肱骨骨不连的手术治疗

目的探讨肱骨骨不连的手术治疗方法及疗效。方法1998年12月～2005年5月共收治肱骨骨不连患者25例,均为肱骨骨折内固定术后发生骨不连,其中3例并发骨髓炎,6例合并不同程度肱骨骨缺损,骨缺损长度为3～6cm。骨不连病程8个月～5年。15例行吻合血管游离腓骨移植,10例采用加压交锁髓内针进行肱骨固定并辅以自体骨植骨。结果术后25例均得到随访,时间6个月～6年2个月。吻合血管游离腓骨移植组中移植的腓骨段均与肱骨干形成骨性愈合,平均骨性愈合时间为3．1个月；交锁髓内针组平均骨愈合时间为3．8个月。按Crates和Whittle肩肘关节功能评价标准,腓骨移植组：优9例,良4例,差2例；交锁髓内针组：优5例,良3例,差2例。结论应用加压交锁髓内针辅以自体骨移植对硬化性肱骨骨不连是一种有效的外科治疗方法；对合并骨髓炎、大段骨缺损及严重骨质疏松的肱骨骨不连,采用吻合血管游离腓骨移植可一期进行修复与重建。     

Do bisphosphonates reduce early micromotion and Periprosthetic bone loss in total knee arthroplasty? A review of the evidence

Early micromotion of implant components and periprosthetic bone loss in patients undergoing total knee arthroplasty are thought to contribute to late aseptic loosening. In the pursuit of longer implant survival, the administration of bisphosphonates may be advocated as a means to buffer implants against microinstability and periprosthetic bone loss. A bibliographic search identified one metaanalysis and two randomised controlled trials dealing with this topic. Current evidence supports the hypothesis that the inhibiting effects of bisphosphonates on bone resorption reduce implant micromotion and periprosthetic bone loss at the one-year follow-up. Tested bisphosphonates include clodronate, pamidronate and alendronate. However, a decline in periprosthetic BMD is observed at the three-year follow-up following a sixmonth course of bisphosphonate administration. Length of follow-up in available studies is currently too short to determine whether bisphosphonates increase the longevity of implants. Furthermore, the optimal dose, modality and length of bisphosphonate administration have yet to be determined.     

大黄素和小剂量雌激素合用对去卵巢大鼠骨质疏松的预防作用

目的观察大黄素和小剂量雌激素联合应用对去卵巢大鼠骨质疏松的预防作用.方法3月龄大鼠双侧卵巢去除术后预防用药90 d.用骨组织形态计量学方法,测定大鼠胫骨近端松质骨静态参数和动态参数,观察骨物理生长指标、血清生化指标和器官指数.结果大黄素90 mg·kg-1·d-1和己烯雌酚5 μg·kg-1·d-1联合应用可抑制去卵巢大鼠的破骨细胞活性,完全对抗其骨转化率增高和骨量丢失的骨质疏松症状,与己烯雌酚30 μg·kg-1·d-1的作用相当,且降低己烯雌酚对子宫和肝脏的刺激作用.结论大黄素和小剂量己烯雌酚联合应用可预防去卵巢大鼠骨质疏松.     

Bone and joint alterations in acromegaly

Growth hormone (GH) is fundamental for the maintenance of bone mass and metabolism both during childhood and in adulthood. This effect is due to a complex interaction between circulating GH and IGF-I produced peripherally. In vitro data and experimental animal models have clarified many of the regulatory mechanisms underlying the characteristic skeletal changes occurring in acromegaly. This review focuses on the effects of GH excess on bone metabolism and mass in acromegalic patients and, in particular, on the influence of factors such as hypogonadism, gender, age and therapy on bone metabolism and arthropathy.     

手术治疗胸腰椎结核合并后凸畸形

目的:探讨单切口双入路椎弓根系统内固定、后外侧植骨同期病灶清除、椎间植骨治疗胸腰椎结核合并后凸畸形的疗效。方法:对78例胸腰椎结核合并后凸畸形患者采用单切口双入路行后外侧植骨椎弓根系统内固定,同期病灶清除、椎间植骨治疗,观察患者症状及截瘫改善情况,后凸畸形矫正情况及植骨融合情况。结果:所有患者症状均明显改善,48例合并截瘫的患者中,25例完全恢复正常,7例ASIA分级改善1￣3级;植骨均在术后6个月￣1年融合,治愈率52.08%,好转率14.58%。后凸Cobb角平均矫正28.7°,随访1.4￣6.5年,平均2.6年,后凸角平均丢失2.9°。结论:单切口双入路后外侧椎弓根系统内固定同期病灶清除、椎间植骨可恢复脊柱的即刻稳定性,有利于植骨融合,后凸畸形矫正满意。     

保留骨骺的保肢手术临床研究

目的 介绍儿童及青少年保留骨骺的保肢手术方法，并讨论肿瘤复发率、转移情况及术后并发症与关节功能。方法1995年12月至2003年1月，对33例儿童及青少年肢体原发性恶性或侵袭性骨肿瘤进行保留骨骺的保肢手术，年龄8-16岁，平均12．2岁。股骨下端24例，胫骨上端9例；骨肉瘤23例，尤文肉瘤6例，软骨肉瘤2例，侵袭性骨母细胞瘤2例。Enneking外科分期：ⅠA期2例，ⅠB期2例，ⅡA期17例，ⅡB期12例。恶性肿瘤患者接受术前2-4个周期、术后6个周期的化疗。采用大段同种异体骨移植重建骨缺损，并用松质骨拉力螺钉将其与骨骺进行固定。结果29例患者随访资料完整。随访时间12～72个月，平均37．6个月。3例复发，分别于术后1年在骨骺处复发、术后15个月和30个月在原肿瘤位置的股动、静脉周围复发，复发率为10．3％。对复发病例行截肢术。共9例死亡，5年生存率为57．9％。4例患者发生5例并发症，发生率为17．2％。依据Enneking术后功能评价标准，优11例，良13例，可3例，差2例，总优良率为82．8％。结论四肢恶性骨肿瘤保留骨骺的保肢手术可以使患者获得较好的肢体功能，在严格掌握手术适应证和有效化疗的前提下，实施该手术是安全的。     

肥胖者骨密度与体重及其他体成分关系的研究

目的肥胖易伴发多种慢性疾病。本文探讨肥胖者体重与体成份(脂肪、肌肉)之间的关系及其对临床减重的意义。方法经临床确诊系单纯性肥胖者45例,男17例,女28例。使用美国LunarDPX-L型双能X线吸收测量仪(DXA),测量全身骨、第2~4腰椎、股骨颈骨矿密度(BMD)及体脂肪和肌肉量,并计算体重指数(BMI=W/H2)、体重(kg)/身高(m)即W/H数值进行比较分析。结果男性体重平均94.54±17.41kg,BMI33±4.87。女性体重平均124.37±14.0kg,BMI35.41±6.39。男女两性全身BMD与体重相关,分别为r=0.415,P<0.05,r=0.529,P<0.0025。女性体重与脂肪、肌肉之间呈正相关分别为r=0.522,P<0.0025、r=0.612,P<0.005。男性体重与BMI、W/H及全身肌肉量相关,与脂肪组织无明显相关。男女性W/H较BMI相关系数高。男性全身BMD与全身肌肉量正相关r=0.421,P<0.05。女性全身及股骨颈BMD与脂肪量相关r=0.360,P<0.05、r=0.323,P<0.05。女性全身肌肉量与股骨颈BMD呈正相关r=0.373,P<0.05。结论①肥胖者体重增加,男性以肌肉增加为主,女性脂肪和肌肉都增加;②男性全身骨密度增高与肌肉量增加有关,而女性则主要为脂肪量增加;③女性肌肉、脂肪量与股骨颈BMD密切相关;④体重(kg)/身高(m)比计算体重指数能更准确地反映总体肥胖的程度。     

Relationship between insulin-like growth factor I, dehydroepiandrosterone sulfate and proresorptive cytokines and bone density in cystic fibrosis

Introduction Patients with cystic fibrosis (CF) are known to be at risk for early osteoporosis, and the mechanisms that mediate bone loss are still being delineated. The aim of the present investigation was to investigate if a correlation exists in these patients between skeletal measurements by dual-energy x-ray absorptiometry (DXA) and two anabolic factors, dehydroepiandrosterone (DHEA) and insulin-like growth factor I (IGF-I), and proresorptive factors such as the cytokines interleukin-1β, tumor necrosis factor α, and interleukin-6. Methods We studied 32 outpatients (18 females; mean age: 26.2 ± 7.9 years) at a tertiary care medical center. The subjects had venous samples obtained, underwent anthropometric and bone mineral density (BMD) measurements, and completed a health survey. Serum IGF-I concentrations were below the age-adjusted mean in 78% of the participants, and DHEA sulfate (DHEAS) concentrations were low in 72%. Serum concentrations of all cytokines were on the low side of normal; nonetheless, there was a modest inverse correlation between IL-1β and BMD at all sites. Results In univariate analyses, IGF-I and DHEAS were significant correlates of BMD or bone mineral content. In final multivariate models controlling for anthropometric and other variables of relevance to bone density, only IGF-I was identified as a significant independent skeletal predictor. While alterations in DHEAS, IGF-I, and specific cytokines may contribute to skeletal deficits in patients with CF, of these factors a low IGF-I concentration appears to be most strongly correlated with BMD. Conclusions These findings may have therapeutic implications for enhancing bone density in these patients.     

老年女性2型糖尿病肾病的骨密度及相关因素分析

2型糖尿病(T2DM)和骨质疏松症的发病率越来越高,它们之间有无关系越来越引起人们的重视,本研究探讨了老年女性2型糖尿病肾病(DN)的骨矿物质密度(BMD)变化与相关因素,报道如下。1对象与方法1.1研究对象按1999年WHO诊断标准确诊为T2DM的≥60岁女性114例,年龄60～75岁,平均(66.3±     

2型糖尿病患者绝经期骨密度与甲状旁腺素、雌激素相关性研究

目的 观察2型糖尿病妇女绝经期骨密度与甲状旁腺素、雌激素相关性研究.方法 测定绝经期2型糖尿病妇女伴骨质疏松（A）组及绝经期2型糖尿病妇女无骨质疏松（B）组的左侧髋部股骨颈、大转子、华氏三角区、及腰椎L2～L4正侧位的骨密度和血清中骨代谢指标,如：骨钙素、碱性磷酸酶、钙、磷、甲状旁腺素、雌二醇、Ⅰ型胶原羧基末端终肽（β-CTx）的浓度,对骨密度与多个变量之间的关系进行相关分析,并对（A）组血清中的甲状旁腺素、雌二醇、骨钙素、β-CTx与不同部位的骨密度之间的关系进行多元逐步回归分析.结果绝经期2型糖尿病妇女（B）组的腰椎、大转子、华氏三角区、股骨颈等骨密度指标明显低于对照组（A）（P＜0.05）;2型糖尿病绝经期妇女血清中雌二醇水平与腰椎L2～L4骨密度呈正相关（P＜0.032）;甲状旁腺素水平与股骨颈骨密度呈负相关（P＜0.034）.结论 绝经期2型糖尿病患者甲状旁腺素和雌激素水平与骨密度密切相关,分别可以用于预测骨质疏松发生的不同部位.