Recurrence of neuropathic ulceration following healing in a total contact cast

Total contact casting has been clearly shown to be an effective technique in the healing of diabetic neuropathic foot ulcerations. The purpose of this study was twofold: (1) to determine the rate of ulcer recurrence in a large population of patients whose ulcerations had healed in a total contact cast, and (2) to determine the reason for which ulcerations had recurred. A random sample of 102 patients was taken from a much larger population, all of whom had healed in a total contact cast. There were 54 men and 48 women, all of whom were diabetics, averaging 50.5 years of age. These patients had an average wound size of 2.6cm by 1.9cm prior to casting and an average healing time of 33.9 days. At the time the sample was drawn, it had been an average of 25 months since casting for this group. Twenty (19.6%) of the 102 patients had ulcer recurrences since initially healing in a cast. Causes of ulcer recurrence were failure to comply with follow-up foot-wear/foot-care protocol (n = 8), biomechanical faults (n = 5), osteophyte or bone fragment (n = 4), osteomyelitis (n = 5), and Charcot joint (n = 4). Some patients had multiple etiologies.     

Thawing of frozen calcaneus bone specimens has no effect on the bone mineral density using dual energy x-ray absorptiometry: a study in rabbits and humans

The purpose of this paper is to study whether the deep freezing of bone and later thawing affects the bone mineral density (BMD) measurement. We used 56 calcanei from 28 adult female New Zealand white rabbits and 102 human calcanei from 51 donors post-mortem (27 men and 24 women, age 30-89). Dual energy x-ray absorptiometry evaluated BMD of the frozen specimen and of the thawed specimen. A main analysis compared BMD of each specimen in the frozen and thawed states. The mean BMD of 224 areas of frozen rabbits' calcanei was 0.31 +/- 0.08 g cm(-2) (95% confidence interval (CI) from 0.30 to 0.32 g cm(-2)) while the mean BMD of thawed rabbits' calcanei was 0.31 +/- 0.08 g cm(-2) (95% CI from 0.30 to 0.32 g cm(-2); paired t-test p > 0.01). The mean BMD of 306 areas of frozen human calcaneus was 0.73 +/- 0.22 g cm(-2) (95% CI from 0.70 to 0.76 g cm(-2)) while the mean BMD of thawed human calcaneus was 0.73 +/- 0.22 g cm(-2) (95% CI from 0.70 to 0.76 g cm(-2); p > 0.01). For both the rabbit and the human calcanei, a Bland-Altman analysis showed a mean difference between the BMD in the frozen and thawed states of 0.00 (limits of agreement, rabbit: -0.07 to 0.08 g cm(-2), human: -0.16 to 0.21 g cm(-2)). A high correlation was observed between calcaneus BMD in the frozen and thawed states (r = 0.94, 0.97, 0.92 and 0.99 respectively in all rabbit calcanei, all human calcanei, immobilized rabbit calcanei and osteopenic human calcanei, all p < 0.01). Bone mineral density is not affected by deep freezing and later thawing of the specimen. Therefore, the specimens need not be thawed to obtain valid and precise BMD measurement. These results are relevant to general musculoskeletal as well as osteoporosis research where the specimens undergo multiple tests in series.     

Relationship between changes in activity and plantar ulcer recurrence in a patient with diabetes mellitus

BACKGROUND AND PURPOSE: Although pressure-reducing interventions have been effective in the healing of neuropathic foot ulcers, these ulcers frequently recur in people with diabetes mellitus (DM). This case report illustrates how sudden changes in weight-bearing activity may have affected ulcer recurrence in a patient with DM and how the physical stress theory (PST) relates to ulcer recurrence for this patient. CASE DESCRIPTION: The patient was a 66-year-old man with a history of DM, peripheral neuropathy, and recurrent plantar ulcers. His plantar ulcer healed after total contact casting. OUTCOME: Despite relatively low peak plantar pressure (9.3 N/cm(2)), the patient's ulcer recurred within 4 weeks of healing. Plantar pressure assessment and activity monitoring suggested that a rapid and sudden increase in weight-bearing activity (steps per day) contributed to cumulative plantar tissue stress that was 3.3 times higher on the day of ulcer recurrence than his average value. Although his cumulative plantar stress was high compared with his usual value, the cumulative value was similar to the amount of daily stress of individuals without a history of recurrent ulcers. DISCUSSION: Within the context of the PST, rapid change in activity level may have an effect on cumulative stress and the risk of ulcer recurrence.     

Use of computed tomography and plantar pressure measurement for management of neuropathic ulcers in patients with diabetes

BACKGROUND AND PURPOSE: Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%-57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology. CASE DESCRIPTION: The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration. OUTCOMES: The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day. DISCUSSION: Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.     

A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers

OBJECTIVE: The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers. RESEARCH DESIGN AND METHODS: In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 相似文献   

A Prospective Study of Calcaneal Bone Mineral Density in Acute Charcot Osteoarthropathy

OBJECTIVE

To measure prospectively bone mineral density (BMD) of the Charcot and non-Charcot foot in 36 diabetic patients presenting with acute Charcot osteoarthropathy.

RESEARCH DESIGN AND METHODS

Calcaneal BMD was measured with quantitative ultrasound at presentation, at 3 months of casting, and at the time of the clinical resolution.

RESULTS

BMD of the Charcot foot was significantly reduced compared with BMD of the non-Charcot foot at presentation (P = 0.001), at 3 months of casting (P < 0.001), and at the time of clinical resolution (P < 0.001). Overall, from the time of presentation to the time of resolution there was a significant fall of BMD of the Charcot foot (P < 0.001) but not of the non-Charcot foot (P = 0.439).

CONCLUSIONS

Although the Charcot foot was treated with casting until clinical resolution, there was a significant fall of BMD only from presentation up until 3 months of casting.Studies on bone mineral density (BMD) have shown a reduction of BMD of the Charcot foot compared with the contralateral non-Charcot foot (1–4). However, it is not known what happens to BMD in the natural history of the osteoarthropathy. The aim of this study was to measure prospectively the longitudinal changes of BMD of the Charcot and non-Charcot foot in patients presenting with acute Charcot osteoarthropathy.     

2型糖尿病女性患者骨密度与骨转换率的相关性

目的探讨2型糖尿病(T2DM)女性患者骨密度与骨转换及骨重建的相关性。方法回顾性分析纳入在南方医科大学第三附属医院内分泌科住院的201例T2DM女性患者住院期间的临床数据,采用双能X线骨密度仪,测量骨密度,包括腰椎、左侧股骨颈和髋部总体,将纳入对象分为骨量正常组85例(T>-1)、骨量减少组87例(-2.5 < T < -1)和骨质疏松组29例(T < -2.5),检测骨钙素N端中分子片段和β-Ⅰ型胶原C-末端交联分别评估骨形成和骨吸收。根据骨形成和骨吸收的T值分别计算骨转换率和骨重建率,比较T2DM患者骨质疏松组和骨量正常组患者的的骨转换率T值以及骨重建率T值的差异,并评估T2DM女性患者骨转换率T值和骨重建率T值与骨密度之间的相关性。结果T2DM女性患者骨质疏松组的骨转换率T值与T2DM女性患者骨量正常组的骨转换率T值差异有统计学意义(P=0.041),T2DM女性患者骨转换率T值与髋部骨密度负相关(r=-0.14,P =0.049)。校正糖化血红蛋白后,T2DM女性患者骨转换T值与髋部仍呈骨密度负相关(r=-0.144,P=0.043)。结论在T2DM女性患者中,随着骨转换率的增高,患者骨密度越低,并发低创伤性骨折的风险也会随之增高。     

Charcot foot: the diagnostic dilemma.

Primary care physicians involved in the management of patients with diabetes are likely to encounter the diagnostic and treatment challenges of pedal neuropathic joint disease, also known as Charcot foot. The acute Charcot foot is characterized by erythema, edema and elevated temperature of the foot that can clinically mimic cellulitis or gout. Plain film radiographic findings can be normal in the acute phase of Charcot foot. A diagnosis of Charcot syndrome should be considered in any neuropathic patient, even those with a minor increase of heat and swelling of the foot or ankle, especially after any injury. Early recognition of Charcot syndrome and immobilization (often with a total contact cast), even in the presence of normal radiographs, can minimize potential foot deformity, ulceration and loss of function. Orthopedic or podiatric foot and ankle specialists should be consulted when the disease process does not respond to treatment.     

腰椎前后位骨矿含量、面积评价骨密度测量的可靠性

背景针对双能X线前后位腰椎骨密度测定受腰椎骨质增生或压缩性骨折等因素的影响,易造成骨密度结果判断的误差,导致临床对骨质疏松症的漏诊、误诊.目的通过对腰椎前后位骨密度、骨矿含量及面积相互关系的探讨,寻找正确评价骨密度可靠的相关依据.设计前瞻性队列研究. 地点和对象实验由解放军总医院老年医学研究所完成.在北京市区选择20岁以上1 567例健康人作为研究对象,其中男591例;女976例,职业包括军队和地方干部、教师、工人、居民.特殊职业者及患有各种影响骨代谢的急、慢性疾病者均除外.干预按10岁为1个年龄段,将其分为8组.应用双能X线骨密度仪(DXA)进行腰椎骨密度、骨矿含量、面积的测定,确定不同性别平衡峰值期骨密度的年龄段、计算其骨矿含量及面积均值,以身高为自变量,骨密度为应变量分别作直线回归,建立骨矿含量、面积与身高的回归方程,利用其回归方程进行骨密度正常值的预报.主要观察指标腰椎前后位骨密度、骨矿含量和面积.结果平衡峰值骨密度的年龄,男性为20～49岁,女性为30～49岁;骨矿含量及面积的均值,男性分别为56.47 g及46 39 cm2,女性分别为47.418%及41.12 cm2.90%正常范围男性骨矿含量=0.327×身高(cm)±14.76,面积=0 271×身高(cm)±5.96,女性骨矿含量0.294×身高(cm)±11.85,面积=0.225×身高(cm)±5.00.结论仅靠腰椎骨密度结果评价骨质疏松的可靠性不准确,正确评价腰椎的骨矿含量与面积,对骨密度测量的可靠程度可做出较准确判断.     

Total contact casting of the diabetic foot in daily practice: a prospective follow-up study

OBJECTIVE: A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection. RESEARCH DESIGN AND METHODS: Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications. RESULTS: Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P < 0.01). In multivariate analyses, PAD, infection, and heel ulcers were associated with a lower percentage healed (all P < 0.05). Median duration of cast treatment was 34 days. New ulcers, all superficial, developed in 9% and preulcerative lesions in 28% of the patients; these skin lesions healed in the cast within a maximum of 13 days. CONCLUSIONS: In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.     

Long-term dalteparin in pregnancy not associated with a decrease in bone mineral density: substudy of a randomized controlled trial

BACKGROUND: The risk of decreased bone mineral density (BMD) with prophylactic dose long-term low-molecular-weight heparin (LMWH) is unknown. OBJECTIVES: We sought to determine whether long-term prophylactic dalteparin in pregnancy leads to loss of BMD. PATIENTS/METHODS: Patients in a substudy of an ongoing multicenter randomized trial investigating the effect of antepartum dalteparin prophylaxis on pregnancy outcomes in thrombophilic pregnant women were randomized to either dalteparin 5000 U s.c. daily until 20 weeks and then 5,000 U s.c. q12 h until >37 weeks or to the control group. The primary outcome was absolute spine BMD at six weeks postpartum. RESULTS: Of 77 patients eligible for the BMD substudy, 62 were analyzed. 33 patients received a mean of 212 days of dalteparin in the intervention group. 29 patients received a mean of 38 days of postpartum dalteparin in the control group. There was no difference in mean BMD between the intervention (1.11 g cm(-2)) and the control groups (1.14 g cm(-2)). Similarly, there was no difference in T-scores; the difference of -0.34 (95% confidence interval -0.93 to +0.25) in favor of the control group excludes a clinically important increase in fracture risk. CONCLUSIONS: Our results suggest that the use of long-term prophylactic dalteparin in pregnancy is not associated with a significant decrease in BMD. Clinical trial registration: ISRCTN87441504 at http://www.controlled-trials.com.     

Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location

This study investigated healing rates of chronic diabetic neuropathic foot ulcerations located on the plantar surface of the forefoot (n = 30) versus those located on other parts of the foot (n = 25). Each type of ulceration was treated with total contact casting. Ulcerations in the first group were located on the metatarsal heads and toes, while ulcerations in the second group were located on the dorsum of the foot, heel, plantar arch, ankle, medial aspect of foot, and toe or transmetatarsal amputation sites. Successfully healed diabetic neuropathic foot ulcerations treated with total contact casting were rated according to patient age, ethnic origin, sex, patient weight, ulcer size, ulcer location, duration of ulcer prior to casting, and ulcer grade. Analysis of variance and posthoc analyses demonstrated that (1) total contact casting was a highly effective method of treatment regardless of ulcer location (forefoot ulcer healing time mean = 30.6 days; nonforefoot ulcer healing time mean = 42.1 days) and (2) forefoot ulcerations healed significantly faster than ulcerations located on other parts of the foot. Complex correlational relationships were explored in this study, and multiple regression equations were developed for each location grouping.     

Mid foot kinetics characterize structural polymorphism in diabetic foot disease

BACKGROUND: Diabetic foot disease is characterized by progressive foot deformities that lead to amputation and disabling morbidity. The purpose is to investigate the classification of two distinct phenotypes of mid foot structural polymorphism in individuals using plantar kinetic and pressure distribution and tarsal bone density assessments. METHODS: Twenty-two individuals (26 ft) with diabetes mellitus, peripheral neuropathy and at least one mid foot deformity were compared to 29 age-, gender- and race-matched healthy controls (58 ft). Eleven subjects with diabetes mellitus and peripheral neuropathy (11 ft) had lateral deformity; 11 subjects (15 ft) had medial deformity. Each subject had calcaneal bone mineral density and plantar force and pressure assessments walking barefoot over an EMED-ST P-2 platform. FINDINGS: Control subjects had lower mid foot vertical forces and pressures despite significantly higher preferred walking speed. In subjects with diabetes and neuropathy, maximum vertical force was 6-fold greater, force-time integral 9.5-fold greater, peak pressure 6.7-fold higher, pressure-time integral was 9.7-fold greater, contact area 2-fold greater and contact time 1.9-fold higher than controls. Pressure values were larger in involved vs uninvolved (P0.05). During stance in the mid foot, subjects with medial column phenotype showed greater pressure in the medial mask; subjects with lateral column phenotype had greater pressures in the lateral mask (P<0.05). Calcaneal bone density was lower for the deformity foot vs the non-deformity foot; bone mineral density was lower in medial column phenotype vs lateral column phenotype (P=0.02). INTERPRETATION: Diabetic foot disease can be classified as stereotypical, structurally-distinct phenotypes of deformities of the medial and lateral columns of the mid foot. Assessments of pedal bone density and plantar mid foot force and pressure during barefoot walking can characterize the structural polymorphic phenotypes and may assist the foot care specialist in clinical decision making.     

Middle-aged premenopausal women with type 1 diabetes have lower bone mineral density and calcaneal quantitative ultrasound than nondiabetic women

OBJECTIVE: To determine whether middle-aged premenopausal women with type 1 diabetes had more self-reported fractures and lower bone mineral density (BMD) compared with nondiabetic women. RESEARCH DESIGN AND METHODS: Participants were premenopausal women aged 35-55 years with type 1 diabetes (n = 67; 32.2 +/- 5.3 years duration) and without diabetes (n = 237). Total hip, femoral neck, whole-body, and spine BMD were measured by dual X-ray absorptiometry. Calcaneal broadband ultrasound attenuation (BUA) was assessed with quantitative ultrasound. RESULTS: Women with type 1 diabetes were more likely to report a fracture after age 20 years compared with nondiabetic women (33.3 vs. 22.6%; age-adjusted odds ratio 1.89 [95% CI 1.02-3.49]). Type 1 diabetes was associated with lower total hip BMD (0.890 vs. 0.961 g/cm2; P < 0.001), femoral neck BMD (0.797 vs. 0.847 g/cm2; P = 0.001), whole-body BMD (1.132 vs. 1.165 g/cm2; P < 0.01), and lower calcaneal BUA (71.6 vs. 84.9 dB/MHz; P < 0.001) after multivariate adjustment. BMD was 3-8% lower in type 1 diabetic compared with control women and calcaneal BUA was 15% lower. Spine BMD and biomarkers of bone remodeling were not significantly different between groups. In the type 1 diabetic women, reduced monofilament detection and blindness were both associated with lower BMD. CONCLUSIONS: Lower BMD in premenopausal women with type 1 diabetes may substantially increase their risk of developing osteoporosis after menopause. Type 1 diabetic women should be targeted for osteoporosis screening and possible fracture prevention as they transition through menopause.     

深圳市13～15岁正常少年超声骨密度特征

背景应用超声骨密度仪检测骨密度缺乏定量超声独立使用的临床指征标准.目的了解深圳地区13～15岁不同性别少年超声骨密度状况;建立该年龄段少年超声骨密度正常参考值.设计横断面调查.单位深圳市龙岗区人民医院超声科.对象选择2003-04-12深圳市二所中学的13～15岁学生健康志愿者158例,排除曾发生骨折者和6个月内服用激素等影响骨代谢药物者,男90例,女68例.女性分为无月经初潮组和有月经初潮组.方法采用美国SAHARA超声骨密度仪,开机后用标准体模校正通过(精确性误差＜1%,准确性误差为3%),测定所有受试者左足跟骨密度值(g/cm2),足跟置于探头间,用定位附件调节固定位置,用同一身高、体重计,测量所有受检者的体质量(kg)、身高(cm).主要观察指标①13～15岁正常少年身高、体质量及跟骨骨密度测量结果.②13～15岁不同性别的正常少年骨密度测量结果.③13～15岁正常女性无月经初潮者和有月经初潮者骨密度分布.结果①13～15岁正常少年身高、体质量及跟骨骨密度测量结果14岁身高增长速度是15岁少年的2倍多(4.705 cm/年,2.096 cm/年),骨密度的平均增长率14岁较13岁为负增长,15岁较14岁增长10.8%;体质量与骨密度呈正相关性(γ=0.820,P＜0.01).②13～15岁不同性别的正常少年骨密度测量结果女性高于男性[13岁(0.542±0.117)比(0.528±0.086)g/cm2,14岁(0.508±0.108)比(0.487±0.079)g/cm2,15岁(0.609±0.234)比(0.501±0.225)g/cm2]③13～15岁正常女性无月经初潮者和有月经初潮者骨密度分布有月经初潮者高于无月经初潮者(P＜0.001).结论①13～15岁少年足跟部骨密度与性别和身高增长快慢有关.②体质量对骨密度的影响比身高对骨密度的影响大.③有月经初潮女性因雌激素增加有促进骨密度增高作用.     

成都地区城乡人群骨密度调查分析

目的调查成都地区城乡人群腰椎、髋部骨密度（BMD）和原发性骨质疏松症（OP）的患病率及影响因素。方法用整群随机抽样≥20岁人群共1460人,采用DEXA测量L     

Semiquantitative analysis of the histopathological features of the neuropathic foot ulcer: effects of pressure relief

OBJECTIVE: This study was designed to evaluate the histopathology of neuropathic ulcers and whether pressure relief could change such histological patterns. RESEARCH DESIGN AND METHODS: We compared neuropathic plantar ulcers tissue excised from 10 diabetic patients (group A) with those taken from 10 patients with comparable lesions and glycemic control after 20 days in a total contact cast (group B). Tissue specimens were blindly examined by two independent pathologists for hyperkeratosis, fibrosis, cutaneous annexes, capillaries, inflammation, cellular debris, and granulating tissue. For each parameter, quantification was obtained according to an arbitrary score: 0, absent; 1, present in <33%; 2, present in 34-66%; and 3, present in >67% of the lesion. RESULTS: Patients in group B showed a marked reduction in ulcer size after 20 days of casting (P < 0.01). The histopathological features of the two groups markedly differed. Group A patients showed a predominance of inflammatory elements as well as matrix alterations, vessel disruptions, inflammation, and debris. Group B ulcers showed a shift toward a reparative pattern with prevalence of neoformed capillaries and fibroblasts. Semiquantitative analysis confirmed the prevalence of hyperkeratosis, fibrosis, inflammation, and cellular debris in group A patients (P < 0.05), whereas cutaneous annexes, capillaries, and granulating tissue were more prevalent in group B lesions (P < 0.01). CONCLUSIONS: These results indicate that pressure relief with a total contact cast is associated with changes in the histology of neuropathic foot ulcers, indicating reduction of inflammatory and reactive components and acceleration of reparative processes.     

FRAX评估绝经后女性2型糖尿病患者的骨折概率

目的：评估绝经后女性2型糖尿病（type 2 diabetes mellitus,T2DM）患者未来10年内发生髋部骨折和主要骨质疏松性骨折的概率。方法：选取298例住院的绝经后T2DM女性患者及183例非糖尿病绝经后女性对照者,采用双能X线骨密度仪测其定腰椎2-4（L2-L4）、股骨颈骨密度。采用FRAX中国模式计算其10年内髋部骨折概率和主要骨质疏松性骨折概率。结果：绝经后T2DM女性患者的10年内髋部骨折概率为（0.94±1.03）%,10年内主要骨质疏松性骨折概率为（3.58±1.68）%。与绝经后女性对照组相比,绝经后T2DM女性患者的股骨颈骨密度[（0.83±0.13）g/cm2比（0.80±0.11）g/cm2,P=0.047]和L2-L4骨密度[（1.04±0.17）g/cm2比（0.97±0.14）g/cm2,P〈0.001]均显著增高,差异有统计学意义（P〈0.05）。但使用FRAX评估的10年内髋部骨折概率[（0.94±1.03）%比（0.96±0.80）%,P=0.814]和主要骨质疏松性骨折概率[（3.58±1.68）%比（3.72±1.35）%,P=0.305],在绝经后T2DM组与对照组间无统计学差异。结论：尽管绝经后T2DM女性患者的股骨颈骨密度和L2-L4骨密度均显著高于对照者,但2组间的10年内发生骨折概率无统计学差异。绝经后女性T2DM患者的骨密度增高及未将T2DM作为一个危险因素纳入FRAX誖计算系统中,可能是2组间骨折概率无差异的原因所在。因此,在未来的FRAX测评系统中,需将T2DM作为一个独立的危险因素纳入其中。     

Contact thermography of painful diabetic neuropathic foot.

OBJECTIVE: To investigate regional differences in skin blood flow (measured by contact thermography) in the diabetic neuropathic foot and to examine the effect of foot temperature on the severity of neuropathic pain. RESEARCH DESIGN AND METHODS: Thirty-five diabetic patients with painful polyneuropathy (PPN) and 33 healthy age- and sex-matched control subjects comprised the study. Mean foot temperature (MFT) in PPN (mean +/- SE 28.3 +/- 0.3 degrees C) was significantly higher (P less than 0.001) than in the control subjects (25.9 +/- 0.5 degrees C), with the highest temperatures over the metatarsal areas and heel. Visual analogue scale pain score (mean +/- SD 5.3 +/- 1.9 cm) did not correlate with MFT (r = -0.14, P = 0.52). In 10 patients with PPN followed for 2-8 mo (mean 4.6), MFT fell by 1.6 degrees C (P = 0.05), but pain scores did not alter. CONCLUSIONS: Neuropathic pain is unaffected by alterations in skin temperature. Elevated skin temperatures at recognized sites of weight bearing (metatarsal heads and heels) are common in the diabetic neuropathic foot and may indicate tissue injury or inflammation induced by pressure trauma or increased arteriovenous shunting. Follow-up studies will determine whether thermographic hot spots are more susceptible to ulceration.     

青年人群腰椎骨密度及标准差对骨质疏松检出率的影响:多中心、大样本分析

背景：不同地区骨峰值和标准差不同，对骨质疏松诊断率有较大影响。探讨建立一完整数据库为中国人骨质疏松诊断准确性提供依据。目的：探讨青年人腰椎骨密度和标准差正常参考值影响骨质疏松症检出率的程度。设计、时间及地点：调查分析，于1997—01／1999-12分别在北京、上海、广州、南京、嘉兴和成都市完成。对象：采用前瞻性及回顾性方法对全国6个中心骨密度参考数据库中11418人进行调查统计分析；男3666人，女7752人：年龄20岁～90岁；分别来自北京（2385人）、广州（1178人）、上海（1404人）、南京（2938人）、成都（1425人）、嘉兴（2088人），受试者来源于社区调查、健康体检和健康志愿者。方法：用GE-Lunar公司的DXA仪测量骨密度，调查全国6个中心11418人L2-L4腰椎后前位和髋部骨密度，建立了骨密度参考数据库。6个中心的仪器内部精度0．3％～0．7％，仪器间的精度1．1％。主要观察指标：①6个中心不同年龄组腰椎骨密度分布。②青年人群骨密度及其标准差值对骨质疏松症检出率的影响。结果：中国汉族女性以腰椎进行骨质疏松症诊断的青年人群的骨密度和标准差值，6个中心，最大差值分别为0．098g／cm^2和0．027g／cm^2。用6个中心及总体各自的青年人平均骨密度和标准差值为参考标准，对同一人群计算T-score和获得的骨质疏松症检出率不相同；发现青年人平均骨密度每变化0．01g/cm^2，则骨质疏松症检出率变化1．6％（呈正相关），其标准差值每变化0．01g／cm^2，则骨质疏松症检出率变化4％（呈负相关）。结论：青年人平均骨密度和标准差值不同引起骨质疏松症检出率也不相同。为了让不同中心的骨质疏松症检出率有可比性，建议同一个类型的骨密度仪，同一个种族，同一个地区用一个设计较完善大样本的参考数据库，以其青年人正常参考值计算T-score。