骨代谢生化指标对预测绝经后骨质疏松性椎体骨折的临床意义

目的探讨骨代谢生化标志物在预测绝经后骨质疏松性椎体骨折风险方面的意义。方法收集在重庆医科大学附属第一医院住院的110例绝经后骨质疏松症患者的临床资料,包括骨科住院的绝经后骨质疏松症伴椎体骨折患者51例和内分泌科住院的绝经后骨质疏松症无椎体骨折患者59例,记录并观察腰椎、髋部骨密度(BMD)、Ⅰ型前胶原氨基端前肽(PINP)、骨钙素(BGP)、骨碱性磷酸酶(BALP)、I型胶原C末端肽特殊序列(β-CTX)、25-羟基维生素D(25-(OH)Vit D)、甲状旁腺激素(PTH)及血清钙磷值。结果绝经后骨质疏松伴椎体骨折组与无骨折组的年龄、体重、身高、BMI、BMD、PTH、Ca2+、P之间的差异无统计学意义(P0.05),两组的PINP、BGP、BALP、β-CTX、25-(OH)Vit D值存在统计学意义(P0.05),绝经后骨质疏松性椎体骨折与β-CTX、BALP呈正相关性(P0.05,B值分别为3.952、0.482),与BGP呈负相关性(P0.05,B=-0.223),与PINP、25-(OH)Vit D无相关性(P0.05)。结论骨代谢生化标志物β-CTX、BALP、BGP与骨质疏松性骨折存在明显相关性,可以作为其发生的风险因素,从而对绝经后骨质疏松性骨折高风险患者进行早期干预,减少骨折发生。     

细胞因子和骨代谢指标与老年男性骨质疏松症的关系

目的 探讨细胞因子与骨代谢生化指标在老年男性骨质疏松症发病机理中的作用及相互关系。方法 采用放射免疫分析法和生化速率法检测90例老年男性骨量减少和骨质疏松患者血清白细胞介素-4(IL-4)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、骨钙素(BGP)、睾酮(T)、血清碱性磷酸酶(AKP)、血清钙(Ca)的水平,同时行骨密度检测,检测结果与青中年和老年健康人比较。结果 老年男性患者IL-4、IL-6水平随病情加重而增高,与不同年龄对照组比较差异有显著性(P<0.05,P<0.01);IL-10、BGP、AKP、T表达则不同程度降低,均与青中年对照组差异有显著性(P<0.05)。两组患者骨密度值均低于青中年对照组,差异有显著性(P<0.01),而老年骨质疏松组骨密度低于骨量减少组(P<0.05)。结论 老年男性在从骨量减少到骨质疏松的病理过程中,骨转化呈骨吸收增加、骨形成减少的变化规律。IL-4、IL-6、IL-10与其他骨代谢生化指标可辅助诊断骨质疏松症。     

唑来膦酸联合复方骨肽在老年骨质疏松性椎体骨折术后的应用效果分析

【摘要】 目的 探讨唑来膦酸联合复方骨肽在老年骨质疏松性椎体骨折术后的应用效果。 方法 选取2017年7月至2019年4月安阳市人民医院收治的60例老年骨质疏松性椎体骨折患者作为研究对象, 按照随机数表法将其随机分为观察组和对照组, 每组 30 例, 观察组患者采用唑来膦酸联合复方骨肽治疗, 对照组患者单纯采用唑来膦酸治疗, 对比两组患者骨密度以及骨钙蛋白 (BGP)、骨碱性磷酸酶 (BALP) 水平变化情况。 结果 治疗3个月后, 观察组患者腰椎、大转子、髋骨骨密度以及 BGP、BALP 水平均明显高于对照组 ( t = 14.541、8.915、3.995、3.048、3.118, P＜0.001、P＜0.001、P＜0.001、P = 0.003、P = 0.002), 但股骨颈骨密度与对照组无明显差异 (t = 0.286, P = 0.775)。结论 唑来膦酸联合复方骨肽能够明显提高老年骨质疏松性椎体骨折术后患者的骨密度, 改善骨代谢水平, 值得临床推广应用。     

模拟失重雌雄大鼠骨密度、骨代谢指标与骨折风险的相关性

 目的 分析模拟失重雌、雄性大鼠模型骨密度及骨代谢生化指标和生物力学之间的相关性,与骨折风险建立联系,探讨航天医疗基础工作。方法 3个月龄雌、雄性SD大鼠各20只,按照性别及是否失重分为4组。采用尾部悬吊模拟失重方法,实验4周后处死SD大鼠,双能X线吸收法(dual-energy X-ray absorption, DEXA)测定L₄椎体、股骨髁部骨密度,骨组织切片染色,ELISA法检测骨代谢生化标志物:骨碱性磷酸酶(bone alkaline phosphatase,BALP)、抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase,TRAP),生物力学测试骨强度。结果 悬吊组大鼠较对照组大鼠BMD均显著下降,雌性悬吊组较雄性组下降明显;组织切片悬吊组较对照组骨组织及骨细胞间隙明显增宽,细胞肿胀;BALP、TRAP雄性悬吊组分别较对照组升高3.09和1.72倍,雌性悬吊组分别较对照组升高3.43和2.14倍;悬吊组椎体的最大压缩载荷(N)、最大压缩压力(MPa)、股骨最大抗弯曲载荷(N)悬吊组较对照组显著下降。骨密度(bone mineral density,BMD)、BALP、TRAP与椎体最大力学强度Fmax相关性系数r值,雄性组分别为0.985、-0.949、-0.970,雌性组分别为0.908、-0.858、-0.921。结论 失重4周后大鼠出现明显的骨质疏松、骨小梁结构破坏、力学强度显著下降。雌性大鼠骨质疏松较雄性组明显加重。最大力学强度Fmax与骨密度成正相关,与BALP、TRAP成负相关,未来精准、便捷的骨代谢指标可能成为航天医学预测骨折风险的手段之一。     

MRS骨髓脂肪含量预测骨质疏松性髋部骨折的价值

目的 探讨股骨颈骨髓脂肪含量(BMF)对评估骨质疏松(OP)髋部脆性骨折风险的预测价值.方法 15例女性髋部骨折组(年龄68.3岁±9.4岁)及74例女性非骨折正常对照组(年龄61.6岁±10.3岁)行髋部双能X线吸收测量法扫描获取股骨颈骨密度(FN-BMD)及磁共振波谱(MRS)扫描测定BMF.采用受试者工作特征曲线(ROC)分析FN-BMD及BMF对预测髋部骨折风险的差异.结果 BMF与FN-BMD(r=-0.579)、年龄(r=0.460)、体重(r=-0.270)、体质量指数(BMI)(r=-0.239)存在轻-中度相关性(P均＜0.05),将年龄、体重、BMI作为协变量加以校正,BMF与FN-BMD之间的相关性依然存在(r=-0.374,P＜0.001).校正年龄、体重、BMI后,髋部骨折组FN-BMD较非骨折组低(P=0.020),BMF较非骨折组高(P=0.007).即使将FN-BMD加以校正,BMF在2组间差异仍存在统计学意义.FN-BMD及BMF判定髋部骨折的ROC曲线下面积分别为0.810、0.801,两者对骨折风险评估无统计学差异(P=0.894 5). BMF联合FN-BMD判定髋部骨折的R)C曲线下面积为0.826,与单独FN-BMD预测髋部骨折风险的能力无统计学意义(P=0.650 2).结论 股骨颈BMF是独立于FN-BMD决定髋部骨强度的预测因子,但BMF联合FN-BMD并不能提高对髋部脆性骨折的预测能力.     

血清β-CTX、IGF-1水平对老年骨质疏松患者并发髋部骨折的预测价值

目的 探讨血清Ⅰ型胶原羧基端肽β 特殊序列(β-CTX)、胰岛素样生长因子-1(IGF-1)预测老年骨质疏松患者并发髋部骨折的价值.方法 前瞻性研究2018年1月—2019年12月华中科技大学同济医学院附属梨园医院骨科收治的164例老年骨质疏松患者临床资料,其中85例老年骨质疏松并发髋部骨折为骨折组,79例单纯骨质疏松患者为无骨折组,另72例门诊体检正常者为对照组.骨折组男性36例,女性49例;年龄63～78岁,平均70.1岁;跌倒42例,摔伤31例,撞击12例.无骨折组男性29例,女性50例;年龄62～79岁,平均71.2岁.对照组男性31例,女性41例;年龄61～78岁,平均70.5岁.检测受试者血清β-CTX、IGF-1水平以及骨质疏松患者骨密度(BMD).比较三组血清β-CTX、IGF-1水平及临床一般资料,Logistic回归分析老年骨质疏松患者并发髋部骨折的影响因素,受试者工作特征曲线(ROC)分析血清 β-CTX、IGF-1预测老年骨质疏松患者并发髋部骨折的价值.结果 骨折组年龄≥70岁比例、户外运动≥3次/周比例、补充钙剂比例均高于无骨折组(P<0.05),骨质疏松病程长于无骨折组(P<0.05),股骨颈、全髋BMD低于无骨折组(P<0.05).血清β-CTX水平在对照组、无骨折组、骨折组依次升高(P<0.05),IGF-1依次降低(P<0.05),各组间差异有统计学意义(P<0.05).Pearson相关性分析结果显示骨折组血清β-CTX水平与股骨颈、全髋BMD呈负相关(r=-0.561、-0.623,P<0.05),IGF-1与股骨颈、全髋BMD呈正相关(r=0.565、0.642,P<0.05).Logistic多元逐步回归分析结果显示年龄≥70岁、低全髋BMD、户外运动<3次/周、高β-CTX、低IGF-1是老年骨质疏松患者并发髋部骨折的危险因素(P<0.01).ROC分析结果显示β-CTX、IGF-1、β-CTX+IGF-1预测老年骨质疏松患者并发髋部骨折的曲线下面积(AUC)分别为0.734、0.723、0.894,灵敏度分别为74.12％、70.59％、90.59％,特异度分别为81.01％、79.75％、91.14％.结论 老年骨质疏松患者并发髋部骨折患者血清β-CTX水平升高,IGF-1水平降低,β-CTX、IGF-1水平与股骨颈、全髋BMD降低、髋部骨折发生均有关,是评估老年骨折疏松患者骨折风险的有价值指标.     

老年男性血清脂肪因子Irisin、Asprosin水平与骨质疏松性髋部骨折的相关性

目的 探讨血清脂肪因子鸢尾素(Irisin)、白脂素(Asprosin)水平与老年男性骨质疏松性髋部骨折的关系。方法 选取2020年6月—2022年6月收治106例老年男性骨质疏松症作为病例组,另选取同期体检的80名老年男性健康人群作为对照组。根据纳入骨质疏松症患者是否发生髋部骨折再分为髋部骨折组(n=44)和无骨折组(n=62)。采用酶联免疫吸附试验检测所有受试者血清Irisin、Asprosin水平,骨密度仪测量骨质疏松症患者股骨大粗隆、健侧股骨颈、第1～4腰椎骨密度,采用受试者工作特征(ROC)曲线评估血清Irisin、Asprosin水平对老年男性骨质疏松性髋部骨折的预测价值,采用多因素Logistic回归分析探讨老年男性骨质疏松性髋部骨折的影响因素。结果 病例组血清Irisin、Asprosin水平高于对照组(P<0.01)。髋部骨折组血清Irisin、Asprosin水平高于无骨折组(P<0.01)。血清Irisin、Asprosin联合预测老年男性骨质疏松症患者发生髋部骨折的曲线下面积为0.907(95%CI:0.862,0.952)。股骨颈骨密度≤0.77 ...     

女性初潮前后骨代谢生化因子与雌激素、瘦体重相关分析

目的:探讨女性骨代谢生化因子骨钙素(OC)、骨碱性磷酸酶(BAP)和抗酒石酸酸性磷酸酶(TRAP)在初潮前后的变化特征及其相关影响因素。方法:以平均年龄(11.4±0.6)岁的115名小学女生为对象,测量其身高(H)、体重(W)、脂肪含量(FM)、瘦体重含量(LM),血清雌二醇(E2)、睾酮(T)、性激素结合蛋白(SHBG)及血清OC、BAP和TRAP。随访获得实验对象的初潮时间,以测量时相距初潮的时间作为自变量,拟合骨代谢生化因子及相关指标的回归曲线方程。采用偏相关方法检测骨代谢生化标志物与其影响因素之间的相关性。结果:初潮前呈上升趋势的OC、BAP在初潮时显著下降,而TRAP从初潮前至初潮一直下降。从初潮前至初潮,H与BAP(r=0.22,P=0.001)、OC(r=0.21,P=0.002)和TRAP(r=0.14,P=0.04)显著相关,E2、LM与BAP(E2:r=0.2,P=0.003;LM:r=0.15,P=0.029)、OC(E2:r=0.34,P<0.0001;LM:r=0.30,P<0.0001)也显著相关,与TRAP无明显相关。结果表明:女性初潮时骨代谢速度明显减慢,身高增长与骨代谢密切相关,雌激素和瘦体重含量是骨组织代谢的相关影响因素。     

老年髋关节置换术后对侧再骨折的危险因素分析和预防

目的探讨老年髋关节置换术后对侧再发骨折的危险因素并加以预防。方法对2008年1月~2011年1月行髋关节置换术的180例老年患者进行随访,其中24例3年内对侧髋部发生再次骨折。通过比较骨折组与未骨折组患者的性别、年龄、居住环境(农村/城市)、术后健侧髋部骨密度值、健侧股骨近端骨小梁类型(Singh)指数等一般情况以及髋关节置换术后总住院时间、出院后日均卧床时间、有无合并内科疾病和抗骨质疏松治疗情况,归纳再发骨折的危险因素。结果两组患者在性别、年龄方面差异无统计学意义(P年龄=0.084,P性别=0.068),但骨折组患者中农村户口所占比例明显高于未骨折组,差异有统计学意义(P=0.012)。骨折组平均住院时间与出院后日均卧床时间明显长于未骨折组,差异有统计学意义(P平均住院时间=0.024,P出院后日均卧床时间=0.028)。骨折组患者健侧Singh指数低于Ⅲ级的比例以及出院后未规律进行抗骨质疏松治疗的比例明显高于未骨折组,差异有统计学意义(PSingh指数=0.010,P抗骨质疏松治疗=0.015);经Logistic单因素回归分析,农村患者、住院时间及出院后日均卧床时间长、骨密度低、Singh指数低、未规律行抗骨质疏松治疗以及合并内科疾病的患者对侧髋部再发骨折的风险较高。结论对于髋关节置换术后的老年患者,健侧髋部骨密度值偏低、Singh指数低于Ⅲ级、卧床时间长、合并内科疾病以及抗骨质疏松治疗不佳均为对侧再发骨折的危险因素,因此应于第一次术后积极治疗合并内科疾病,行抗骨质疏松治疗并及早进行功能训练,以避免健侧再发骨折。     

寻常型银屑病患者BMD、ALP、Ca、P、TRACP-5b的检测及其意义

目的检测寻常型银屑病患者骨代谢生化指标及骨密度的情况,以了解寻常型银屑病患者的骨代谢异常状况。方法采用双能X线吸收法对48例寻常型银屑病患者(实验组)和40例健康对照者(对照组)行腰椎、股骨颈、左前臂骨密度检测;在相同条件下用贝克曼自动生化分析仪检测两组血液中ALP、Ca、P的浓度;ELSIA法检测两组血清中抗酒石酸酸性磷酸酶-5b(TRACP-5b)的浓度。结果寻常型银屑病患者血清TRACP-5b、ALP的浓度明显高于对照组(P<0.05),差异具有统计学意义;血清Ca浓度较正常对照组低,差异有统计学意义(P<0.05);血清P的浓度和正常对照组比较差异无统计学意义(P>0.05),腰椎、股骨颈、左前臂的骨密度及T值与对照组比较,具有统计学意义(P<0.05)。结论寻常型银屑病患者骨形成和骨吸收相关酶较正常人的血清水平升高,骨密度较正常人降低,说明寻常型银屑病患者骨代谢异常并已致骨量减少。血钙异常可能是寻常型银屑病骨代谢异常的原因之一,而血P在寻常型银屑病骨代谢异常中无影响。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.