应用循证医学探讨福利院中老年骨折的特点

目的：应用循证医学探讨福利院中老年骨折的特点（原因、好发部位、骨折时骨骼的状态）。方法：在循证医学指导下对福利院369名老年人中3年间发生骨折的病人进行X线摄片和骨密度、骨生化代谢指标测定。结果：369人中有73人骨折，其中50人患中度以上骨质疏松症；骨生化测定仅骨钙素与骨密度呈正相关；骨折常见于髋、腕和脊柱等部位。结论：骨质疏松为老年骨折的主要原因，骨密度下降提示骨折的可能性增高；髋、腕和脊柱是老年骨折好发部位。     

经皮椎体后凸成形术后邻近节段再骨折的危险因素分析

  目的  对经皮椎体后凸成形术(PKP)术后邻近椎体再骨折的相关危险因素进行分析和探讨, 以减少骨质疏松性椎体压缩性骨折(OVCF)术后邻近节段再骨折的发生。  方法  收集2016年1月—2017年12月浙江中医药大学附属第二医院骨科行PKP术治疗的438例单节段OVCF患者的资料进行回顾性分析。依据PKP术后是否发生邻近节段再骨折分为再骨折组(32例)和非骨折组(257例)。比较2组患者的年龄、性别、体重指数、胸腰段比例、骨密度、骨水泥注入量、椎体高度恢复率、骨水泥渗漏情况、随访期间外伤情况及再骨折时骨密度,对这些因素进行单因素分析,将其中差异有统计学意义的因素纳入多因素logistic回归模型中,分析其与邻近节段再骨折的相关性。  结果  289例患者随访资料完整并纳入本研究,术后随访12~24(13.5±0.9)个月。至末次随访,术后共32例患者新发生邻近椎体骨折。单因素分析结果显示,邻近节段再骨折与再骨折时骨密度和随访期间外伤情况有关(均P＜0.05)。多因素logistic回归分析结果显示,再骨折时骨密度(OR=0.225)是术后邻近节段再骨折的影响因素(P < 0.01);随访期间轻微外伤(OR=5.254)可能是导致再骨折发生的重要外部影响因素(P < 0.01)。  结论  PKP术后邻近节段再骨折的发生主要原因是骨质疏松的进展和随访期间的再次外伤。因此术后早期腰围保护和正规抗骨质疏松治疗及避免外伤必不可少。      

Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment.

CONTEXT: Large segments of the population at risk for osteoporosis and fracture have not been evaluated, and the usefulness of peripheral measurements for short-term prediction of fracture risk is uncertain. OBJECTIVES: To describe the occurrence of low bone mineral density (BMD) in postmenopausal women, its risk factors, and fracture incidence during short-term follow-up. DESIGN: The National Osteoporosis Risk Assessment, a longitudinal observational study initiated September 1997 to March 1999, with approximately 12 months of subsequent follow-up. SETTING AND PARTICIPANTS: A total of 200 160 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis, derived from 4236 primary care practices in 34 states. MAIN OUTCOME MEASURES: Baseline BMD T scores, obtained from peripheral bone densitometry performed at the heel, finger, or forearm; risk factors for low BMD, derived from questionnaire responses; and clinical fracture rates at 12-month follow-up. RESULTS: Using World Health Organization criteria, 39.6% had osteopenia (T score of -1 to -2.49) and 7.2% had osteoporosis (T score 相似文献   

多层螺旋CT后处理技术在腕、踝关节损伤中的临床应用价值

目的探讨多层螺旋CT后处理技术在腕、踝关节损伤中的临床应用价值。方法多层螺旋CT扫描腕、踝关节损伤患者共计50例,其中腕关节损伤30例,踝关节损伤20例,通过工作站后处理得到MPR、VR及SSD图像。结果多层螺旋CT后处理技术清晰显示了50例共76处腕及踝关节骨折,MPR能清晰地显示关节诸组成骨的微小骨折、骨折移位及与周围组织关系,VR显示骨折全貌,SSD能准确评估关节对位关系。结论多层螺旋CT后处理技术的联合应用能较全面地显示腕、踝关节损伤的基本征象,为腕、踝关节损伤的诊断及手术方案的制定提供了更精确的检查方法,具有重要的临床应用价值。     

Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 9. Calcitonin in the treatment of osteoporosis.

OBJECTIVE: To describe potential therapeutic uses of calcitonin in the prevention and treatment of osteoporosis. OPTIONS: Parenterally and intranasally administered calcitonin (eel, salmon or human). OUTCOMES: Fracture, fracture pain and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures, reduction of pain and improved quality of life associated with calcitonin treatment. EVIDENCE: Relevant clinical studies and reports were examined, with an emphasis on recent randomized, placebo-controlled trials. In vitro and in vivo studies of osteoclast activity were also considered. VALUES: Reducing fractures and fracture pain, increasing bone mineral density and minimizing side effects of treatment were given a high value. BENEFITS, HARMS AND COSTS: Calcitonin reduces acute pain associated with osteoporotic fractures and has been found useful in treating chronic back pain following vertebral fractures in spinal osteoporosis. It can prevent bone loss and may be effective in preventing fractures. Side effects are dose related and generally mild; they include gastrointestinal, vascular and dermatologic conditions that can be treated symptomatically or by varying the dosage. Side effects are much rarer with nasal administration than with injection. True allergic reactions are rare. RECOMMENDATIONS: Calcitonin in both intramuscular and intranasal forms can reduce the pain of acute osteoporotic vertebral fractures and may be effective in treating that associated with chronic vertebral osteoporotic fractures. Calcitonin may also prevent postmenopausal bone loss and increase bone density in those with established osteoporosis. Current evidence for long-term prevention of fractures is limited and does not support the use of calcitonin as a first-line treatment for established osteoporosis. Most side effects can be avoided with nasal administration. Further trials are needed to assess fracture prevention and effective dose ranges for treating pain and increasing bone mineral density and to determine the long-term efficacy of calcitonin in secondary osteoporosis, in premenopausal women, in men and in elderly people.     

膨胀髓内钉治疗肱骨干骨折46例体会

目的探讨可膨胀髓内钉在肱骨干骨折的临床应用及疗效上的体会和护理来进行探讨。方法观察收集治疗2007年9月至2008年6月应用可膨胀髓内钉治疗收治的46例肱骨干骨折患者,并回顾性的对其进行临床上的分析。46例肱骨干骨折患者治疗上应用可膨胀髓内钉。其中男性24例患者,女性患者22例,其中在46例患者中属于陈旧性上骨折的为14例,伴有骨质疏松5例,新鲜骨折29例。结果 46例均获随访0.5～1年内,平均为12个月,均骨性愈合,肩关节功能根据标准评分,优30例,良16例,差0例。结论膨胀髓内钉固定具有固定可靠,创伤小,破坏或最小限度破坏骨折端骨膜及血运,防止骨折缩短、旋转畸形,有利于骨折愈合,功能恢复好,它是治疗肱骨干骨折的可行性内固定理想的方法。     

Bone densitometry in assessment of bone mineral density

Osteoporosis is a serious disease characterized by low bone mineral density. Osteoporosis affects 24 million people annually and may be responsible for devastating hip, wrist and spinal fractures. Bone mineral density is considered the best predictor for osteoporotic fracture. Progress has been made toward noninvasive assessment of bone mineral density to provide early diagnosis of osteoporosis. A variety of methods are used to assess bone mineral density. These methods are presented and dual energy X-ray absorptiometry is discussed in detail.     

Magnitude and determinants of osteoporosis in adult population of South Sharqiya region of Oman

OBJECTIVE: To estimate the incidence of hip fractures as an indicator for osteoporosis in the >40 years old Omani population of the South Sharqiya region of Oman. We also recommended a policy for addressing osteoporosis in this community. METHODS: Orthopedic surgeons noted and treated patients with hip fracture that were due to a fall over 5 years September 2002 to August 2007 at Sur Hospital, Oman. Their preoperative information, such as bone involved, co-morbidities, history of fractures, and the type of treatment were collected. We used the population of the study area to calculate the annual incidence of fractures. RESULTS: In our study, 147 persons 70 male, and 77 female of >40 years with hip fractures were included. The age adjusted annual incidence rate of hip fracture in >40 population of South Sharqiya was 0.14%. While operating on 96 65.3% patients, we used dynamic hip screw. Hemi-arthroplasty with Austin-Moore prosthesis was performed in 37 (24.5%) patients. Eighteen (12.2%) patients had previous bone fractures. CONCLUSION: The incidence of hip fracture was high. Osteoporosis screening programs and adequate interventions could detect the high-risk group and prevent such fractures in the future.     

NiTi记忆合金在四肢骨折中的应用

目的 寻找易于操作并具有良好固定作用的内固定器械。方法 使用记忆合金环抱器内固定治疗四肢各类管状骨骨折共26例,其中股骨干骨折9例,肱骨干骨折1例,尺骨骨折3例,尺挠骨骨折7例,胫腓骨骨折3例,掌骨骨折2例,桡骨骨折术后骨不连并内固定断裂1例。结果 随访3~12月,平均6个月。1例肱骨干粉碎性骨折术后1月骨折端有多量的骨痂,但骨折断端出现成角移位,其余患者均顺利愈合。结论 环抱器治疗骨折手术操作简单,创伤小,有利于骨折愈合和减少固定后骨质疏松。是治疗管状骨骨折较有效的方法。但要注意环抱器与骨折处骨干的匹配,且骨折愈合后环抱器取出较为困难。     

激素诱导骨质疏松性胸腰椎体骨折PVP后再发骨折分析

目的 探讨激素诱导骨质疏松性胸腰椎体骨折患者行经皮椎体成形术(PVP)后再发骨折的危险因素.方法 选取2010年4月至2015年7月解放军第425中心医院收治的骨质疏松性胸腰椎体骨折患者646例,根据骨折类型分为原发性骨质疏松性胸腰椎体骨折(n=542)和激素诱导骨质疏松性胸腰椎体骨折(n=104),比较两组患者的再发骨折发生率.根据再发骨折发生情况将激素诱导骨质疏松性胸腰椎体骨折患者分为骨折组和无骨折组,对两组患者的临床资料进行单因素和多因素Logistic回归分析.结果 原发性骨质疏松性胸腰椎体骨折患者再发骨折102例(18.82％),激素诱导骨质疏松性胸腰椎骨折患者再发骨折53例(50.96％).骨折组和无骨折组患者的体质量指数、骨密度、骨水泥渗漏、术前椎体裂隙样变、未接受抗骨质疏松治疗比例差异有统计学意义(P＜0.05).骨密度、骨水泥渗漏、术前椎体裂隙样变、未接受抗骨质疏松治疗是影响激素诱导骨质疏松性胸腰椎体骨折患者行PVP后再发骨折的独立危险因素(P＜0.05).结论 激素诱导骨质疏松性胸腰椎体骨折患者再发骨折风险较高,骨密度、骨水泥渗漏、术前椎体裂隙样变、是否接受抗骨质疏松治疗等是再发骨折的主要危险因素.     

Underdiagnosis and under-treatment of osteoporosis following fragility fracture

AIM: Assess the treatment and diagnosis rates for osteoporosis following a fragility fracture. DESIGN: A retrospective chart review. FINDINGS: Out of 93 patients with fragility fractures, 26.9% received an osteoporosis or osteopenia diagnosis within 6 months after the time of fracture. CONCLUSION: Despite availability of clinical tools and therapeutic options of the treatment of low bone density, osteoporosis remains underdiagnosed and under-treated.     

自体尺骨骨钉治疗腕舟骨骨折

目的:总结自体尺骨骨钉作为内植物对39例腕舟骨骨折的病人进行治疗的经验。方法:对39例腕舟骨骨折采用切开复位加自体尺骨骨钉内固定治疗。结果:术后平均随访21个月。从术后疼痛程度、腕关节活动度、影像学检查等进行疗效评估。随访39例,均获得骨性愈合,其中2例背屈时轻微疼痛,1例疼痛较重。按刘树清功能评定标准评价[1],优良率达91.11%。结论:自体尺骨骨钉治疗腕舟骨骨折操作简单,疗效可靠。     

How reliable is a radiological report in osteoporosis in diagnosing low bone density?

Patients are often referred to osteoporosis clinics with a radiological diagnosis of osteoporosis. Previous studies attempting to ascertain risk of osteoporosis from radiographs have been conflicting. The aim of our study was to determine how reliable spinal radiographs were at detecting low bone density compared with Dual Energy X ray Absorptiometry (DXA). We retrospectively measured the Bone Mineral Density (BMD) at the spine in 130 patients with a radiological diagnosis of osteopenia or osteoporosis in the absence of vertebral fractures. They were compared with a group of 119 age and sex matched patients with one or more low trauma vertebral fractures. There was a statistically significant difference in the mean BMD between these two groups. 12.7%, of the x-ray group with osteopenia reported, had a normal bone density, 49.2% had osteopenia (T-score -1 to -2.5) and 38.1% had osteoporosis (T-score <-2.5). Of those with a radiological report of osteoporosis, 12.8% had a normal bone density, 44.7% had osteopenia and 42.6% had osteoporosis. We conclude that a radiological report of low bone density is a strong predictor of osteopenia or osteoporosis by BMD measurement.     

骨质疏松性椎体骨折患者血清破骨细胞生成抑制因子和破骨细胞分化因子的表达及意义

目的 探讨骨质疏松性椎体骨折患者血清破骨细胞生成抑制因子(osteoclast suppressor,OCIF)和破骨细胞分化因子(osteoclast differentiation factor,ODF)的表达及意义。 方法 选择衢州市人民医院2013年1月—2016年12月符合标准的骨质疏松性椎体骨折患者70例为骨质疏松组,非骨质疏松性椎体骨折患者70例为对照组。采用双抗体夹心酶联免疫吸附实验(Double antibody sandwich enzyme-linked immunosorbent assay,ELISA)法测定血清OCIF和ODF水平。采用双能X线骨密度仪测量腰椎正位总体L_1-4骨密度及左侧股骨颈骨密度。采用SPSS20.0统计软件对数据进行分析。 结果 骨质疏松组血清OCIF和ODF水平均高于对照组(均P<0.05)。骨质疏松组腰椎正位骨密度和股骨颈骨密度均低于对照组(均P<0.05)。骨质疏松患者血清OCIF、ODF水平与腰椎正位骨密度、股骨颈骨密度均呈负相关(均P<0.05)。骨质疏松患者血清OCIF、ODF水平与骨折程度无显著相关性(均P>0.05)。 结论 骨质疏松性椎体骨折患者血清OCIF、ODF水平升高,血清OCIF、ODF水平与骨质疏松性椎体骨折患者的骨密度关系密切,与骨折的严重程度关系不大。      

FRAX对老年骨质疏松性脊柱骨折的预测诊断价值分析

目的:分析骨质疏松性骨折风险预测简易工具(fracture risk assessment tool,FRAX)对老年骨质疏松性脊柱骨折发生的预测诊断价值。方法:分析在本院接受诊疗的96例老年骨质疏松患者的临床资料,依据是否合并骨质疏松性脊柱骨折将患者分为观察组(骨折,n=45)及对照组(未骨折,n=51)。每位患者均行FRAX及骨质疏松自我筛查工具(osteoporosis self-assessment tool for asians,OSTA)评估,并接受骨密度测量。结果:观察组患者FRAX指数显著高于对照组患者,而OSTA指数及骨密度值均显著低于对照组患者,各项差异均具有统计学意义(P<0.05)。ROC曲线分析显示,以3.92为截点值,FRAX指数预测诊断老年骨质疏松性脊柱骨折的敏感性为92.16%,特异性为84.44%,曲线下面积为0.94,优于OSTA指数。相关性分析显示观察组患者FRAX指数与骨密度值呈现显著负相关,具有统计学意义(r=-0.538,P<0.01)。结论:FRAX在预测老年骨质疏松患者脊柱骨折发生中具有一定价值,该工具具有临床推广价值。     

Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators.

CONTEXT: Raloxifene hydrochloride, a selective estrogen receptor modulator, prevents bone loss in postmenopausal women, but whether it reduces fracture risk in these women is not known. OBJECTIVE: To determine the effect of raloxifene therapy on risk of vertebral and nonvertebral fractures. DESIGN: The Multiple Outcomes of Raloxifene Evaluation (MORE) study, a multicenter, randomized, blinded, placebo-controlled trial. SETTING AND PARTICIPANTS: A total of 7705 women aged 31 to 80 years in 25 countries who had been postmenopausal for at least 2 years and who met World Health Organization criteria for having osteoporosis. The study began in 1994 and had up to 36 months of follow-up for primary efficacy measurements and nonserious adverse events and up to 40 months of follow-up for serious adverse events. INTERVENTIONS: Participants were randomized to 60 mg/d or 120 mg/d of raloxifene or to identically appearing placebo pills; in addition, all women received supplemental calcium and cholecalciferol. MAIN OUTCOME MEASURES: Incident vertebral fracture was determined radiographically at baseline and at scheduled 24- and 36-month visits. Nonvertebral fracture was ascertained by interview at 6-month-interim visits. Bone mineral density was determined annually by dual-energy x-ray absorptiometry. RESULTS: At 36 months of the evaluable radiographs in 6828 women, 503 (7.4%) had at least 1 new vertebral fracture, including 10.1% of women receiving placebo, 6.6% of those receiving 60 mg/d of raloxifene, and 5.4% of those receiving 120 mg/d of raloxifene. Risk of vertebral fracture was reduced in both study groups receiving raloxifene (for 60-mg/d group: relative risk [RR], 0.7; 95% confidence interval [CI], 0.5-0.8; for 120-mg/d group: RR, 0.5; 95% CI, 0.4-0.7). Frequency of vertebral fracture was reduced both in women who did and did not have prevalent fracture. Risk of nonvertebral fracture for raloxifene vs placebo did not differ significantly (RR, 0.9; 95% CI, 0.8-1.1 for both raloxifene groups combined). Compared with placebo, raloxifene increased bone mineral density in the femoral neck by 2.1 % (60 mg) and 2.4% (120 mg) and in the spine by 2.6% (60 mg) and 2.7% (120 mg) P<0.001 for all comparisons). Women receiving raloxifene had increased risk of venous thromboembolus vs placebo (RR, 3.1; 95% CI, 1.5-6.2). Raloxifene did not cause vaginal bleeding or breast pain and was associated with a lower incidence of breast cancer. CONCLUSIONS: In postmenopausal women with osteoporosis, raloxifene increases bone mineral density in the spine and femoral neck and reduces risk of vertebral fracture.     

Loss of bone mass after Colles’ fracture: a follow-up study

Background Colles’ fracture usually associated with osteoporosis is regarded as the predictor of subsequent osteoporotic fracture. However, it is not clear how the local changes of bone mass take place during the course of treatment and whether the changes are related to clinical practice. The objective of the current study was to investigate the local changes of bone mass in patients with Colles’ fracture and their possible clinical relevance in a follow-up study.Methods The radiograms of the second metacarpal in 64 patients with Colles’ fracture were assessed for bone density immediately after fracture, 6 weeks, 6 months and 1 year after fracture, respectively. Functional results were evaluated at one year.Results Bone mass six weeks after Colles’ fracture was significantly decreased without returning to normal at one year though increased bone mass had been identified 6 months after fracture (P&lt; 0.05), (P&lt; 0.01). At one year significant (P&lt; 0.05) or highly significant (P&lt; 0.01) correlations were observed between bone mass indices of metacarpal and functional results, indicating that poor function is associated with lower bone density. Significant differences (P&lt; 0.05) between fracture patterns also suggested that patients with more severe fractures have a more pronounced bone loss.Conclusions Bone loss during the course of treatment will have a direct effect upon the prognosis, so different treatment should be proposed for different patterns of fractures. Active exercise should be made to improve the recovery of bone mass.     

感染下颌骨骨折的内固定手术临床评估

目的评估感染下颌骨骨折内固定的临床疗效。方法对2000—2008年间两家三甲医院感染下颌骨骨折内固定的患者临床疗效、手术处置、细菌学检查及抗生素使用情况进行回顾性分析。根据感染部位将下颌骨骨折患者分为软组织感染及骨组织感染两组。结果31例感染下颌骨折患者术后随访12个月,软组织感染下颌骨骨折治愈率100％,骨组织感染亚组治愈率85％;分离出病原菌22株,其中革兰阳性球菌16株,革兰阴性杆菌6株。革兰阳性球菌对万古霉素、替考拉宁敏感率达100％,革兰阴性杆菌对亚胺培南、美罗培南敏感率达1OO％。患者术后全部使用抗生素。结论感染区切开引流灌洗、骨清创、骨折复位、坚强内固定、足量抗生素的临床治疗程序可有效治疗感染下颌骨骨折。     

腕关节外伤骨折患者DR与MSCT检查的合理应用

目的：探讨腕部外伤患者行x线检查或者CT检查的必要性,以及腕关节x线拍片位置及CT的扫描及重建方式。方法：收集近一年来腕关节外伤骨折患者,已经做腕关节x线DR平片和64排螺旋CT轴位容积扫描腕骨,其中MSCT进行多平面重建或者3D重建40例,分析相应影像表现及诊断。结论：普通x线检查腕关节骨折是初步的而且是必要的检查方法,同时应结合临床外伤史、查体有无压痛、x线平片影像,然后决定是否CT检查,CT扫描尤其是MSCT扫描重建对平片未能明确诊断的腕关节骨折有很大的价值。     

A controversy: linking atypical femoral fractures to bisphosphonate therapy

Several cases have been reported of unusual spontaneous fractures with minimal trauma in the subtrochanteric and diaphyseal areas of the femur linked to long-term bisphosphonate use. After encountering three such patients, we conducted a review of published cases. The average age of these individuals were 68 years and approximately 25% had received concomitant glucocorticoids. Histomorphometric bone biopsy studies performed in some individuals have suggested that severe suppression of bone turnover may be the underlying cause; however, cause and effect has not been firmly established. Moreover, population studies have found this type of fracture rare and not increased in patients who have received bisphosphonate treatment. Physicians should continue to use bisphosphonate agents as a primary treatment for osteoporosis.