骨代谢指标与骨关节炎及绝经后骨质疏松症的关系

背景：研究显示,在绝经后骨质疏松症及骨关节炎状态下,原本正常的骨转换平衡状态被破坏,血清、尿液中一些特异性指标可以较敏感地反映出骨转换的具体变化过程。 目的：测量绝经后原发性膝骨关节炎及绝经后骨质疏松症患者的骨密度及骨代谢指标,分析两疾病骨密度及骨代谢指标的变化特点。 方法：选取248例绝经女性受试者,行骨密度、膝关节X射线片检查,最终选出180例进入试验,分为骨关节炎组、骨质疏松组及对照组。对比分析各组观察对象的骨代谢指标：骨碱性磷酸酶、骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b。通过二元Logistic回归分析判断两疾病发病与各项指标间的相关性。 结果与结论：与对照组比较,骨关节炎组腰椎骨密度升高,Ⅰ型胶原交联C末端肽值降低;骨质疏松组腰椎及全髋部骨密度降低,骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b升高。血清Ⅰ型胶原交联C末端肽水平的降低与骨关节炎发病具有显著相关性;血清骨钙素、Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b水平的升高与骨质疏松发病具有显著相关性。提示绝经女性骨关节炎患者骨吸收速率减低,骨质疏松患者骨转换率加快,骨代谢水平的差异导致两疾病患者骨密度呈现出负相关趋势。监测Ⅰ型胶原交联C末端肽、血清抗酒石酸酸性磷酸酶5b、骨钙素,特别是Ⅰ型胶原交联C末端肽血清水平对骨关节炎及骨质疏松的早期诊断及治疗有一定的参考价值。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

骨代谢标志物与骨质疏松的相关性研究

目的探讨绝经后妇女骨代谢标志物与骨质疏松的相关性。方法应用双能X线骨密度仪测量绝经期妇女腰椎和股骨的骨密度值,并按骨密度值将136例患者分为63例骨量减少组和73例骨质疏松组,用电化学发光法测定两组患者血清骨钙素(N-MID),总骨I型前胶原N端肽(PINP)和β胶原特殊序列(β-crosslaps)的水平。结果在骨量减少组和骨质疏松组血清N-MID测定结果分别为21.63±24.77ng/mL和21.4±15.6ng/mL、PINP分别为46.8±46.37ng/mL和61.4±52.83ng/mL、β-crosslaps分别为0.48±0.46ng/mL和0.49±0.40ng/mL,两组间的差异无统计学意义(P>0.05)。结论绝经后骨质疏松患者血清骨代谢标志物水平与骨密度不存在密切的相关性;血清N-MD、PINP、β-Crosslaps只反映绝经后妇女骨转换的高低,对骨质疏松的诊断无明显帮助。     

临产孕妇胰岛素抵抗指数与骨代谢标志物水平的相关性

目的调查临产孕妇胰岛素抵抗指数分布情况及其与总1型前胶原氨基端前肽等骨代谢标志物水平的相关性。方法纳入孕周为38~41周的临产孕妇共190例,检测空腹血糖、糖化血红蛋白、胰岛素、C肽、总1型前胶原氨基端前肽、N端-骨钙素、β-胶原特殊序列水平。分析糖化血红蛋白、胰岛素抵抗指数等糖代谢标志物与各骨代谢标志物水平的相关性,同时根据糖化血红蛋白水平分为糖代谢异常组和糖代谢正常组进行分组比较。结果胰岛素抵抗指数与总1型前胶原氨基端前肽、N端-骨钙素和β-胶原特殊序列的相关系数分别为0.558（P〈0.001）,0.448（P〈0.001）和0.488（P〈0.001）,均为正相关。糖代谢异常组孕妇胰岛素抵抗指数与总1型前胶原氨基端前肽、N端-骨钙素和β-胶原特殊序列的相关系数分别为0.664（P〈0.001）,0.641（P〈0.001）和0.593（P〈0.001）,均为中度正相关。结论临产孕妇的胰岛素抵抗指数与骨合成代谢、骨转换率和骨分解代谢的相关标志物存在正相关,此相关性在糖代谢异常孕妇中表现得更为明显。     

中孕晚期孕妇胰岛素抵抗指数与骨代谢标志物水平的相关性

目的 调查中孕晚期孕妇胰岛素抵抗指数分布及其与总1型前胶原氨基端前肽等骨代谢标志物水平的相关性.方法 纳入孕周为24～26周孕妇共154例,检测空腹血糖、空腹胰岛素、空腹C肽、总Ⅰ型胶原氨基端延长肽、N端-骨钙素、β-胶原特殊序列水平.比较胰岛素抵抗指数与各骨代谢标志物水平的相关性,同时根据有无妊娠糖尿病进行分组比较.结果 胰岛素抵抗指数与总1型前胶原氨基端前肽、N端-骨钙素和β-胶原特殊序列的相关系数分别为0.469（P＜0.001）,0.201（P=0.012）和0.337（P ＜0.001）,均为正相关.妊娠糖尿病组孕妇胰岛素抵抗指数与总1型前胶原氨基端前肽、N端-骨钙素和β-胶原特殊序列的相关系数分别为0.623（P ＜0.001）,0.535（P ＜0.001）和0.718（P ＜0.001）,均为强正相关.结论 中孕晚期孕妇的胰岛素抵抗指数与骨合成代谢、骨转换率和骨分解代谢的相关标志物存在正相关,此相关性在妊娠糖尿病患者群体中表现得更为明显.     

胰岛素样因子、睾酮及骨代谢指标预测老年男性骨质疏松性骨折的意义

背景：老年男性骨质疏松的发病率随着国内人口老龄化趋势的加剧逐年提升,骨质疏松患者容易发生骨折,对患者的生命安全造成严重威胁,但目前临床上仍缺少有效的筛选措施预防骨质疏松的发生。 目的：探究胰岛素样因子、睾酮及骨代谢指标水平在预测老年男性骨质疏松性骨折中的临床意义。 方法：选取骨质疏松症男性患者120例作为观察组,另选择同时期收治的非骨质疏松症体检健康的男性人群120例作为对照组,两组受试者在年龄及体质量指数等方面比较差异无显著性意义,具有可比性。对两组受试者抽血检测胰岛素样因子、血清睾酮及骨代谢指标的水平。 结果与结论：观察组患者腰椎侧位骨密度和左股骨颈骨密度均显著低于对照组(P < 0.05);观察组患者血液中胰岛素样因子和血清睾酮水平显著低于对照组(P < 0.05);观察组患者Ⅰ型胶原C端异物肽和Ⅰ型胶原羧基端肽β特殊序列(β-CTX)水平也显著高于对照组(P < 0.05);两组患者骨钙素(BGP)、血清钙、血清磷水平相比差异无显著意义(P > 0.05)。结果提示,通过检测老年男性血清中睾酮、胰岛素样因子及部分骨代谢指标的水平,可早期预测骨密度,为筛查老年男性骨质疏松症的高危状态起到一定的预测作用,具有一定的参考价值。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

中晚期孕妇两种胰岛β细胞功能指数与骨代谢标志物水平的相关性

目的 调查中孕晚期孕妇静态和动态胰岛β细胞功能指数与总1型前胶原氨基端前肽等骨代谢标志物水平的相关性.方法 纳入孕期为24～ 26周孕妇共135例,检测空腹及餐后血糖、空腹胰岛素、空腹C肽、总Ⅰ型前胶原氨基端前肽、N端-骨钙素、β-胶原特殊序列水平.计算并比较两种胰岛β细胞功能指数与各骨代谢标志物水平的相关性,同时根据有无妊娠糖尿病进行分组比较.结果 静态胰岛β细胞功能指数与总1型前胶原氨基端前肽、N端-骨钙素和β-胶原特殊序列的相关性均无统计学意义(P＞0.05).动态胰岛β细胞功能指数与总1型前胶原氨基端前肽和β-胶原特殊序列的相关系数分别为-0.242(P =0.005)和-0.277(P =0.001),均为弱负相关.妊娠糖尿病组动态胰岛β细胞功能指数与总1型前胶原氨基端前肽、N端-骨钙素的相关系数分别为-0.418(P =0.002)、-0.365(P =0.008),为低度负相关;与β-胶原特殊序列的相关系数为-0.560(P ＜0.001),为显著负相关.结论 中孕晚期孕妇的动态胰岛β细胞功能指数与骨合成代谢、骨分解代谢的相关标志物存在负相关性,且此相关性在妊娠糖尿病患者群体中表现得更为明显.     

去卵巢大鼠不同时期骨量、骨转换指标、雌激素水平的变化规律及相关性

背景：目前对去卵巢大鼠的研究较多,而对不同时间点大鼠骨量、骨转换指标、雌激素水平的变化规律及各因素的相关性研究报道较少。 目的：分析去卵巢大鼠不同时期骨量、骨转换指标、雌激素水平的变化规律并探讨其相关性。 方法：34只3月龄雌性SD大鼠,随机分为基线组、假手术组和去卵巢组。实验开始先将基线组处死,假手术组及去卵巢组于术后第4,8,12周分次处死。双能X射线吸收法(DXA)测定L1-3及股骨不同分区(头颈部R1区、转子部R2区、股骨干R3区、股骨整体R4区)的骨矿含量、骨密度、骨面积;酶联免疫吸附法(ELISA)检测血清Ⅰ型前胶原氨基端原肽、Ⅰ型胶原羧基端肽及雌激素水平。对大鼠体质量、离体骨密度、Ⅰ型前胶原氨基端原肽、Ⅰ型胶原羧基端肽、雌激素水平、月龄间的相关性进行分析。 结果与结论：①去卵巢后4周去卵巢组离体腰椎及股骨骨矿含量、骨密度均较基线组、假手术组明显降低(P < 0.05),第8,12周时均显著改善(P < 0.05),腰椎、股骨各区域骨量丢失幅度最大的为L1及股骨转子区。       ②去卵巢后4周去卵巢组血清Ⅰ型前胶原氨基端原肽、Ⅰ型胶原羧基端肽水平较基线组、假手术组均显著升高(P < 0.05),第8,12周差异无显著性意义。③去卵巢组第8,12周血清雌激素较假手术组及基线组明显降低(P < 0.01,P < 0.05)。④月龄与大鼠体质量、腰椎及股骨骨密度呈正相关,Ⅰ型前胶原氨基端原肽、Ⅰ型胶原羧基端肽与腰椎及股骨骨密度呈负相关(P < 0.01)。提示去卵巢后大鼠腰椎、股骨骨量变化呈先快速降低、再缓慢回升的趋势,其中L1及股骨转子部受影响最大;骨转换指标在去卵巢后显著加快、后期逐渐回归正常;雌激素水平变化规律为第1个月先升高、后期快速降低;体质量、骨转换指标及雌激素水平与骨量密切相关。  中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

基于病因和国际骨微循环研究协会分期的股骨头坏死患者骨代谢水平研究

背景：目前缺乏大样本研究对不同病因、分期的股骨头坏死患者的骨代谢水平进行分析,这不利于制定更优的促坏死修复策略。目的：研究不同病因、国际骨微循环研究协会(ARCO)分期股骨头坏死患者的骨代谢水平。方法：回顾性纳入股骨头坏死的患者401例作为试验组,81例健康体检者作为对照组。试验组按照病因不同分为激素性股骨头坏死、酒精性股骨头坏死和创伤性股骨头坏死3组,并按ARCO分期的不同分为Ⅱ期/Ⅲ期/Ⅳ期。收集所有受试者的7项骨代谢相关指标,包括骨代谢调控激素25-羟基维生素D,骨转换标志物Ⅰ型前胶原N末端前肽、β-胶原降解产物、骨钙素N端中分子片段,骨代谢一般生化标记血清Ca、P、碱性磷酸酶。比较各组受试者的骨代谢水平,并应用二元Logistic回归分析与股骨头坏死发病相关的独立因素。结果与结论：(1)与对照组比较,试验组患者的β-胶原降解产物、Ⅰ型前胶原N末端前肽、骨钙素N端中分子片段、血清P、碱性磷酸酶水平均显著升高(均P <0.05);(2)以是否发病为结局,应用二元Logistic回归分析得出β-胶原降解产物、Ⅰ型前胶原N末端前肽、骨钙素N端中分子片段是与股骨头坏死发病相关的独立...     

血清β-CTX和BGP联合应用在乳腺癌骨转移诊断中的意义

目的:探讨血清Ⅰ型胶原羧基端肽β特殊序列(β-CTX)和骨钙素(BGP)定量检测诊断乳腺癌骨转移的价值。方法:用电化学发光免疫分析(ECLIA)测定35例乳腺癌骨转移患者及30例乳腺癌无骨转移患者血清β-CTX和BGP水平。结果:乳腺癌骨转移组患者血清β-CTX和BGP水平均明显高于无骨转移组和对照组(P<0.01),无骨转移组与对照组间无显著差异(P>0.05)。血清β-CTX诊断乳腺癌骨转移的敏感性、特异性和准确性分别为62.3%、88.5%、82.7%;血清BGP诊断乳腺癌骨转移的敏感性、特异性和准确性分别为75.6%、92.1%、83.5%。两者联合诊断乳腺癌骨转移的敏感性、特异性和准确性分别为91.8%、87.6%、84.2%。结论:血清β-CTX和BGP对乳腺癌骨转移的诊断均有重要价值,两者联合有助于提高乳腺癌骨转移的敏感性和准确性。     

血清-βCTX和Total-P1NP联检在前列腺癌骨转移监测中的价值

目的：为探讨血清Ⅰ型胶原羧基端肽β特殊序列（-βCTX）和总Ⅰ型胶原氨基端延长肽（Total-P1NP）在前列腺癌骨转移监测中的意义。方法：用电化学发光免疫分析检测血清β-CTX和Total-P1NP水平。结果：发现前列腺癌骨转移组的血清β-CTX明显高于无骨转移组及正常对照组（P均〈0.05）,而血清Total-P1NP明显低于无骨转移组及正常对照组（P均〈0.05）。结论：检测血清β-CTX和Total-P1NP对前列腺癌患者骨转移的及时诊断有重要的参考意义。     

Subsequent hip fracture in osteoporotic hip fracture patients

Purpose: A significant number of patients who have experienced previous surgical treatment for an osteoporotic hip fracture experience a subsequent hip fracture (SHF) on the opposite side. This study aims to analyze the risk factors and the correlation between osteoporosis and SHF on the opposite side in order to assess the usefulness of bisphosphonate treatment for the prevention of SHFs. Materials and Methods: We included 517 patients treated from March 1997 to April 2009 in this study. The inclusion criteria included previous unilateral hip fracture, without osteoporotic treatment, and a T-score less than -3.0 at the time of the fracture. We studied these patients in terms of death, SHF, alcoholism, living alone, dementia, dizziness, health status, osteoporotic treatment after fracture and bone mineral density (BMD). In total, 34 patients experienced a SHF. We selected another 34 patients without a SHF who had similar age, sex, body mass index, BMD, diagnosis, treatment and a follow up period for a matched pair study. We compared these two groups. The average follow up was 8.3 years and 8.1 years, respectively. Results: The mortality rate of the 517 patients was 138 (27%). The BMD at the time of fracture demonstrated no statistical difference between the two groups (p>0.05). Nine patients (26%) within the SHF group were prescribed Risedronate and 18 patients (53%) received the same treatment in the non-SHF group. There was a statistical relationship with the treatment of osteoporosis (p=0.026). The average BMD of patients with SHF was -5.13 and -5.02 in patients without SHF was (p>0.05). Conclusion: Although primary surgical treatments are important for an excellent outcome in osteoporotic hip fractures, treatment of osteoporosis itself is just as important for preventing SHFs.     

女性2型糖尿病患者的骨密度变化

目的：探讨女性2型糖尿病与骨质疏松的关系。方法：应用双能X线骨密度仪（DEXA）对56例女性2型糖尿病患者及52例女性健康对照者进行骨密度（BMD）测定,并测定糖尿病患者的空腹胰岛素及餐后2h胰岛素（2h Ins）水平,结合病程、年龄等相关因素进行分析。结果：52例健康对照组中低骨量8例,骨质疏松5例,骨密度减低的发生率为25%;56例2型糖尿病患者中,低骨量16例,骨质疏松23例,骨密度减低的发生率为69.7%,明显高于对照组,差异有显著性（P〈0.01,χ^2=21.524）,骨密度减低者胰岛素水平相对更低。结论：女性2型糖尿病患者的骨质疏松发生率高,且与年龄、病程、胰岛素水平相关。     

Long-term reaction to bone cement in osteoporotic bone: new bone formation in vertebral bodies after vertebroplasty

Elderly patients frequently suffer from osteoporotic vertebral fractures resulting in the need of vertebroplasty or kyphoplasty. Nevertheless, no data are available about the long-term consequences of cement injection into osteoporotic bone. Therefore, the aim of the present study was to evaluate the long-term tissue reaction on bone cement injected to osteoporotic bone during vertebroplasty. The thoracic spine of an 80-year-old female was explanted 3.5 years after vertebroplasty with polymethylmethacrylate. The treatment had been performed due to painful osteoporotic compression fractures. Individual vertebral bodies were cut in axial or sagittal sections after embedding. The sections were analysed using contact radiography and staining with toluidine blue. Furthermore, selected samples were evaluated with scanning electron microscopy and micro-compted tomography (in-plane resolution 6 microm). Large amounts of newly formed callus surrounding the injected polymethylmethacrylate were detected with all imaging techniques. The callus formation almost completely filled the spaces between the vertebral endplate, the cancellous bone, and the injected polymethylmethacrylate. In trabecular bone microfractures and osteoclast lacuna were bridged or filled with newly formed bone. Nevertheless, the majority of the callus formation was found in the immediate vicinity of the polymethylmethacrylate without any obvious relationship to trabecular fractures. The results indicate for the first time that, contrary to established knowledge, even in osteoporosis the formation of large amounts of new bone is possible.     

Changes in Bone Metabolism in Young Castrated Male Rats

PurposeTo determine the window of time during which osteoporosis affects the management of spinal surgery and the mechanism of bone metabolism changes in males with osteoporosis by examining changes in bone metabolism in young castrated male rats.ResultsFemoral and lumbar BMDs were decreased in the orchiectomy groups. BMDs in the sham and orchiectomy groups showed statistically differences at POD 8, 10, and 12 weeks for the femur (p=0.032, 0.008, 0.008) and lumbar spine (p=0.151, 0.008, 0.008, respectively). Serum osteocalcin, ALP, and CTX decreased gradually; however, N-terminal type 1 procollagen (P1NP) showed a slight increase yet no significant change.ConclusionIn young castrated male rats, a significant decrease in BMD was observed after orchiectomy due to the mixture of two detrimental factors. Young castrated male rats did not reach peak BMD. Increased bone turnover causes bone resorption to exceed bone formation. This study may contribute to the creation of a valuable model for studies of male osteoporosis and the spinal surgery field.     

Association of the CT gene (CA) polymorphism with BMD in osteoporotic Mexican women

Calcitonin (CT) plays a role in the pathogenesis of osteoporosis and genetic variations in or adjacent to the CT gene may be associated with loss of bone mineral density (BMD). The correlation between a dinucleotide (cytosine-adenine) repeat polymorphism at the CT locus and BMD was examined in 70 osteoporotic women, 70 non-osteoporotic women and 500 subjects from the Mexican population. The allele A and genotype AA frequencies were significantly higher in osteoporotic women than in non-osteoporotic women (60% vs 32%; p < 0.0001 and 41% vs 14%; p = 0.0007, respectively). Genotype AA was associated with the presence of osteoporosis [odds ratio 2.58; 95% confidence interval (CI); 1.62-4.12]. Likewise, the loss of lumbar BMD and T scores were related to the presence of allele A: subjects with a single A allele displayed lower values for lumbar BMD and T score (84.02% and -1.51, respectively) than those who do not present any A allele (89.61% and -0.88, respectively). Individuals with two alleles A showed the lowest lumbar BMD and T-score values (73.77% and -2.51, respectively). Analysis of potential confounder demonstrated that aging has a significant effect on osteoporosis development (odds ratio 1.1; 95% CI; 1.1052-1.152).     

A long-term study of bone mineral density in patients with phenylketonuria under diet therapy

Introduction

Dietary control of classic phenylketonuria (PKU) needs restriction of natural proteins; adequate protein intake is achieved by adding low phenylalanine (phe) formulae. The adequacy of this diet for normal bone mineralization had not been sufficiently evaluated. Our aim was to evaluate and follow up bone mineral density (BMD) in children and adolescents with PKU within a 2-year time interval to assess the adequacy of a phenylalanine restricted diet for bone mineralization and to search for a possible relationship between BMD, dietary control and blood phenylalanine (phe) concentrations.

Material and methods

Thirty-two patients with classic PKU (3-19 years) were evaluated for their bone mineral status using dual energy X-ray absorptiometry (DEXA) both at the beginning (baseline) and the end (follow-up) of the study.

Results

Low BMD was detected in 31.25% at the start and in 6.25% of patients after 2 years follows-up. No relationship was found between BMD and the duration of diet compliance and phe level as well.

Conclusions

In this study the low BMD detected in our patients was both at baseline and follow-up independent of diet restriction. A yearly DEXA would be highly beneficial for early detection and treatment, thus preventing osteoporosis and decreasing the risk of fractures. We also suggest the importance of searching for new emerging therapies such as enzyme substitution or gene therapy as low protein diet compliance was not enough to maintain normal bone mineral density.     

不同形式运动对原发性骨质疏松患者骨代谢指标影响的Meta分析

文题释义：原发性骨质疏松：骨质疏松症是最常见的骨骼疾病,是一种以骨量低,骨组织微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病。骨质疏松症分为原发性和继发性两大类。原发性骨质疏松症包括绝经后骨质疏松症(Ⅰ型)、老年骨质疏松症(Ⅱ型)和特发性骨质疏松症(包括青少年型)。 体育锻炼：是指参加者通过重要性的身体运动,以增强体质、增进健康为目的的体力活动。诸多研究证实,体育锻炼对原发性骨质疏松有一定效果,但其作用方式、具体作用效果并不明确。 背景：体育锻炼对骨质疏松症患者骨量丢失、疼痛及骨代谢指标均有明显改善作用,但尚缺乏循证依据。 目的：系统评价不同体育运动对原发性骨质疏松患者治疗效果的干预作用。 方法：筛选体育运动与原发性骨质疏松患者治疗效果的临床随机对照试验,干预组以体育锻炼为主,对照组试验期间无规律运动,主要结局指标为腰椎L₂-L₄骨密度、疼痛目测类比评分、骨代谢指标(骨钙素、总Ⅰ型胶原氨基端延长肽、尿吡啶啉/肌酐、血钙、血磷)。采用Review Manager 5.3软件对纳入的结局指标进行Meta分析。 结果与结论：①总计纳入25篇随机对照试验研究;②Meta分析结果显示,体育锻炼可以有效提高原发性骨质疏松患者L₂-L₄骨密度(MD=0.06,95%CI：0.04-0.08,P < 0.000 01,I²=89%),亚组分析结果为：五禽戏-易筋经、健身操组、复合训练组、递增负荷训练组与对照组比较差异均有显著性意义(P < 0.05),其他运动组与对照组比较差异无显著性意义(P > 0.05);③体育锻炼可显著降低骨质疏松症患者疼痛程度(MD=-0.93,95% CI：-1.08至-0.79,P < 0.000 01,I²=83%);④运动干预可提高骨质疏松症患者血清骨钙素、总Ⅰ型胶原氨基端延长肽及血磷水平,并降低骨质疏松症患者尿吡啶啉及血钙水平,但各运动组与对照组比较差异均无显著性意义(P > 0.05);⑤Egger’s及Begg’s检验结果表明,纳入研究发表偏倚处于低水平;结果提示,体育运动对中老年原发性骨质疏松症患者的骨密度、疼痛具有显著干预作用。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

骨质疏松椎体压缩性骨折患者脊柱矢状面的失平衡

背景：国内外总结脊柱失平衡的原因包括脊柱畸形、脊柱退变性疾病、骨质疏松椎体压缩性骨折等,作者通过临床研究认为动力性因素(腰背肌)在脊柱矢状面失平衡中起关键作用。 目的：通过观察骨质疏松椎体压缩性骨折患者的临床表现和治疗效果,分析脊柱矢状面失平衡的原因。 方法：回顾性分析2012年1月至2013年5月收治的骨质疏松压缩性骨折伴脊柱矢状面失平衡患者41例,均在局麻下行经皮穿刺球囊扩张椎体成形治疗。治疗前患者均行骨密度、站立位全脊柱正侧位X射线、以伤椎为中心的CT及MR检查。于患者站立位全脊柱正侧位片中测量伤椎前缘高度、脊柱后凸Cobb角及改善角度、伤椎楔形变角度及改善角度;要求患者行负重试验及行走试验,对比治疗前后数据。 结果与结论：治疗前患者出现脊柱矢状面失平衡症状所需行走的距离显著短于治疗后(P < 0.05);治疗前出现脊柱矢状面失平衡负重试验时间亦显著短于治疗后(P < 0.05)。在治疗前后站立位全脊柱正侧位片中,Cobb角的平均差值为(10.01±0.76)°,椎体楔形变改善的平均差值为(4.84±0.40)°,差异有显著性意义(P < 0.05)。所有患者均获随访,患者腰背部疼痛及矢状面失平衡症状明显缓解。所有患者行经皮球囊扩张椎体成形治疗后无严重并发症发生。提示骨质疏松压缩性骨折部分患者会出现脊柱矢状面失平衡症状,原因并非伤椎楔形变单一因素所致。且患者通过经皮球囊扩张后凸成形治疗后,失平衡症状往往会明显改善,提示脊柱骨折后腰痛限制腰背肌力量是导致脊柱矢状面失平衡的一个重要原因。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;组织工程全文链接：     

椎体成形治疗伴椎体裂隙骨质疏松性椎体压缩骨折

背景：临床实践证明经皮椎体成形治疗骨质疏松性椎体压缩骨折有显著的疗效。 目的：比较经皮椎体成形治疗伴或不伴椎体内裂隙样变骨质疏松性椎体压缩骨折的治疗效果,以确定椎体成形治疗椎体裂隙样变骨质疏松性椎体压缩骨折的有效性和安全性。 方法：选择骨质疏松性椎体压缩骨折患者76例,分两组,实验组27例伴椎体内裂隙样变,对照组49例不伴椎体内裂隙样变。采用椎体成形治疗后,比较两组间目测类比评分和Oswesty功能障碍指数值、椎体前缘高度的变化,以及发生骨水泥外漏的类型和特点。 结果与结论：两组治疗后的目测类比评分、Oswesty功能障碍指数值均明显低于治疗前(P < 0.05),治疗后两组间目测类比评分、Oswesty功能障碍指数值及骨水泥外漏发生率比较差异无显著性意义(P > 0.05)。两组治疗后的伤椎高度与治疗前比较差异无显著性意义(P > 0.05)。说明椎体成形是减轻伴或不伴有椎体裂隙骨质疏松性椎体压缩骨折患者疼痛,改善脊柱活动功能及提高患者社会活动能力的有效方法,但不能有效恢复椎体高度。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;组织工程全文链接：     

腰椎磁共振影像组学对女性骨质疏松症的诊断价值

背景:磁共振成像(MRI)在骨质疏松症诊断中发挥着越来越重要的作用。影像组学作为一种新的图像分析方法在骨质疏松症诊断中有潜在的临床意义。目的:探讨基于腰椎磁共振影像组学模型对骨质疏松症的诊断价值。方法:纳入2017年2月至2018年10月河北医科大学第一医院门诊女性患者50例,年龄40-84岁,同期进行腰椎MRI及双能X射线骨密度测量。双能X射线骨密度测量结果显示骨质疏松症28例及骨质正常22例,分别在腰椎MRI矢状位T1WI及T2WI序列图像选取L2-4椎体中间连续5个层面进行图像分割,提取影像组学特征,建立诊断模型,并与临床特征结合建立影像临床特征模型,使用曲线下面积(AUC)评估模型效能。试验获河北医科大学第一医院伦理委员会批准。结果与结论:①在50例受试者T1WI、T2WI序列及联合序列分别提取出396×3个特征,通过特征降维后分别筛选出最相关的T1WI序列4个特征、T2WI序列6个特征,T1WI及T2WI联合序列图像筛选出4特征,建立诊断模型,T1WI、T2WI单序列诊断模型AUC值分别为0.810,0.820,T1WI+T2WI联合序列诊断模型AUC值为0.937,高于单个序列;②将T1WI+T2WI组学特征与临床资料结合构建了适用于女性的联合临床资料的影像组学诊断模型,其AUC值为0.960;③结果表明,基于常规腰椎MRI的影像组学特征可以区分骨质疏松及骨量正常,结合临床特征建立的联合诊断模型能够提高诊断效能,对诊断骨质疏松症有较高的临床价值。