骨质疏松与骨诱导生长因子

随着人类平均寿命的延长,人口老龄化日益严重,由老年人生理老化引起的疾病,给家庭和社会带来了一系列社会经济问题.骨质疏松症(Osteoporosis)以其发病普遍及后果严重而受到广泛关注.骨质疏松症以骨量减少和骨折易感性增加为特征,一旦发生骨折,临床治疗非常困难,并发症发生率高,严重危害老年人的身体健康,是老年人致死、致残的重要原因.目前国内外学者多注重骨质疏松症发病原因及预防措施的研究,而对骨质疏松症的直接不良后果-骨质疏松性骨折的研究较少.……     

骨质疏松与骨诱导生长因子

随着人类平均寿命的延长,人口老龄化日益严重,由老年人生理老化引起的疾病,给家庭和社会带来了一系列社会经济问题.骨质疏松症(Osteoporosis)以其发病普遍及后果严重而受到广泛关注.骨质疏松症以骨量减少和骨折易感性增加为特征,一旦发生骨折,临床治疗非常困难,并发症发生率高,严重危害老年人的身体健康,是老年人致死、致残的重要原因.目前国内外学者多注重骨质疏松症发病原因及预防措施的研究,而对骨质疏松症的直接不良后果-骨质疏松性骨折的研究较少.     

骨质疏松骨折护理体会

伴随着人口老龄化,骨质疏松症发病率越来越高,而骨质疏松症导致骨密度和骨质量下降,骨强度减低,在日常活动中受到轻微暴力即可发生骨折,是骨质疏松最严重后果[1].具有致残率、致死率高,严重威胁老年人生命健康,且其治疗和康复复杂繁重棘手,因此重视加强骨质疏松骨折病人心里干预、基础护理、并发症的预防和护理是骨质疏松骨折治疗和康复的重要一环.     

锝[~(99)Tc]亚甲基二膦酸盐治疗骨质疏松症的研究进展

骨质疏松症是一种全身性代谢性骨骼疾病,临床主要表现为骨骼疼痛、骨密度降低和骨折危险性增加,严重影响患者的生活质量。现阶段我国老年人中骨质疏松患病比例超过50%以上,其中骨折发生率接近1/3。双膦酸盐是目前治疗骨质疏松的主要药物之一,因其具有强有力的破骨细胞抑制作用,临床应用广泛,而锝[~(99)Tc]亚甲基二膦酸盐(technetium methylenediphosphonate,~(99)Tc-MDP)注射液,商品名云克,是我国自主研制成功的新药,其主要成分是锝经氯化亚锡还原后与亚甲基双膦酸盐形成的螯合物,具有清除人体自由基、保护超氧化物歧化酶活力、抑制病理复化物的产生、抑制白细胞游走、降低胶原酶对软骨组织的破坏并修复破骨作用。可抑制骨吸收、改善骨质量、提高各个部位的骨密度、减低骨折风险,促进成骨,缓解骨痛。近年来已广泛应用于骨质疏松症的治疗,并已取得了较好的效果,且使用安全,无明显的副作用。本文对近年来云克应用于骨质疏松症的动物实验、临床疗效及安全性研究进行综述。     

锝[99Tc]亚甲基双膦酸盐治疗骨质疏松症的研究进展

骨质疏松症是一种全身性代谢性骨骼疾病, 临床主要表现为骨骼疼痛、骨密度降低和骨折危险性增加，严重影响患者的生活质量。现阶段我国老年人中骨质疏松患病比例超过50% 以上，其中骨折发生率接近1/3。双膦酸盐是目前治疗骨质疏松的主要药物之一，因其具有强有力的破骨细胞抑制作用，临床应用广泛，而锝（99 Tc）亚甲基双膦酸盐( technetium methylenediphosphonate，99Tc-MDP) 注射液，商品名云克，是我国自主研制成功的新药，其主要成分是锝经氯化亚锡还原后与亚甲基双膦酸盐形成的螯合物，具有清除人体自由基、保护超氧化物歧化酶活力、抑制病理复化物的产生、抑制白细胞游走、降低胶原酶对软骨组织的破坏并修复破骨作用。可抑制骨吸收、改善骨质量、提高各个部位的骨密度、减低骨折风险，促进成骨，缓解骨痛。近年来已广泛应用于骨质疏松症的治疗，并已取得了较好的效果，且使用安全，无明显的副作用。本文对近年来云克应用于骨质疏松症的动物实验、临床疗效及安全性研究进行综述。     

椎体成形术治疗老年胸腰椎骨质疏松性骨折的研究进展

正骨质疏松症可导致骨量减少,骨强度下降,轻微的外力就可引起老年人四肢及胸腰椎骨折[1],给社会及家庭带来了巨大的经济压力。随着老龄化人口比例的进一步扩大,我国骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的发病率日益增加。临床上骨质疏松性脊柱骨折是老年常见的骨折之一,约占骨质疏松性骨折的45%[2-4]。经皮椎体成形术(percutaneous vertebroplasty,PVP)已广泛应用于老年胸腰椎骨质疏松性骨折的治疗中,     

社区骨质疏松症老人预防跌倒研究进展

随着人口老年化问题的出现，老年人骨质疏松逐渐受到社会各界的关注，目前我国骨质疏松症病人约有8400万，骨质疏松症并发骨折的发病率为9.6%,并有逐年增高的趋势，有研究指出应将防止骨折的焦点从预防骨质疏松转为防止跌倒。本文试从体育锻炼、居家环境、健康教育等方面来阐述骨质疏松症老年人预防跌倒的措施。其目的是为了预防社区骨质疏松症老人跌倒后带来的一 系列并发症，提高老年人生活质量。     

骨质疏松性椎体压缩性骨折诊疗现状及其对策

骨折是骨质疏松症的严重后果,骨质疏松性椎体压缩性骨折是其最常见的骨折。相关诊疗工作已广泛开展,但临床工作的执行尚欠规范。本文就骨质疏松性椎体压缩性骨折的诊疗现状及其对策进行概述,以期为临床规范化个体化治疗、降低相关并发症的风险提供一定帮助。     

老年骨质疏松致髋部骨折的综合治疗

目的观察老年髋部骨质疏松性骨折综合治疗的状况。方法回顾分析2002年1月至2007年4月收治的321例骨质疏松引起的髋部骨折患者,采用综合治疗方法包括人工关节置换手术、骨折复位内固定、药物以及功能锻炼等综合治疗。结果中度骨质疏松101例,轻度36例,症状均有较明显的好转,重度184例未继续加重。手术组患者住院时间17-33 d,平均22 d,并发症少,死亡2例;非手术组至少卧床3个月,疗效差,并发症多,死亡5例。结论老年髋部骨质疏松骨折的治疗,除需对局部骨折治疗以外,同时应对原发骨质疏松症进行综合治疗可能提高骨折愈合力,缩短愈合时间,改善临床症状,提高老年人的生活质量。     

椎体成形术治疗骨质疏松性椎体压缩骨折的并发症及其防治策略

随着我国人口老龄化趋势的加剧,骨质疏松症患者日渐增多,是引起老年人腰腿痛的主要原因,因骨质疏松造成的椎体压缩性骨折也是骨科门诊常见的脊柱疾患,严重影响着患者的生活质量,椎体成形术是目前治疗老年骨质疏松性椎体压缩性骨折的主要技术,能起到＂立竿见影＂的效果,而术中及术后引发的并发症也是影响疗效的关键因素,本文就其并发症及防治策略做一综述。     

Quality of life in patients with osteoporosis

Complaints regarding, and morbidity of, osteoporosis are caused by fractures which are associated with pain and decrease of physical function, social function, and well-being. These are aspects of quality of life. Health-related quality of life covers physical, mental, and social well-being. Quality of life may be measured for evaluation of treatment effects in clinical trials, for the assessment of the burden of the disease of osteoporosis, and for estimates of the cost-effectiveness of different treatment scenarios in health care policy. Quality of life has been measured in patients with osteoporosis with generic questionnaires such as SF-36 and EQ-5D, which can be used in many diseases, or with one of the six available osteoporotic-specific questionnaires, e.g., Qualeffo-41 or OPAQ. Every questionnaire has to be validated to assess psychometric properties and discrimination power between patients with osteoporosis and control subjects. The value attached to specific health states (utility) can be assessed with some generic instruments or by systematic questioning of the patient, e.g., the time-trade-off method. This results in one value for health status ranging from 0 (death) to 1 (perfect health). Utility values can be used to calculate loss of quality-adjusted life years (QALY). Most data have been obtained in patients with prevalent vertebral fractures. Scores of specific and generic questionnaires showed significant loss of quality of life with prevalent vertebral fractures. In addition, studies with Qualeffo-41 and OPAQ showed a deteriorating quality of life with increasing number of vertebral fractures. Lumbar fractures had more impact on quality of life than thoracic fractures. Incident vertebral fractures were also associated with a decrease of quality of life especially in the physical function domain. This applied to clinical incident vertebral fractures as well as to subclinical fractures to a lesser degree. Loss of quality of life following hip fracture has been documented with generic and osteoporosis-specific questionnaires. A considerable loss was observed in the 1st year with some improvement in the 2nd year, but not to baseline values. Quality of life depended on comorbidity, mobility, activities of daily life (ADL)–independence, and fracture complaints. Utility loss has been observed following hip fracture, especially disabling hip fracture, hip and vertebral fracture combined, or multiple vertebral fractures. Utility following osteoporotic fractures has been valued by patients, the healthy elderly, and panels of experts. The healthy elderly gave the worse quality-of-life scores (lower utility) to various hip fractures than patients with hip fractures themselves. In conclusion, suitable instruments exist for measuring quality of life in patients with osteoporotic fractures. These instruments are useful for clinical trials and for assessment of the burden of disease.     

糖尿病性骨质疏松症的中医研究进展

骨质疏松症作为糖尿病在骨骼系统的慢性并发症,其发病率与糖尿病的发病率均在逐年上升,严重者可导致骨折,影响患者的生活质量。目前现代医学在治疗骨质疏松方面治疗效果不确切,不良反应多,价格昂贵。本病属于中医"消渴"合并"骨痿"的范畴,中医治疗逐渐受到重视,近年来在中医中药治疗糖尿病性骨质疏松方面展开许多临床和实验研究,疗效确切。现将从病因病机、辨证分型、临床研究和实验研究4个方面对近年来相关的研究进展进行综述。     

Current Aspects of Fragility Fracture Repair

Due to the demographic developments worldwide, fragility fractures represent an increasing problem for the public health system. The risk of developing osteoporosis increases with age and is relatively higher in women and in the Caucasian population. The stability of bone is reduced because of accentuation of the normal loss of bone mass in ageing, leading to an increased susceptibility to fracture with an increased rate of complications after surgical stabilization. Due to this, the orthopedic surgeon has to assess the quality of the bone during preoperative planning and select the implants and postoperative care accordingly to achieve the best. Over the last 10 years fixed locking implants have been introduced into clinical practice. These represent a new type of angle stable fixation devices that address the mechanical instability between bone and implant. The novel problems associated with this device are due to higher cut-out rates when the bone structure is altered and mass is reduced. The developments in joint replacement have also resulted in longer standing times and lower complication rates with immediate fullweight-bearing after implantation. However, to date, little is known about the mechanisms of fracture healing in osteoporosis or fragility fractures. One future approach may be in supporting biological fracture healing by regenerative therapies using growth hormones and/or (stem) cells. The most frequent initial clinical symptom of osteoporosis is a fracture without a relevant trauma. At this stage, the trauma surgeon should initiate diagnostic procedures, treatment of osteoporosis and tertiary prevention according to the European guidelines. Ultimately, all female patients older than 50 years and all male patients older than 60 years with fractures should be assessed and treated for bone quality. Orthogeriatric specialists or interdisciplinary orthogeriatric teams should initiate a specific surgical treatment followed by early rehabilitation in order to allow the elderly patient to return to daily living as soon as possible. The authors are members of the “Working Group Osteology” of the German Society of Trauma Surgeons.     

中药淫羊藿治疗骨质疏松症的研究进展

骨质疏松症是以骨的微观结构破坏为特征,易于导致骨折发生的代谢性骨病,随着近年来老龄化的发展和发病率的上升,骨质疏松症已经成为严重影响老年人生活质量的社会问题。骨质疏松在中医称为"骨痹"、"骨萎",利用中药治疗骨质疏松历史悠久,近年来随着骨质疏松发生的机理逐渐明了,诸多研究者发现中药治疗骨质疏松的潜力巨大,且临床使用疗效良好。因此本文从古典医籍中治疗骨质疏松的经典中药淫羊藿为入手点,通过文献筛选来总结近年来淫羊藿治疗骨质疏松症的基础与临床的研究成果,旨在为临床使用中药治疗骨质疏松提供思路。     

The management of ankle fractures in the elderly

In recent years, the incidence and severity of ankle fractures in the elderly population have increased. Although surgical fixation has gained wide acceptance for younger ankle fracture patients, controversy exists within the orthopaedic community with respect to the optimal way to manage these fractures in the geriatric patient population. Although some authors categorise ankle fractures in the elderly as fragility fractures associated with osteoporosis, it appears that risk factors such as increased weight, poly-pharmacy and propensity for falls play larger roles than poor bone quality. The presence of osteoporosis may increase the level of difficulty involved with the surgical management of these patients, leading some authors to alter their standard operative technique. Early studies cited high complication rates and poor outcome following operative intervention, however, more recent investigations have demonstrated successful functional outcomes following surgical management and appropriate postoperative rehabilitation. Based on the current evidence, the literature appears to support surgical fixation of displaced ankle fractures in the elderly patient population.     

骨质疏松性骨折风险预测工具的研究现状

骨质疏松性骨折(osteoporotic fractures,OF)是骨质疏松(osteoporosis,OP)患者最严重的并发症,对生活质量影响极大且致死率高;骨密度结合临床风险因子的OF预测工具可以有效评估骨折发生的风险,有助于OF的早预防、早治疗。本文主要阐述目前使用最多的三种OF风险评估工具:FRAX、QFracture和Garvan nomogram,通过查阅近些年发表的文献收集相关数据,从风险因子、适用人群、预测能力等方面总结其优缺点,以便为临床医生工作和患者自我管理提供参考。     

消化系统疾病并发骨质疏松症与肠道菌群的关系探讨

随着全球人口老龄化,骨质疏松症的发病率逐年增高,在我国,50岁以上人群中骨质疏松症总患病率达15.7%,预计到2020年,我国骨质疏松和低骨量患者将增加至2.8亿,骨质疏松症已经成为影响我国老年人口生活质量的重大公共卫生问题。消化系统疾病并发骨质疏松症,其发生机制较复杂,目前仍未彻底阐明,常常并发骨质疏松症的消化系统疾病有胃切除术后、慢性肝脏疾病、炎症性肠病等。研究发现,消化系统疾病伴随着肠道菌群的失调,而肠道菌群与骨质疏松症从发病、发展及治疗等方面关系密切,越来越多的研究表明肠道菌群失衡与多种代谢性疾病的发生发展紧密相关,因此,骨质疏松症作为一种全身性骨代谢疾病,其与肠道菌群失衡之间的关系近年来逐渐受到关注。从肠道菌群的视角探讨消化系统疾病并发骨质疏松症的机制,对于开拓该类合并症的防治思路具有启示意义。     

Adverse outcomes of osteoporotic fractures in the general population.

Osteoporotic fractures exact a terrible toll on the population with respect to morbidity and cost, and to a lesser extent mortality, which will increase dramatically with the growing elderly population. Attention has focused on the 12-20% excess deaths after hip fracture, but most are caused by underlying medical conditions unrelated to osteoporosis. More important is fracture-related morbidity. An estimated 10% of patients are disabled by hip fracture, and 19% require institutionalization, accounting for almost 140,000 nursing home admissions annually in this country. Distal forearm and vertebral fractures less commonly result in nursing home placement, but about 10% of postmenopausal women have vertebral deformities that cause chronic pain, and a substantial minority have poor function after forearm fracture. These fractures interfere greatly with the activities of daily living, and all of them can have a substantial negative impact on quality of life. Annual expenditures for osteoporotic fracture care in the United States (dollar 17.5 million in 2002 dollars) are dominated by hip fracture treatment, but vertebral fractures, distal forearm fractures, and importantly, the other fractures related to osteoporosis contribute one-third of the total. Although all fracture patients are at increased risk of future fractures, few of them are currently treated for osteoporosis, and only a subset (i.e., those with vertebral fractures) are considered candidates for many clinical trials. Eligibility criteria should be expanded and fracture end-points generalized to acknowledge the overall burden of osteoporotic fractures.     

FRAX在国内骨质疏松性骨折风险评估中的应用进展

骨质疏松性骨折是骨质疏松症最常见和最严重的并发症。骨质疏松患者一旦发生骨折,严重影响其生活质量,可致残或致死,而由此产生的治疗和护理费用给家庭及社会带来巨大的负担,因此进行骨折风险评估、预防骨质疏松性骨折显得尤为重要。WHO推荐FRAX作为骨折风险的预测工具,国外对此已有诸多报道,而国内使用FRAX评估骨折风险的研究尚处于起步阶段,相关报道仍较少。本文就FRAX在国内各类疾病患者、不同地区的应用现状作一综述,旨在探讨FRAX对国人的适用性,预测未来骨折风险,降低骨折发生率、提高生活质量。