指标在不同体质指数之间的差异及其变化趋势;采用多元逐步回归法分别分析未来10年骨折风险概率(PMOF)、BMD与各因素、各生化指标之间的相关回归关系。结果非优势手臂桡骨远端1/3处骨密度BMD随年龄增长而降低,各年龄组男性BMD值均大于女性,PMOF随年龄增长而增加,各年龄组男性PMOF均小于女性,差异有统计学意义(P0.05);各年龄组25(OH)D_3水平男性均大于女性,50岁以上年龄组N-MID男性均小于女性,差异有统计学意义(P0.05);多元逐步回归分析中BMD与年龄、N-MID呈负相关,与BMI为正相关,男性大于女性;PMOF与BMD、年龄呈负相关,与BMI、N-MID呈正相关,男性小于女性;在不同性别、各年龄组中BMI正常组的PMOF最低,超重组最高,差异有统计学意义。其他生化指标与BMD、PMOF之间的相关关系不显著(P0.05)。结论 BMD、PMOF与性别、年龄、BMI、骨钙素均相关,其中女性OF的风险均高于男性;BMD随年龄增长而降低,骨折风险增加;BMD与BMI呈正相关,但PMOF表现为超重人群骨折风险最高,故超重亦是使骨折风险增加的危险因素。随血清骨钙素增高,BMD降低,骨折风险增高,可在一定程度上反映骨组织的新陈代谢情况。关注骨代谢生化指标变化可在一定程度上预判骨密度及PMOF水平,对骨质疏松及其骨折的的早发现、早诊断、早预防和早治疗提供一定参考及理论依据。     

福建地区畲族和汉族骨密度流行病学调查分析

目的对福建地区畲族、汉族健康人群2424例骨密度测定,分析本地区峰值骨量、骨密度以及骨质疏松发病率,为本地区骨质疏松诊断、预防、治疗提供依据。方法采用美国Osteometer MediTech公司生产的DTX-200型骨密度仪检测受试者非受力侧前臂挠尺骨远端三分之一处的骨密度。获得骨密度均值、T评分值及Z值。按汉族、畲族、性别、每10岁为一年龄段进行分组,进行统计学的分析。结果汉族的骨密度峰值男性女性均在30～39岁之间;畲族的骨密度峰值男性、女性都在40～49岁之间。与国内同类型仪器检测报道不同。女性的骨密度在19岁之前均高于男性,女性在50岁以后不管是汉族还是畲族都迅速下降,到80岁以后缓慢下降。畲族的男性骨密度在50岁达到高峰,到70岁以后才逐渐下降,与汉族的骨密度峰值在40岁之前不同。总体汉族男女性骨密度均高于畲族,尤其在19岁之前的汉族女性骨密度明显高于畲族女性,统计学有明显差异。结论本次调查骨密度汉族与畲族的峰值出现时间有所不同,可能与生活习惯、种族、生活条件不同有关,但骨密度峰值高者骨质疏松的发生率较低,提示早期诊断、早期治疗可预防骨质疏松的发生、发展。关键词:畲族;汉族;骨密度测定;峰值骨量DXA     

跖骨感染骨外露的显微外科治疗

[目的]回顾总结跖骨骨感染骨外露的显微外科治疗方法。[方法]自1995年～2005年采用显微外科技术治疗214例跖骨骨外露骨感染患者。[结果]全部病例获得随访1～10年，平均随访3年，14例游离植皮术后皮肤成活良好，199例术后皮瓣全部成活，1例腓肠神经营养血管皮瓣移位修复术出现远端部分皮肤坏死，后经换药处理后，伤口自然愈合。皮瓣移植术后质地良好，无溃疡复发。患足均可负重走路。[结论]应用显微外科技术治疗跖骨骨感染骨外露可获得较好的疗效。     

Assessment of bone density and bone loss

Osteoporosis International - Dual-energy X-ray absorptiometry has become the standard for the evaluation of osteoporosis. It is useful both for identifying those people who are going to be at risk...     

骨胶原与骨质疏松骨密度及骨生物力学的相关性研究

目的探讨骨胶原含量在绝经后骨质疏松症的发生、发展及在骨质疏松性骨折中的作用。方法取7个月龄未交配雌性SD大鼠60只，随机分为四组，A组：对照组（sham组）；B组：切除卵巢组；C组：切除卵巢＋雌激素治疗组；D组：切除卵巢＋降钙素治疗组。除A组外，其他三组通过切除双侧卵巢法12周后制成骨质疏松模型，24周后分别行k的力学特性、右侧股骨三点弯曲试验、羟脯氨酸含量、k骨密度（BMD）测定，Masson三色染色法显示骨胶原形态。结果A、C、D组与B组在k羟脯氨酸含量、BMD、k压缩力学参数值、右侧股骨生物力学参数值、骨胶原染色含量及形态方面差异均有统计学意义（P〈0．05），而A、C、D组之间差异无统计学意义（P〉0．05）。统计学分析显示羟脯氨酸含量与BMD及骨生物力学参数值呈直线相关性。结论骨质疏松的发生与骨胶原含量下降有关。骨胶原含量的下降与BMD降低及骨生物力学改变呈相关性。应用雌激素和降钙素治疗去势后骨质疏松大鼠，不仅可以提高其BMD含量和骨生物力学性能，而且还可以提高骨胶原的含量。     

Repair of long bone defects with demineralized bone matrix and autogenous bone composite

Background:

Repair of diaphyseal bone defects is a challenging problem for orthopedic surgeons. In large bone defects the quantity of harvested autogenous bone may not be sufficient to fill the gap and then the use of synthetic or allogenic grafts along with autogenous bone becomes mandatory to achieve compact filling. Finding the optimal graft mixture for treatment of large diaphyseal defects is an important goal in contemporary orthopedics and this was the main focus of this study. The aim of this study is to investigate the efficacy of demineralized bone matrix (DBM) and autogenous cancellous bone (ACB) graft composite in a rabbit bilateral ulna segmental defect model.

Materials and Methods:

Twenty-seven adult female rabbits were divided into five groups. A two-centimeter piece of long bone on the midshaft of the ulna was osteotomized and removed from the rabbits’ forearms. In group 1 (n=7) the defects were treated with ACB, in group 2 (n=7) with DBM, and in group 3 (n=7) with ACB and DBM in the ratio of 1:1. Groups 4 and 5, with three rabbits in each group, were the negative and positive controls, respectively. Twelve weeks after implantation the rabbits were sacrificed and union was evaluated with radiograph (Faxitron), dual-energy x-ray absorptiometry (DEXA), and histological methods (decalcified sectioning).

Results:

Union rates and the volume of new bone in the different groups were as follows: group 1 - 92.8% union and 78.6% new bone; group 2 - 72.2% union and 63.6% new bone; and group 3 - 100% union and 100% new bone. DEXA results (bone mineral density [BMD]) were as follows: group 1 - 0.164 g/cm², group 2 - 0.138 g/cm², and group 3 - 0.194 g/cm².

Conclusions:

DBM serves as a graft extender or enhancer for autogenous graft and decreases the need of autogenous bone graft in the treatment of bone defects. In this study, the DBM and ACB composite facilitated the healing process. The union rate was better with the combination than with the use of any one of these grafts alone.     

Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow

BACKGROUND: On the assumption that an aneurysmal bone cyst has an intrinsic potential to heal by ossification, a new, minimally invasive protocol was developed. Demineralized bone powder mixed with bone-marrow aspirate was introduced into the cyst to halt the expansion phase and to allow the cyst to ossify. We hypothesized that, in order to induce bone-healing, cells from the cyst are needed to respond to the inductive material but that curettage or extensive surgery is not necessary. The goals of the present study were to assess cyst-healing and to determine the prevalence of recurrence associated with this new procedure. METHODS: Thirteen biopsy-proven primary aneurysmal bone cysts were entered through a small incision, and a paste of demineralized bone and autologous bone marrow was introduced with an applicator. The study group included three male and ten female patients with a mean age of 16.6 years. The cyst was located in a long bone in six patients, the pelvis in five patients, and the scapular glenoid and the calcaneus in one patient each. Five patients had not received treatment previously, whereas one had had a preoperative embolization and seven had recurrent lesions that had been treated previously. RESULTS: After a mean duration of follow-up of 3.9 years, healing was achieved in eleven patients. CONCLUSIONS: This minimally invasive method is able to promote the self-healing of a primary aneurysmal bone cyst. As no curettage is required, the proposed treatment avoids extensive surgery and blood loss and is convenient for the treatment of poorly accessible lesions such as those occurring in the pelvis. LEVEL OF EVIDENCE: Therapeutic Level IV.     

Spinal fusions: bone and bone substitutes

Vertebral arthrodesis is one of the most commonly performed, yet incompletely understood, procedures in spinal surgery. Despite major progress in internal fixation techniques, the high rate of non-unions indicates that physiologic, biologic and molecular events that are crucial to this process are not well known. This article will analyze the general biology of bone regeneration, and particularly discuss the properties and use of various bone graft materials and graft substitutes. Received: 9 August 2000/Accepted: 11 August 2000     

Aneurysmal bone cyst and solitary cyst of bone]

Results of treatment of 7 cases of aneurysmal bone cysts and 12 cases of solitary bone cysts in 19 patients treated in our Department between 1991 and 1996 are presented. Changes were found in the humerus, femur, tibia and fibula. Curettage or excision was the mode of treatment. Recurrence of the condition has been noted in 4 cases. Excision of the change and filling of the defect with autologous or homologous bone graft is more efficient than curettage alone.     

Banked bone grafting for bone defect repair--clinical evaluation of bone union and graft incorporation

One hundred and twenty-four banked bone grafts performed during the past 15 years were studied in respect to union and graft incorporation processes using X-ray, bone scintigraphy and histology. Radiological study of the chip graft showed an absence of cavity contours, and homogenization of the grafted area, followed by development of the trabecular structure. In the block graft, initial union was shown at the junctional area followed by the appearance of mottled shadows throughout the entire graft and finally differentiation of bone marrow and cortex. Bone scintigraphy showed an initial increase in RI uptake at the junction and then a gradual increase in the entire graft. Histological study showed that bone apposition on the trabeculae of the graft starts in the junction and later extends to other areas. The replacement of cancellous bone is more rapid than that of cortical bone. The porous surface seems to promote bone union and incorporation when large block grafts of cortical bone are used.