Antibiotic-impregnated autogenic cancellous bone grafting is an effective and safe method for the management of small infected tibial defects: a comparison study

OBJECTIVE: Bone grafting plays an important role in reconstructing infected tibial nonunions. The effects of antibiotic-impregnated bone grafting in infection elimination and bone incorporation was reported in this retrospective study. METHODS: Ninety-six patients treated for infected tibial nonunions were evaluated. These patients were managed with local antibiotic bead therapy and staged antibiotic-impregnated autogenous cancellous bone graft or pure autogenous cancellous bone graft. Patients were randomized to antibiotic-impregnated bone grafting or bone grafting-only groups on the basis of whether the admission date was odd or even. Patients were divided into two groups (antibiotic-impregnated bone grafting group and pure cancellous bone grafting group), according to the procedure used in preparing the bone grafts. The antibiotic-impregnated bone grafting group included 37 men and 9 women whose average age was 36 years (range, 17 to 72 years). The average follow-up period was 4.8 years. By using the Cierny-Mader staging classification of chronic osteomyelitis, 32 of 46 patients (70%) were stage 4A, and 14 of 36 patients (30%) were stage 4B. The pure cancellous bone grafting group included 39 men and 11 women whose average age was 37 years (range, 18 to 72 years). The average follow-up period was 4.5 years (range, 4 to 6 years). Thirty-nine of 50 patients (78%) were stage 4A, and 11 of 50 patients (22%) were stage 4B. The bone defects in both groups ranged from 2 to 4 cm. RESULTS: Wound healing and bony union were achieved in the antibiotic-impregnated bone grafting group. Only two patients had recurrent infections. The infection arrest rate was 95.6%. However, 9 of 50 patients in the pure cancellous bone grafting group had recurrent infections. The infection arrest rate was 82%. The antibiotic-impregnated bone grafting group had significantly superior results (95.6% vs. 82% chi2 test, p < 0.05) in infection elimination than the pure cancellous bone grafting group. CONCLUSION: After 4 to 6 years of follow-up, our results suggest that the use of impregnating antibiotics have no adverse effects on autogenic cancellous bone graft incorporation and could help to eliminate infection effectively.     

Surgical treatment of proximal ulna nonunion

We reviewed our experience in the surgical treatment of 12 cases of proximal ulna nonunion. The primary injuries were 2 fracture-dislocations of the olecranon, 6 Monteggia lesions and 3 isolated fractures of the proximal ulna. According to the type of primary injury and its anatomical site, the nonunions were classified into 2 groups, considering that the nonunions nearest to the humerus-ulna joint present a more disabling clinical profile and are more difficult to treat: group A (6 patients — nonunion within 5 cm from the olecranon tip of the olecranon) and group B (6 patients — nonunion between 5 and 10 cm from the olecranon tip of the olecranon). In all cases, after fibrous callus debridement and bone surface remodelling, fixation was performed with plate and screws and homoplastic cortical bone graft (orthogonal or parallel to the plate) and an intercalary bone cylinder when the bone defect was severe. In 3 patients (group A), where the defect was smaller than 1 cm, fixation of the ulna was combined with a resection of the radial neck. Clinical-radiographic healing was achieved in all patients followed for a mean of 27 months. Complications included a case of nonunion due to failure of the intercalary graft with plate breakage. The patient healed after a new surgery performed with same technique. The score, according to the Broberg-Morrey scoring system, was 78 in group A patients and 93 in group B patients. The use of homoplastic cortical bone graft represents an effective technique to improve the mechanical properties of the fixation and supports biological union, even when the bone defect is severe.     

PKP治疗不同骨密度椎体压缩骨折的手术疗效分析

目的:观察经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗不同骨密度椎体压缩骨折的临床疗效。方法:回顾性分析2008年3月～2009年11月在我院行PKP治疗的76例单节段中老年椎体压缩骨折患者的临床资料,其中男32例,女44例,年龄50～81岁。应用双能X线吸收法(DEXA)测定腰椎(L2～L4)骨密度值,根据骨密度T值大小将其分为骨质疏松组(A组,33例)、骨量减少组(B组,26例)和骨质正常组(C组,17例),每组均采用标准的PKP手术治疗,术后对患者进行VAS评分、Oswesty功能障碍指数(ODI)评定,并观察各组患者伤椎椎体高度恢复和并发症发生情况。结果:患者疼痛均得到迅速缓解,未发生脊髓神经损伤及球囊破裂。术后随访1.5～2.7年,平均2.1年。三组术后3d及末次随访时VAS、ODI评分均较术前明显降低(P<0.05),组间比较差异无显著性(P>0.05)。伤椎椎体平均高度A组术前为15.7±3.2mm,术后为23.1±5.7mm;B组术前为16.3±3.9mm,术后为22.5±4.8mm;C组术前为15.9±3.0mm,术后为21.8±5.2mm,差异均有统计学意义(P<0.05)。局部后凸角A组术前为24.7°±7.1°,术后为17.8°±5.9°;B组术前为23.5°±6.2°,术后为18.2°±6.5°;C组术前为24.1°±5.6°,术后为18.0°±5.8°,与术前比较均有显著性差异(P<0.05)。A组椎体高度恢复率为65.3%,B组为57.9%,C组为54.2%,组间比较差异具有显著性(P<0.05)。A组1例患者发生骨水泥肺栓塞,经及时抗凝治疗后症状缓解。A组骨水泥渗漏率为6.06%,B组为11.54%,C组为17.65%,组间比较差异无统计学意义(P>0.05)。随访中有2例患者发生邻近椎体骨折,均发生于骨密度最低的A组。结论:PKP对不同骨密度的椎体压缩骨折患者均有良好的疼痛缓解作用,骨密度较低者椎体高度及后凸角度恢复更理想,但合并有骨质疏松症者需注意邻近椎体骨折的发生。     

总前列腺特异抗原、游离前列腺特异抗原、碱性磷酸酶和Gleason评分联合检测对前列腺癌骨转移的预测价值

探讨总前列腺特异抗原（tPSA）、游离前列腺特异抗原（fPSA）、碱性磷酸酶（ALP）和Gleason评分与前列腺癌骨转移的关系,评价联合检测对前列腺癌骨转移的预测价值。 方法 回顾性分析2015年1月1日至2018年11月1日在本院临床诊断为良性前列腺增生或前列腺癌的患者（tPSA>10 ng/mL）以及健康体检人群的临床资料,其中前列腺癌患者又经核素骨显像分为骨转移组和非骨转移组;共收集304例完整病例进行分析,其中前列腺癌骨转移组48例(15.8%）,前列腺癌未发生骨转移组116例（38.2%）,良性前列腺增生组56例（18.4%）,健康对照组84例（27.6%）。检测分析所有患者的tPSA 、fPSA、ALP值及Gleason评分。结果 任意两组之间的tPSA、fPSA比较,差异均有统计学意义（P<0.05）;前列腺癌骨转移组的ALP均高于其他三组,差异均有统计学意义（P<0.05）;前列腺癌骨转移组的Gleason评分高于非骨转移组,差异有统计学意义（P<0.05）,对不同分化程度的前列腺癌患者骨转移率进行比较,发现低风险组的骨转移率明显低于中高风险组（P<0.05）。单指标tPSA、fPSA和ALP预测前列腺癌骨转移时,绘制ROC曲线下面积分别为0.664、0.700和0.783,其cut off值分别为57.47 ng/mL、8.44 ng/mL、85.47 U/L;三项指标联合检测时发现tPSA+fPSA+ALP的特异度和阳性预测值分别达86.20%和64.40%,高于单指标和两项指标联合检测。结论 对于怀疑有骨转移的前列腺癌患者,不宜单独用血清前列腺特异性抗原（PSA）浓度来判断骨转移,应联合tPSA、fPSA、ALP三者及Gleason评分对前列腺癌患者发生骨转移风险的预测。     

T细胞多克隆抗体在公民逝世后器官捐献供肾移植中有效性及安全性的研究

目的 观察T细胞多克隆抗体在公民逝世后器官捐献(deceased donation,DD)供肾移植患者中的有效性和安全性.方法 回顾性分析昆明市第一人民医院甘美医院自2015年8月20日至2020年2月28日符合研究标准的共324例肾移植受者资料,将其分为使用兔抗人胸腺细胞免疫球蛋白(rabbit anti human...     

美学区单颗牙即刻种植即刻修复和延期种植修复的效果比较

目的 比较美学区单颗牙即刻种植即刻修复和延期修复的效果。方法 选取2015年10月-2021年 12月于我院行单牙修复治疗的132例患者为研究对象,根据修复时间方案不同分为对照组和研究组,各 66例。对照组给予延期种植修复,研究组给予即刻种植即刻修复,比较两组唇侧骨厚度、牙槽嵴骨吸收高 度及满意度评分。结果 研究组术后1年唇侧骨厚度高于对照组,牙槽骨吸收高度低于对照组（P＜0.05）; 研究组色泽、咀嚼功能、附着高度、整体美观评分均高于对照组（P＜0.05）。结论 美学区单颗牙即刻种 植即刻修复在提高软组织稳定性、促进咀嚼功能恢复及提高种植牙美观度等方面优于延期种植修复,有利 于减少唇侧骨厚度丢失,降低牙槽骨吸收。     

乌鲁木齐地区维族、汉族绝经后糖尿病患者骨代谢结果分析

目的探讨新疆维族、汉族绝经后2型糖尿病(T2DM)骨密度变化及骨代谢的差异,为临床骨质疏松症的诊治工作提供进一步依据。方法选取2008年1月-2013年12月于新疆生产建设兵团医院内分泌科住院的维吾尔族、汉族女性且已绝经2型糖尿病患者共405人,按族别分为两组,记录并分析患者血清钙、磷、碱性磷酸酶、骨钙素、25羟维生素D3变化,并进行骨密度测定。结果维吾尔族组血清钙略低于汉族组,但无统计学差异,血清磷水平差异亦不显著;维吾尔族组血清碱性磷酸酶、25羟维生素D3水平均低于汉族组,P0.05,维吾尔族组血清骨钙素高于汉族组,P0.05;按绝经年限不同统计:维吾尔族女性骨量减低比例较高,发生骨质疏松的比例维吾尔族组亦高于汉族组,骨密度正常组汉族比例明显高于维吾尔族。两组股骨颈、股骨大转子、腰椎骨密度值比较,维吾尔族组骨密度值均低于汉族组,在维吾尔族股骨颈及腰椎骨密度下降更明显,但无统计学差异。结论维吾尔族绝经后糖尿病患者骨代谢水平较汉族下降明显。     

人工骨联合自体骨髓移植技术的骨缺损修复研究与应用

目的分析人工骨联合自体骨髓移植技术治疗骨缺损的临床疗效。方法选取2011年4月至2013年9月,来本院诊治的四肢粉碎性骨折术后骨缺损患者40例,随机分为两组（A、B组）,分别行自体髂骨植骨和人工骨联合自体骨髓移植治疗四肢粉碎性骨折所致骨缺损。术后观察两组骨折愈合时间,骨折愈合率,并发症的发生及骨缺损的修复和功能重建优良率。结果两组均行6～12个月随访,平均（9.14±1.36）月,所有患者植骨术后均无切口感染、发热等并发症。A组15例骨缺损区愈合良好,住院时间平均（19.36±2.54）天,骨折愈合时间平均（5.67±1.52）个月,骨缺损的修复和功能重建评价标准,优12例,良3例,可3例,差2例,优良率75%;B组18例骨缺损区愈合良好,住院时间平均（12.19±1.52）天,骨折愈合时间平均（3.61±1.13）个月,骨缺损的修复和功能重建评价标准,优16例,良2例,可2例,差0例,优良率90%。B组骨缺损治疗效果显著优于A组。结论人工骨联合自体骨髓移植较单纯自体髂骨移植治疗骨缺损更能促进骨痂生长,加速骨折后骨缺损愈合,更加有效地减少住院时间及骨折愈合时间,骨折愈合率更高,骨缺损修复和功能重建效果更加显著。     

经牙槽嵴顶提升术在上颌后牙种植修复中的应用效果

目的 探讨经牙槽嵴顶提升术在上颌后牙种植修复中的应用效果。方法 选取我院2019年1月-2021年 1月收治的100例上颌后牙种植修复患者为研究对象,按照随机数字表法分为对照组和观察组,各50例。对 照组采用侧壁开窗上颌窦底提升术联合同期种植,观察组采用经牙槽嵴顶提升术联合同期种植,比较两组手 术指标、近远期疗效及疼痛程度。结果 两组上颌窦提升高度、种植体直径和种植体长度比较,差异无统计 学意义（P＞0.05）;观察组手术时间短于对照组,差异有统计学意义（P＜0.05）;两组术后12、24个月周围 骨吸收比较,差异无统计学意义（P＞0.05）;观察组术后12、24个月种植体稳定性系数、剩余牙槽骨高度 和平均获得骨高度均高于对照组,差异有统计学意义（P＜0.05）;观察组术后12、24 h VAS评分均低于对 照组,差异有统计学意义（P ＜0.05）。结论 采用经牙槽嵴顶提升术进行上颌后牙种植修复可有效缩短手 术时间,降低术后疼痛程度,改善植体稳定性系数、剩余牙槽骨高度和平均获得骨高度。     

Does salvage and tranexamic acid reduce the need for blood transfusion in revision hip surgery?

We carried out a retrospective case-control study in 80 patients who underwent a revision total hip replacement. Group A (40 patients) received tranexamic acid and intra-operative cell salvage. Group B (40 patients) was a matched control group and did not receive this management. Each group was divided into four subgroups: revision of both components, revision of both components with bone grafting, revision of the acetabular component with or without bone graft, and revision of the femoral component with or without bone graft. In group A the total number of units transfused was 52, compared with 139 in group B, representing a reduction in blood usage of 62.5%. The mean amount of blood transfused from cell salvage in each group was 858 ml (113 to 2100), 477 ml (0 to 2680), 228 ml (75 to 315) and 464 ml (120 to 1125), respectively. There was a significant difference in the amount of blood returned between the groups (p < 0.0001). In group A, 22 patients needed transfusion and in group B, 37 (p < 0.0001). A cost analysis calculation showed a total revenue saving of pounds sterling 70 000 and a potential saving throughout our facility of pounds sterling 318 288 per year. Our results show that a significant reduction in blood transfusion can be made using combined cell salvage and tranexamic acid in revision surgery of the hip.     

骨质疏松治疗培训对脆性髋部骨折患者骨质疏松诊疗率的影响

目的观察骨质疏松的治疗培训对髋部骨折患者骨质疏松诊疗率的影响。方法回顾性分析福建医科大学附属第二医院2013年1月至2015年12月收治的651例老年脆性髋部骨折住院患者,根据是否对治疗的医师进行骨质疏松治疗培训,将651例患者分为培训组和未培训组,比较两组医师对脆性髋部骨折患者骨质疏松诊疗的情况。结果培训组220例,其中接受骨密度检查者109例(49. 5%),接受骨转换标志物检测者130例(59%),骨质疏松治疗率为80. 5%;未培训组431例,其中接受骨密度检查者142例(32. 9%),接受骨转换标志物检测者124例(28. 8%),骨质疏松治疗率为72. 6%(χ~2=16. 940、56. 277、4. 800,P均0. 05)。结论通过对骨科医师进行骨质疏松相关知识的培训,有助于改善骨质疏松患者骨转换标志物及骨密度的检测率,提高骨质疏松的治疗率。     

Bisphosphonates in the Treatment of Thalassemia-Induced Osteoporosis

The aim of our randomized, placebo-controlled study was to investigate the effects of 2 years’ daily oral administration of alendronate or intramuscular administration of clodronate every 10 days, on bone remodeling parameters and bone mineral density (BMD), safety and tolerability in a group of osteoporotic thalassemic patients. Twenty-five young patients (mean age 26.6 ± 7.1 years) with beta-thalassemia major were randomly divided to receive placebo or 100 mg of clodronate intramuscularly every 10 days or 10 mg of alendronate per os daily. All patients took 500 mg of elemental calcium and 400 IU cholecalciferol in the evening at meal time. After 2 years, pyridinium crosslinks, which are bone resorption markers, did not differ significantly from baseline values in the placebo group, whereas they had decreased significantly in the clodronate and alendronate groups. Osteocalcin, a bone formation marker, did not change significantly in the placebo group, whereas it decreased slightly, but not significantly, in the clodronate and alendronate groups after 12 and 24 months. At the end of the study, the lumbar spine BMD had decreased significantly in the placebo group; it did not change significantly in the clodronate group; in the alendronate group it had increased but not significantly, whereas the increase was significant with respect to the placebo group. Femoral neck BMD decreased significantly in the placebo group; it did not change significantly in the clodronate group, but increased significantly in the alendronate group. No relevant side effects were recorded during our study. In conclusion, in patients with thalassemia-induced osteoporosis, the daily administration of alendronate significantly increases BMD, the most important predictor of the risk of fracture at several sites. Clodronate treatment at our dosage is ineffective in this pathology in spite of the good compliance of patients. Received: 13 August 2001 / Accepted: 19 February 2002     

自体椎板关节突柱状植骨融合治疗腰椎退行性疾病的疗效分析

[目的]通过与同种异体+自体骨融合比较,探讨术中整块切除椎板关节突裁制柱状植骨融合治疗退行性腰椎退行性疾病的临床疗效.[方法]对本院2008年10月～2011年11月采用术中整块切除椎板关节突裁制柱状植骨块与同种异体+自体骨融合治疗的62例腰椎退变患者进行回顾性分析,其中A组(椎弓根螺钉固定与自体柱状骨融合,自体柱状骨组)28例,B组(椎弓根螺钉固定与同种异体+自体骨融合,同种异体+自体骨组)34例,比较两种治疗方法在手术时间、术中出血量、手术切口大小、住院天数、手术费用、住院总费用等的差异.通过JOA评分、术后1年融合率等指标来评价两种治疗方法的疗效.[结果]术后随访20～35个月,平均26.3个月.A组与B组手术材料费和住院总费用比较有差异(P＜0.05),A组比B组少;两组患者在手术时间、术中出血量、手术切口、住院天数、术后1年融合率无明显差异(P＞0.05).两组患者术后各时间点JOA评分较术前比较有差异(P＜0.05),组间比较无明显差异(P＞0.05).A组未见明显并发症,B组术后有2例伤口周围红肿、白细胞升高及1例脑脊液漏.[结论]通过与同种异体骨+自体骨融合比较,术中整块切除椎板关节突裁制柱状椎体间植骨块作为植骨材料,植骨融合界面大,椎间融合率高,临床疗效好,是一种安全、方便、经济和实用的临床技术.     

碳酸钙D3、骨化三醇联合唑来膦酸对2型糖尿病合并原发性骨质疏松症患者骨密度和骨痛的影响

目的分析探讨碳酸钙D3、骨化三醇联合唑来膦酸对2型糖尿病(type 2 diabetes mellitus,T2DM)合并原发性骨质疏松症老年患者骨密度和骨痛的影响。方法选取我院2014年5月至2015年5月期间收治的T2DM合并原发性骨质疏松症老年患者220例,将所有患者按照随机数字表法随机分为对照组和试验组,所有患者均给予骨化三醇和碳酸钙D3进行治疗,其中试验组患者使用碳酸钙D3、骨化三醇联合唑来膦酸进行治疗。所有患者均持续治疗3年,3年后观察两组患者的骨密度(bone mineral density,BMD)及骨痛视觉模拟评分(visual analogue scale,VAS)评分情况,比较两组患者的不良反应发生情况。结果两组患者治疗前的骨密度情况并无明显差异(P均0. 05);治疗三年后,两组患者的骨密度均比治疗前有所增加(P0. 05),试验组患者的骨密度显著优于同期对照组患者(P均0. 05)。两组患者治疗前的VAS评分并无明显差异(P 0. 05);经过三年的治疗后,两组患者的VAS评分均显著低于本组治疗前(P0. 05),试验组患者的VAS评分显著低于同期对照组患者(P0. 05)。试验组患者在治疗期间没有新发骨折出现,而对照组患者则有1例出现左侧股骨颈骨折;试验组患者在静注唑来膦酸注射液后有5例出现轻微的头疼、乏力、发热、感冒等症状,在服用塞来昔布洛索洛芬后症状缓解。结论对T2DM合并原发性骨质疏松症老年患者采取碳酸钙D3、骨化三醇联合唑来膦酸进行治疗能够有效增加患者的骨密度,改善其骨痛VAS评分,效果显著,值得在临床上加以推广运用。     

Osteopenia/osteoporosis in patients with calcium nephrolithiasis

The objective of this study is to analyze the alterations in bone mineral density and bone and calcium–phosphorus metabolism in patients with calcium nephrolithiasis. We designed a study with 182 patients who were distributed among three groups: group O, 56 patients without nephrolithiasis; group A, 67 patients with calcium nephrolithiasis and mild lithogenic activity; and group B, 59 patients with calcium nephrolithiasis and severe lithogenic activity. Metabolic parameters of blood and urine that were related to calcium–phosphorous and bone metabolism and bone densitometry were assessed in all patients. A comparative study was performed on the variables of bone and calcium–phosphorus metabolism and bone densitometry as well as the presence or absence of osteopenia/osteoporosis. The patients in group B had a greater loss of bone mineral density, measured by the T-score, than the patients in groups O and A. Moreover, the proportion of patients in group B with osteopenia/osteoporosis was statistically significantly higher than the proportion of patients in groups O and A. We observed higher values of calciuria, fasting calcium/creatinine ratio, and 24-h calcium/creatinine among the patients in group B compared to the other two groups. Calciuria, citraturia, and fasting calcium/creatinine were independent factors that showed a relationship with severe lithogenic activity compared to the control group, and β-crosslaps is an independent factor that has a relationship with severe lithogenic activity as compared to mild lithogenic activity. Patients with calcium lithiasis and severe lithogenic activity have a greater loss in bone mineral density and therefore a greater risk of osteopenia/osteoporosis.     

Nobel clinician软件引导上颌窦内提升术在磨牙缺失修复中的应用研究

目的:研究Nobelclinician软件引导上颌窦内提升术在磨牙缺失的应用效果,为临床应用提供指导。方法:选择2016年10月-2018年10月在笔者医院进行手术的86例上颌磨牙缺失患者为研究对象,按照随机数表法分为观察组和对照组,每组43例。对照组:采用常规上颔窦内提升术;观察组:在Nobelclinician软件引导下进行上颌窦内提升术,两组均使用nobelreplace种植体种植。比较两组患者的种植体存留率及种植体周围组织情况[包括术前上颌窦底距牙槽嵴骨高度(Bone height of the maxillary sinus floor from the alveolar ridge,RBH)、术后6个月新骨获得量、术后1年垂直骨丧失、牙周探诊深度(Periodontal probing depth,PPD)];比较两组患者治疗后的X片检查结果及治疗满意度。结果:观察组的RBH、PPD及术后1年垂直骨丧失均显著小于对照组,术后6个月新骨获得量显著大于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后随访6个月,观察组的种植体存留率(100.00%)与对照组(94.55%)相比,差异不具有统计学意义(P>0.05),X片检查结果显示,两组患者的种植体及周围骨组织均结合良好,术后1年均已生成新的上颌窦底壁。观察组患者的满意度(100.00%)显著高于对照组(90.70%),差异具有统计学意义(P<0.05)。结论:Nobelclinician软件引导上颌窦内提升术能够降低垂直骨丧失量,增加新骨获得量,有助于提高磨牙缺失修复的美学效果,提高患者满意度。     

不同穿刺入路经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的疗效对比

目的对比分析双侧分层交叉穿刺与常规单/双侧穿刺入路行经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)术后骨水泥分布情况及临床疗效。方法回顾性分析2015年6月—2018年12月采用PVP治疗的127例OVCF患者影像学及临床资料,根据穿刺入路分为双侧分层交叉组(A组,n=37)、常规单侧组(B组,n=48)及常规双侧组(C组,n=42)。记录3组患者手术时间、骨水泥注入量及相关并发症发生情况。术前、术后1 d、术后3 d、末次随访时采用疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)评估疼痛程度及术后功能恢复情况。术后复查CT三维重建,比较3组椎体内骨水泥分布情况。结果所有手术顺利完成,患者随访3 ～ 15个月。A组于冠状位中线两侧骨水泥连接上下终板率较B、C组显著升高;C组骨水泥注入量较A、B组明显增多;B组手术时间较A、C组明显减少;A组术后3 d、末次随访时VAS评分及ODI较B、C组降低;以上组间差异均有统计学意义(P 0.05)。所有患者均未发生穿刺针道口感染、骨水泥渗漏入椎管、骨水泥拖尾、肺栓塞等并发症。结论与单/双侧穿刺入路PVP相比,双侧分层交叉穿刺PVP术后骨水泥于伤椎冠状位中线两侧连接上下终板率更高,术后疼痛程度、功能状况均改善明显,是治疗OVCF的有效手段,值得临床推广。     

Preoperative bone quality as a factor in dual-energy X-ray absorptiometry analysis comparing bone remodelling between two implant types

Recently it was shown that the design changes from the ABG-I to ABG-II hip stem resulted in a better, although not significant, proximal bone preservation. Our hypothesis was that by matching patients for preoperative bone quality, statistical power would increase and that the trend of better proximal bone preservation in ABG-II might become significant. Twenty-four ABG-II patients were compared to two different ABG-I groups: (1) 25 patients from our earlier prospective study and (2) a group of 24 patients selected to perfectly match the ABG-II group regarding gender, age and preoperative bone quality. Postoperative changes in periprosthetic bone mineral density (BMD) were quantified at 2 years postoperatively using DEXA scanning. Bone preservation (less BMD loss) was better for the ABG-II than the ABG-I (all two groups) in the proximal zones 1 and 7. In Gruen zone 7, a statistically significant difference was found for group B (p = 0.03). By matching patients for preoperative bone quality and gender, a statistical significant difference was found in proximal bone preservation in favour of ABG-II. In future comparative bone remodelling studies using DEXA, patients should be matched for preoperative bone quality and gender.     

CT精确定位穿刺与常规穿刺经皮椎体成形术治疗Kummell’s病的对照研究

目的通过和常规穿刺的对照研究,探讨CT精确测量定位单侧穿刺在治疗Kummell＇s病中应用的可靠性。安全性及其临床疗效。方法选取自2011-01-2013—01诊治的64例Kummell＇s病患者,随机分为2组,A组为CT精确定位组,B组为常规穿刺组,2组均行经皮椎体后凸成形术。结果64例获得随访6～24个月,平均11．9个月。A组射线暴露次数、手术时间明显低于B组,差异有统计学意义（P〈0．01）,A组骨水泥分布状态要优于B组,差异有统计学意义（P〈0．05）,骨水泥渗漏率2组差异无统计学意义（P〉0．05）。末次随访时,2组VAS评分、ODI评分均较术前明显改善,差异均有统计学意义（P〈0．05）,组间比较差异无统计学意义（P〉0．05）。结论对于Kummell＇s病患者,CT精确定位穿刺法骨水泥分布状态要优于常规穿刺组,该技术操作简单,明显减少了患者和术者的射线暴露次数,安全性更高。     

唑来磷酸钠联合骨化三醇治疗原发性骨质疏松症的疗效观察

目的探讨唑来磷酸钠联合骨化三醇治疗骨质疏松症的临床效果。 方法前瞻性收集2012年10月至2017年10月天津市泰达医院收治的203例骨质疏松症患者,采用随机数字表法将其分为唑来磷酸钠组（A组）和唑来磷酸钠联合骨化三醇（B组）,A组102例,B组101例,比较两组患者治疗前后的骨密度变化、骨代谢情况、不良反应等情况。 结果203例患者均获得完整随访,随访率100%,随访时间3~5年,平均（3.9±0.5）年。治疗前两组患者的髋部骨密度[A组（0.557±0.052）g/cm³,B组（0.554±0.056）g/cm³]、腰椎骨密度[A组（0.669±0.047）g/cm³,B组（0.670±0.047）g/cm³]无明显差异,治疗后腰椎骨密度水平[A组（0.863±0.023）g/cm³,B组（0.870±0.021）g/cm³]均有显著改善,与治疗前相比,差异均有统计学意义（t=38.661,t=38.152,P<0.05）,髋部骨密度水平均有改善[A组（0.720±0.023）g/cm³,B组（0.750±0.044）g/cm³],与治疗前相比,差异均有统计学意义（t=28.653,t=32.533,P<0.05）,治疗后组间差异有统计学意义（t=2.001,t=5.921,P<0.05）;两组患者治疗前血钙指标[A组（2.200±0.059）mmol/L,B组（2.201±0.054）mmol/L]无明显差异,治疗后[A组（2.211±0.060）mmol/L,B组（2.323±0.044）mmol/L]B组血钙变化明显,与A组比较差异有统计学意义（P<0.05）。B组（15.8%）的不良反应发生率低于A组（33.3%）,两组患者均无严重药物不良反应发生。 结论唑来磷酸钠联合骨化三醇可提高骨质疏松患者骨密度,改善骨代谢状态,并且降低药物不良反应的发生率。