细胞因子配体3和绝经后骨质疏松症严重程度相关性研究

目的 探讨绝经后骨质疏松症患者血清细胞因子配体3(CCL3)水平是否与疾病严重程度相关。方法 82例绝经后骨质疏松症妇女,76例绝经后非骨质疏松症妇女,80例育龄健康妇女。采用双能X线骨密度仪测定全髋、股骨颈和腰椎L1-L4骨密度;使用商用酶联免疫吸附测定试剂盒检测血清CCL3水平;同时检测血清炎症细胞因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和1型交联的羧基末端端肽(CTX-1)和抗酒石酸酸性磷酸酶5b(TRACP-5b)。视觉模拟评分和OSwestry残疾指数评分用于评估临床严重程度。结果 绝经后骨质疏松症组患者血清CCL3水平明显高于绝经后非骨质疏松症组[(40.9±15.1) pg/mL vs (24.2±8.7) pg/mL,P＜0.001]和对照组[(40.9±15.1) pg/mL vs (23.9±9.1) pg/mL,P＜0.001]。血清CCL3水平与全髋(r=-0.345,P=0.002)、股骨颈(r=-0.329,P=0.003)和腰椎L1-L4(r=-0.354,P =0.001)的骨密度呈负相关,与视觉模拟评分(r=0.413,P＜0.001)和OSwestry残疾指数(r=0.360,P＜0.001)呈正相关。此外,血清CCL3水平与肿瘤坏死因子-α(r=0.305,P=0.005)、白细胞介素-6(r=0.288,P=0.008)、CTX-1(r=0.371,P＜0.001)和TRACP-5b(r=0.317,P=0.004)密切相关。在调整了体重指数和年龄后,所有的相关性仍然显著。结论 CCL3可能是一种有用的生物标志物,可用于预测绝经后骨质疏松症的病情严重程度。     

铁死亡血清学标志物在绝经后骨质疏松症发病中的作用及预测模型构建

目的 探索铁死亡血清生物标志物谷胱甘肽过氧化酶4(GPX4)、谷胱甘肽(GSH)以及丙二醛(MDA)和绝经后骨质疏松症(postmenopausal osteoporosis, PMOP)发病的关系及对其的预测价值。方法 以80名绝经后女性作为研究对象，按照骨质疏松症诊断标准分为骨质疏松组(60例)和非骨质疏松组(20例)。比较两组受试者一般资料及血清GPX4、GSH、MDA水平；Spearman相关分析各变量和骨密度及各变量之间的相关性；随机森林算法评估各变量对PMOP发病的重要性；ROC曲线进一步肯定各变量对PMOP的预测效能。最后，构建PMOP预测模型。结果 两组受试者体质量指数、体重、身高相比无明显差异(P>0.05);非骨质疏松受试者腰椎骨密度、GPX4、GSH水平均比骨质疏松症组高，年龄、MDA值则比骨质疏松组低(P<0.05)。Spearman相关分析显示，随着GPX4水平(R=0.42,P<0.05)、GSH水平(R=0.43,P<0.05)升高，受试者骨质疏松程度越低；随着MDA水平(R=-0.30,P<0.05)升高，受试者骨质疏松程度...     

血清VIP水平与老年人群骨密度及肌肉减少症相关性研究

目的探索血管活性肠肽(vasoactive intestinal peptide,VIP)水平与老年人群骨密度和肌肉减少症相关性。方法受试者包括216名成年人(79名男性和137名女性;平均年龄73.5岁)接受全面体检。检测所有受试者骨骼肌指数(SMI)、腰椎(L1-L4)和股骨颈骨密度和步行速度,符合亚洲肌肉减少症工作组标准的受试者被分配到肌肉减少症组。仅肌肉量减少的受试者被分配到肌量减少组,其他受试者分配到正常组。Oswestry功能障碍指数(ODI)和腰痛视觉模拟评分(VAS)用于评估腰痛。同时检测血清VIP水平;对三组之间肌肉减少症决定因素如骨密度、VAS和VIP等数据进行统计学分析。结果12名受试者(5.5%)患有肌肉减少症。肌肉减少症组的平均ODI评分显著高于肌量减少组和正常组[分别为(25.2±12.3)%、(11.2±10.0)%和(11.9±12.3)%,P<0.05]。肌肉减少症组血清VIP水平显著低于肌量减少组和正常组(P<0.05)。肌肉减少症组的腰椎(L1-L4)和股骨颈骨密度和BMI显著低于其他组(P<0.05)。腰椎(L1-L4)和股骨颈骨密度及步行速度、ODI与血清VIP水平之间存在正相关(P<0.05)。结论老年人群中肌肉减少症及腰椎(L1-L4)和股骨颈骨密度、腰痛与血清VIP水平密切相关。     

绝经后骨质疏松利塞膦酸钠及钙尔奇D治疗临床观察

目的观察钙尔奇D片联合利塞膦酸钠治疗女性绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者的效果及对血清尿脱氧吡啶酚(deoxypyridinoline,DPD)、25羟维生素D[25-(OH) D]水平的影响。方法选取我院于2016年6月至2018年6月收治的120例PMOP患者,依据随机数字表法分为观察和对照两组,每组60例,对照组给予钙尔奇D片,而观察组给予钙尔奇D片联合塞膦酸钠。比较两组患者的股骨颈和腰椎的骨密度、疼痛视觉模拟量表(VAS)评分以及不同时间点血清DPD、25-(OH) D水平,统计分析两组不良反应发生情况。结果两组患者经治疗后VAS评分显著降低,其中观察组患者VAS评分在治疗后3、6、12个月的改善程度均优于对照组(P0.05)。两组患者治疗后右股骨颈、腰椎正位(L2-L4)以及Ward’s区骨密度均显著增加,其中观察组患者在治疗后第6、12个月的骨密度均显著高于对照组(P0.05)。两组患者治疗后血清DPD、BGP、NTX、BAP水平显著降低,而血清25-(OH) D水平显著增加,观察组患者在治疗12个月后的各指标血清水平均显著优于对照组(P0.05)。骨折事件主要为股骨颈骨折以及腰椎压缩性骨折,其中观察组骨折事件发生率显著低于对照组(P0.05)。结论钙尔奇D片联合利塞膦酸钠治疗PMOP疗效显著,可有效降低疼痛,改善改善骨质代谢和血清DPD、25-(OH) D水平,促进骨形成和提高骨密度,从而减少骨折风险。     

金天格胶囊对经皮球囊椎体后凸成形术后患者骨密度、骨代谢及生活质量的影响

目的观察骨质疏松椎体压缩性骨折患者,在经皮球囊椎体后凸成形术(percutaneous kyphoplasty,PKP)后服用金天格胶囊对骨密度、骨代谢及生活质量的改善情况。方法选取2016年5月至2019年1月在我院行PKP治疗的骨质疏松椎体压缩性骨折患者80例,根据治疗方法不同分为治疗组(n=40)与对照组(n=40);在术后1周治疗组口服金天格胶囊治疗,对照组口服钙尔奇D3片。在治疗前、治疗后6个月记录骨密度(腰椎、股骨颈)、血清骨钙素(OC)和血清Ⅰ型胶原C末端肽(S-CTX)评估骨密度和骨代谢改善情况;在治疗前及治疗后3、6个月记录健康调查简表(SF-36)、疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数评分(ODI)评估生活质量改善情况。结果对比治疗前,两组患者的骨密度、SF-36量表、VAS评分与ODI评分在6个月随访中均显著改善(P<0.05);治疗组的骨密度、SF-36量表、VAS评分和ODI评对比对照组改善更为显著(P<0.05);治疗组的OC水平升高,S-CTX水平降低,对照组OC与S-CTX水平较治疗前无明显差异(P>0.05)。结论PKP术后服用金天格胶囊可提升患者骨密度,调节骨代谢,进一步缓解腰背部疼痛,改善术后生活质量。     

绝经后妇女骨密度影响因素的相关性分析

目的 探讨沈阳地区绝经后妇女不同部位骨密度值与亚洲人骨质疏松自我筛查工具(OSTA)得分、体表面积(BS)、体重指数（BMI）的关系,判断OSTA评分与绝经后妇女髋关节骨折风险的相关性。方法 采用双能X线骨密度仪测定沈阳地区670例绝经后妇女的骨密度值( BMD),并与OSTA 得分、体表面积、体重指数( BMl)、绝经年限进行Pearson相关性回归分析。应用WHO骨折风险因子评估工具(FRAX)评估绝经后妇女髋关节骨折风险,采用线性图表及Pearson相关性回归分析比较OSTA评分与绝经后妇女髋关节骨折风险是否存在相关性。结果 骨密度与OSTA评分、体表面积、体重指数呈线性正相关,相关性由大到小分别为OSTA评分、体表面积、体重、身高、BMI、年龄、绝经期、肥胖度;骨密度与绝经年限呈线性正相关趋势;OSTA评分与髋关节骨折风险呈负相关。结论 OSTA得分能较好的反映出绝境后妇女骨密度减低的趋势及程度,同时也能预测绝经后妇女髋关节骨折风险的程度,在临床中应对OSTA评分较低患者应采取必要的相关性治疗及干预。     

重组人甲状旁腺素1-34治疗绝经后骨质疏松症的临床研究

目的观察重组人甲状旁腺素1-34(recombinant human parathyroid hormone 1-34)应用于绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者的临床疗效。方法筛选出68例绝经后骨质疏松症患者,所有患者入组后均口服元素钙500 mg/d和维生素D 200 U/d,连续服用26周后加用皮下注射重组人甲状旁腺素1-34(特立帕肽)20μg/d,再连续治疗26周,于应用特立帕肽治疗前及治疗后的13和26周测定腰椎(L_(1-4))和股骨近端骨密度(BMD),采静脉血测定血清骨钙素(OC)、碱性磷酸酶(AKP)水平,应用疼痛视觉模拟评分法(VAS评分)评价患者的疼痛程度,并记录不良反应情况。结果 68位患者均完成全疗程治疗。应用特立帕肽治疗13周时,腰椎L_(1-4)、股骨颈、大粗隆和股骨干骨密度改善不明显(P0.05),血清骨钙素和碱性磷酸酶较治疗前升高(P0.05),疼痛缓解明显(P0.05);治疗26周时,腰椎L_(1-4)和股骨颈骨密度较治疗前明显增高(P0.05),而大粗隆和股骨干骨密度改善不明显(P0.05),血清骨钙素和碱性磷酸酶呈持续升高趋势(P0.05),疼痛明显减轻(P0.05)。治疗期间不良反应的情况均较轻微,没有给予特殊处理即自行缓解。结论连续26周使用重组人甲状旁腺素1-34能有效地促进患者骨形成,缓解骨质疏松症患者疼痛症状,提高患者腰椎、股骨骨密度。     

绝经后妇女血清OPN水平与骨密度及骨转换水平的相关性研究

目的：研究绝经后女性血清骨桥蛋白（OPN）水平与骨密度（BMD）、骨标志物的关系,探索OPN在绝经后骨质疏松症（ PMOP）中的临床应用价值。方法对125名绝经后女性进行研究,双能X线骨密度仪测量腰1－4及左股骨颈BMD,测定血中I型原胶原N－端前肽（PINP）、β－胶原降解产物（β－CTX）、25羟维生素D、甲状旁腺素、OPN、骨钙素（OC）、钙（Ca）和磷（P）。结果①骨质疏松组血清OPN水平明显高于骨量减少和正常组（ F＝0．118,P＝0．000）;②血清OPN水平与BMD（腰1－4,左股骨颈）、血Ca显著负相关,与年龄、β－CTX、OC显著正相关（ P均＜0．05）;③多元线性回归分析结果表明,左股骨颈骨密度（B,－11．971;SE,2．383;标准系数,－0．402;P＝0．000）、血钙（B,－6．696;SE,2．383;标准系数,－0．225;P＝0．006）是OPN水平独立预测因子。结论高血清OPN水平与低BMD、高β－CTX水平及钙缺乏相关,该结果丰富了现有的临床证据,为防治PMOP提供了新的思路。     

绝经后妇女血清瘦素水平与骨代谢的关系

目的探讨绝经后妇女血清瘦素水平与骨代谢的关系.方法测定85例绝经妇女血清瘦素水平及体重指数、体脂量、甘油三脂和总胆固醇,用双能X线法测定股骨和腰椎的骨密度,并测定骨钙素及尿钙水平,分析瘦素与上述指标之间的相关性.结果用骨密度与瘦素及瘦素相关指标进行多元逐步回归分析,瘦素没有进入腰椎和股骨颈骨密度方程;瘦素与骨钙素及尿钙水平也均无相关.结论瘦素与绝经后妇女的骨代谢无直接关系.     

椎体骨折评估在绝经后女性骨质疏松诊断中的应用价值

目的研究利用双能X线骨密度仪扫描的脊柱影像进行椎体骨折评估在绝经后女性骨质疏松诊断中的应用价值。方法回顾499名年龄≥50岁的绝经后女性行骨密度检测同时行椎体侧位扫描,分析骨密度及椎体骨折评估(vertebral fracture assessment,VFA)的检测结果,收集研究对象的一般资料。结果对499名绝经后女性进行VFA检测结果分析:(1)椎体骨折诊断率提高了41.1%,骨质疏松诊断率提高了6.3%,严重骨质疏松诊断率提高了29.1%(P0.05);(2)当骨密度达到骨质疏松阈值时,椎体骨折率明显升高,较骨密度未达到骨质疏松阈值的椎体骨折发生率提高了29.2%(P0.05);(3)年龄增加、绝经年限延长的女性椎体骨折、骨质疏松、严重骨质疏松的患病率显著增加,骨量显著减少(P0.05);此外,体质量指数(body mass index,BMI)降低的绝经后女性骨量显著减少,骨质疏松的患病率显著增加(P0.05)。结论骨密度检测联合椎体骨折评估可以显著提高椎体骨折、骨质疏松、严重骨质疏松的诊断率;骨密度越低,年龄越大,绝经年限越长,椎体骨折的风险就越高;随年龄增长、绝经年限增加、BMI降低,骨密度减少,骨质疏松患病率增加。     

绝经后骨质疏松症生存质量的调查研究

目的对约经后骨质疏松症患的生存质量进行调查和评价。方法对４２１名社区绝经后妇女进行腰椎双能Ｘ线扫描测定骨密度,利用ＳＦ－３６生存质量调查量进行了生存质量调查。结果４２１名绝经后妇女中骨质疏松症的发病率为６０％。同时,骨质疏松症患生存质量低于非骨质疏松症患。结论绝经后骨质疏松症患的生存质量与正常人相比下降,生存质量的进一步的研究有可能引入骨质疏松症的诊断与疗产评价。     

A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication

BACKGROUND: The relationship between objective measurements and subjective symptoms of patients with spinal stenosis and the degree of narrowing of the spinal canal is not clear. The purpose of this study was to evaluate patients undergoing surgery for lumbar spinal stenosis and intermittent neurogenic claudication with functional testing, quantitative imaging, and patient self-assessment. METHODS: Sixty-two patients with lumbar spinal stenosis and neurogenic claudication were prospectively enrolled in the study. All underwent preoperative magnetic resonance imaging and/or computed tomography myelography, and all were treated with decompressive surgery and were followed for a minimum of two years. The evaluation included treadmill and bicycle exercise tests as well as patient self-assessment with use of the Oswestry Disability Index and a visual analog pain scale preoperatively and postoperatively. RESULTS: Preoperatively fifty-eight (94%) of the patients had a positive result (provocation of symptoms) on the treadmill test and twenty-seven (44%) had a positive result on the bicycle test, whereas postoperatively six and twelve, respectively, had positive results. The mean preoperative scores on the Oswestry Disability Index and visual analog pain scale were 58.4 and 7.1, respectively. Postoperatively, these scores decreased to 21.1 and 2.3, respectively, and both decreases were significant (p < 0.05). Forty-seven (76%) of the patients were seen to have central stenosis on the preoperative imaging studies; forty-one of them had a cross-sectional area of the dural tube of <100 mm (2) at at least one level and twelve had a cross-sectional area of <100 mm (2) at at least two levels. CONCLUSIONS: A positive treadmill test was consistent with a diagnosis of spinal stenosis and neurogenic claudication in >90% of the patients preoperatively. Following surgical decompression of the lumbar spinal stenosis, more functional improvement was demonstrated by the treadmill test than by the bicycle test. The scores on the Oswestry Disability Index and visual analog pain scale also improved postoperatively. The severity of central canal narrowing at a single level does not appear to limit the postoperative improvement in either functional ability or patient self-assessment. Patients with multilevel central stenosis were, on the average, older and walked a shorter distance preoperatively and postoperatively, although the improvement in their postoperative self-assessment scores was similar to that of patients with single-level stenosis.     

Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care setting.

STUDY DESIGN: A randomized trial designed to compare interferential therapy with motorized lumbar traction and massage management for low back pain in a primary care setting. OBJECTIVE: To measure and compare the outcome of interferential therapy and management by motorized lumbar traction and massage. SUMMARY OF BACKGROUND DATA: Management of low back pain by interferential therapy and motorized lumbar traction and massage is common in Germany. No reports of previous randomized trials for the outcome from interferential therapy were found. METHODS: Consenting patients were randomly assigned into one of two groups. A pretreatment interview was performed by the patient using a computer-based questionnaire. It also incorporated the Oswestry Disability Index and a pain visual analog scale. Management consisted of six sessions over a 2- to 3-week period. Oswestry Disability Indexes and pain visual analog scale scores also were obtained immediately after and at 3 months after treatment. RESULTS: A total of 152 patients were recruited. The two treatment groups had similar demographic and clinical baseline characteristics. The mean Oswestry Disability Index before treatment was 30 for both groups (n = 147). After treatment, this had dropped to 25, and, at 3 months, were 21 (interferential therapy) and 22 (motorized lumbar traction and massage). The mean pain visual analog scale score before treatment was 50 (interferential therapy) and 51 (motorized lumbar traction and massage). This had dropped, respectively, to 46 and 44 after treatment and to 42 and 39 at 3 months. CONCLUSIONS: This study shows a progressive fall in Oswestry Disability Index and pain visual analog scale scores in patients with low back pain treated with either-interferential therapy or motorized lumbar traction and massage. There was no difference in the improvement between the two groups at the end of treatment. Although there is evidence from several trials that traction alone is ineffective in the management of low back pain, this study could not exclude some effect from the concomitant massage.     

Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy.

STUDY DESIGN: A prospective double-blind randomized controlled trial was performed. OBJECTIVE: To assess the efficacy of percutaneous radiofrequency articular facet denervation for low back pain. SUMMARY OF BACKGROUND DATA: Uncontrolled observational studies in patients with low back pain have reported some benefits from the use of facet joint radiofrequency denervation. Because the efficacy of percutaneous radiofrequency had not been clearly shown in previous studies, a randomized controlled trial was conducted to assess the efficacy of the technique for improving functional disabilities and reduce pain. METHODS: For this study, 70 patients with low back pain lasting of more than 3 months duration and a good response after intraarticular facet injections under fluoroscopy were assigned randomly to receive percutaneous radiofrequency articular facet denervation under fluoroscopic guidance or the same procedure without effective denervation (sham therapy). The primary outcomes were functional disabilities, as assessed by the Oswestry and Roland-Morris scales, and pain indicated on a visual analog scale. Secondary outcomes included spinal mobility and strength. RESULTS: At 4 weeks, the Roland-Morris score had improved by a mean of 8.4% in the neurotomy group and 2.2% in the placebo group, showing a treatment effect of 6.2% (P = 0.05). At 4 weeks, no significant treatment effect was reflected in the Oswestry score (0.6% change) or the visual analog pain score (4.2% change). At 12 weeks, neither functional disability, as assessed by the Roland-Morris scale (2.6% change) and Oswestry scale (1.9% change), nor the pain level, as assessed by the visual analog scale (-7.6% change), showed any treatment effect. CONCLUSIONS: Although radiofrequency facet joint denervation may provide some short-term improvement in functional disability among patients with chronic low back pain, the efficacy of this treatment has not been established.     

Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty

BACKGROUND: There has been an increasing number of reports regarding the benefits of vertebroplasty for the treatment of vertebral compression fractures. In this investigation, validated outcome tools were utilized to document the impact of vertebroplasty on pain and function. METHODS: Fifty patients were recruited at a tertiary university hospital. Patients had been treated for intractable pain due to osteoporotic compression fracture(s) for at least four weeks. The vertebroplasty procedures were performed by a radiologist. The subjects were followed prospectively for one year and received conservative treatment in conjunction with the vertebroplasty. Validated outcome tools, including a visual analog scale, the Oswestry scale, and the Roland-Morris functional activity questionnaire, were used to evaluate changes in pain and functional capabilities. RESULTS: Fifty patients, thirty-one women and nineteen men (mean age, 68.6 years), were followed prospectively for one year. One hundred and three fractures (fifty-nine thoracic and forty-four lumbar) were treated. The visual analog scale showed the greatest improvement between the baseline score (mean, 7.76) and the score at one month (mean, 2.9), and the score remained improved at one year (mean, 2.9). The Oswestry and Roland-Morris questionnaires demonstrated significant (p < 0.0001) functional improvement between the baseline and one-month scores. With the numbers available, there were no significant changes in any variable from one month to one year (p > 0.05). CONCLUSIONS: Vertebroplasty is an effective treatment for patients with intractable pain due to osteoporotic vertebral compression fractures. Improvement in pain scores and functional capabilities that were found at one month were maintained at one year.     

Transforaminal lumbar interbody fusion: a retrospective study of long-term pain relief and fusion outcomes

No long-term studies exist on the effectiveness of transforaminal lumbar interbody fusion. This study sought to determine postoperative pain, disability, and fusion status of transforaminal lumbar interbody fusion patients after > or = 4 years to establish long-term outcomes. A retrospective analysis of 42 patients with minimum 4-year follow-up was conducted. Patients completed visual analog pain scale (VAS) and Oswestry functional capacity evaluation pre- and postoperatively. Statistically significant improvement was noted in VAS and Oswestry functional capacity evaluation scores. Transforaminal lumbar interbody fusion is effective in alleviating intractable back pain over an extended time period. Solid radiographic fusion is unnecessary for clinically successful outcomes.