男性骨密度测量中不同部位骨质疏松检出率差异的比较

目的探讨中国男性腰椎与左右侧股骨不同部位骨质疏松检出率的差异。方法选取246例50~65岁健康男性,双能X线吸收法测量其腰椎、左右两侧股骨(包括股骨颈、粗隆、全髋)的骨密度,根据不同部位的T值得出相应的骨质疏松检出率,比较分析各部位检出率的差异。结果不同部位骨质疏松检出率分别为腰椎16.3%、左侧股骨颈32.1%、右侧股骨颈30.9%、左侧粗隆13.4%、右侧粗隆16.7%、左侧全髋16.7%、右侧全髋15.0%,约30%的男性股骨存在左右侧相差0.5个T值以上。综合选取上述最低T值得出的检出率为41.1%,明显高于选取单一部位T值得出的骨质疏松检出率(P=0.000)。结论综合选取多部位中最低的T值作为判断标准,能够提高中国男性骨质疏松的检出率,减少漏诊率。     

中国女性的年龄相关骨密度、骨丢失率、骨质疏松发生率及参考数据库——多中心合作项目

目的 本研究采用多中心合作调查了中国女性的年龄相关骨密度(BMD)、骨丢失率和骨质疏松发生率.调查结果被用来建立一个BMD参考数据库.用以诊断中国女性的骨质疏松.方法 采用双能X线吸收骨密度测量仪(DXA)测量了北京、上海、广州、成都、南京和嘉兴地区20～89岁女性的腰椎(L1～L4)(n=8 142)和髋部(n=7 290)的BMD值.不同部位骨骼BMD随年龄的变化用三次回归模型拟合来描述.结果 股骨颈和全股骨的BMD峰值出现在30～34岁,脊柱和股骨粗隆部的峰值出现在40～44岁.年轻成人的(YA)的BMD值(均值和标准差(SD)用20～39岁年龄段的平均BMD进行计算)在后前位脊柱、股骨颈、股骨粗隆和全股骨分别为1.116±0.12 g/cm2、0.927±0.12 g/cm2、0.756±0.11 g/cm2和0.963±0.13 g/cm2.85岁老年女性脊柱的BMD减少了32%,股骨减少了30%～35%.骨质疏松的定义是BMD值与本研究组中确立的年轻成人BMD值相比≤-2.5个标准差,在50岁及以上的女性,发生率分别为脊柱28%、股骨任何部位15%、脊柱或者股骨为31%.结论 本研究为中国女性骨质疏松的预防和治疗提供了重要数据,并且建立了一个可供全中国范围内女性骨质疏松诊断使用的可靠的参考数据库.     

不同国家和地区各种族人群骨密度参考值及其相互比较

目的了解各种族之间骨密度(BMD)参考值的差异。方法收集科学引文索引(SCI)收录杂志发表的20多个国家和地区不同种族人群的BMD参考值,并进行分类整理和比较分析。结果BMD拟合参考曲线显示,各种族女性和男性人群不同骨骼部位的峰值BMD(PBMD),绝大多数发生在20~30岁,日本女性股骨颈达到PBMD的年龄最早(15岁),中国香港男性腰椎达到PBMD的年龄最晚(40岁)。中国人群的PBMD和BMD参考曲线显著低于其他种族,黑人BMD显著高于所有种族。在腰椎、股骨颈和总体髋部,中国女性的PBMD比美国白人女性分别低6.7%、4.9%和6.1%;美国黑人女性股骨颈和总体髋部的PBMD比中国长沙女性分别高13.9%和13.7%,比美国白人女性分别高10.4%和8.8%;墨西哥女性股骨颈的PBMD与北欧女性人群一致。美国黑人男性股骨颈的PBMD与中国香港男性人群的差异最大,为20.9%。结论不同国家和地区各种族人群之间的BMD参考值绝大多数存在种族或地域差异。     

中国男女性骨大小和体积骨密度的探讨

目的　确定中国北方人群在腰椎和股骨部位峰值骨大小和体密度的性别差异 ,并分析影响其大小的因子。方法　年龄 15至 4 0岁 2 5 6例健康男性和 30 9例健康女性 ,他们的腰椎和股骨颈的骨大小和体积骨密度用双能X线骨密度仪测量。椎体和股骨颈近似为圆柱体 ,骨体积V =π× (宽度 2 ) 2 ×高度 ,vBMD =BMC 体积。结果　椎体峰值BMC ,体积和vBMD女性在 30～ 4 0岁达到峰值 ,而男性 15～ 17岁达到峰值。椎体和股骨颈的BMC男性比女性高 18 1%～ 2 6 7% ,而骨体积相应高 2 8 5 %～ 32 0 % ,这样vBMD男性比女性低 4 0 %～ 8 3% (P <0 0 1)。初潮较晚 (≥ 15岁 )绝经前妇女比来潮较早者 (≤ 12岁 ) ,BMC低 10 % (P <0 0 5 )。男性抽烟者与非抽烟者骨大小和vBMD没有统计学差异。饮酒也没有观察到明显的效应。结论　中国男性比女性有较低的vBMD ,这可能部分地解释中国男性有较高骨折发生率的原因     

合肥市两家省级医院髋部骨折的性别及年龄分布分析

调查和分析合肥市两家省级医院髋部骨折的性别及年龄分布。方法 对合肥市两家省级医院2008-2012年,年龄≥50岁的髋部骨折患者,总计2371例,分为男、女两组,并在组内根据不同年龄段分为亚组,分析髋部骨折在不同的年龄组和性别的分布情况。探讨髋部骨折与性别、年龄的相关性。结果 2371例髋部骨折病人中1007例（42.5%）男性,1364例（57.5%）女性,男女之比为：0.74:1。70-79岁患者占 34.5%,80-89岁患者占 29.7%,明显高于其他组别（P<0.05）。男性股骨颈骨折与股骨粗隆间骨折比为1.5：1,女性为1.7：1(χ2=3.6,df=1, P=0.058),骨折类型不存在性别差异。男性股骨颈骨折和粗隆间骨折的平均年龄分别为72.40±10.13岁和74.43±10.61岁 (P＜0.001), 女性为71.20±11.17岁和77.75±8.75岁（P <0.001）,两种类型骨折的平均年龄差有统计学意义。随着年龄的增加股骨粗隆间骨折的占髋部骨折比例在不断增加,且骨折增长的速率要快于股骨颈骨折。结论 股骨颈骨折和股骨粗隆间骨折有性别、年龄的分布差异,对于髋部骨折的预防,股骨颈骨折在年龄上要早于股骨粗隆间骨折,女性是预防的重点。预防跌倒是降低骨折发生的关键。     

股骨粗隆间骨折髓外内固定方法的进展

股骨粗隆间骨折是股骨颈基底部髋关节囊线以下至小粗隆水平以上部位的骨折,约占髋部骨折的一半.国内髋部骨折的流行病学调查发现,髋部骨折女性高峰在60～80岁,男性在70～80岁.股骨粗隆间骨折多与骨质疏松有关,其中约75%病人为女性,病人平均年龄约70岁.     

昆明地区中老年人群定量CT骨密度测定及骨质疏松症患病率调查

目的 采用定量CT（quantitative computed tomograph,QCT）分析昆明地区中老年人群腰椎和髋部骨密度(bone mineral density,BMD)及骨质疏松（osteoporosis,OP）情况。方法 选取2021年3月至11月于云南省第一人民医院自愿接受腰椎和髋部QCT扫描的昆明地区50岁及以上中老年人,并记录其身高、体重和病史。将受检者以10岁为1个年龄层,按照不同性别,各分为3组（50~59岁,60~69岁,70岁及以上）。分别测量腰1~2椎体平均骨密度（L1-2 BMD）及全髋面积骨密度（TH aBMD）、全髋体积骨密度（TH vBMD）、股骨颈面积骨密度（FN aBMD）、股骨颈体积骨密度（FN vBMD）、股骨大粗隆面积骨密度（TR aBMD）、股骨大粗隆体积骨密度（TR vBMD）、股骨粗隆间面积骨密度（IT aBMD）、股骨粗隆间体积骨密度（IT vBMD）等参数。结果 共纳入555例受检者（男性180例,女性375例）,基于腰椎、全髋及二者任一部位BMD测量获取的OP总体患病率分别为33.51 %、12.79 %和36.04 %,其中任一部位的OP检出率与腰椎检出率差异无统计学意义（P＞0.05）,腰椎和任一部位的OP检出率均明显高于髋部（P均＜0.001）。50~59岁年龄组,男性与女性L1-2 椎体BMD差异无统计学意义（P>0.05）,60~69岁及70岁以上年龄组女性L1-2 椎体BMD均小于男性（P<0.001）。男性髋部各部位BMD与年龄无关（P>0.05）,女性则与年龄呈负相关（P<0.05）。50~59岁年龄组男女TH vBMD、FN vBMD、TR aBMD、IT vBMD差异有统计学意义（P<0.05）,除女性TR aBMD低于男性外,其余均高于男性;60~69岁年龄组男性TH aBMD、FN aBMD、TR aBMD、TH vBMD、IT aBMD均大于女性（P<0.05）;70岁以上年龄组男性髋部各部位BMD均大于女性（P<0.05）。结论 昆明地区中老年人群腰椎测量OP总体患病率为33.51 %,全髋为12.79 %。60岁以上女性OP患病率显著高于男性,女性髋部BMD较男性更低。     

广州地区骨质疏松症合并髋部骨折骨密度阈值的研讨

目的 了解广州地区骨质疏松髋部骨折的骨密度阈值为预防髋部骨折提供有用的数据和措施。方法 调查和分析133例年龄在65岁以上，受伤后两周内入院治疗的男女性不同类型的髋部骨折患者的骨密度情况，分析及提出髋部骨折的骨密度阈值。结果 无论何种类型的股骨颈骨折男性的骨密度均比女性高，差异有显著性，虽然男性股骨颈骨折平均BMD≥-2.31SD；但其中73％病例有1个部位骨密度≤-2.5SD。女性股骨颈骨折和男，女性粗隆间骨折髋部骨量损失相近似，都明显低于男性股骨颈骨折。结论 股骨颈骨折的类型以及粗隆间骨折Garden分型与骨量无关；外伤后女性发生股骨颈骨折或粗隆间骨折与骨量无关。男性发生粗隆间骨折与骨量丢失更多有关。男女性骨质疏松髋部骨折都可以用骨密度减低2．5SD作为骨折的阈值。     

福州地区老年骨折患者回顾性分析

目的回顾分析福建省第二人民医院老年骨折的流行病学特征,以大致推断福州地区的流行病学特征,为该地区骨质疏松性骨折的防治提供理论依据。方法回顾性收集2012年6月至2017年6月福建省第二人民医院老年骨折住院患者(≥50岁),统计骨折部位构成情况,并分析其随年龄、性别变化趋势。结果共收集老年骨折1535例,男性467例(30.42%),女性1068例(69.58%),男女比例12.29,75~79岁骨折患者最多。骨折部位以胸腰椎(36.48%)最多,其次为股骨近端骨折(20.65%)(股骨粗隆间骨折11.01%,股骨颈骨折9.19%)和尺桡骨远端(7.23%)。女性以胸腰椎骨折(40.17%)最多,其次为股骨粗隆间骨折(10.21%)和尺桡骨远端骨折(9.74%);男性同样以胸腰椎骨折(28.05%)最多,其次为股骨粗隆间骨折(12.85%)和股骨颈骨折(8.35%)。老年骨折患者中骨质疏松患者占比59.54%,女性(47.82%),男性(11.72%),并以跌倒所致骨折居多(68.62%)。结论福州地区老年骨折患者中女性多于男性,骨折主要集中于胸腰椎、股骨近端和尺桡骨远端,且男女骨折的好发部位有所不同。跌倒是老年人骨折的一个重要原因,而绝经后骨质疏松加大了老年女性骨折的风险,预防应主要加强对老年人的抗骨质疏松治疗,并加强看护、陪伴及采取相应防护措施。     

泉州市农村老年性骨质疏松性骨折的流行病学调查

目的调查泉州市农村老年人骨质疏松性骨折的患病率,为预防老年骨质疏松性骨折提供依据。方法对泉州地区一个沿海乡镇、一个山区乡镇的各两个村庄的60岁以上整体人群随机抽样调查500人,采用体检、问卷调查和拍摄Χ片、测量股骨颈骨密度等手段。结果泉州地区不论男女,60岁以后各年龄组股骨颈BMD值均随年龄增加而逐年下降,男性各组的BMD值均高于女性相应各组。泉州农村60岁以上女性骨质疏松性骨折发生率为39.74%,男性为13.64%,山区农民骨质疏松性骨折发生率为40.8%,沿海渔民骨质疏松性骨折发生率为18.4%,男女之间、山区与沿海比较差异均具有非常显著性,骨质疏松性骨折部位以脊柱骨折的患病率最高为14.6%、髋部骨折为7.6%、前臂远端骨折为6.8%。结论骨质疏松性骨折随年龄增高而上升,女性患者明显高于男性。山区农民明显高于沿海渔民,骨质疏松性骨折发生部位以脊柱最多,其次为髋部、前臂远端。     

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.     

Bone microstructure at the distal tibia provides a strength advantage to males in late puberty: An HR‐pQCT study

Bone is a complex structure with many levels of organization. Advanced imaging tools such as high‐resolution (HR) peripheral quantitative computed tomography (pQCT) provide the opportunity to investigate how components of bone microstructure differ between the sexes and across developmental periods. The aim of this study was to quantify the age‐ and sex‐related differences in bone microstructure and bone strength in adolescent males and females. We used HR‐pQCT (XtremeCT, Scanco Medical, Geneva, Switzerland) to assess total bone area (ToA), total bone density (ToD), trabecular bone density (TrD), cortical bone density (CoD), cortical thickness (Cort.Th), trabecular bone volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular spacing standard deviation (Tb.Sp SD), and bone strength index (BSI, mg²/mm⁴) at the distal tibia in 133 females and 146 males (15 to 20 years of age). We used a general linear model to determine differences by age‐ and sex‐group and age × sex interactions (p < 0.05). Across age categories, ToD, CoD, Cort.Th, and BSI were significantly lower at 15 and 16 years compared with 17 to 18 and 19 to 20 years in males and females. There were no differences in ToA, TrD, and BV/TV across age for either sex. Between sexes, males had significantly greater ToA, TrD, Cort.Th, BV/TV, Tb.N, and BSI compared with females; CoD and Tb.Sp SD were significantly greater for females in every age category. Males' larger and denser bones confer a bone‐strength advantage from a young age compared with females. These structural differences could represent bones that are less able to withstand loads in compression in females. © 2010 American Society for Bone and Mineral Research     

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.

     

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。     

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.     

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.

     

Massive bone reconstruction with heat‐treated bone graft loaded autologous bone marrow‐derived stromal cells and β‐tricalcium phosphate composites in canine models

Bone marrow‐derived stromal cells (BMSCs) contain mesenchymal stem cells that are capable of forming various mesenchymal tissues. We hypothesized that BMSCs and β‐tricalcium phosphate (β‐TCP) composites would promote the remodeling of large‐sized autologous devitalized bone grafts; therefore, the aim of this study was to evaluate the effects of the composites on the remodeling of autologous devitalized bone grafts. Autologous BMSCs cultured in culture medium containing dexamethasone (10^?7 M) were loaded into porous β‐TCP granules under low‐pressure. Theses BMSC/TCP composites were put into the bone marrow cavity of autologous heat‐treated bone (femoral diaphysis, 65‐mm long, 100°C, 30 min) and put back to the harvest site. In the contralateral side, β‐TCP without BMSC were used in the same manner as the opposite side as the control. Treatment with the BMSC/TCP composites resulted in a significant increase in thickness, bone mineral density, and matured bone volume of the cortical bone at the center of the graft compared to the control. Histological analysis showed matured regenerated bone in the BMSC loaded group. These results indicate that BMSC/TCP composites facilitated bone regeneration and maturation at the graft site of large‐sized devitalized bone. This method could potentially be applied for clinical use in the reconstruction of large bone defects such as those associated with bone tumors. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1308–1316, 2013

     

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.     

Oxyphenbutazone (Tanderil®) in Surgery for Herniated Discs: A Double Blind Trial

Background and purpose In detection of glenoid labrum pathology, MR arthrography (MRA) has shown sensitivities of 88-100% and specificities of 89-93%. However, our practice suggested that there may be a higher frequency of falsely negative reports. We assessed the accuracy of this costly modality in practice.

Patients and methods We retrospectively reviewed MRA reports of 90 consecutive patients with clinical shoulder instability who had undergone shoulder arthroscopy. All had a history of traumatic anterior shoulder dislocation and had positive anterior apprehension tests. All underwent arthroscopy and stabilization during the same procedure. We compared the findings, using arthroscopic findings as the gold standard in the identification of glenoid labrum pathology.

Results 83 of the 90 patients had glenoid labrum tears at arthroscopy. Only 54 were correctly identified at MRA. All normal glenoid labra were identified at MRA. This gave a sensitivity of 65% and a specificity of 100% in identification of all types of glenoid labrum tear. 74 patients had anterior glenoid labral tears that were detected at an even lower rate of sensitivity (58%).

Interpretation The sensitivity of MRA in this series was substantially lower than previously published, suggesting that MRA may not be as reliable a diagnostic imaging modality in glenohumeral instability as previously thought. Our findings highlight the importance of an accurate history and clinical examination in the management of glenohumeral instability. The need for MRA may not be as high as is currently believed.