骨质疏松症和激素补充治疗

骨质疏松症是一种全身性的骨代谢疾病 ,以骨量减少、骨的微结构退化、骨的脆性增加 ,易于发生骨折为特征 ,并受多种因素影响的疾病。在美国约有 2 5 0 0万骨质疏松症患者 ,每年约有 15 0万患者发生骨折 ,约 2 0 %的髋部骨折患者在 1年内并发肺栓塞、肺炎等并发症而死亡。半数髋部骨折的存活者将永久丧失独立生活能力。用于骨质疏松性骨折的费用耗资目前每年已达 130亿美元 ,其中 2 3的费用可归因于髋部骨折[1 3] 。在我国骨质疏松症的发病率虽无确切的报道 ,但从上海朱汉民的调查结果以Ｔ ｓｃｏｒｅ - 2 0为标准(ＤＥＸＡ)男性为 13 4 %…     

妊娠和哺乳相关的骨质疏松症病例分享

妊娠和哺乳相关的骨质疏松症(pregnancy and lactation-associated osteoporosis, PLO)是一种罕见的临床特殊骨质疏松症,大多数病例出现在初产妇的妊娠晚期或产后早期,但是也会发生于经产妇中。PLO患者主要表现为在妊娠晚期以及产后初期严重的下背部疼痛、身高下降和脆性骨折,尤其是椎骨骨折。迄今为止,全球报道的PLO患者患病率仅有120余例。目前尚缺乏PLO治疗的指南与共识,各报告病例中指出双膦酸盐、钙和维生素D的补充是治疗PLO的一线疗法,此外特立帕肽、雷奈酸锶、地舒单抗也被证明有助于增加骨密度(bone density, BMD)。本文通过回顾分析两例PLO患者的临床资料,并对相关文献进行复习,以提高对PLO疾病的认识。     

应用FRAX筛查骨质疏松高危人群的方法研究

目的应用骨折风险评估工具(FRAX)预测不同骨质疏松性骨折危险因子及股骨颈骨密度(BMD)情况下10年骨折风险性的差异,探讨筛查骨质疏松高危人群的方法。方法应用FRAX的中国大陆子模型软件,综合年龄、性别、体重指数,计算单一危险因子或多重危险因子在联合或不联合BMD的条件下预测骨折风险性。结果随着BMD下降、骨折危险因子增多,10年骨质疏松性骨折风险增大。不同骨折危险因子和BMD配对时骨折风险性不同,当BMD未达骨质疏松诊断标准而合并部分危险因子时的骨折风险性大于BMD的T值达-2.5SD但无危险因子时的骨折风险性。结论 FRAX模型使原来单凭BMD转向综合各类危险因子评估长期骨质疏松性骨折风险性,在无条件行BMD检测地区可用以筛查骨质疏松高危人群。     

广州地区骨质疏松症合并髋部骨折骨密度阈值的研讨

目的 了解广州地区骨质疏松髋部骨折的骨密度阈值为预防髋部骨折提供有用的数据和措施。方法 调查和分析133例年龄在65岁以上，受伤后两周内入院治疗的男女性不同类型的髋部骨折患者的骨密度情况，分析及提出髋部骨折的骨密度阈值。结果 无论何种类型的股骨颈骨折男性的骨密度均比女性高，差异有显著性，虽然男性股骨颈骨折平均BMD≥-2.31SD；但其中73％病例有1个部位骨密度≤-2.5SD。女性股骨颈骨折和男，女性粗隆间骨折髋部骨量损失相近似，都明显低于男性股骨颈骨折。结论 股骨颈骨折的类型以及粗隆间骨折Garden分型与骨量无关；外伤后女性发生股骨颈骨折或粗隆间骨折与骨量无关。男性发生粗隆间骨折与骨量丢失更多有关。男女性骨质疏松髋部骨折都可以用骨密度减低2．5SD作为骨折的阈值。     

绝经后骨质疏松症合并四肢骨折临床初探

目的 :研究绝经后骨质疏松症与四肢骨折的关系 ,为防治绝经后四肢骨质疏松性骨折提供有用的数据和预防措施。方法 :测量绝经后骨质疏松症患者骨密度值和雌二醇水平 ,统计近 8年来收集的 978例绝经后四肢骨质疏松性骨折病例的年龄、骨折部位和致伤原因的分布规律及其与骨密度和雌二醇的相关性。结果 :年龄与骨密度、雌二醇均呈显著负相关 ,骨密度与雌二醇呈显著正相关 (P <0 .0 1) ;绝经后四肢骨质疏松性骨折患者随着年龄的增加发病率也增加 ;跌倒是绝经后四肢骨质疏松性骨折的主要原因 ;骨折组与非骨折组骨密度、雌二醇比较 ,差异有显著性 (P <0 .0 1)。结论 :骨密度值和雌二醇水平下降是绝经后四肢骨质疏松性骨折重要的内在因素 ,但外在因素也不可忽视。     

降钙素对骨质疏松症治疗的临床观察

目的 研究降钙素在骨质疏松症（OP）治疗中对骨密度（BMD）的作用。方法 198例根据自愿选择分为钙剂组92例，降钙素＋钙剂组102例，其中各组按疗程分为3个月和6个月两个亚组；钙剂组：每日口服元素钙600mg，维生素D125U。降钙素＋钙剂组：每日口服元素钙600mg，维生素D125U；鲑降钙素50IU（商品名密钙息，北京诺华制药有限公司），肌肉注射，每d1次，连续14d，接着隔日1次，连续14次，以后为每周2次直至完成疗程。治疗前及疗程结束后，采用双能X线骨密度仪测定前后位k。腰椎及非优势侧（左）股骨颈骨密度。结果 降钙素＋钙剂组缓解疼痛快而有效。降钙素＋钙剂组腰椎和股骨颈骨密度在3个月和6个月治疗后均有显著提高，6个月组骨密度提高大3个月组（P〈0．01），腰椎疗效优于股骨颈。结论 降钙素治疗骨质疏松症有明显疗效，选择适当的长疗程患者受益更大。     

重组人甲状旁腺激素（1-34）和依降钙素治疗原发性骨质疏松症的随机对照研究

目的评价重组人甲状旁腺激素(1-34)[rhPTH(1-34)]治疗原发性骨质疏松症(OP)的疗效和安全性,并与依降钙素进行对比。方法 60例原发性OP患者按3:1被随机分入rhPTH(1-34)组(PTH组)和依降钙素组(CT组)。PTH组予rhPTH(1-34)20μg每日1次皮下注射,连续用药18月。CT组予益钙宁20U每周1次肌肉注射,连续用药12月。受试前检测腰2-4椎体(L2-4)和股骨颈骨密度(BMD)、血钙、血磷、尿钙、血清骨特异性碱性磷酸酶(BSAP)、尿Ⅰ型胶原交基C端肽(CTX-I),治疗后6、12、18月复查上述指标。结果与基线时比较,PTH组L2-4BMD在治疗6、12、18月时显著升高,股骨颈BMD在18月时显著升高,BSAP在6、12月时均显著升高,CTX-I校正值在6、12、18月时均显著升高;CT组L2-4BMD在治疗12月前升高,股骨颈BMD在12、18月时升高,BSAP12、18月时均显著下降,CTX-I校正值治疗前后无统计学差异。两组比较,PTH组患者在6、12月和18月时L2-4的BMD增长值和增长率均高于CT组。但CT组在治疗12月时股骨颈BMD增长值高于PTH组,不良反应:两组差异无统计学意义;PTH组有一过性高钙血症。结论 rhPTH(1-34)治疗原发性OP安全有效,对改善椎体BMD起效时间、增长速度和增长幅度均优于依降钙素,但改善股骨颈BMD较依降钙素起效更慢,增长幅度更小。     

锻炼配合抗骨吸收剂治疗绝经后骨质疏松症的临床研究

目的 探讨身体锻炼配合抗骨吸收剂在治疗绝经后骨质疏松症中的作用。方法 对照、动态检查腰椎、左右髋部骨密度（BMD）变化率及四肢和脊柱骨折发生率。结果 主动进行身体运动和缺乏运动的妇女BMD均显升高，尤以新近运动1年内升高最明显，达6．76％－9．79％（P＜0．05），1年后常年运动组、新近运动组和缺乏运动组的BMD增长率无显意义的差别（P＜0．05）；常年运动组和新近运动组的第2年骨折率低于缺乏运动的病人。结论 身体锻炼配合抗骨吸收剂治疗绝经后骨质疏松症时，以新近运动BMD增长最快，常年运动组骨折率最低。     

重组人甲状旁腺激素1-34治疗绝经后骨质疏松症疗效的临床观察

绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)属于原发性骨质疏松的一种,是一种全身性骨代谢疾病,一旦发生骨折,就会给家庭和社会造成极大的负担.目前用于治疗PMOP的药物大多主要通过抑制骨吸收来提高骨密度(bone mineral density,BMD),而甲状旁腺激素(parathyroid hormone,PTH)却是通过促进骨形成来提高BMD,临床和试验研究证实,单独小剂量间断给药能提高BMD、改善骨质量、降低骨折的发生率;联合雌激素、雌激素受体调节剂、降钙素、膦酸盐同样能增加腰椎及全髋骨密度、降低骨折发生率.本文着重介绍重组人甲状旁腺激素(1-34)及其联合用药对PMOP的临床疗效.     

甲状旁腺激素(1-34)对空心钉治疗老年股骨颈骨折合并骨质疏松症的疗效影响

目的甲状旁腺激素(1-34)对空心钉治疗老年股骨颈骨折合并骨质疏松症疗效的观察及分析,为老年股骨颈骨折合并骨质疏松寻找到安全可靠,更具有良好疗效的治疗方案。方法 2010年1月至2016年1月间收治的老年股骨颈骨折合并骨质疏松患者78例,采用随机数字表法将其分为治疗组和对照组,每组39例,两组患者均接受空心钉治疗。治疗患者术后加用甲状旁腺激素治疗,比较两组患者治疗后患者视觉模拟痛疼评分(VAS)、髋关节Harris功能评分、骨折愈合时间及股骨颈及腰椎的骨密度改变。结果术后1、3、6个月两组患者VAS评分均明显降低,且治疗组患者评分明显低于对照组(P0.05);术后3、6个月两组患者的Harris评分均明显上升,且治疗组患者评分明显高于对照组(P0.05);治疗组骨折愈合的时间明显少于对照组(P0.05);术后3、6个月两组患者股骨颈及腰椎的骨密度,治疗组患者骨密度较术前显著改善(P0.05),而对照组治疗前后上述指标无明显变化(P0.05)。结论甲状旁腺激素对空心钉治疗老年股骨颈骨折合并骨质疏松症是一种安全、疗效更好的方法。     

Our approach to non-ablative treatment of photoaging

BACKGROUND AND OBJECTIVES: Many laser, light and energy emitting devices are utilized for skin rejuvenation. STUDY DESIGN/MATERIALS AND METHODS: The clinical approach to multiple problems of photoaging are discussed and an algorithm for approach by problem is presented. RESULTS: Clinical use of various modalities such as LED photomodulation, intense pulsed light, pulsed dye laser, KTP laser, radiofrequency and fractional resurfacing are presented with successful parameters, developed over several years, utilized on a daily basis in a busy cosmetic dermatology clinic. CONCLUSIONS: Significant improvement in the appearance of signs and symptoms of photoaging, including telangiectasias, mottled pigmentation, irregular surface texture, wrinkling and skin sagging can achieved by relatively non-invasive means.     

Our preferred surgical approach to cicatricial cryptotia

Background

Adhesions between the auricle and retroauricular cranial wall and mastoid occur after burns to this area due to cicatricial contracture, leading to the distortion of the otocranial angle and obscuring the remnant auricle in the scar. A definition of cicatricial cryptotia was devised to describe the ear deformity after burn by the authors, and a novel surgical approach to cicatricial cryptotia was employed to reconstruct the auricle.

Patients and methods

A total of 33 ears in 26 adult patients were operated upon. As many as 19 cases of cicatricial cryptotia were unilateral, seven cases bilateral. The patients’ age ranged from 19 to 31 years. Because of a lack of normal tissues surrounding the remnant ear, a periauricular cicatricial flap was designed to repair the helix and antihelix defect and a horizontal bifoliate skin flap for earlobe reconstruction. Two triangular cicatricial flaps located at the cephalic or caudal direction of the survival ear were used for shaping the otocranial angle and auriculotemporal sulci, combined with zoned transplantation of a full-thickness skin graft.

Results

All cicatricial flaps demonstrated nearly 100% survival and the take rate of transplanted skin grafts was approximately 95%. The main structures were visible and cosmetically acceptable; the otocranial angle and auriculotemporal sulci were acceptably restored. The function of wearing eye glasses or a mask was regained. The patients were followed up from 3 months to 6 years after surgery; the mean follow-up period was 3.2 years. The contour of the reconstructed auricle was maintained well, and the scar contracture was acceptable.

Conclusion

Periauricular cicatricial flaps combined with skin grafting is a new approach to cicatricial cryptotia when auricle reconstruction after burn is limited by a scarcity of supple, elastic local skin and fascia.     

Our approach to pediatric dermatologic laser surgery

BACKGROUND AND OBJECTIVES: Many pediatric dermatological conditions may be successfully treated with laser surgery. STUDY DESIGN/MATERIALS AND METHODS: The clinical approach to various pediatric dermatological conditions utilizing laser treatment options is discussed. RESULTS: Clinical uses of various modalities such as pulsed dye laser, KTP laser, Nd-YAG laser, Q-switched ruby laser, erbium-YAG laser, diode laser, non-coherent blue light sources, and fractional resurfacing are presented with successful parameters, developed over 22 years, utilized on a daily basis in a laser surgery clinic. CONCLUSION: Laser surgery can make a significant improvement in many pediatric skin lesions, thanks to the unique properties of pediatric skin and a vast array of laser technologies.     

Our operative approach to the elbow joint

Summary Several surgical approaches to the elbow joint have been described. The disadvantage of all is an insufficient view of a single incision to the anterior and posterior as well as the ulnar aspect of the joint. They require therefore an additional incision or the resection of the radial head with a detachment of the radial collateral ligament. Our single incision allows for an extensive view to the anterior and posterior aspect of the elbow joint without resection of the radial head and the sacrificing of the radial collateral ligaments. It makes in most instances an additional ulnar incision unnecessary. This incision has mainly been tested for subtotal elbow synovectomy in rheumatoid arthritis, for the mobilization of posttraumatic stiff elbows and the removal of loose bodies as in chondromatosis.     

Our approach to primary enuresis in children

In 150 children with enuresis following protocol was applied: a detailed questionnaire, a voiding chart, clinical examination, ultrasound of the kidneys, and uroflow. A tentative treatment based on the flowchart shown in the paper is installed. If after 4-5 weeks no amelioration is observed observation is completed by a urodynamical examination and a permictional urethocystography and the treatment adapted to the results. On this bases each enuresis case could be categorized in one of 4 groups with typical clinical and urodynamical characteristics requiring a specific treatment. The study shows that by an appropriate selective treatment including physical and psychological training and medication nearly all children can get dry.     

A systems change: Leading the way to meeting health needs

Demonstrating the efficacy of our practice requires a paradigm shift. Becoming an effective leader and clinician can facilitate opportunities for program development and clinical research. The use of strategic planning strategies, such as needs assessment and SWOT analysis, can help lead the way to such change. The following illustrates the use of strategic planning to develop The Carpal and Cubital Tunnel Syndrome Program (CCTSP) within a growing orthopedic practice.     

A novel approach to ventricular rupture: clinical needs and surgical technique

Cardiac rupture is a life-threatening event that often occurs after myocardial infarction and is often associated with significant death. Pericardiocentesis provides hemodynamic short-term improvement; however, patients with cardiac rupture require an emergency operation. This report describes a new procedure used to repair left ventricle free wall rupture after myocardial infarction. The technique described repairs the rupture off-pump and without the need for suturing. Midterm results demonstrate the feasibility and durability of this procedure.