μCT研究药物对骨结构的影响

以往人们一直都以增加骨密度或骨量作为对骨质疏松症疗效的主要衡量指针。20世纪80年代临床骨质评定的最终指针主要是骨质密度。对药物治疗效果的评价亦以骨密度为准,即遵循治疗期短,骨密度升高显著,则治疗效果好的原则。后来在对氟化物的研究中发现,氟化制剂能使骨密度显     

骨质量与骨量

骨强度同时反映骨量与骨质量的完整性。骨强度由骨材料、构筑、力学性能及骨量共同构成。骨质量能解释一些单纯用骨量或骨密度（BMD）不能解释的问题，诸如在正常BMD仍发生骨折；给予抗骨吸收制剂后，虽只有小的面积骨密度（aB—MD）变化也能减少骨折风险；应用氟化物虽能增加脊柱BMD，但并不能减少脊柱骨折风险；骨折风险早在BMD最大变化之前即可出现等。     

经皮椎体成形术后邻近椎体继发骨折危险因素分析

目的 探讨骨水泥灌注量联合骨密度(bone mineral density,BMD)对骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)经皮椎体成形术(percutaneous vertebroplasty,PVP)后邻近椎体继发骨折(adjacent vertebral compression fracture,AVCF)的影响和预测作用。方法 回顾性分析我院2018年1月至2020年12月收治的627例行PVP的OVCF患者临床资料,根据是否发生AVCF分为骨折组(n=78)和未骨折组(n=549),分析两组患者性别、年龄、高血压、糖尿病、体质量指数(body mass index,BMI)、骨折部位、BMD、骨折椎体压缩率、术前椎体前缘高度、术前Cobb’s角、骨水泥灌注量、术后骨水泥渗漏、骨水泥分布、术后抗骨质疏松治疗、术后椎体前缘高度、术后Cobb’s角恢复程度、矢状面垂直轴偏移量(sagittal vertical axis,SVA)、术后支具佩戴时间、骨水泥灌注量和BMD的差值。采用单因素和多因素L...     

脊柱转移性肿瘤患者腰椎骨密度与椎体骨折关系分析

[目的]探讨脊柱转移性肿瘤患者腰椎骨密度与椎体骨折的关系。[方法]以脊柱转移性肿瘤并病变椎体骨折的患者25例作为病例组,脊柱转移性肿瘤椎体骨折的患者25例作为对照组,并按年龄、性别与病例组进行频数匹配。利用单光子计算机断层扫描（SPECT）/CT仪测量骨密度。利用t检验比较两组间骨密度差异,并以多因素Logistic回归计算OR值与95%CI描述骨密度与椎体骨折发生风险的关系。[结果]病例组腰椎骨密度为（178±46）mg/cm3,对照组为（174±48）mg/cm3,两组比较,差异无统计学意义（t=0.30,P=0.788）。将两组患者骨密度统一排序以P25和P752个四分位数为分界,把患者分成高骨密度、中骨密度、低骨密度,多因素Logistic回归分析结果显示,经性别、年龄调整后,低骨密度患者骨折风险是高骨密度者的2.35倍（95%CI：1.02~17.37）。[结论]脊柱转移性肿瘤患者腰椎骨密度可能与椎体骨折有关。     

雌激素对骨质疏松性骨折愈合影响的实验研究

目的研究雌激素对大鼠骨质疏松性骨折愈合的影响。方法选择6月龄雌性SD大鼠60只,随机分为雌激素组、对照组（骨质疏松组）及假手术组,每组20只,前二组建立去卵巢大鼠骨质疏松性骨折模型,假手术组暴露卵巢而不切除,术后3个月行右侧股骨中段骨折内固定术。前二组术后分别皮下注射苯甲酸雌二醇及等量生理盐水,进行骨密度、X线片、组织病理学和生物力学检测,观察骨折愈合的情况。结果雌激素组骨折局部骨密度、生物力学性能明显高于对照组,差异有统计学意义（P〈0．05）;雌激素组比同时期的对照组骨痂生成量多。结论雌激素在促进骨质疏松性骨折愈合时能增加骨量,同时能提高骨生物力学特性和抗骨折能力。     

椎体后凸成形术治疗骨质疏松性椎体压缩骨折后加固椎体再压缩危险因素分析

目的探讨椎体后凸成形术治疗骨质疏松性椎体压缩骨折后加固椎体发生再压缩的危险因素。方法回顾性分析2012年1月至2014年1月,我院收治的单节段骨质疏松性椎体压缩骨折并接受椎体后凸成形术患者共252例,根据患者随访影像学资料,将所有患者分为无压缩对照组和再压缩组,应用单因素和多因素分析研究导致椎体再压缩的可能因素,如年龄、性别、体质指数、是否为新鲜骨折、术前是否存在其它合并症、既往是否发生其它椎体压缩骨折、是否发生骨水泥渗漏、术前骨密度T值、注射骨水泥量、术前椎体压缩率、术后椎体压缩率、骨水泥是否与上下终板均接触、伤椎是否发生椎体内裂隙,推测其中可能导致术后加固椎体再压缩的危险因素。结果术后发生再压缩45例,未再压缩者207例,压缩组术前合并其它合并症40例,未再压缩组141例;压缩组平均术前骨密度T值(-2.89±0.32),未再压缩组(-2.64±0.29);压缩组骨水泥与上下终板均接触者13例,未再压缩组141例;压缩组骨水泥发生椎体内裂隙者19例,未再压缩组44例。单因素分析结果表明,术前存在其它合并症、术前骨密度T值、骨水泥与上下终板均接触在两组之间差异有统计学意义。多因素Logistic回归分析显示术前存在其它合并症(OR=0.223)和术前骨密度T值低(OR=0.053)是危险因素,骨水泥与上下终板均接触(OR=6.296)是保护因素。结论术前存在其它合并症和患者骨密度过低是椎体后凸成形术后加固椎体再压缩的重要危险因素,对有存在以上两种情况的患者进行密切观察随访十分重要。     

小剂量骨水泥PVP治疗多节段椎体压缩性骨折

目的 探讨采用小剂量骨水泥椎体成形术治疗多节段骨质疏松伴椎体压缩性骨折的临床效果。方法 回顾性研究自2006年９月至2011年８月我院采用小剂量骨水泥椎体成形术治疗46例多节段骨质疏松伴椎体压缩性骨折的病例。其中,男11例,女35例,年龄56～83岁,平均67.3岁。所有患者术前均行骨密度测定Ｔ值≤-2.5,提示骨质疏松,并行Ｘ线片、CT及MRI检查明确责任椎体及后壁完整情况。本组治疗的病例均为多节段椎体压缩性骨折,责任椎体分别分布在：胸６椎（１个）、胸７椎（１个）、胸８椎（２个）、 胸９椎（２个）、胸10椎（５个）、胸11椎（11个）、胸12椎（31个）、腰１椎（36个）、腰２椎（８个）,腰３椎（９个）、腰４椎（13个）、腰５椎（14个）等,本组治疗的病变椎体最少２个,最多４个,平均2.32个。所有患者均经单侧椎弓根穿刺椎体,１次对２个或２个以上责任椎体行小剂量骨水泥椎体成形术。术前、术后３天、１周、术后６个月随访时进行疼痛视觉类比评分（VAS）,评价临床治疗效果。结果 46例患者共行108个椎体成形术,平均１次2.32个椎体,单个椎体内骨水泥注射剂量约1.2～2.1 ml,平均（1.8±0.38）ml。所有患者定期随访,随访时间6～18个月（平均12.6个月）,术前患者VAS评分为7.95±0.82,术后３天VAS评分为4.48±0.80,随访时VAS评分为2.38±0.55,采用配对 t 检验对术前、术后随访时VAS评分进行统计学分析,差异有统计学意义（P＜0.001,α＝0.05）。结论 小剂量骨水泥椎体成形术作为一种微创手术,可有效地缓解多节段骨质疏松伴椎体压缩性骨折引起的疼痛症状,是一种有效的治疗方法。     

乳腺癌治疗对骨质的影响及防治策略

骨折是骨质疏松最常见的并发症随着雌激素水平的降低,绝经后女性骨质疏松的发生风险逐年增加。乳腺癌的一些治疗方法会进一步降低患者血清雌激素水平,加速骨质的流失（即肿瘤治疗诱导的骨丢失）,从而增加患者罹患骨质疏松和骨折的风险。一系列研究已证实,化疗、内分泌治疗（尤其是芳香化酶抑制剂的使用）能显著增加乳腺癌患者骨质疏松及骨折的发生率。近年来,国内外相关组织相继发布了针对此类患者的骨质疏松预防和治疗指南,并推荐将其用于临床实践,尤其用于绝经后乳腺癌患者的临床治疗中。     

经皮椎体成形术治疗胸腰椎体转移瘤的疗效分析

[目的]探讨经皮椎体成形术（PVP）对胸腰椎体转移瘤治疗的临床疗效。[方法]对40例胸腰椎体转移瘤患者采取不同的治疗方法,包括放疗组20例,总剂量为30Gy,分10次2周完成;经皮椎体成形术治疗组20例。观察两组的临床疗效及并发症发生情况。[结果]随访6—24个月,所有患者均按计划完成治疗,PVP组疼痛完全缓解率和部分缓解率明显高于放疗组（P〈0．05）,PVP组术后5例椎体出现骨水泥渗漏,但都未引起临床症状。[结论]经皮椎体成形术能迅速缓解椎体转移瘤引起的疼痛．手术安全有效,值得临床推广。     

恶性肿瘤患者骨质改变的研究

本文测量了５０例恶性肿瘤患者桡骨超远端骨矿物质含量及骨密度。骨密度平均值为０．３６２±０．０７１。５０例患者中有４０例骨密度降低（占８０％）。本文按与疾病年龄组相配的同性别正常人骨密度的均值－２ＳＤ作为骨密度降低。即恶性肿瘤患者骨质减少的诊断标准。恶性肿瘤患者骨密度与正常对照组比较。差异有显著意义（Ｐ＜０．０５）。并且，骨密度降低程度与病程密切相关（Ｐ＜０．０５）。上述结果提示：恶性肿瘤患者常有骨质减少，骨密度降低是其特异性、敏感性指标。     

Paget's disease of the bone in a Chinese woman

Paget's disease, otherwise known as osteitis deformans, is an unusual condition in the Oriental population. We report a case of Paget's disease in a Chinese woman, incidentally diagnosed on a bone scan. This was confirmed by clinical history, biochemistry and imaging findings using other modalities. Although bone scans are commonly performed to diagnose traumatic occult fractures and bone metastases, they can also be used to diagnose metabolic bone diseases, such as osteoporotic fractures, and to evaluate Paget's disease. It can also diagnose acute fractures secondary to renal osteodystrophy and osteomalacia.     

Successful salvage using percutaneous vertebroplasty in cancer patients with painful spinal metastases or osteoporotic compression fractures

Percutaneous vertebroplasty significantly improved pain, mobility and quality of life in cancer patients with bone metastases who failed radiation or with osteoporotic compression fractures. The serious complication is relatively rare.     

球囊扩张椎体成形术中填充人工骨与骨水泥治疗椎体压缩性骨折疗效比较

目的回顾性分析球囊扩张椎体成形术中填充人工骨与骨水泥治疗椎体压缩性骨折疗效比较。方法对30例（31个骨折椎体）随访1年以上资料完整的脊柱压缩骨折患者进行回顾性分析（平均随访时间1．7年）,A组15例患者填充硫酸钙骨水泥（CSC）,B组填充骨水泥,分析术前、术后患者视觉模拟评分（VAS）、Oswestry功能障碍指数及骨折椎体高度恢复。结果A、B两组患者术后VAS疼痛评分、Oswestry功能障碍指数与术前比较均较术前明显改善（P〈0．05）;A组和B组骨折椎体高度与术前比较均较术前明显改善（P〈0．05）,两组术后结果与1年后随访比较无显著性差异;组间比较无统计学差异。结论硫酸钙治疗椎体压缩骨折同样可以取得骨水泥治疗骨质疏松性椎体骨折的疗效,能完全或部分缓解患者的疼痛及提高患者脊柱功能活动;恢复骨折椎体的高度避免骨折椎体高度进一步丢失。     

Calcitonin, carcinoembryonic antigen and neuron-specific enolase in medullary thyroid carcinoma

Calcitonin, carcinoembryonic antigen (CEA) and neuron specific enolase (NSE) were studied in the thyroid glands of patients with multiple endocrine neoplasia (MEN) type 2a, 2b, and with sporadic thyroid carcinomas (MTC). Calcitonin, CEA and NSE were localized in normal C-cells, hyperplastic C-cells, and in MTC. While the distribution of calcitonin and CEA was quite similar in most cases, a smaller proportion of cases were positive for NSE. C-cell hyperplasia was identified in all nine patients with MEN 2a and in four of six patients with MEN 2b. None of the four patients with sporadic MTC had C-cell hyperplasia. These results indicate that C-cell hyperplasia is present in patients with MEN 2a and 2b and that NSE in addition to calcitonin and CEA is a useful marker for the thyroid C-cells.     

Breast cancer prevention

Epidemiological, experimental, and clinical data strongly support the possibility that breast cancer will be prevented by using anti-estrogenic interventions in healthy women. Three trials involving over 20,000 women have so far been reported using tamoxifen 20 mg/day or placebo in healthy women to chemoprevent breast cancer. The American National Surgical Adjuvant Breast and Bowel P-1 Project randomized over 13,000 women to take tamoxifen or placebo and showed a 49% reduction in the early incidence of breast cancer. This was associated with a reduction in osteoporotic fractures but increases in the risks of endometrial cancer, cataract, and thromboembolism. The Royal Marsden tamoxifen trial randomized 2,500 women, and the Italian national trial randomized 5,000 women. Interim analyses from these two trials showed no effect on the early incidence of breast cancer. These results, therefore, have not been able to clearly show an overall clinical benefit of giving tamoxifen to healthy women, nor have they shown which women are likely to benefit. Another selective anti-estrogen (SERM), raloxifene, has been used in a clinical trial to prevent osteoporotic fractures in women with low bone mineral density. Annual mammography in this trial has shown an approximate 80% reduction in the early incidence of breast cancer, and further follow-up of this trial continues. New trials in chemoprevention of breast cancer being started or being proposed use luteinizing-hormone-releasing hormone analogues, aromatase inhibitors, and other SERMs.     

Calcitonin as a marker for bronchogenic cancer: a prospective study.

A prospective study was done of serum calcitonin (HCT) levels in 61 patients with bronchogenic cancer. Initially, 52% of patients had hypercalcitonemia. Hypercalcitonemia was not confined to patients with any particular histologic type. Seventy-eight percent of those with high calcitonin remained normocalcemic. There was no correlation between high calcitonin levels and osseous metastases. Selective thyroid venous sampling delineated two types of hypercalcitonemia: thyroidal and ectopic. To date, the ectopic type has been associated with the small cell bronchogenic carcinoma. High initial calcitonin levels decreased significantly in 75% of patients on antitumor therapy. In 13 evaluable patients calcitonin levels mirrored clinical status changes 67% of the time. Calcitonin may be a useful marker to assess the results of therapy in patients with bronchogenic cancer.     

Skeletal health in postmenopausal survivors of early breast cancer

Estrogen plays an important role in the skeletal health of all women. Many therapies used in the treatment of breast cancer reduce estrogen levels and have the potential to affect bone negatively by increasing the risk of osteoporosis and associated bone fractures. The long-term effects of systemic endocrine therapy on bone, therefore, are an important consideration in the adjuvant setting. Tamoxifen has been shown to have a moderate protective effect on postmenopausal bone due to its partial estrogen agonist activity; however, its long-term use is potentially associated with negative side effects, such as an increased risk of thromboembolic disease and endometrial cancer. Newer agents, the third-generation aromatase inhibitors (AIs), anastrozole, letrozole and exemestane, for example, do not possess estrogen agonist effects and have improved breast cancer outcomes when compared to the standard 5 years of tamoxifen. However, patients treated with adjuvant AIs have been shown to have an increased incidence of osteoporosis and osteoporotic fractures. In order to select the optimal adjuvant therapy for each patient, it is important to assess the overall risk:benefit ratio for each endocrine strategy. All postmenopausal women should follow published guidelines to assess the risk of osteoporosis and, where appropriate, they should receive bone mineral density monitoring. Postmenopausal women with breast cancer who are at increased risk of osteoporotic fracture should be identified and managed with appropriate nonpharmacologic and pharmacologic measures.     

骨质疏松性椎体压缩骨折治疗进展

随着经济的发展和科技的进步，老年性疾病越来越多地被人们重视。骨质疏松症作为一种常见疾病，无声无息地影响着老年人的生活，其严重的后果是骨折以及骨折造成的残疾和死亡。脊柱骨折是骨质疏松症常见的骨折部位之一，因其严重影响生活质量和造成巨大经济开支逐渐受到社会和医生的高度关注。骨质疏松性椎体压缩骨折（osteoporoticvertebralcompressionfractures，OVCFs）的发生率与年龄、性别、种族等因素密切相关，国外关于发病率的报道较多。一项研究估计，2000年全球发生140万例椎体压缩骨折，其中51%发生在欧洲和美国[1]。另一项多中心、多国家前瞻性研究分析了2451名女性脊柱影像资料，年龄在65～80岁，没有明确骨质疏松病史，但结果显示32%女性至少1个椎体骨折，而其中34%的骨折最初未被发现[2]。目前国内尚无权威数据，北京协和医院徐苓等[3]报道北京地区50岁以上女性椎体骨折发生率15%，低于美国女性。OVCFs患者较一般人有更高的死亡率，主要是长期卧床而引起的并发症所致。     

骨质疏松椎体压缩骨折磁共振信号特征及其意义

目的分析骨质疏松椎体压缩骨折不同时期磁共振（ MRI ）信号改变特征及其临床意义。方法选择骨质疏松椎体压缩骨折患者行磁共振影像检查,并与 X 线影像对比,对骨折后24个月内 MRI 信号变化特征进行分析,探讨其临床意义。结果发生骨质疏松骨折椎体内 MRI 信号变化特征：T1WI 低信号、T2WI 高信号、T2WI＋FS 信号进一步增高,信号伴随整个骨折发生、临床愈合及愈合后修复重建过程,在骨折后6个月内均出现信号变化。一般在6～12个月修复重建结束后椎体内磁共振信号逐渐恢复为 T1WI 等信号、T2WI 等信号、T2WI＋FS 等信号。骨折后12～24个月磁共振信号完全恢复正常。与 X 线比较,磁共振可通过信号变化特征反应椎体内骨折发生、愈合及修复重建过程,推测骨折时间。临床上可区分新鲜骨折及陈旧骨折,可对 X 线检查无法早期发现的骨挫伤、隐匿性骨折及跳跃性骨折做出早期诊断。结论椎体内磁共振信号变化反映了骨折发生、愈合及修复重建变化,有利于揭示椎体内松质骨骨折病理生理过程;可提高隐匿性椎体骨折、跳跃性椎体骨折诊断准确率,避免误诊、漏诊;对已变形椎体可提示椎体骨折时间,是否引起临床症状,有利于诊断、治疗方案制订及指导治疗及康复进程。磁共振作为一种可靠的影像学工具有利于骨质疏松椎体压缩骨折诊断和治疗。