维汉老年男性糖尿病患者骨代谢水平分析

目的 探讨汉族和维吾尔族男性糖尿病患者骨代谢水平的特点,为糖尿病性骨质疏松的临床研究提供参数.方法 选择符合研究对象的143名汉族和维吾尔族男性糖尿病患者,测量骨密度(BMD)、骨碱性磷酸酶(BAP)、骨钙素(BGP)、抗酒石酸酸性磷酸酶(TRACP-5b)、25羟基维生素D3(25-(OH) VD3),按BMD值分为...     

哈萨克族女性绝经后骨代谢水平及生活方式的研究

目的 探讨绝经后哈萨克族族女性骨代谢水平及生活方式的特点.方法 选择符合研究对象的208名绝经后哈萨克族女性,测BMD、Ca、P、BAP、BGP、TRACP-5b、25-(OH)D3,按BMD值分为正常组,骨量减少组和骨质疏松组并进行比较.结果 经单因素方差分析,各组中各自BGP、BAP、TRACP-5b、25-(OH)D3中有统计学意义(P＜0.01),骨代谢水平与哈萨克族生活方式有关.结论 骨代谢水平在哈萨克族绝经妇女中差异反应出绝经后妇女与生活方式、膳食结构有关,维生素D代谢上可能存在基因多态性影响.     

阿仑膦酸钠对汉族、维吾尔族骨质疏松患者骨生化标志物和维生素D水平的影响?

目的 观察阿仑膦酸钠对新疆乌鲁木齐地区汉族与维吾尔族骨质疏松(Osteoporosis,OP）患者25羟基维生素D（25-(OH) D）和骨代谢标志物的影响。方法 选择2008年5月至2011年8月期间,我院就诊的骨质疏松患者132例,其中汉族90例（68.2%）,维族42例（31.8%）,对比治疗前后两组骨代谢指标以及25-(OH) D水平。结果 两组平均年龄、体重指数、血清Ca、P、Mg水平无统计学差异(P>0.05);治疗前后25-(OH) D水平均具有统计学显著性差异;两组抗酒石酸酸性磷酸酶5b(TRACP-5b)水平明显降低,汉族组有统计学显著性差异;骨特异性碱性磷酸酶(BAP)、骨钙素(BGP) 治疗前后变化不明显。结论 在汉族和维吾尔族间,阿仑膦酸钠通过抑制破骨细胞活性达到治疗骨质疏松的目的,不同种族无明显差异。     

补肾壮骨颗粒剂对老年男性骨转换指标的影响

目的 观察补肾健脾活血中药对老年男性骨密度(BMD)、骨特异性碱性磷酸酶(BAP)、抗洒石酸酸性磷酸酶5b(TRAP5b)、氨基端和中段骨钙素(BGP)的影响.方法 采用自身前后对照的方法,临床选取符合骨量减少及骨质疏松患者的老年男性病例35例,平均年龄(75.56±5.8)岁,给予口服补肾壮骨颗粒剂,钙尔奇D片和法能胶丸做为基础用药.分别测定服药前及服药半年后患者BMD、BAP、TRAP5b、BGP4项骨转换指标,并将服药前后测定值做比较.结果 服药半年后患者的BMD及BAP较服药前升高明显(P＜0.05),有统计学意义;TRAP5b较服药前降低(P＜0.05),有统计学意义;而BGP服药前后改善不明显,(P＞0.05),无统计学意义.结论 补肾健脾活血中药与钙剂、维生素D联合应用,能抑制骨吸收,降低血清TRAP5b;促进骨形成,提高血清BAP及BGP含量,减缓骨量丢失,提高骨密度,有效防治老年男性骨质疏松症.     

老年女性骨质疏松患者血清IGF-1和ET-1水平变化的意义

目的探讨老年女性骨质疏松患者血清胰岛素样生长因子-1(IGF-1)和内皮素-1(ET-1)水平变化的意义。方法选取93例老年女性骨质疏松患者作为病例组,并选取同期50例老年女性健康者作为对照组。采用ELISA法检测血清IGF-1和ET-1水平及骨代谢指标;采用双能X线骨密度(BMD)测量仪对每位研究对象L1~4椎体处和股骨颈的BMD进行检测。采用Pearson相关分析对变量间相关关系进行分析。结果病例组IGF-1、骨钙素(BGP)、骨碱性磷酸酶(BAP)和BMD水平均低于对照组,而ET-1、Ⅰ型胶原交联羧基端肽(CTX-1)和抗酒石酸酸性磷酸酶5b(TRACP-5b)水平均高于对照组,差异均有统计学意义(P0.001)。Pearson相关分析显示,病例组血清IGF-1水平与ET-1、CTX-1和TRACP-5b呈负相关(P0.05),而与BGP、BAP和BMD呈正相关(P0.05);病例组血清ET-1水平与BGP、BAP和BMD呈负相关(P0.05),而与CTX-1和TRACP-5b呈正相关(P0.05)。结论老年女性骨质疏松患者血清IGF-1水平降低而ET-1水平升高,且与BMD和骨代谢指标密切相关,可能共同参与了骨质疏松发病过程。     

新疆乌鲁木齐汉族、维吾尔族女性骨质疏松患者骨生化指标和血脂水平研究

目的 通过分析新疆乌鲁木齐地区汉族与维吾尔族女性骨质疏松患者骨代谢和血脂的水平,探讨血脂与骨质疏松症的关系。方法 选择2008年5月至2010年2月期间,我院就诊的女性骨质疏松患者134例,其中,汉族88例,维吾尔族46例,对比分析两组体重指数、血清电解质、部分骨生化标志物以及血脂水平。结果两组体重指数、血清Ca、P、Mg水平无统计学差异(P0.05);骨特异性碱性磷酸酶(BAP)、骨钙素(BGP)水平,维族组高于汉族(P0.05),抗酒石酸酸性磷酸酶5b(TRACP-5b)水平两组无显著性差异(P0.05);高密度脂蛋白、总胆固醇、低密度脂蛋白、甘油三酯和载脂蛋白α,两组无明显统计学差异(P0.05);高密度脂蛋白低于正常值的维族患者有6例,汉族有25例,两组具有统计学差异(P0.05)。结论 通过影响成骨细胞的骨代谢水平,高密度脂蛋白异常可能是新疆乌鲁木齐地区汉族女性骨质疏松患者的危险因素之一。     

新疆乌鲁木齐地区汉族与维吾尔族绝经后女性骨质疏松患者发病特点的研究

目的 探讨新疆乌鲁木齐地区汉族与维吾尔族绝经后女性骨质疏松患者发病特点.方法 将确诊为绝经后女性骨质疏松症患者汉族(118例),维吾尔族(39例)进行分组,分析对比两组患者骨密度测定值,骨特异性碱性磷酸酶(BAP)、骨钙素(BGP)、抗酒石酸酸性磷酸酶5b(TRACP-5b)、1-(OH)维生素D_3以及血清Ca、P、Mg水平.结果 维吾尔族女性原发性骨质疏松症患者发病年龄小于汉族患者,维吾尔族女性原发性骨质疏松症患者的绝经年龄早.维吾尔族1-(OH)维生素D_3水平明显低于汉族组(P<0.01),骨钙素(BGP)检测值维吾尔族原发性骨质疏松症患者高于汉族(P<0.05).结论 维吾尔族原发性骨质疏松症患者,可能与汉族有着不同的骨质疏松症发病机制.维吾尔族原发性骨质疏松症患者更应补充足量的活性维生素D.     

铁过载对绝经后骨质疏松患者骨密度和骨代谢的影响

目的 观察铁过载对绝经后骨质疏松患者骨密度和骨代谢的影响。方法 将234名绝经后妇女按照骨密度（bone mineral density, BMD）分为正常组、骨量减少组和骨质疏松组。分析铁过载对年龄、绝经年数、血钙(Ca)、磷(P)、体质量指数（bone mass index,BMI）、肝肾功能、葡萄糖代谢、脂质代谢、炎症反应、BMD、抗酒石酸酸性磷酸酶5b(TRACP-5b)、ALP、Ⅰ型胶原交联C端肽(β-CTX)和Ⅰ型胶原交联N端肽(PINP)的影响。结果 与正常组相比,骨量减少组和骨质疏松组血清铁蛋白(Fer)显著升高(P<0.05)。Fer水平与BMD呈负相关(P<0.05)。TRACP-5b水平在骨质疏松组明显高于正常组(P<0.05)。与正常组相比,骨质疏松症组的ALP水平显著升高(P<0.05)。与骨量减少组相比,骨质疏松组血清β-CTX水平明显升高(P<0.05);且骨质疏松组的PINP水平显著高于正常组(P<0.05)。更重要的是,血清Fer和PINP之间存在正相关(P<0.05);血清Fer和β-CTX之间呈正相关(P<0.05)。结论 铁过载对绝经后骨质疏松患者骨密度和骨代谢均有显著影响。     

新疆乌鲁木齐汉族、维族骨量减少女性骨生化标志物和维生素D水平的研究

目的通过分析新疆乌鲁木齐地区汉族与维吾尔族骨量减少女性之间骨生化标志物和维生素 D的水平,探讨维吾尔族骨量减少的特点。方法选择2008年5月至2011年3月期间,我院就诊的 骨量减少的女性500例,其中汉族306例（61. 2% ),维族194例（38. 8% ),对比分析两组体重指数、血 清电解质、部分骨生化标记物以及25羟基维生素D水平。结果两组平均年龄、体重指数、血清Ca、 P、Mg水平无统计学差异（P>0. 05 );骨特异性碱性磷酸酶（BAP)无显著性差异（P>0. 05 );骨钙素 (BGP)、抗酒石酸酸性磷酸酶5b( TRACP-5b)水平,维吾尔族高于汉族组（P<0. 05);汉族各年龄阶段 VitD水平均高于维吾尔族,具有统计学显著性差异。结论骨转换水平较高和VitD缺乏在维吾尔族 女性骨量减少中发挥着重要的作用。     

活性维生素D对骨量减少的强直性脊柱炎患者骨代谢指标及病情的影响

目的探讨补充活性维生素D对于骨量减少的强直性脊柱炎(AS)患者骨代谢标志物、骨密度及炎性指标的影响。方法选取骨量减少的AS患者60例为研究对象,同期健康体检者20例作为健康组,比较两组受试者血清骨特异性碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶异构体-5b(TRACP-5b)、25-(OH)D3的水平。将上述AS患者随机分为治疗组和对照组,每组30例,对照组口服美洛昔康、柳氮磺吡啶、碳酸钙,治疗组在此基础上加用骨化三醇口服。比较2组治疗前后BALP、TRACP-5b、25-(OH)D3,骨密度(BMD)以及红细胞沉降率(ESR)、C反应蛋白(CRP)等指标的变化水平。结果 AS组BALP、TRACP-5b高于健康组,25-(OH)D3低于健康组(P0.05)。治疗组和对照组治疗后血清BALP、25-(OH)D3水平均有升高(P0.05),TRACP-5b水平均有下降(P0.05);治疗组BALP及25-(OH)D3治疗前后差值高于对照组(P0.05)。6个月后治疗组复查腰椎、大转子、转子间BMD较对照组均有不同程度的提升(P0.05),5例骨量恢复正常;对照组6个月后BMD变化不明显;治疗组治疗前后腰椎、大转子、转子间BMD变化差值均高于对照组(P0.05);治疗组与对照组ESR、CRP及BASDAI评分较前均有所降低(P0.05),其中治疗组ESR下降水平较对照组差异具有统计学意义(P0.05)。结论活性维生素D可以改善骨量减少的强直性脊柱炎患者的骨代谢指标并降低疾病活动度。     

跖骨感染骨外露的显微外科治疗

[目的]回顾总结跖骨骨感染骨外露的显微外科治疗方法。[方法]自1995年～2005年采用显微外科技术治疗214例跖骨骨外露骨感染患者。[结果]全部病例获得随访1～10年，平均随访3年，14例游离植皮术后皮肤成活良好，199例术后皮瓣全部成活，1例腓肠神经营养血管皮瓣移位修复术出现远端部分皮肤坏死，后经换药处理后，伤口自然愈合。皮瓣移植术后质地良好，无溃疡复发。患足均可负重走路。[结论]应用显微外科技术治疗跖骨骨感染骨外露可获得较好的疗效。     

Assessment of bone density and bone loss

Osteoporosis International - Dual-energy X-ray absorptiometry has become the standard for the evaluation of osteoporosis. It is useful both for identifying those people who are going to be at risk...     

Spinal fusions: bone and bone substitutes

Vertebral arthrodesis is one of the most commonly performed, yet incompletely understood, procedures in spinal surgery. Despite major progress in internal fixation techniques, the high rate of non-unions indicates that physiologic, biologic and molecular events that are crucial to this process are not well known. This article will analyze the general biology of bone regeneration, and particularly discuss the properties and use of various bone graft materials and graft substitutes. Received: 9 August 2000/Accepted: 11 August 2000     

Trabecular bone remodeling and bone balance in hyperthyroidism

In vivo tetracycline double-labeled iliac crest bone biopsies from 15 hyperthyroid patients were used for the reconstruction of curves describing the variation of resorption depth and formation thickness with time. The curves emerging were compared to curves reconstructed from 13 age- and sex-matched normal individuals (mean age 44 years). The median function period for resorptive cells in hyperthyroid patients (16 days) was about one-third the resorptive period in normals (51 days). No significant difference between the osteoclast-, mononuclear-, or preosteoblast-like cell resorption depths could be demonstrated between the two groups. Consequently, the median resorption rate in hyperthyroid patients (3.8 μm/day) was more than 3 times higher than the value in the control group (1.1 μm/day). Median Sigma_f, was shorter in the hyperthyroid group (109 days) than in the control group (151 days, P < 0.05), as was the median initial mineralization lag time (5 and 16 days, respectively, P < 0.01). No significant difference between the measured mean completed wall thickness (mcwT) values in the hyperthyroid groups and the control group could be demonstrated (58.1 and 60.5 μm respectively). Median initial mineralization rate in the hyperthyroid group (1.2 μm³/μm² per day) was not significantly higher than the value calculated in the control group (0.9 μm³/ μm² per day), but median initial matrix appositional rate in hyperthyroids (4.8 μm³/μm² per day) was 3 times higher than the value calculated for normals (1.6 μm³/μm² per day) (P < 0.01). Direct measurements of mean completed wall thickness in the hyperthyroid group gave results (58.1 μm) that were not in accordance with the mean completed wall thickness calculated from the growth curve (52.1 μm, P < 0.02). In normals no such discrepancy could be demonstrated. Using the mcwT value estimated from the growth curve, the bone formation period was calculated to 90 days for hyperthyroid patients. This maximal estimate for mcwT was also significantly lower than the mean resorption depth measured in the hyperthyroid group (61.7 μm, P < 0.05), which means that a net negative balance per remodeling cycle existed in the hyperthyroid group. Bone balance was preserved in the control group.     

骨胶原与骨质疏松骨密度及骨生物力学的相关性研究

目的探讨骨胶原含量在绝经后骨质疏松症的发生、发展及在骨质疏松性骨折中的作用。方法取7个月龄未交配雌性SD大鼠60只，随机分为四组，A组：对照组（sham组）；B组：切除卵巢组；C组：切除卵巢＋雌激素治疗组；D组：切除卵巢＋降钙素治疗组。除A组外，其他三组通过切除双侧卵巢法12周后制成骨质疏松模型，24周后分别行k的力学特性、右侧股骨三点弯曲试验、羟脯氨酸含量、k骨密度（BMD）测定，Masson三色染色法显示骨胶原形态。结果A、C、D组与B组在k羟脯氨酸含量、BMD、k压缩力学参数值、右侧股骨生物力学参数值、骨胶原染色含量及形态方面差异均有统计学意义（P〈0．05），而A、C、D组之间差异无统计学意义（P〉0．05）。统计学分析显示羟脯氨酸含量与BMD及骨生物力学参数值呈直线相关性。结论骨质疏松的发生与骨胶原含量下降有关。骨胶原含量的下降与BMD降低及骨生物力学改变呈相关性。应用雌激素和降钙素治疗去势后骨质疏松大鼠，不仅可以提高其BMD含量和骨生物力学性能，而且还可以提高骨胶原的含量。     

Repair of long bone defects with demineralized bone matrix and autogenous bone composite

Background:

Repair of diaphyseal bone defects is a challenging problem for orthopedic surgeons. In large bone defects the quantity of harvested autogenous bone may not be sufficient to fill the gap and then the use of synthetic or allogenic grafts along with autogenous bone becomes mandatory to achieve compact filling. Finding the optimal graft mixture for treatment of large diaphyseal defects is an important goal in contemporary orthopedics and this was the main focus of this study. The aim of this study is to investigate the efficacy of demineralized bone matrix (DBM) and autogenous cancellous bone (ACB) graft composite in a rabbit bilateral ulna segmental defect model.

Materials and Methods:

Twenty-seven adult female rabbits were divided into five groups. A two-centimeter piece of long bone on the midshaft of the ulna was osteotomized and removed from the rabbits’ forearms. In group 1 (n=7) the defects were treated with ACB, in group 2 (n=7) with DBM, and in group 3 (n=7) with ACB and DBM in the ratio of 1:1. Groups 4 and 5, with three rabbits in each group, were the negative and positive controls, respectively. Twelve weeks after implantation the rabbits were sacrificed and union was evaluated with radiograph (Faxitron), dual-energy x-ray absorptiometry (DEXA), and histological methods (decalcified sectioning).

Results:

Union rates and the volume of new bone in the different groups were as follows: group 1 - 92.8% union and 78.6% new bone; group 2 - 72.2% union and 63.6% new bone; and group 3 - 100% union and 100% new bone. DEXA results (bone mineral density [BMD]) were as follows: group 1 - 0.164 g/cm², group 2 - 0.138 g/cm², and group 3 - 0.194 g/cm².

Conclusions:

DBM serves as a graft extender or enhancer for autogenous graft and decreases the need of autogenous bone graft in the treatment of bone defects. In this study, the DBM and ACB composite facilitated the healing process. The union rate was better with the combination than with the use of any one of these grafts alone.