血清胃饥饿素水平与绝经后骨质疏松症合并代谢综合征患者骨密度相关性研究

目的 探索胃饥饿素与绝经后骨质疏松症合并代谢综合征患者骨密度相关性.方法 本研究纳入我院初诊未经治疗的绝经后骨质疏松症患者(T评分<-2.5)参加了研究,共纳入320位绝经后骨质疏松症女性受试者,其中绝经后骨质疏松症合并代谢综合征78位,绝经后骨质疏松症女性不合并代谢综合征242位.采用酶联免疫吸附法测定血清胃饥饿素和...     

甲状旁腺素与二磷酸盐治疗绝经妇女骨质疏松症有效性及安全性评价——Meta分析

目的 评价甲状旁腺素与二磷酸盐治疗绝经妇女骨质疏松症有效性及安全性差异.方法 通过检索Pubmed、Cochrane图书馆、EMbase、Highwire、中国生物医学文献数据库CBM、CNKI等中外生物医学数据库,收集有关应用甲状旁腺素与二磷酸盐治疗绝经妇女骨质疏松症的临床随机对照试验,检索文献日期从2002年1月至2012年9月.采用Cochrane系统评价方法,按照纳入和排除标准限定研究对象,评估所纳入研究的文献质量,并提取有效数据后采用RevMan5.0软件进行Meta分析.结果 共纳入应用甲状旁腺素与二磷酸盐对比治疗绝经妇女骨质疏松症的临床对照研究9项(共1287例).结果 显示:在有效性方面,甲状旁腺素组比二磷酸盐组能提高绝经妇女骨质疏松症者腰椎BMD[WMD=3.96,95%CI(3.10,4.82)]和股骨颈BMD[WMD=2.05,95%CI(0.27,3.83)],而后者比前者更能提高髋BMD[WMD=-1.07,95%CI(-1.72,-0.41)];在安全性方面,甲状旁腺素组不良事件总发生率低于二磷酸盐组[WMD=0.87,95%CI(0.59,1.30)].二者背痛与非椎体骨折发生率无显著差异,但前者血钙、尿钙超出正常水平发生率显著高于后者{血钙:[WMD=13.68,95%CI(6.12,30.59)];尿钙:[WMD=2.21,95%CI(1.14,4.26)]}.结论 甲状旁腺素类药物比二磷酸盐类药物更能提高绝经妇女骨质疏松症病人腰椎、股骨颈BMD,改善骨质量的疗效肯定,且安全性较高.但在临床使用中,要定时监测患者血钙、尿钙水平,进一步提高用药安全性.     

绝经后骨质疏松症体质因素的病例对照研究

目的 进行绝经后骨质疏松症相关体质因素研究.方法 对224例绝经后骨质疏松症患者和238例非绝经后骨质疏松症者进行病例对照研究,体质判定标准采用<中医体质分类判定标准>.结果 多元Logistic回归分析显示:在P<0.05水平,最终进入回归方程的相关体质因素有4个:平和质、阳虚质、阴虚质、血瘀质,其中阳虚质、阴虚质,血瘀质为绝经后骨质疏松症发生的危险因素,且血瘀质在绝经后骨质疏松症的发病中相对重要;平和质为其保护因素.结论 从体质角度探索绝经后骨质疏松症的发病机制是对其病因病机研究的补充.     

2型糖尿病患者血清戊糖素与骨转换指标之间的相关性分析

目的 探讨在2型糖尿病患者中血清戊糖素水平与骨转换指标之间的相关性以了解戊糖素对骨代谢的影响。方法 190例绝经后女性及＞60岁男性2型糖尿病患者于空腹状态下抽取空腹静脉血液查肝肾功能、糖化血红蛋白(HbA1C)、I型胶原羧基端肽β特殊序列（β-CTX）、I型前胶原氨基端前肽(PINP)、骨钙素（OC）及戊糖素水平,分析戊糖素与肝肾功能及骨转换指标之间的相关性。结果 相关分析结果提示戊糖素与糖尿病病程、HbA1c、β-CTX水平相关（r=0.492、0.158和-0.156,P均＜0.05）,而与P?NP及OC之间的相关性无统计学意义（P =0.646和0.72）。多元线性回归分析结果提示戊糖素水平与糖尿病病程、HbA1C相关（P均＜0.05）,而与β-CTX的相关性无统计学意义（P =0.199）。结论 2型糖尿病患者血戊糖素水平与骨转换指标P?NP、β-CTX及OC水平之间无明显的相关性。     

阿仑膦酸钠肠溶片对绝经后骨质疏松症 的疗效观察

目的观察阿仑膦酸钠(石家庄欧意药业有限公司生产的"固邦")治疗绝经后骨质疏松症的临床疗效。方法选取80例绝经后骨质疏松症患者应用阿仑膦酸钠肠溶片治疗12个月,于治疗前后测定肝肾功能、ALP、骨钙素、尿NTX及腰椎、股骨颈、Wards三角区骨密度。结果应用阿仑膦酸钠肠溶片治疗12个月后患者骨密度较前升高(P<0.01),尿NTX(T值4.499)及ALP(碱性磷酸酶)(T值9.833)较治疗前降低(P<0.05)。结论阿仑膦酸钠肠溶片对绝经后骨质疏松症患者的治疗是有效的,不良反应少,且依从性好。     

血清Asprosin水平与绝经后女性骨密度、平衡能力和骨折发生率的相关性

目的 探讨血清Asprosin(白脂素)水平与绝经后女性骨密度(bone mineral density,BMD)、平衡能力和骨折发生率的相关性.方法 回顾性分析海南医学院第一附属医院收治的164例绝经后女性骨质疏松症(osteoporosis,OP)患者的临床资料.记录患者一般临床资料以及骨折发生率、髋部骨密度、平衡...     

绝经后骨质疏松症差异表达lncRNAs及其靶基因抑瘤素M在外周血的表达研究

目的 探讨绝经后骨质疏松症差异表达lncRNAs及其靶基因抑瘤素M(oncostatin M,OSM)在绝经后骨质疏松症外周血的表达及其意义.方法 在前期lncRNA-mRNA芯片检测绝经后骨质疏松症差异lncRNAs并进行共表达分析的基础上,利用blat软件分析lncRNA TTC28-AS1、linc-IRF2BP...     

骨松Ⅰ号治疗绝经后骨质疏松症初步临床观察

通过对３５例绝经后骨质疏松症妇女运用骨松Ⅰ号治疗后血Ｔ、Ｅ２及尿Ｃａ／Ｃｒ的观测，发现治疗６～９月及治疗１～２年后，血Ｅ２显著升高，治疗１～２年后血Ｔ与尿Ｃａ／Ｃｒ显著下降。血Ｅ２与尿Ｃａ／Ｃｒ及血Ｔ与血Ｅ２治疗前后变化值呈显著相关。说明骨松１号具有提高绝经后妇女血Ｅ２水平，抑制尿Ｃａ移除的作用，能防治绝经后骨质疏松症。其升高血Ｅ２水平的作用，可能与促进Ｔ向Ｅ２的转化有关。     

低强度脉冲电磁场对绝经后骨质疏松症患者U-DPD与BMD的影响

目的 观察低强度脉冲电磁场(PEMFs)对绝经后骨质疏松症患者尿脱氧吡啶啉(U-DPD)及骨密度(BMD)的影响.方法 将80例绝经后骨质疏松症患者随机分为对照组和治疗组各40例,对照组采用钙剂、阿法骨化醇胶囊口服药物治疗6个月,治疗组则在对照组口服药物基础上加用PEMFs治疗,磁场强度2×10-3T,频率20Hz,每天40min/次,连续治疗8周后停用PEMFs,继续口服药物直至满6个月,并在治疗前和治疗3个月、6个月时分别测定对照组和治疗组患者U-DPD与BMD.结果在治疗3个月及6个月时,治疗组U-DPD含量均明显低于治疗前及对照组;在治疗6个月时,治疗组BMD相比治疗前及对照组明显改善,有统计学意义.结论 低强度PEMFs疗法能明显抑制绝经后骨质疏松症患者骨吸收程度,提高骨密度,达到骨重建目的,本疗法联合钙剂及促进钙吸收药物效果更佳.     

骨松I号治疗绝经后骨质疏松症初步临床观察

通过对３５例绝经后骨质疏松症妇女运用骨松１号治疗后血Ｔ、Ｅ２及尿Ｃａ／Ｃｒ的观测，发现治疗６￣９月豚治疗１￣２年后，血Ｅ２显著升高，治疗１￣２年后血Ｔ与尿Ｃａ／Ｃｒ显著下降。血Ｅ２与尿Ｃａ／Ｃｒ及血Ｔ与血Ｅ２治疗前后变化值呈相关。说明骨松１号具有提高绝经后妇女血Ｅ２水平，抑制尿Ｃａ移除的作用，能防治绝经后骨质疏松症，其升高血Ｅ２水平的作用，可能与促进Ｔ向Ｅ２的转化有关。     

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.