Practical Use of Bone Scan in Patients with an Osteoporotic Vertebral Compression Fracture

Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis.

Graphical Abstract

相似文献   

鼻部外伤性骨折的诊断和修复（附500例分析报告）

目的 探讨鼻骨和鼻软骨骨折正确的诊断方法和最佳的诊断方法和最佳的复位方法。方法 对５００例鼻部外伤患者的鼻骨骨折Ｘ线侧位和轴位摄片（其中１６２例同时做ＣＴ水平扫描）等资料分析。其中３５０例诊断为双侧鼻骨骨折。单侧鼻骨骨折２３例,鼻软骨骨折２５例。单纯上颌骨额突骨折２１例,鼻骨,上颌骨额突复合骨折１６例。鼻骨,上颌窦、上颌骨额突和筛骨垂骨板复合骨折６例。鼻骨和鼻副窦复合４例。鼻眶骨折９例。均行手术和和手法复位。结果 ４９０例复位满意,１０例复位不佳。结论 Ｘ摄片鼻骨只能诊断双鼻骨同时骨折。而单例鼻骨骨折,上颌骨额突骨折,筛骨垂直板等复杂骨折ＣＴ扫描均能清楚显示。但鼻骨Ｘ拍片和鼻骨骨折ＣＴ扫描在诊断鼻骨骨折中二者不可缺一。鼻骨骨折和鼻软骨骨折同时要有两们耳科专科医师参与则诊断更加明确。     

胫骨平台骨折的现代治疗探讨

目的总结近年来治疗胫骨平台骨折的经验教训，为临床选择更好的治疗方法、提高胫骨平台骨折手术疗效提供参考。方法回顾分析自2001-2007年收治的胫骨平台骨折89例，其中按照Schatzker分型复杂胫骨平台骨折（Ⅴ型，Ⅵ型）67例，男性75例，女性14例。均行切开复位，严格按照内固定原则分别采用螺丝钉和／或外固定架、钢板、微创内固定系统固定骨折进行治疗，必要时辅以关节镜探查镜下手术。结果75例得到随访，最短6个月，最长6年，平均31个月。骨折均愈合，疗效评定参照Merchant标准，术后6个月优良率为81．6％，术后1年优良率为89．3％。结论胫骨平台骨折应当考虑手术治疗，周密的术前计划、妥善处理软组织损伤、正确选择切口、灵活应用内外固定物及关节镜辅助均是手术成功的重要因素。     

掌背侧联合入路锁定加压钛板内固定治疗桡骨远端粉碎性骨折

目的探讨锁定加压钛板内固定治疗桡骨远端骨折疗效。方法对2001～2006年间49例桡骨远端骨折经掌背侧联合入路锁定加压钛板内固定，钛板置于桡骨远端背侧，骨缺损严重者（20例）均置入人工骨（OsteoSet）。术后功能康复时间，6～24周，平均10.6剧。结果随访6～24个月。按Dienst功能评估标准进行评定：优40例，良7例，差2例，优良率95.9％。结论掌背侧联合入路锁定加压钛板内固定治疗移位的桡骨远端骨折疗效显著。     

锁定接骨板治疗肱骨近端骨折

目的 探讨肱骨近端锁定接骨板治疗肱骨近端骨折的疗效.方法 采用AO锁定肱骨近端接骨板(LPHP)内固定治疗肱骨近端骨折18例,术后早期功能锻炼.结果 术后患者平均随访8.5个月,骨折愈合时间平均9周(7～12周).按Constant评分标准,平均82分(45～95分),其中优10例,良5例,可2例,差1例,优良率83.3%.结论 LPHP治疗肱骨近端骨折是一种安全有效的方法,LPHP具有操作方便,固定可靠,保护血供,利于关节囊和肩袖修复,有利于骨折愈合及肩关节功能恢复等优点.     

Gamma钉治疗股骨转子间粉碎性骨折——附32例分析

使用Gamma钉治疗老年人股骨转子间粉碎性骨折32例，术后3天坐起作患肢伸屈段练，2周后扶拐逐渐负重活动，29例获得术后1-1.5年随诊，全部骨愈合，无发生伤口深部感染、褥疮和内固定弯折，髋活动良好，无不适，其中1例严重粉碎性骨折需用钢丝捆扎者，要延期离床活动，另1例远端横锁螺丝钉错位的不稳定骨折者，术后髓内棒下沉，患肢缩短1.5cm，Gamma钉手术具有损伤小，坚强内固定，允许早期活动的优点，是对老年人股骨转子间粉碎性骨折治疗的一种新进展。     

腓骨内固定修复胫骨干远端1/3骨折：可明显改善胫骨外翻畸形及踝关节功能

背景：胫腓骨干骨折是四肢骨干骨折中最常见的骨折类型,对于腓骨固定在胫骨干远端骨折的临床意义,一直存在争论,各研究报道也不尽相同。 目的：探讨腓骨内固定在胫骨干远端1/3骨折修复中的临床意义。 方法：回顾性分析2006年1月至2010年3月于海洋石油总医院骨科治疗的64例胫骨干远端1/3骨折患者的临床资料,根据是否固定腓骨分为两组,其中腓骨固定组36例,腓骨非固定组28例。比较两组患者的骨折愈合率、骨折愈合时间及胫骨外翻角,根据Merchant-Dietz标准评估对比两组的踝关节活动度及踝关节功能评分。 结果与结论：两组患者的骨折愈合率、骨折愈合时间、踝关节活动度差异无显著性意义;腓骨固定组的胫骨外翻角(5.42±1.16)°小于腓骨非固定组(7.54±1.90)°,差异有显著性意义(P=0.006);腓骨固定组踝关节功能评分(93.58±0.97)分高于腓骨非固定组(90.57±3.92)分,差异有显著性意义(P=0.000)。腓骨固定组中3例伤口浅部感染,抗炎换药后愈合良好。提示在胫骨干远端1/3骨折治疗中,腓骨内固定可明显缩小胫骨外翻角,改善踝关节功能。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

踝关节骨折的治疗与踝关节功能预后影响因素分析

目的：探讨踝关节骨折的治疗方法及影响踝关节功能的预后因素。方法：对自2005年1月至2008年12月以来采用手法复位石膏固定和切开复位手术治疗并得到随访的40例踝关节骨折者的临床资料进行回顾分析。按Lauge—Hansen分型,旋后外旋型27例,旋后内收型3例,旋前外展型2例,旋前外旋型6例,垂直压缩型（pilon骨折）2例。采用保守治疗10例,切开复位内固定治疗30例。按照美国足踝骨科协会（AOFAS）推荐的足踝评分系统评估治疗结果。对患者年龄、性别、合并伤、受伤至治疗时间、骨折类型等5个可能的相关因素进行多因素分析。结果：40例术后均获平均15个月（6～20个月）随访。按AOFAS评分平均97分。单因素Logistic回归分析发现年龄和骨折类型的差异有统计学意义,多因素Logistic逐步回归分析发现骨折类型的差异有统计学意义。结论：影响踝关节骨折后踝关节功能的主要预后因素是骨折类型,应主要根据这个因素采取个体化的治疗方法。     

Incidence and Mortality after Distal Radius Fractures in Adults Aged 50 Years and Older in Korea

The purpose of this study was to assess the incidence and mortality of distal radius fracture among patients 50 years of age and older with diagnosis code (ICD10; S52.5, S52.6) and treatment code using a nationwide claims database from 2008 to 2012. All patients were followed using patient identification code to identify deaths. Standardized mortality ratios (SMRs) of distal radius fracture were calculated based on age and gender-specific rates in the entire Korean population. The number of distal radius fractures increased by 54.2% over the 5-year study (48,145 in 2008 and 74,240 in 2012). The incidence of distal radius fracture increased from 367.4/100,000 in 2008 to 474.1/100,000 in 2012. The cumulative mortality rate over the first 12 months after distal radius fracture was decreased from 2.0% (968/48,145) in 2008 to 1.4% (1,045/74,240) in 2012. The mean year mortality over 5 years in men (2.6%, 1,279/50,128) over the first 12 months was 1.7-times higher than in women (1.5%, 3,952/257,045). The mean of SMR of distal radius fracture at 1 year post-fracture was 1.45 in men and 1.17 in women. This study using a nationwide database demonstrates that the distal radius fractures are increasing with a decreasing mortality in Korea.     

抗氧化剂结合外固定架治疗胫腓骨骨折49例

目的 探讨胫腓骨骨折合并软组织严重损伤的有效途径。方法 回顾性分析2003年5月～2005年10月收治的49例胫腓骨骨折患者的临床资料。在急诊单侧多功能为固定架固定术后即应用下列抗氧化剂治疗：①20％甘露醇250ml，30分钟内静脉滴完，6h或8h一次。七叶皂甘钠20mg加入5％GS 250ml中静脉滴注，每天一次。上述两种药物连续应用5～7天。②丹参注射液20ml加入5％GS或生理盐水250ml中静脉滴注，每天一次，连续应用2周。早期维持液体轻度负平衡及电解质平衡，预防感染，支持治疗。结果 49例患者全部随访6个月～2年均骨性愈合，无畸形。骨折愈合时间4～8个月，平均6个月，外固定架固定时间3～9个月，平均6个月。术后4例患者少量皮肤坏死，经换药痊愈。3例切口延期愈合。无钉道延重感染及螺钉松动。无缺血性肌挛缩。按照平定标准：治愈47例，好转2例，未愈0例。结论 抗氧化剂结合外固定架可以明显促进创伤软组织的修复及骨折愈合，符合中医“筋骨并重”的原则，是治疗胫腓骨骨折合并软组织损伤的有效方法。     

Mixed-mode fracture of human cortical bone

Although the mode I (tensile opening) fracture toughness has been the focus of most fracture mechanics studies of human cortical bone, bones in vivo are invariably loaded multiaxially. Consequently, an understanding of mixed-mode fracture is necessary to determine whether a mode I fracture toughness test provides the appropriate information to accurately quantify fracture risk. In this study, we examine the mixed-mode fracture of human cortical bone by characterizing the crack-initiation fracture toughness in the transverse (breaking) orientation under combined mode I (tensile opening) plus mode II (shear) loading using samples loaded in symmetric and asymmetric four-point bending. Whereas in most structural materials, the fracture toughness is increased with increasing mode-mixity (i.e., where the shear loading component gets larger), in the transverse orientation of bone the situation is quite different. Indeed, the competition between the maximum applied mechanical mixed-mode driving force and the weakest microstructural paths in bone results in a behavior that is distinctly different to most homogeneous brittle materials. Specifically, in this orientation, the fracture toughness of bone is markedly decreased with increasing mode-mixity.     

单臂多根针外固定架治疗肱骨干骨折

目的 探讨单臂多根针外固定架治疗肱骨干骨折的优点及手术方法.方法 采用单臂多根针外固定架治疗肱骨干骨折.结果 随访35例,全部获得骨性愈合,其中优31例,良4例,差0例.结论 单臂多根针外固定架治疗肱骨干骨折具有手术操作简便、创伤小,固定牢靠,愈合快的优点.     

ZHD─1型微冲击振动仪诱发骨折端微动对骨折愈合的影响

兔实验性股骨干骨折髓针内固定，术后随机分成振动组、对照组，振动组用ＺＨＤ─１型微振仪（冲击力大小４３克，频率０．５Ｈｚ）诱发骨折段微动，对照组仅作对照，结果证明，振动组骨折愈合快，肢体血流量、骨痂光密度、骨折段的扭距优于对照组。     

糖皮质激素对大鼠骨折愈合方式的影响

目的:探讨糖皮质激素对大鼠骨干骨折愈合方式的影响。方法:取3月龄雌性SD大鼠60只分为实验组和对照组,实验组肌肉注射醋酸强的松5mg·kg-1.d-1,对照组注射等容积的生理盐水。3周后制成胫骨干骨折模型,骨折后不同阶段处死,分别进行组织学、骨密度、Western印迹检测骨痂中Ⅱ型胶原蛋白的表达以及生物力学测定。结果:肌肉注射醋酸强的松3周后骨密度检查证实模型制造成功。骨折后第3d2组均开始形成原始骨痂;第2周实验组软骨骨痂明显比对照组少,第4-6周实验组骨痂面积高于对照组,且软骨骨痂比例较高,骨密度减低。实验组中Ⅱ型胶原蛋白表达明显延迟。第6周生物力学测定对照组实际最大载荷为(69.77±8.46)N,较实验组(51.38±3.37)N增加35.8%。结论:大剂量糖皮质激素在大鼠骨折早期延缓软骨骨痂的产生,在骨折中后期使软骨性骨痂至骨性骨痂演变过程减缓。Ⅱ型胶原蛋白的表达延迟可能是其对骨折愈合产生不利影响的原因之一。     

机械振动诱发骨折间微动的体外测量

在离体防腐尸体湿股骨上，利用应变加速度传感器检测机械振动在内固定条件下对截骨骨折间微动的影响。结果表明，本测量方法可以满足测量的要求，且证实在髓内固定条件下机械振动可以诱发骨折间微动。     

实验性狗胫骨骨折的组织学和超微结构观察

目的 长管状骨骨折的愈合过程。方法 20支杂种狗,于左胫骨粗隆下3cm造成横行骨折模型,管型石膏外固定。术后1、2、4、8周行x—ray、组织学、超微结构观察。结果 实验动物骨折断端对位对线良好,4周时骨痂出现,8周时大量骨痴生长,术后早期镜下为轻度炎性反应,继之出现纤维骨痂,术后4周成骨活跃,8周时以软骨化骨为主。结论 狗胫骨上段骨折愈合方式与传统的愈合方式基本一致,成骨方式主要以软骨内化骨为主。     

Fracture energy of bone in a shear mode

The role of the osteon as the basic strengthening unit of compact bone is discussed. Using previous work on the shear strength of bone, an analysis is given enabling a computation to be made of the mode-II (debonding) fracture energy. The evidence suggests that bone, like many reinforced composites, derives its excellent fracture characteristics from the existence of a week osteon-matrix interface.     

骨片钉治疗儿童肱骨髁上及肱骨髁骨折

目的 探讨骨片钉治疗儿童肱骨髁上及肱骨髁骨折的临床效果。方法 对45例儿童肱骨髁上及 肱骨髁骨折采用骨片钉内固定。结果 术后随访3～24个月,平均5个月,骨折全部愈合,无感染, 无骨不连,无骨片钉松动退出,1例轻度肘内翻,神经损伤病例功能完全恢复。结论 骨片钉吸收了克 氏针和螺钉固定的优点,可以使碎骨片解剖复位且操作简单,固定可靠,骨折愈合率高,对骨骺影响小, 值得推广。     

微创DHS内固定与传统DHS内固定治疗老年股骨粗隆间骨折比较研究

目的:对微创动力髋螺钉(dynamic hip screw,DHS)内固定和传统DHS内固定治疗老年股骨粗隆间骨折的效果进行比较.方法:将91例老年股骨粗隆间骨折患者随机分为两组,传统组46例采用传统方式置入内固定物治疗,微创组45例采用微创方式置入内固定物.对两组手术创伤大小、术后并发症、骨折愈合及功能恢复情况进行比较.主要通过考察手术切口长度、出血量、输血量、血红蛋白下降幅度、术后术区肢体肿胀情况、血沉变化等来反映手术创伤大小.结果:两组手术创伤差异有统计学意义,传统组大于微创组(P＜0.05).微创组有2例复位不良,传统组有3例复位不良,两组均无深部血肿发生.传统组围手术期死亡2例,其余患者均顺利出院,获12～30个月随访,平均17.1个月.两组各有1例在随访期间死于其它内科疾病,其余骨折均获愈合.术后平均骨折愈合时间微创组3.6个月,传统组3.8个月.术后1年髋关节功能优良率微创组84.1%,传统组79.1%,两组差异无统计学意义(P＞0.05).结论:微创DHS内固定治疗老年股骨隆间骨折,手术创伤小,有利于围手术期恢复和髋关节功能康复.     

Anterograde Removal of Broken Femoral Nails without Opening the Nonunion Site: A New Technique

OBJECTIVE:

We describe a new technique for removing the distal fragments of broken intramedullary femoral nails without disturbing the nonunion site.

METHODS:

This technique involves the application of an AO distractor prior to the removal of the nail fragments, with subsequent removal of the proximal nail fragment in an anterograde fashion and removal of the distal fragment through a medial parapatellar approach. Impaction of the fracture site is then performed with a nail that is broader than the remaining fragmented material.

RESULTS:

Nails were removed from five patients using the technique described above without any complications. After a mean follow-up period of 61.8 months, none of these patients showed worsened knee osteoarthritis.

CONCLUSION:

The original technique described in this article allows surgeons to remove the distal fragment of fractured femoral intramedullary nails without opening the nonunion focus or using special surgical instruments.