CT骨矿密度测定的方法研究

目的 作者对临床上常用的CT检查部位,腹部和盆腔作了临床应用性实验,以期能获得测量骨矿密度的简便方法。方法 26例患者(男13例,女13例),分别作了CT平扫和增强腹部检查,随后作无专用体模的QCT定量骨密度测定,QCT测量部位为L1-L3椎体。结果 平扫CT和QCT的平均骨矿密度分别是96.54和87.70(平均差为8.85,p=0.0005;95％自信区间4.32～13.38)。平扫和增强CT扫描之间QCT测量平均差无统计学意义(P=0.17)。结论 根据本文作出的换算公式,可在常规CT平扫和增强扫描的方法中作QCT骨矿密度测量,无需作专门的QCT扫描测量。换算公式为D_(平均值)=C-8.45×0.995,式中“D”和“C”分别表示QCT骨矿密度测量和常规CT扫描检查。     

双能CT评估骨密度

目的 评价利用双能CT（DECT）测量容积CT值评估骨密度（BMD）的可行性。方法 对11名志愿者采用双能X线吸收法（DXA）测量腰椎（L1~L4）及股骨（股骨颈）BMD值;并对所有研究对象进行DECT检查,获得钙值图,测量容积CT值,分析容积CT值与BMD值的相关性。结果 腰椎容积CT值与BMD值呈显著正相关（r=0.82,P<0.001;相关函数为Y=0.004X-0.879,其中Y为BMD值,X为容积CT值）;股骨容积CT值与DXA所测BMD值无明显相关性（P>0.05）。结论 DECT所测腰椎容积CT值与DXA所测BMD值密切相关,可定量反映腰椎BMD变化。     

骨髓涂片细胞形态学EQA软件的开发与应用

目的开发并应用ClinetEQA网络版骨髓专业软件进行室间质量评价。方法设计开发包括:①将骨髓专业用语转换成计算机能识别的编码语言;②开发质评回报网络平台;③设计诊断意见、细胞形态频率等十六项分析统计模块,以及能设置评分条件的评分模块,便于计算机对原始结果分类统计、对照靶值逐一量化和标准化给分。结果应用显示软件具有便捷、可靠、高效,低成本的优点。结论该软件能实现多种统计分析,是EQA组织者直观地了解骨髓检验现状,完善高效管理的手段。     

骨髓涂片细胞形态学EQA软件的开发与应用

目的开发并应用Clinet EQA网络版骨髓专业软件进行室间质量评价。方法设计开发了包括:①将骨髓专业用语转换成计算机能识别的编码语言;②开发质评回报网络平台;③设计了诊断意见、细胞形态频率等十六项分析统计模块,以及能设置评分条件的评分模块,便于计算机对原始结果分类统计、对照靶值逐一量化和标准化给分。结果应用显示软件具有便捷、可靠、高效,低成本的优点。结论该软件能实现多种统计分析,是EQA组织者直观地了解骨髓检验现状,完善高效管理的手段。     

定量CT评价股骨近段骨皮质厚度及骨密度

目的 初步探讨采用定量CT(QCT)骨结构分析系统(BIT)测量股骨近段骨皮质的信度和可重复性。方法 收集30例髋部低能量骨折患者,正常侧股骨用于测量,采集髋部QCT扫描数据,于QCT分析工作站上BIT自动选定垂直于股骨颈中段长轴最狭窄处横断面,将该横断面分为4个象限,即上前象限(SA),下前象限(IA),下后象限(IP),上后象限(SP),BIT自动估算各象限骨皮质厚度(C.Th),由3名测量者分别进行测量,比较测值的差异及一致性。结果 3名测量者测得的股骨颈最狭窄处横断面平均C.Th及SA、SP、IA象限C.Th和骨密度差异均无统计学意义(P均>0.05),一致性均较好,其中平均C.Th的ICC值最高,为0.883。而3名测量者测得的IP象限C.Th和骨密度差异均有统计学意义(P均<0.05)。结论 BIT能够实现获取股骨近段骨密度结果的同时获得骨结构信息,测得的股骨颈横断面上象限及前下象限C.Th及骨密度具有很好的重复性。     

钙干预对儿童生长性骨痛骨代谢和骨密度的影响

目的 通过对确诊为生长性骨痛的儿童进行钙干预,探讨其补充钙的效果.方法 将160例患儿随机分为补钙组、对照组,不同时点记录生长痛症状缓解情况,腰椎骨密度( L1～4 BMD)、骨代谢生化指标血bALP、尿Ca、血Ca的变化.结果 生长性骨痛的儿童钙干预后,1 a内骨痛症状有效缓解,而且无复发;补钙后其骨释放减少;自身L1～4 BMD提高;血钙值无统计学差异;补钙组尿钙排出量不变,对照组尿钙排出量减少且低予实验组.结论 生长性骨痛的儿童适当补充钙,对其症状的缓解和骨骼的发育有较好的作用.     

产褥期骨密度的变化及分析

为探讨产褥期妇女骨量的变化情况，利用超声骨密度仪，对产妇足跟部进行骨密度测定，发现其超声传导速度和骨强度指数明显下降。提示应注意孕产妇的健康教育。     

Statistical model based analysis of bone mineral density of lumbar spine

Objective  For planning surgical interventions at the spine affected by osteoporosis, accurate information about the local bone quality in terms of anchorage strength for implants is very important. Based on previous work on automated bone quality assessment on the proximal femur with a completely automated model-based approach, this paper describes first applications and results on the lumbar vertebrae. Materials and methods  As basis for the analysis, CT datasets of 17 spinal specimens, with a resolution of 0.7 mm × 0.7 mm × 0.7 mm have been used. A combined statistical model of 3D shape and intensity value distribution was created for these datasets and used to predict the measured bone mineral density (BMD). Different regions of interest were tested, model parameters with high correlation with BMD were identified. Leave-one-out tests were performed to evaluate the capability for the BMD-prediction using regression models. Results  High correlation values (R = 0.94) between measured and predicted BMD were achieved and the high predictive quality of the model could be shown. Conclusion  Although the results are only valid for an insufficient small sample size of specimen data, they show a clear potential for clinical application. Therefore, work in the future will focus on clinical validation with larger sample size and the inclusion of biomechanical properties in addition to BMD.     

骨矿含量测定在老年人骨关节病康复评价中的价值

目的：探讨骨矿含量测定在老年人骨关节病康复评价中的价值。方法：使用ＳＰＡ－ＩＶ型骨矿分析仪器对１０７例６０岁以上老年人骨关节病患者进行骨矿含量测定，并对其中４１例在治疗前后的骨矿含量与其症状改变的关系进行分析。结果：４９例男性的测定值为：０．５９４士０．０９７（ｇ／ｃｍ２）；５８例女性为：０．４６９±０．０８９（ｇ／ｃｍ２）；均显著低于四川省普查结果的正常值（Ｐ≤０．０５）；其中８６例低于该正常值（即检出率为：８０．３７％）：在７２例有Ｘ线片“骨质密度改变”老中的６４例低于该正常值，即两者符合率为：８８．８９％。有４１例经过康复治疗，其中３６例的症状有缓解，其骨矿含量由治疗前男性０．５８５士０．０８１（ｇ／ｃｍ２）和女性０．４６３±０．０７９（ｇ／ｃｍ２）分别增加至治疗后的０．５９１士０．０９２（ｇ／ｃｍ２）和０．４９６土０．０９０（ｇ／ｃｍ２），结论：采用该法测定骨矿含量，简便、快速、精度高，属量化指标，无创伤，对老年人骨关节病的康复评价有一定价值；老年人骨关节病的发生发展可能与其骨矿含量有一定关系。     

Longitudinal assessment of bone quality by quantitative ultrasonography in children and adolescents

Among the techniques available to assess bone quality, quantitative ultrasonography of the proximal phalanges of the hand (QUS) has emerged as particularly attractive. In this study, amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) were obtained by the sonographic device DBM Sonic BP IGEA in two sessions at two years' interval, in a school-age population (589 subjects, 290 mol/L and 299F, aged 3 to 16 y) with the aim to determine accuracy of QUS measurements, evaluate QUS variable changes during growth, relate these values with age and growth variables.Mean AD-SoS and BTT at age classes from 5 to 12 y as determined at the first and second measurement sessions were not significantly different. A significant increment (p < 0.0001) between the first and the second measurement was observed for both QUS variables. AD-SoS and BTT showed significantly different variations in the various age groups (ANOVA). Correlations were found of AD-SoS and BTT increments with age, height, weight, pubertal stage and with height growth velocity (p < 0.05). AD-SoS and BTT increment curves presented a very similar trend decreasing from 4 to 7 y of age. Thereafter a plateau was reached up to the age of 10 to 11 y in girls and 11 to 12 y in boys, when an increase was observed corresponding to pubertal growth rate acceleration.In conclusion, the present study would confirm that QUS measurements are accurate. Ad-SoS and BTT increment models are similar to most growth velocity curves and follow a strongly age- and growth-dependent pattern.     

骨髓涂片细胞形态学室间质量评价体系的建立与应用

目的研究骨髓涂片细胞形态学室间质量评价（EQA）方法、标准，探讨其临床应用价值。方法用已确诊的骨髓涂片附临床资料及实验室有关检查结果，定期发放至参评单位进行细胞形态学室间质量评价。结果诊断完全符合率逐年提高，1988年50％，2005年提高到85．8％（P〈0．01）。其中急性髓细胞白血病首次28．3％，历年总体均值提高到56．6％，亚型符合率也从39．6％提高到70．0％（P〈0．01）。其他血液病的诊断符合率均有显著提高。结论以细胞形态学检查为主，结合临床资料，全面综合分析作出实验室诊断的骨髓涂片EQA体系，能有效提高血液病细胞形态学检查技术与诊断水平。     

骨髓涂片细胞形态学室间质量评价体系的建立与应用

目的研究骨髓涂片细胞形态学室间质量评价(EQA)方法、标准,探讨其临床应用价值。方法用已确诊的骨髓涂片附临床资料及实验室有关检查结果,定期发放至参评单位进行细胞形态学室间质量评价。结果诊断完全符合率逐年提高,1988年50%,2005年85.8%(P<0.005)。其中急性髓细胞白血病首次28.3%,历年总体均值提高到56.6%,亚型符合率也从39.6%提高到70.0%(P<0.005)。其他血液病的诊断符合率均有显著提高。结论以细胞形态学检查为主,结合临床资料,全面综合分析作出实验室诊断的骨髓涂片EQA体系,能有效提高血液病细胞形态学检查技术与诊断水平。     

A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women

OBJECTIVE: To evaluate the potential benefits of programmed Tai Chi Chun (TCC) exercise on the weight-bearing bones of early postmenopausal women. DESIGN: Age-matched and randomized prospective intervention. SETTING: University medical school. PARTICIPANTS: One hundred thirty-two healthy postmenopausal women (mean age, 54.0+/-3.5y) within 10 years of menopause onset were recruited and randomized into the TCC exercise group (n=67) or the sedentary control group (n=65). INTERVENTION: Supervised TCC exercise was performed by the TCC group for 45 minutes a day, 5 days a week, for 12 months; control subjects retained a sedentary life style.Main outcome measures Bone mineral density (BMD) was measured in the lumbar spine and proximal femur by using dual-energy x-ray absorptiometry and in the distal tibia by using multislice peripheral quantitative computed tomography (pQCT). All BMD measurements were repeated after 12 months in both groups. Fracture rate was also documented. RESULTS: Baseline measurements showed homogeneity in age, anthropometric variables, and menstruation status between the TCC and control groups. Exactly 81.6% of the subjects in the TCC group and 83.1% of subjects in the control group completed the 12-month follow-up study. BMD measurements revealed a general bone loss in both TCC and sedentary control subjects at all measured skeletal sites, but with a reportedly slower rate in the TCC group. A significant 2.6- to 3.6-fold retardation of bone loss (P<.01) was found in both trabecular and cortical compartments of the distal tibia in the TCC group as compared with the controls, as measured by pQCT. A total of 4 fracture cases were documented during follow-up, including 3 subjects in the control group and 1 in the TCC group. CONCLUSIONS: This is the first prospective and randomized study to show that a programmed TCC exercise intervention is beneficial for retarding bone loss in weight-bearing bones in early postmenopausal women. Long-term follow-up is needed to substantiate the role of TCC exercise in the prevention of osteoporosis and its related fracture.     

放射性核素骨显像骨代谢与骨密度的相关性分析

目的：探讨放射性核素骨显像骨代谢与骨密度的相关性,通过骨显像了解骨质疏松状况.方法：18例患者,男5例,女13例,年龄50～88岁,平均65岁.所有患者均通过骨密度扫描仪进行骨密度检查后,进行全身骨显像.骨显像与骨密度检查均取第L1～L4和股骨颈,并勾画感兴趣区（ROI）,然后分别测定各部位ROI放射性计数和骨密度值,计算骨显像各部位ROI值与同侧股骨中段ROI值的比值,观察各部位ROI比值与其骨密度值之间的相关性.结果：骨显像L1～L4各部位ROI比值与其骨密度值呈显著相关,而且,正常组与骨质疏松组的ROI比值与骨密度的相关性存在显著性差异.股骨颈的ROI比值与其骨密度无显著相关.骨显像L1～L4的ROI比值与其相应部位骨密度测定值之间变化趋势基本一致.结论：放射性核素SPECT骨显像腰椎ROI比值与其对应部位的骨密度值之间均呈显著相关,可通过其反映腰椎骨密度的变化.     

老年代谢综合征与骨代谢及骨密度的相关性研究

目的探讨老年代谢综合征(MS)与骨代谢及骨密度的关系。方法选择老年MS患者157例为MS组,健康体检者192例为对照组,测量腰围、空腹血糖(FBG)、血胆固醇(TC)、甘油三酯(TG)等,ELISA法检测血清骨钙素(OC)、甲状旁腺素(PTH)、骨碱性磷酸酶(B-ALP),双能X线骨密度测量仪检测骨密度。结果 MS组骨密度T值及OC、B-ALP均显著低于对照组,PTH显著高于对照组。各代谢指标正常组与异常组之间骨密度比较发现:血压、TG、腰围异常组患者骨密度显著低于正常组患者,其余代谢组分的正常组与异常组骨密度无统计学差异。结论 MS主要通过肥胖、血脂、血压代谢异常引起体内与骨代谢相关的因子如甲状旁腺素、骨碱性磷酸酶等的改变进而导致骨代谢异常、骨密度下降。     

Biomechanical assessment of a novel bone lengthening plate system — A cadaveric study

Background

Although many types of external fixators have been developed for distraction osteogenesis, all have some drawbacks. We recently developed a novel bone lengthening plate to overcome these problems. The purpose of this study is to conduct biomechanical analyses using cadavers to assess the stability of the bone lengthening plate in relation to distraction length and femoral bone mineral density.

Methods

We used human cadaveric femurs (n = 18) to assess the effects of distraction length and bone mineral density on the biomechanical stability of the bone lengthening plate. After establishing control (n = 6, 0 mm lengthening) and experimental groups (n = 12, 30 mm lengthening), we measured biomechanical stability (structural stiffness, ultimate load, and displacement) under a compressive load. The experimental group was subdivided into a group with normal bone mineral density (n = 6) and a group with osteoporosis (n = 6), and the biomechanical stability of these groups was compared.

Finding

Structural stiffness differed significantly between the control (417.6 N/mm) and combined experimental groups (185.6 N/mm, p = 0.002). Ultimate load also differed significantly between the control (1327.8 N) and combined experimental (331.4 N, p = 0.002) groups. Bone mineral density was unrelated to structural stiffness (p = 0.204), ultimate load (0.876), or displacement (0.344). In all cases, failure of the bone lengthening plate occurred at the longitudinal connectors, such as the connecting columns between the upper and lower plates, and the lengthening shaft of the bone lengthening plate.

Interpretation

The biomechanical stability of the bone lengthening plate was affected by the lengthening length but not by bone mineral density. In addition, biomechanical stability during lengthening was most strongly influenced by the longitudinal connectors.     

基于双能X线吸收测量法的三种胫骨软骨下骨骨密度测量方法的信度与效度分析

目的 观察基于双能X线吸收测量法(DXA)的三种胫骨近端软骨下骨骨密度检测方法的信度与效度。方法 招募28名健康女性,利用双能X线骨密度仪扫描膝关节;由2名研究者分别应用三种不同测量方法选取ROI进行测量分析,通过计算组内相关系数值(ICC),评价各方法的复测信度与测量者间信度,利用t检验评价区分效度。结果 三种方法均具有较好的复测信度(ICC 0.833~0.998)与测量者间信度(ICC 0.905~0.997),且对低年龄者和高年龄者具有较好的区分效度(P<0.05)。结论 利用双能X线骨密度仪研究膝关节软骨下骨具有可行性;本研究分析的三种测量方法可有选择地用于临床研究。     

退行性膝关节骨关节病患者的骨强度与骨密度的相关性研究

目的退行性膝关节骨关节病患者的骨强度与骨密度的相关性。方法组和对照组的患者均进行胫骨超声速率(SOS)和髋部骨密度(BMD)的测定。依据髋部BMD,再将研究组分为单纯退行性膝关节骨关节病组和合并骨质疏松症组。结果组和研究组的胫骨SOS和髋部BMD呈正相关,对照组的胫骨SOS和髋部BMD相关系数显著地高于研究组的相关系数,单纯组的相关系数没有显著性意义。结论退行性骨关节病患者的骨强度与骨密度呈正相关,但相关性较低,所以胫骨超声速率(SOS)测定仅能反映骨强度的情况,不能反映骨密度的情况。