中国农村人群骨折基本情况分析

调查了中国≥50岁中老年农村人群20岁以后的骨折发生情况。共计8266人,骨折率为6.42%;其中男性3771人,骨折率为7.48%;女性4495人,骨折率为5.54%。男性显著高于女性(P<0.01)。同时分析了不同部位的骨折发生情况,其中髋部骨折率为0.68%。骨折与跌跤发生因素密切相关,为此本研究还阐述了最近一年中人群跌倒情况,其跌倒率为11.13%。其结果为人群骨折的预防提供了科学依据。     

Radiographic study of osteoarthritic elbows in professional basebal pitchers

We examined radiographs of the elbows of the pitching arms of 79 professional baseball pitchers (mean age, 25.1 years; mean duration of professional career, 4.7 years) and noted the frequency and size of spurs, bone fragments, and intra-articular loose bodies according to site. The influence of duration of professional baseball career on these osteoarthritic changes was also investigated. The olecranon tip was the most frequent site of spurs (62/79; 78.5%), and fragmentation of the spur was detected in 17 joints. The frequency of spurs was also high at the medial margin of the olecranon, the tip of the coronoid process, the medial margin of the sigmoid notch, the medial margin of the trochlea and the olecranon fossa. In 38 subjects, spurs were observed at the distal portion of the radial notch of the ulna. However, few pitchers had osteoarthritic changes in the humeral capitellum or radial head. Intra-articular loose bodies were detected in 4 of 79 joints (5.1%), and bone fragments were present below the medial humeral epicondyle in 25 of 79 joints (31.6%). Osteoarthritic changes in the elbow joint appeared to be attributable mainly to traction stress and impingement associated with extension and valgus strain. Significant osteoarthritic changes were often found in professional pitchers whose careers exceeded 5 years.     

Importance of Albumin, 25(OH)-Vitamin D and IGFBP-3 as Risk Factors in Elderly Women and Men with Hip Fracture

The relative importance of vitamin D deficiency, secondary hyperparathyroidism, nutritional deficiency and low bone mineral density (BMD) as risk factors for hip fracture is not definitely established. In the framework of a case-control study of risk factors for hip fractured, biochemical markers of bone metabolism and nutrition and femoral BMD data were compared in 136 female and 43 male hip fracture patients, 126 female and 44 male age-matched hospitalized controls, and 47 healthy elderly women (8 men). Patients with hip fracture had lower albumin (−10%9 and 25(OH)-vitamin D (25(OH)D; −19%) compared with hospitalized controls, and lower albumin (−28%) and 25(OH)D levels (−52%) compared with the elderly controls. Serum values of IGFBP-3 were also significantly lower (−33%) in hip fracture patients than in community controls. BMD of femoral neck was lower (p < 0.001) in patients than in hospitalized and community controls. In hip fracture patients, parathyroid hormone (PTH) correlated weakly with BMD (neck: r = −0.19, trochanter: r = −0.17; both p < 0.05). When all women were pooled (n = 233), albumin correlated significantly (age-adjusted) with BMD at all sites (neck: r = 0.27, trochanter: r = 0.25; all p < 0.001). Albumin, but not 25(OH)D, also correlated with skinfold thickness (r = 0.19, p < 0.0025) and with body mass index (BMI) (r = 0.14, p < 0.05). Male patients with hip fracture had lower BMD and albumin (both p < 0.001), 25(OH)D (p = 0.02) and IGFBP-3 levels (p <: 0.005) compared with the controls. When male patients and controls were pooled together, albumin, skinfold thickness and BMI were significantly correlated with each other, but not with BMD. IGFBP-3 was highly correlated with albumin (p < 0.0001), 25(OH)D (p < 0.005) and, less significantly, with PTH (p < 0.05), but not with BMI or skinfold thickness. IGFBP-3 was significantly correlated with BMD at all sites (neck: r = 0.27, p < 0.05); trochanter: r = 0.40, p < 0.0005). In conclusion, low albumin and low BMD were both important risk factors for hip fracture. Low serum albumin was the strongest independent variable correlated with hip fractures. In men, IGFBP-3 was correlated with BMD. The femoral BMD depended only weakly on PTH and 25(OH)D, but was correlated at all sites with albumin, a non-specific parameter of nutrition and general health.     

胚胎颅骨骨膜移植修复髋关节软骨大面积缺损

１９９０年５月～１９９４年４月，对４２例（４７个髋）关节软骨全厚缺损患者采用冷冻保存胚胎颅骨骨膜移植进行修复，其中１４例股骨头骨质Ⅳ期坏死者，同时施行带旋髂深血管蒂髂骨植骨。对３４例（３８个髋）进行了２年～６年（平均４０个月）随访。结果表明，按照吴之康髋关节人工置换术后疗效评定标准，优良２５例，很好５例，好３例，尚可１例。认为，与自体移植物修复关节软骨大面积缺损相比，这种方法无附加损伤，具有移植材料、形态与股骨头相似等特点，是治疗髋关节软骨大面积缺损的一种有效方法。     

骨与关节损伤治疗中存在的问题与对策

尽管骨关节损伤治疗已取得巨大进展,但仍存在许多问题,主要包括:对骨折治疗理念转变和微创外科概念的错误理解,对骨折治疗技术的不正确使用,忽视骨折分类方法和功能评定标准.正确的分析和解决这些问题会进一步促进创伤骨科临床实践和科研的进步.     

Clinical and radiological profile of symptomatic knee osteoarthritis in Malaysia

Aims: To create a clinical and radiological profile of patients with symptomatic osteoarthritis of the knee in Malaysia. Methods: One hundred consecutive patients presenting with symptomatic knee osteoarthritis at a private rheumatology clinic were profiled for demographic and clinical features. Anteroposterior weight‐bearing, skyline and lateral knee X‐rays were taken. Statistical Package for Social Sciences was used for data analysis. Results: Women predominated (93%). Fifty‐eight percent of the patients reported bilateral knee pain. Difficulty in walking, climbing and squatting was high (85%, 97% and 93% respectively). Patients with knee pain had a higher BMI than controls. Radiological abnormality, related to osteoarthritis was present in 97%. Osteophytes were generally tricompartmental while joint space narrowing was less evident in the lateral tibiofemoral joint than in the medial tibiofemoral joint and the patellofemoral joint. Almost half (49%) the patients manifested radiological varus deformity The severity of radiological abnormality increased with age. Although patients with unilateral pain had milder radiological abnormality, it tended to be bilateral. Clinically detectable hip abnormality and nodal osteoarthritis were uncommon, as was radiological chondrocalcinosis. Conclusions: Patients presenting with symptomatic knee osteoarthritis to a rheumatology service had a high degree of disability, radiological abnormality and varus deformity. Radiological abnormalities were essentially bilateral and tricompartmental.     

80 例人工全髋关节置换术的中期疗效分析

目的 探讨人工全髋关节置换术的疗效。方法 回顾性研究了1997年3月至2002年12月期间连续全髋关节置换术80例(92髋)患者，平均随访54个月(14～84个月)，分析其中期疗效。结果 翻修率为5．4％(5／92)，Harris髋评分为优良以上84．8％(78／92)，中等8．7％(8／92)，差6．5％(6／92)。结论 外科技术的提高和假体生物工程的发展，提高了全髋关节置换术重建关节功能的疗效。     

骶髂螺钉固定在骶髂关节脱位中的应用解剖学研究

目的 :为应用骶髂螺钉固定骶髂关节脱位提供形态学依据。方法 :对 3 0具成人干燥骨盆标本 ,模拟骶髂螺钉内固定手术并作CT扫描 ,对进针点与不同解剖结构之间的距离、进针的方向、进针的深度以及S1骶孔上方的骶骨翼的前后径和上下径进行测量。结果 :进针点距臀肌线的距离为 ( 2 0 70± 3 2 7)mm ,距坐骨大切迹的距离为( 3 5 0 0± 1 91)mm ;轴位及冠状位CT测量进针与髂骨外板的交角分别为 ( 90 18± 2 69)°和 ( 90 40± 2 87)° ;进针深度为 ( 67 77± 3 63 )mm ;S1骶孔上方骶骨翼的前后径和上下径分别为 ( 18 2 6± 2 0 6)mm和 ( 18 74± 1 5 1)mm。结论 :临床应用骶髂螺钉固定需选择恰当的进针点和进针方向 ,术中需行骨盆正位、入口位和出口位的透视以确定螺钉植入的准确性     

磨损微粒诱导的局部生物学反应

人工髋关节置换失败的主要原因是假体的无菌性松动。研究表明 ,这和假体长期磨损产生的微粒作用于周围的巨噬细胞而诱发的生物学反应有关。磨损微粒激活假体周围组织细胞释放前炎症介质 ,诱导破骨细胞的活化和分化 ,引发假体周围的骨溶解。充分地认识这个过程 ,对减少人工关节无菌性松动 ,延长假体使用寿命具有重要意义。     

Bone levels of cephradine and cefuroxime after intravenous administration in patients undergoing total hip replacement

Summary A randomised, comparative study is reported of single intravenous doses of cephradine 2 g or cefuroxime 1.5 g given as prophylactic cover for total hip replacements in 40 patients. The serum and bone levels of cephalosporin achieved were higher in the cephradine treated group in proportion to the higher dose employed. Both agents provided adequate bone levels on average, cephradine 25.34 mcg/g, cefuroxime 17.39 mcg/g, although bone penetration was more variable with cefuroxime.

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Résumé Dans cette étude comparative randomisée, 40 patients ont reçu une dose intraveineuse unique de 2 g de céphradine ou de 1,5 g de céfuroxime en tant que couverture prophylactique d'arthroplastie totale de hanche. Les concentrations sériques et osseuses de céphalosporine ont été plus élevées dans le groupe traité par la céphradine, en rapport avec l'utilisation d'une dose plus importante. Des concentrations osseuses adéquates ont été obtenues en moyenne avec les deux produits (25,34 mcg/g avec la céphradine et 17,39 mcg/g avec le céfuroxime) bien que la pénétration osseuse ait été plus variable avec le céfuroxime.