骨质疏松性髋部骨折患者髂骨活检及扫描电镜观察

目的 了解骨显微结构退变在骨质疏松性髋部骨折发病机制中的应用。方法 对14例老年髋部骨折患者和11例对照者进行了髂骨活检和扫描电镜观察。结果 老年髋部骨折患者的扫描电镜观察结果可以分为低转换和高转换两种情况，后者除骨小梁数量减少，变细等改变外，骨小梁结构显著退变。结论 因活跃的骨转移活动而导致的骨显微结构退变，是部分髋部骨折的重要原因。     

骨质疏松性髋部骨折股骨上端微构筑研究

目的：研究骨质疏松症患者髋部易发生骨折的微构筑改变，方法：对12例股骨头颈标本（8例老年股骨折行人工关节置换术者及4例死于其他外伤的青年作对照）进行扫描电镜观察。结果：老年组股骨头骨小梁稀疏，变细，穿孔，股骨颈皮质变薄，哈氏管扩大，骨胶原纤维排列紊乱并出现腔隙，结论：老年人因股骨上端微构筑退变，损伤而易出现髋部骨折。     

脂蛋白E基因多态性与骨质疏松性髋部骨折

骨质疏松症是一种多因素性疾病。主要特征是单位体积骨量减少,骨脆性增加。骨质疏松症的严重危害是并发骨折即骨质疏松性骨折:主要包括桡骨远端骨折、脊柱骨折及髋部骨折;其中髋部骨质疏松患者由于骨转换出现特异性改变,骨形成与骨吸收失耦合,导致股骨近端骨显微结构发生明显退变,骨组织力学性能下降,因此更易诱发骨折,髋部     

老年髋部骨折患者围手术期的护理效果探析

目的探究老年髋部骨折患者围手术期护理的效果。方法 2012年6月至2013年6月在本院就诊的76例70岁以上的老年髋部骨折患者,随机分为观察组和对照组,各为38例。观察组采用围手术期护理方法治疗,对照组采用传统护理方法治疗。结果在观察组中,没有1例老年髋部骨折患者出现髋骨不能愈合的情况,也无并发症发生。而对照组中,老年髋部骨折患者出现髋骨不能愈合的有23例,发生并发症的有9例。观察组患者的髋骨愈合率为100%,而对照组患者的髋骨愈合率仅为39.47%。两组比较有统计学差异(P<0.05)。结论老年髋部骨折患者采用围手术期护理能够获得显著的治疗效果,以此同时也能大幅度地降低并发症的发生,让老年髋部骨折患者的生活质量能够获得有效保障。     

骨形态发生蛋白人工骨在老年骨质疏松性髋部骨折治疗中的应用

目的 比较骨折内固定后植入骨形态发生蛋白(BMP)人工骨、自体髂骨和不植骨治疗老年骨质疏松性髋部骨折的效果.方法 自2002年5月至2006年5月治疗81例老年骨折疏松性髋部骨折患者,所有患者均行切开复位骨折内固定,根据植骨材料的不同,将患者分为A组(植入BMP人工骨,26例),B组(自体髂骨植骨,25例),C组(未植骨,30例),比较三组患者的骨折愈合情况和临床效果.结果 术后随访12～14个月,平均13.5个月,临床愈合时间、髋内翻、术后髋关节功能优良率A组与B、C组之间差异有统计学意义(P＜0.05).结论 采用BMP人工骨植入优于自体髂骨植骨及未植骨组,是治疗老年骨质疏松性髋部骨折的有效方法.     

足底静脉泵预防老年髋部骨折术后深静脉血栓的护理

目的探讨足底静脉泵预防老年髋部骨折术后深静脉血栓的护理。方法选取我院老年髋部骨折患者50例,收治时间在2013年2月至2014年6月,并将老年髋部骨折患者随机分为两组(观察组和对照组),两组患者均采用足底静脉泵物理疗法,对照组患者再采用常规护理,观察组患者采用护理干预。结果观察组患者护理后深静脉血栓发生率8.00%显著低于对照组,观察组老年髋部骨折患者的满意度96.00%显著高于对照组患者的满意度64.00%(P<0.05)。结论通过给予老年髋部骨折患者采用足底静脉泵与护理干预,能有效预防深静脉血栓发生。     

80例老年髋部骨折患者的围术期护理

目的探讨老年髋部骨折患者的围手术期护理措施。方法对80例老年髋部骨折患者进行疼痛评估管理、教授功能锻炼,术后加强病情观察、防止并发症、指导患者合理康复训练等围手术期护理。结果老年髋部骨折患者未发生深静脉血栓等并发症。结论加强老年髋部骨折患者围术期护理可显著提高护理质量,减少并发症,促进术后康复。     

老年髋部骨折非手术治疗的护理

目的 分析87例老年髋部骨折病人非手术治疗的过程,总结老年髋部骨折病人非手术治疗的护理经验。方法 通过对87例老年髋部骨折病人非手术治疗患者实施心理护理、牵引术后护理,采取措施预防并发症、及时处理现存病、作好健康指导和宣教。结果 87例老年髋部骨折病人中,无出现护理并发症,均取得满意的治疗效果。结论 对老年髋部骨折病人非手术治疗时,严密观察病情及正确评估病人的情况,采取正确的护理措施,增强了病人的治疗信心,并能有效防止并症发生,直接提高治疗质量,增加治愈率,降低致残率,从而提高患者的生活质量。     

老年患者髋部骨折后行保守治疗的护理体会

目的探讨老年患者髋部骨折后行保守治疗的护理。方法 2008年2月至2011年8月对67例老年患者髋部骨折后行保守治疗、根据老年患者的心理及生理特点、全面评估患者的精神及身体健康状况、制订护理计划并实施针对性护理。结果 67例老年髋部骨折患者中均未出现护理并发症,取得满意的治疗效果。结论对老年髋部骨折患者行保守治疗时,应严密观察病情及正确评估患者的情况,采取针对性护理措施加强基础护理及心理护理向患者介绍显效病例,增强患者的治疗信心,增加治愈率,降低致残率,从而提高患者的生活质量。     

老年髋部骨折患者围术期至出院后的连续性护理分析及临床价值

目的研究老年髋部骨折患者围术期至出院后的连续性护理方案及其临床价值。方法选择2011年11月至2013年11月来我院骨外就诊的120例老年髋部骨折患者作为研究对象,所有患者均行髋部骨折术,将所有患者随机分为两组,每组60例。对照组依据患者病情给予常规护理,实验组在对照组基础上给予从围术期至出院后的连续性护理干预,观察随访两组护理干预前后髋关节功能恢复情况和患者抑郁程度。结果实验组经过3个月连续性护理,髋关节功能评分为(85.42±12.63)分,对照组为(74.38±10.62)分,实验组显著高于对照组,具有统计学意义(P<0.05)。护理后实验组患者焦虑评分为(46.23±4.15)分,对照组为(54.27±4.31)分,实验组显著低于对照组,具有统计学意义(P<0.05)。结论老年髋部骨折患者围术期至出院后的连续性护理有助于恢复髋关节的功能,可显著改善老年髋部骨折患者精神抑郁的状态。     

Calcitonin for osteoporosis and bone pain

Calcitonin has been approved for the treatment of osteoporosis and other diseases involving accelerated bone turnover for approximately 25 years. The most commonly studied and prescribed form is salmon calcitonin, which has a greater efficacy in clinical use. A wealth of well-controlled clinical studies have demonstrated that calcitonin preserves or increases bone mineral density (BMD) and reduces the risk of vertebral fractures in osteoporosis. Recent studies have indicated that while a low BMD is correlated with an increase in fracture risk, increases in BMD alone do not explain the antifracture efficacy of antiresorptive therapies such as calcitonin. Therapies that moderately increase BMD may reduce fracture risk by reducing the rate of bone turnover and maintaining the integrity of the trabecular architecture, resulting in the preservation of bone strength and quality in osteoporotic patients. An advantage of calcitonin that is not shared by other antiresorptive therapies is its direct analgesic effect on bone pain. Calcitonin has been demonstrated to be clinically useful in improving pain, not only from the acute vertebral fractures of osteoporosis, but also in Paget's disease, bone malignancies, and other sources of musculoskeletal pain. Drugs containing calcitonin may be approved for additional indications in the near future, and as more convenient routes of administration such as the oral route become available, the demand for the calcitonin peptide is expected to increase.     

Heavy metals accumulation affects bone microarchitecture in osteoporotic patients

Bone metabolism is affected by mechanical, genetic, and environmental factors and plays a major role in osteoporosis. Nevertheless, the influence of environmental pollution on the occurrence of osteoporosis is still unclear and controversial. In this context, heavy metals are the most important pollutants capable to affect bone mass. The aim of this study was to investigate whether heavy metals accumulation in bone tissues could be related to the altered bone metabolism and architecture of osteoporotic patients. To this end, we analyzed 25 bone head biopsies osteoporotic patients and 25 bone head biopsies of osteoarthritic patients. Moreover we enrolled 15 patients underwent hip arthroplasty for high‐energy hip fracture or osteonecrosis of the femoral head as a control group. Bone head biopsies were studied by BioQuant‐osteo software, scanning electron microscopy and Energy Dispersive X‐ray microanalysis. We found a prevalence of lead, cadmium and chromium accumulation in osteoporotic patients. Noteworthy, high levels of sclerostin, detected by immunohistochemistry, correlate with the accumulation of heavy metal found in the bone of osteoporotic patients, suggesting a molecular link between heavy metal accumulation and bone metabolism impairment. In conclusion, the presence of heavy metals into bone shed new light on the comprehension of the pathogenesis of osteoporosis since these elements could play a non redundant role in the development of osteoporosis at cellular/molecular and epigenetic level. Nevertheless, in vivo and in vitro studies need to better elucidate the molecular mechanism in which heavy metals can participate to osteoporosis. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1333–1342, 2017.     

持续康复护理对老年腰椎骨折患者骨密度的影响

目的 探讨康复护理对老年腰椎骨质疏松性骨折患者骨密度的影响.方法 依据是否坚持康复护理将我院201 1年因骨质疏松性腰椎骨折住院手术治疗并接受康复护理出院指导的患者分为两组,分别在入院、出院1个月、3个月、6个月进行自行设计的基线问卷调查和骨密度测量.结果 6个月后康复护理组骨密度提高,未坚持康复护理组骨密度下降.康复护理组术后1个月、3个月、6个月的骨密度,随运动时间越长,骨密度提高越显著.室外自主负重运动方式对骨密度的影响更有效.结论 坚持康复护理可以提高老年腰椎骨质疏松性骨折患者的骨密度,是改善骨质疏松的有效手段之一.     

强骨饮联合益生菌对大鼠骨质疏松性骨折的愈合作用

目的 研究强骨饮联合益生菌对大鼠骨质疏松性骨折的愈合作用。方法 将♂SD大鼠50只随机分成5组：一般骨折对照组、骨质疏松性骨折模型组、强骨饮组、益生菌组、强骨饮联合益生菌组,每组10只。骨质疏松性骨折模型组和所有治疗组均摘除双侧卵巢制备骨质疏松模型。6周后,每组制备右侧股骨干中段横行骨折模型。造模成功后即给予强骨饮组生药灌胃量102 g·kg^-1,益生菌组灌胃量12.5 g·kg^-1,未给药组灌胃等量生理盐水,每日1次,连续6周。骨密度扫描仪测定骨密度,Micro-CT扫描股骨相关参数,酶联免疫法测定大鼠血清骨源性碱性磷酸酶（bone alkalinephosphatase,BALP）、骨钙素（osteocalcin,OC）、I型胶原C端肽（type I procollagen carboxy-terminal propeptide,CTX-I）,生化仪测定钙浓度（Ca）。HE观察骨折骨痂组织病理变化。结果 与骨质疏松性骨折组比较,强骨饮组或益生菌组均可促进骨折愈合（增加骨小梁数量和骨密度）,增加骨形成参数（BALP和OC）和降低吸收参数（CTX-I）,而强骨饮联合益生菌组作用更明显。结论 益生菌和强骨饮均有促进骨质疏松性骨折愈合的治疗作用,联合用药效果更佳。     

Relationship between change in femoral neck bone mineral density and hip fracture incidence during treatment with strontium ranelate

ABSTRACT

Objective: Strontium ranelate (SR) increases bone mineral density (BMD) in postmenopausal osteoporotic women and reduces vertebral and non-vertebral fracture incidence. Hip fracture reduction has also been observed during 3-year treatment with SR in osteoporotic women at high risk of hip fracture. The objective of this study is to analyse the association between BMD changes and hip fracture incidence during treatment with SR.

Material and methods: In this post-hoc analysis, 465 women aged over 74 years with low BMD at the femoral neck (T-score ≤ –2.4 according to NHANES normative values) were selected from the population of a recently published study (the Treatment of Peripheral Osteoporosis Study – TROPOS). BMD was assessed at the femoral neck at baseline and after a follow-up of 3 years. Hip fractures were reported by study investigators.

Results: After adjusting for age, body mass index, femoral neck BMD at baseline and number of prevalent vertebral fractures, we found that for each 1% increase in femoral neck BMD observed after 3 years, the risk to experience a hip fracture after 3 years decreased by 7% (95% CI: 1–14%) (?p = 0.04). In patients experiencing a hip fracture over 3 years of treatment with SR, femoral neck BMD increased by (mean [SE]) 3.41 (1.02)% compared to 7.23 (0.81)% in patients without hip fracture (?p = 0.02).

Conclusion: In this post-hoc analysis of women undergoing 3 years of SR treatment, an increase in femoral neck BMD is associated with a decrease in hip fracture incidence.     

Zoledronic acid for cancer therapy-induced and postmenopausal bone loss

Background: Cancer therapy-induced bone loss (CTIBL) and bone loss in postmenopausal (PMW) increase fracture risk. Objective: To review the efficacy and safety of zoledronic acid (ZA) for prevention and treatment of CTIBL and postmenopausal bone loss. Methods: Using PubMed, a search of the English language literature (January 1950 to November 2007) was performed to identify articles evaluating ZA in CTIBL patients without bone metastases and for postmenopausal bone loss; articles were reviewed and evaluated. Results/conclusion: Intermittent administration of ZA increases BMD, decreases bone turnover markers, and is well tolerated in both cancer patients without bone metastases and osteopenic/osteoporotic PMW. In osteopenic/osteoporotic PMW, ZA also decreases fracture rates and prevents second fractures. The optimal regimens in these populations are unknown.     

骨髓间充质干细胞复合I型胶原修饰的聚乳酸聚乙醇酸对骨质疏松大鼠骨缺损的影响

目的 通过将骨髓间充质干细胞复合I型胶原修饰的聚乳酸聚乙醇酸(PLGA)微球支架注入骨质疏松大鼠股骨转子间,探讨其对骨缺损后骨质量的局部改善情况.方法 通过切除30只SD雌性大鼠双侧卵巢建立骨质疏松动物模型,并用电钻在股骨转子间人为制作骨缺损;实验动物按随机数字表法均分为给药组、模型组和假手术组.给药组大鼠骨缺损部位注入骨髓间充质干细胞复合I型胶原修饰的PLGA微球,模型组大鼠骨缺损部位注入PBS缓冲液,假手术组大鼠行假手术.分别考察术后1、3个月骨缺损部位的骨矿含量、骨密度、骨小梁厚度、骨小梁面积百分比及分离度.结果 骨髓间充质干细胞与I型胶原修饰的PLGA微球支架体外培养7 d,发现细胞在支架表面黏附、生长良好.与模型组比较,给药组动物术后1个月的骨密度、骨小梁厚度、骨小梁面积百分比均显著增大,骨小梁分离度显著减小,均差异有统计学意义(P<0.05),骨矿含量变化不明显(P>0.05);给药组动物术后3个月的骨矿含量、骨密度、骨小梁厚度、骨小梁面积百分比均显著大于模型组,骨小梁分离度显著小于模型组,均差异有统计学意义(P<0.05).结论 骨髓间充质干细胞复合I型胶原修饰的PLGA微球可修复大鼠骨质疏松部位骨缺损,改建骨小梁结构,提高骨质量.     

骨质疏松性髋部骨折的治疗

目的提高髋部脆性骨折治愈率,降低伤残率。方法对108例髋部脆性骨折患者资料进行回顾性分析,平均随访23个月。探讨Singh分级、治疗措施与预后的关系。结果①SinghⅢ～Ⅵ级者行内固定术,Ⅰ～Ⅱ级者行人工关节置换,优良率为83．3％;②内固定与人工关节置换的并发症发生率分别为11．4％、7．9％（P〉0.05）;③脆性骨折经口服阿仑膦酸钠5个月后,94．4％的患者Singh分级不变;④预防使用抗生素由平均6．9d减为1．7d,术后感染未增多（P〈0.05）。结论Singh指数为基层医院了解股骨近端骨质疏松程度的一种方法;内固定或人工关节置换治疗高龄髋部脆性骨折,并发症不少;脆性骨折术后应使用阿仑膦酸钠;限制使用抗生素不会增加骨科内植物术后感染率。     

老年人髋部骨折与骨质疏松发病率的相关性研究

目的探讨老年人髋部骨折与骨质疏松发病率的相关性。方法选取本院2011年2月～2013年2月诊治的髋部骨折老年患者91例,均为单侧骨折。将健侧作为对照组,将髋部骨折侧作为观察组,分别行骨密度测定,分析老年人髋部骨折与骨质疏松发病率的相关性。结果依60岁～、66岁～、〉71岁的顺序,老年髋部骨折患者两侧骨密度均不同程度地下降。健侧骨密度明显高于患侧骨密度,差异有统计学意义（P〈0.05）。依60岁～、66岁～、〉71岁的顺序,老年髋部骨折患者骨质疏松发病率明显升高,差异有统计学意义（P〈0.05）。Pearson相关性分析显示老年患者髋部骨折与骨质疏松发病率存在显著的正相关性（r=0.419,P=0.012）。结论老年人髋部骨折与骨质疏松发病率存在明显的正相关性,骨质疏松发病率越高,老年人髋部骨折发生率越高。     

Examining the relationship between bone mineral density and fracture risk reduction during pharmacologic treatment of osteoporosis

Osteoporosis is a skeletal disorder characterized by compromised bone strength that predisposes the patient to an increased risk for fracture. Elements of bone strength include bone mineralization, architecture, turnover, size, and bone mineral density (BMD). Measurement of BMD is the most readily available, noninvasive method for assessing osteoporotic fracture risk and is used by the World Health Organization for diagnostic purposes. Because low BMD is predictive of increased fracture risk, it was believed that changes in BMD during pharmacologic therapy for osteoporosis would strongly predict observed fracture risk reductions. We examined the relationship between changes in BMD and reduction in fracture risk during pharmacologic therapy in postmenopausal women with osteoporosis. The correlation between BMD increases and fracture risk reduction during treatment is not consistent; larger increases in BMD do not necessarily correlate with greater reductions in fracture risk. Multiple factors, in addition to BMD, appear to contribute to the increased bone strength and decreased fracture risk achieved with approved drug therapies for osteoporosis. Until the exact relationship of these factors is fully understood, clinicians should continue to evaluate drug efficacy for osteoporosis based on the fracture risk reductions from well-designed clinical trials.