经皮椎间盘摘出联合医用臭氧治疗腰椎间盘突出症

目的探讨经皮髓核摘除术(PLD)联合医用臭氧注射治疗腰椎间盘突出症的临床效果及可行性。方法临床与影像检查确诊为腰椎间盘突出25例,先行PLD,后行椎间盘内及椎旁注射臭氧。结果25例病人治疗后经一年随访,治愈21例,有效24例,无效1例,无一例并发症。结论PLD联合医用臭氧治疗腰椎间盘突出症,安全可靠,可改善治疗效果,减少不良反应,值得推广应用。     

人工骨椎体成形术治疗胸腰椎爆裂骨折

目的:探讨经椎弓根人工骨植入椎体成形术治疗胸腰椎爆裂性骨折的方法和效果。方法:胸腰椎爆裂骨折12例,男8例,女4例;年龄28～61岁,平均47.5岁;受伤时间4～12d;术前Frankel分级:C级1例,D级3例,E级8例;受伤椎体:T112例,T122例,L15例,L23例;术前后突角11°～35°,平均24°;术前椎管占位率39%～85%,平均64.5%;术前伤椎椎体前缘高度平均为正常的47%。行后路切开复位短节段椎弓根钉内固定后,人工骨经伤椎椎弓根植入椎体成形术。结果:所有患者均获随访,时间3～19个月,平均13个月。脊柱后突角平均恢复20°,椎体高度平均恢复96%,椎管占位率平均恢复至7%。2例人工骨椎体内充填不足;无内固定松动、断裂、椎体高度变低及生理弧度丢失。神经功能恢复:1例术前Frankel分级C级及2例D级患者术后均恢复至E级。结论:经椎弓根人工骨植入椎体成形术重建了椎体高度,增加了脊椎前柱的抗压稳定性,使患者能早期活动,减少内固定物因应力过大造成的断钉、松动、椎体再压缩等并发症。     

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.     

Novel explant model to study mechanotransduction and cell-cell communication.

To understand in situ behavior of osteocytes, we characterized a model of osteocytes in their native bone matrix and demonstrated real-time biologic activity of osteocytes while bending the bone matrix. Using 43 male Sprague-Dawley rats, dumbbell-shaped explants were harvested from stainless steel femoral implants after 6-12 weeks and incubated in culture medium or fixed. Sixteen specimens were used to determine bone volume density (BV/TV), volumetric bone mineral density (BMD) and histology for different implantation periods. Osteocyte viability was evaluated by L-lactate dehydrogenase (LDH) activity in 12 cultured explants. Confocal microscopy was used to assess tracer diffusion in three explants and changes in osteocyte pH of a mechanically loaded explant. From 6 to 12 weeks, explant BV/TV and volumetric BMD trended up 92.5% and 101%, respectively. They were significantly and highly correlated. Tissues were uniformly intramembranous and all bone cell types were present. Explants maintained LDH activity through culture day 8. Diffusion at 200 microM was limited to 1,209 Da. Explants appeared capable of reproducing complex bone biology. This model may be useful in understanding osteocyte mechanotransduction in the context of a physiologically relevant bone matrix.     

腕舟状骨疲劳骨折3例

疲劳骨折亦称行军骨折，多发生在下肢骨骼，发生在第2、3跖骨、胫骨、股骨颈等部位的疲劳骨折已不少见，但是发生在上肢的疲劳骨折尚不多见。自2002年以来，发现3例腕舟骨疲劳骨折，现报告如下。     

Do children with primary nocturnal enuresis have a retarded bone age? A cross‐sectional study

OBJECTIVE: Nocturnal enuresis is a common pediatric problem, the etiology of which is unclear. In recent years, various studies have been published stating that children with nocturnal enuresis exhibit growth and skeletal maturation retardation. METHODS: In this cross-sectional study, we included 27 patients (16 boys, 11 girls) between the ages of 6 and 14 years who had presented with primary nocturnal enuresis (PNE) complaints. We included in the evaluation 19 healthy subjects (12 boys, 7 girls), who were the siblings of the children with PNE, as the control group. RESULTS: The patients in both groups were similar in chronological age, bone age, height and weight, with no significant difference between groups (P>0.05). CONCLUSION: The two groups in our study consisted of the same genetic background. Thus, our results were found to be different from the previous studies. We have concluded that there is no direct relationship between enuresis nocturnal and skeletal maturation.     

定期骨髓象观察指导急性淋巴细胞白血病诱导缓解治疗

目的评价定期骨髓象检查对急淋诱导化疗的指导意义。方法对引例初治成人急淋患音，于诱导化疗首疗程期间定时作骨髓象观察，用这两个时限的骨髓白血病细胞比率及／或白血病细胞减少指数指导化疗。结果本组完全缓解（CR）率82.4%（42/51），其中首疗程CR率60.8%（31／51）。结论诱导化疗期定时骨髓象观察指导化疗有助于提高急淋CR率及首疗程CR率。