仙灵骨葆胶囊联合钙剂治疗乳腺癌患者术后内分泌治疗后骨质疏松及对骨代谢的影响

目的:探讨中药联合钙剂对绝经后内分泌治疗后骨质疏松乳腺癌患者骨代谢的影响。方法:将2012年3月—2013年3月期间收治的绝经后乳腺癌患者92例按照随机数字表法分为观察组与对照组,每组46例,均为术后内分泌治疗后骨质疏松患者。对照组口服碳酸钙片,观察组在对照组基础上口服中药仙灵骨葆胶囊。两组疗程均为24周。比较两组治疗前后骨密度和骨代谢指标变化。结果:治疗后,两组腰椎和髂骨骨密度增加(P0.05),且观察组腰椎和髂骨骨密度高于对照组(P0.05);两组I型胶原蛋白c末端交联端肽(s-CTX)降低(P0.05),且观察组s-CTX低于对照组(P0.05);两组I型原骨胶原蛋白N-端肽(s-PINP)降低(P0.05),且观察组s-PINP低于对照组(P0.05);两组骨钙素(BGP)增加而碱性磷酸酶(ALP)降低(P0.05),且观察组BGP高于对照组而ALP低于对照组(P0.05)。结论:仙灵骨葆胶囊联合钙剂可改善绝经后内分泌治疗后骨质疏松的乳腺癌患者骨代谢障碍和骨质疏松。     

抗骨质疏松组合方案辅助治疗老年骨质疏松性桡骨远端骨折可行性研究

目的探讨淫羊藿总黄酮联合低频脉冲电磁场组合方案对老年骨质疏松性桡骨远端骨折的影响。方法 148例老年骨质疏松性桡骨远端骨折患者,随机分为2组,所有患者均给予手法复位结合石膏固定,对照组给予淫羊藿总黄酮治疗,治疗组给予淫羊藿总黄酮联合低频脉冲电磁场治疗;治疗为期6个月,观察治疗后桡骨骨密度、骨代谢指标以及骨折愈合时间。结果治疗6月后,两组患者血清骨碱性磷酸酶(BALP)、骨钙素(BGP)及I型前胶原羧基端肽(PICP)水平较治疗前显著升高(P0.05),而治疗组较对照组升高更为明显。两组患者双侧桡骨远端BMD较治疗前显著升高(P0.05),而治疗组较对照组升高更为明显(P0.05);治疗组平均愈合时间明显短于对照组(P0.05),而治疗有效率显著高于对照组(P0.05)。两组治疗期间不良反应比较无差异(P0.05)。结论淫羊藿总黄酮联合低频脉冲电磁场可以显著改善老年骨质疏松性骨折患者骨代谢,增加骨密度,促进骨折愈合,减少治疗失败率。     

仙灵骨葆胶囊对骨质疏松性骨折大鼠骨生长因子及骨折愈合的影响

目的 探讨仙灵骨葆胶囊对骨质疏松性骨折大鼠骨生长因子BMP-2、IGF-1表达及骨折愈合的影响。方法 48只雌性SD大鼠随机分为：假手术组、模型组、雌二醇组、仙灵骨葆组，12只/组，采用“双侧卵巢切除术+右侧股骨干骨折髓内固定术”构建骨质疏松性骨折大鼠模型，评估骨折愈合情况，检测股骨骨痂BMD、股骨骨生物力学指标和血清骨代谢相关指标，检测骨痂BMP-2、IGF-1蛋白表达。结果 模型组较假手术组骨折愈合评分、股骨痂BMD、股骨骨生物力学指标（最大载荷、最大应力、最大位移）、骨痂BMP-2和IGF-I阳性表达均显著降低（P<0.05），雌二醇组、仙灵骨葆组较模型组骨折愈合评分、股骨痂BMD、股骨骨生物力学指标、骨痂BMP-2和IGF-I阳性表达均显著升高（P<0.05），均以仙灵骨葆组最高。模型组较假手术组血清骨代谢指标（BGP、PICP、TRACP-5b）均显著升高（P<0.05），雌二醇组、仙灵骨葆组较模型组血清骨代谢指标均显著降低（P<0.05），以仙灵骨葆组最低。结论 仙灵骨葆胶囊可能通过介导提高骨质疏松性骨折大鼠骨生长因子BMP-2和IGF-1表达，改善骨代谢，加速骨痂形成，增加骨密度，提高骨生物力学，促进骨折愈合。     

两种不同药物对骨质疏松性椎体骨折术后老年患者疗效的影响

目的研究丹参注射液联合仙灵骨葆胶囊对骨质疏松性椎体骨折术后老年患者血清胰岛素生长因子-1(insulin growth factor-1,IGF-1)及碱性成纤维细胞生长因子(basic fibroblast growth factor,b FGF)水平的影响。方法选取我院于2017年6月至2018年10月收治的123例老年骨质疏松性椎体骨折患者,依据随机数字表法分为观察(62例)和对照(61例)两组。两组患者均行经皮椎体成形术(PVP)治疗,对照组患者服用仙灵骨葆胶囊(持续用药3个月),观察组患者在对照组基础上使用丹参注射液(持续用药1周)。比较两组患者的治疗效果、骨折愈合情况,以及VAS评分和血清b FGF及IGF-1在不同时间点水平变化,统计两组并发症发生情况。结果观察组患者治疗有效率(95.00%)显著高于对照组(83.33%),差异有统计学意义(P0.05)。治疗后6个月两组患者骨密度显著增加,而椎体后凸Cobb角显著降低,且观察组患者改善情况显著优于对照组(P0.05)。两组患者经治疗后VAS评分显著降低,血清b FGF、IGF-1水平显著增加,其中观察组患者VAS评分、血清b FGF、IGF-1水平在治疗2周、4周、6周的改善程度均优于对照组(P0.05)。两组患者并发症发生率的差异无统计学意义(P0.05)。结论丹参注射液联合仙灵骨葆胶囊可增强PVP对老年骨质疏松性椎体骨折患者的疗效,可通过提高血清b FGF及IGF-1水平促进骨折修复,从而加快骨折愈合,降低疼痛。     

仙灵骨葆联合用药治疗骨质疏松性椎体压缩性骨折疗效观察

目的探讨仙灵骨葆联合钙尔奇D治疗骨质疏松性椎体压缩性骨折的临床疗效。方法将68例骨质疏松性椎体压缩性骨折患者随机分为为两组,治疗组35例和对照组33例。治疗组采用仙灵骨葆联合钙尔奇D治疗,对照组采用钙尔奇D治疗,时间3个月。观察治疗前后疼痛评分变化和椎体恢复情况。结果治疗组对疼痛的改善和椎体的恢复率均优于对照组（P〈0．05）,总体临床疗效治疗组优于对照组。结论仙灵骨葆联合钙尔奇D对骨质疏松性椎体压缩性骨折有较好疗效。     

中西药联合使用结合保守治疗对老年骨质疏松性肱骨近端骨折影响的临床研究

目的分析中西药联合使用结合保守治疗在老年骨质疏松性肱骨近端骨折患者中的疗效。方法选取老年骨质疏松性肱骨近端骨折患者100例,将100例患者随机分为治疗组(n=50)和对照组(n=50)。所有患者均给予手法复位结合可调节上肢外展架治疗,治疗组在此基础上给予阿仑膦酸钠联合仙灵骨葆,为期12个月。比较治疗前后患者骨折愈合时间、并发症发生情况,骨代谢和骨密度等指标改变。结果治疗后1个月、3个月、6个月及12个月时两组患者疼痛情况比较,治疗组疼痛数字分级法(numeric pain intensity scale,NPIS)评分明显低于对照组(P0.05),随访12个月时治疗组患者肩关节功能恢复情况明显优于对照组(P0.05),治疗组术后并发症发生率明显低于对照组(P0.05),治疗组骨折愈合时间明显短于对照组(P0.05)。治疗6个月、12个月后,治疗组患者腰椎正位(L2~4)、左股骨颈的骨密度和血清骨钙素水平均明显高于对照组,而治疗组血清β-CTX水平较对照组明显降低,差异均有统计学意义(P0.05);治疗6个月、12个月后,两组患者血清N端中段骨钙素水平与治疗前的差异无统计学意义(P0.05)。结论阿仑膦酸钠联合仙灵骨葆治疗对老年骨质疏松性肱骨近端骨折外展架固定后安全有效,能够有效减轻患者疼痛,加速骨折愈合,改善患者肩关节功能,降低治疗后并发症的发生率。     

仙灵骨葆胶囊对骨质疏松性髋部骨折的研究近况

骨质疏松症是老年人的常见病和多发病,其最大的危害是导致骨折的发生。随着老龄化社会的到来,骨质疏松性髋部骨折的发病率也显著增高。仙灵骨葆作胶囊具有滋补肝肾,活血通络,强筋壮骨的功效。具有类雌激素样作用,能提高全身的骨量,同时对骨质疏松性髋部骨折具有良好的防治效果,能减少骨折发生,促进骨折愈合,缓解疼痛。本文就仙灵骨葆治疗骨质疏松性髋部骨折进行综述。     

仙灵骨葆对老年妇女Colles骨折血清碱性磷酸酶及钙磷的影响

目的观察老年妇女Colles骨折用仙灵骨葆胶囊治疗对血清碱性磷酸酶(ALP)及总钙(TCa)、磷(P)的影响,从而评价其临床作用。方法将124例患者分为治疗组、对照组,每组62例,分别于就诊次日、4周、8周和12周空腹抽血进行ALP、TCa及P等生化指标检测和X线片观察骨痂生长情况。结果 4、8周时治疗组ALP活性高于同时间点对照组(P0.01),12周时低于对照组;4周时治疗组TCa显著高于同时间点对照组(P0.01),8周后TCa逐渐低于对照组;4、8周时治疗组P浓度均高于同时间点对照组(P0.01),12周时基本与对照组相当;4、8、12周时治疗组X线骨痂评分明显高于同时间点对照组(P0.01)。结论仙灵骨葆胶囊可影响血清ALP、TCa、P的浓度变化,促进骨折区域血液循环改善,实现钙盐的沉积和骨痂形成,从而达到促进骨折愈合的目的。     

仙灵骨葆胶囊治疗骨质疏松症的疗效及其对骨代谢及骨转换指标的影响分析

目的 分析仙灵骨葆胶囊治疗骨质疏松症的疗效及其对骨代谢及骨转换指标的影响。方法 将160例原发性骨质疏松症(POP)患者分为观察组80例和对照组80例。对照组患者行钙尔奇D联合唑来膦酸盐治疗,观察组患者行仙灵骨葆胶囊治疗。于2组患者治疗前、治疗3疗程后及6个疗程后,测量患者的腰椎正位(L2-4)和右股骨颈的骨密度（BMD),并检测患者的骨代谢指标包括血钙(Ca)、磷(P)、碱性磷酸酶(ALP)及骨转换指标包括骨钙素（OC)和I型胶原交联C-末端肽（CTX-1)。 同时,分析BMD与OC、CTX-1的相关性。结果 治疗后,2组患者的BMD较治疗前均增加(P均<0.05),但治疗6个疗程后,观察组患者BMD的增加幅度大于对照组(P <0. 05)。治疗后,2组患者的OC均较治疗前上升（P均<0. 05)、CTX-1均较治疗前下降(P均<0. 05);但治疗6个疗程后,观察组患者OC、CTX-1的改善幅度均大于对照组（P均< 0. 05)。BMD与OC呈正相关性(r = 0.352,P =0.21),与CTX-1呈负相关性(r = -0.453,P =0.017)。结论 仙灵骨葆胶囊治疗骨质疏松症的疗效 显著,能有效增加患者的骨密度,改善骨代谢及骨转换状态,控制骨量减少;且OC、CTX-1与患者BMD密切相关,可作为评价 POP疗效的有效指标。     

石膏外固定联合愈骨疗伤胶囊治疗桡骨远端骨折的临床观察

目的观察手法复位石膏外固定联合愈骨疗伤胶囊治疗桡骨远端骨折的临床疗效。方法纳入120例首次单侧桡骨远端骨折,60例手法复位石膏外固定口服愈骨疗伤胶囊辅助治疗(观察组),60例手法复位石膏外固定口服碳酸钙片(对照组)。比较2组治疗前及治疗后2个月血清骨碱性磷酸酶(BALP)占血清碱性磷酸酶(ALP)的百分比,以及骨折愈合时间、骨折愈合效果。结果 120例均获得随访7~12个月,平均9.5个月。治疗过程中定期检查肝肾功能及电解质,无不良反应发生。观察组治疗后2个月血清BALP百分比明显高于对照组,骨折愈合时间明显少于对照组,骨折愈合有效率明显高于对照组,差异均有统计学意义(P0.05)。结论愈骨疗伤胶囊在骨折修复过程中促进了骨诱导生长因子的生成,提升了骨诱导能力,促进骨折愈合,且该药使用简便,未见明显不良反应。     

Osteogenesis after Bone and Bone Marrow Transplantation: II. The Initial Cellular Events Following Transplantation of Decalcified Allografis of Cancellous Bone

An experimental study was done in rabbits to investigate the fate of allogeneic iliac cancellous bone, both non-decalcified and decalcified with hydrochloric acid, transplanted to a muscular site for up to 14 days. Some of the treated allografts were impregnated with autologous bone marrow cells, obtained from the femoral medulla by aspiration, and each was compared with allografts alone. Combined myelo-osseous grafts produced bone after 7 to 8 days implantation, as did marrow autografts alone. In addition non-decalcified implants stimulated the production of multinucleated giant cells. Three different types of wash solution were used but these did not influence the cell population seen, nor the new bone formation. It is concluded that the critical events in bone formation after transplantation occur less than 8 days after the transplantation and that marrow cells have osteogenic capacity. This has relevance to the clinical aspects of bone grafting.     

Bone cement with reduced proportion of monomer in total hip arthroplasty: Preclinical evaluation and randomized study of 47 cases with 5 years' follow-up

Bone cement with reduced amount of monomer and low curing temperature may improve implant fixation due to reduced toxicity. We analyzed the mechanical, chemical and thermal properties of such a cement (Cemex Rx) using Palacos R as control. The in vivo performance of the 2 cements was also evaluated in a prospective randomized study of 47 hips, where either of the cement types was used to fixate Lubinus SP2 prostheses with the stem made of titanium alloy. Cemex Rx had a reduced tensile strength, probably because this cement was manually mixed, as recommended by the manufacturer. A standardized laboratory test showed lower curing temperature for Cemex, but measurements at 37° and with prechilled Palacos R and Cemex Rx, as in clinical work, showed no difference. In the clinical study radiostereometric measurements of cup and stem migration showed similar values in the 2 groups up to 5 years after the operation. The cement mantle was stable in both groups, but the stems migrated similarly inside the cement mantle regardless of the type of cement used. Proximal wear was low (0.04-0.05 mm/year) and tended to be lower in the Cemex group (p = 0.02). Aluminum and vanadium levels in serum increased 5 years after the operation, but no difference was noted between the 2 groups. Collagen markers (PICP, ICTP) showed similar increases in bone turnover 6 weeks and 6 months after operation in both groups.     

感染性骨缺损的治疗及研究进展

感染性骨缺损由于存在感染及骨缺损双重病变,治疗棘手,疗程长,且易出现肌肉萎缩、局部瘢痕而致肢体功能受到严重影响.近年来随着外固定技术、显微外科技术、生物材料技术及骨组织工程技术等的发展,感染性骨缺损的治疗取得明显进步,短缩了治疗时间,且效果显著,笔者对其研究进展综述如下.     

重组合异种骨植骨修复骨囊肿所致骨缺损

2001年10月～2003年9月,笔者共收治28例骨囊肿患者,均采用病灶刮除,瘤腔灭活和重组合异种骨植骨治疗,获得满意疗效,体会如下。     

Building better bone: The weaving of biologic and engineering strategies for managing bone loss

Segmental bone loss remains a challenging clinical problem for orthopaedic trauma surgeons. In addition to the missing bone itself, the local tissues (soft tissue, vascular) are often highly traumatized as well, resulting in a less than ideal environment for bone regeneration. As a result, attempts at limb salvage become a highly expensive endeavor, often requiring multiple operations and necessitating the use of every available strategy (autograft, allograft, bone graft substitution, Masquelet, bone transport, etc.) to achieve bony union. A cost‐sensitive, functionally appropriate, and volumetrically adequate engineered substitute would be practice‐changing for orthopaedic trauma surgeons and these patients with difficult clinical problems. In tissue engineering and bone regeneration fields, numerous research efforts continue to make progress toward new therapeutic interventions for segmental bone loss, including novel biomaterial development as well as cell‐based strategies. Despite an ever‐evolving literature base of these new therapeutic and engineered options, there remains a disconnect with the clinical practice, with very few translating into clinical use. A symposium entitled “Building better bone: The weaving of biologic and engineering strategies for managing bone loss,” was presented at the 2016 Orthopaedic Research Society Conference to further explore this engineering‐clinical disconnect, by surveying basic, translational, and clinical researchers along with orthopaedic surgeons and proposing ideas for pushing the bar forward in the field of segmental bone loss. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1855–1864, 2017.

     

The Penetration of Lincomycin into Normal Human Bone: Determinations of Penetration into Compact Bone, Spongy Bone and Bone Marrow

The penetration of lincomycin into normal bone was studied in 10 patients with fracture of the neck of the femur, a separate determination being made of the lincomycin concentration in serum, bone marrow, spongy bone and compact bone. The concentration of lincomycin in bone marrow was found to be at the same level as that in the serum. The concentration in spongy bone amounted in most cases to 50 to 75 per cent of the concentration in the serum, whereas the concentration in compact bone varied from 0 to 15 per cent of that in the serum.     

No adverse effects of early weight bearing after uncemented total hip arthroplastyA randomized study of 20 patients

Experimental fibular defects in 16 rats were filled with an acid decalcified homogenous bone matrix (bone inductive material). Autogenous bone grafts in corresponding defects in the other legs of the same rats served as controls. After 3 months, 11 of the 16 defects filled with bone inductive material healed with bony union, but only 4 of the 16 defects treated with autogenous bone grafts had healed. The results suggest that bone inductive material can repair bone defects which are too large to be healed by autogenous bone grafts.     

Repair of Bone Defects by Bone Inductive Material

Experimental fibular defects in 16 rats were filled with an acid decalcified homogenous bone matrix (bone inductive material). Autogenous bone grafts in corresponding defects in the other legs of the same rats served as controls. After 3 months, 11 of the 16 defects filled with bone inductive material healed with bony union, but only 4 of the 16 defects treated with autogenous bone grafts had healed. The results suggest that bone inductive material can repair bone defects which are too large to be healed by autogenous bone grafts.     

The benefit of bone marrow concentrate in addition to a glass‐reinforced hydroxyapatite for bone regeneration: An in vivo ovine study

This study evaluates the ability of a Glass Reinforced Hydroxyapatite Composite (GRHC), in a new microporous pellet formulation with autologous bone marrow concentrate (BMC), to enhance bone regeneration and new bone formation. Ninety non‐critical sized bone defects were created in the femurs of nine Merino breed sheep and randomly left unfilled (group A), filled with GRHC pellets alone (group B) or filled with GRHC pellets combined with BMC (group C). The sheep were sacrificed at 3 weeks (three sheep), 6 weeks (three sheep) and 12 weeks (three sheep) and histological analysis (Light Microscopy‐LM), scanning electron microscopy (SEM) and histomorphometric analysis (HM) were performed. At 3, 6, and 12 weeks, HM revealed an average percentage of new bone of 48, 72, 83%; 25, 73, 80%, and 16, 38, 78% for Groups C, B and A respectively (significantly different only at 3 weeks p < 0.05). LM and SEM evaluation revealed earlier formation of well‐organized mature lamellar bone in Group C. This study demonstrates that the addition of a bone marrow concentrate to a glass reinforced hydroxyapatite composite in a pellet formulation promotes early bone healing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1176–1182, 2017.