椎体骨质疏松性骨折漏诊率的研究

目的调查不同级别医院不同级别医生对椎体骨质疏松性骨折的诊断率，探讨椎体骨质疏松性骨折的漏诊率原因。方法回顾2000年1月～2007年6月在我院就诊并拍摄脊柱X线片的患者（〉60岁），随机抽取100例患者的正侧位脊柱X平片，随机抽取我院骨科高级、中级、初级职称的医生各两名读取上述所选的脊柱X平片，并记录诊断结果；请放射科高年资医生读取同样的X片，记录诊断结果，以放射科医生读取的结果为标准，分析各级医生对脊柱骨质疏松性骨折的漏诊率。结果高级职称医生的漏诊率为2．7％，中级职称医生的漏诊率为5．1％，初级职称医生的漏诊率为7．9％；不同级别医院同一级别医师的漏诊率分别为：三甲医院漏诊率为3．2％，三乙医院漏诊率为5．7％；二甲医院漏诊率为8．2％，二乙医院漏诊率为10．3％。结论椎体骨质疏松性骨折漏诊率较高，同一医院不同级别医生及不同级别医院同一职称医生对椎体骨质疏松性骨折的诊断率存在明显差异，应在骨质疏松性骨折的防治中引起重视，并早期对其进行治疗。     

骨纳米微结构与机械强度

骨强度主要由骨密度和骨质量两方面决定。骨质量属于骨生物力学范畴，用以描述骨的材料学特征和结构强度，骨质量下降则骨脆性增加。与骨质量密切相关的骨显微结构、代谢转化率、积累性损伤以及骨矿化和骨重建等因素都会影响骨强度。正常骨组织内各个纳米级组分的结构形态、生理特征和机械强度决定整体骨质量。了解骨基质内独立胶原纤维和矿化晶体的纳米级结构特征对理解骨质量具有重要意义。本文试从骨基质内部胶原纤维排列和导向、矿物晶体几何学形貌和构筑以及两者聚合方式等方面，讨论骨纳米级结构与骨强度的关系。     

纤维多孔钛微球复合纳米锶磷灰石修复骨缺损的实验研究

Objective To evaluate the effect of titanium fiber mesh microballoons combined with nano-Sr-HAP on repair of bone defects in vivo. Methods The experimental model was set up by creating drill defects in the bilateral femoral condyle of 24 SD rats [6 months, with the mean weight of (545±22 g)]. The left femoral defects were filled with titanium fiber mesh microballoons combined with nano-Sr-HAP, and the right with pure metal scaffolds. At the 1st, 2nd, 4th, and 8th week after surgery, the specimens were killed and taken the X-ray, histology, and histomorphology observation. The results were contrasted and ana-lyzed. Results X-ray observation showed that the bone defects in both sides were repaired. Histological re-sults showed that the titanium fiber mesh microballoons allowed the new bones growing inside, and more new bones in the left implants compared with those in the right sides. The results of histomorphometrical analysis confirmed that neo-bones in the left sides gradually increased as time passed. There were statistic differences in neo-bones at the 2nd, 4th, and 8th week, and the differences between the two sides were statistically sig-nificant at the 4th and 8th week. Conclusion As titanium fiber mesh microballoons used in this experiment have good biocompatibility and osteoconduction ability, they can be used as scaffold for bone defect repair; and Nano-Sr-HAP can enhance the repair ability of titanium fiber mesh.     

老年髋部骨折的住院治疗费用分析

目的 统计比较我院近6年来髋部骨质疏松性骨折的治疗费用的变化.方法 收集上海交通大学附属第九人民医院骨科患者资料,对2001～2006年6年中50岁以上髋部患者的年龄、性别、骨折类型、住院天数、治疗费用进行统计分析.结果 髋部骨折患者中女性明显多于男性,多见于70～89岁;老年股骨颈骨折的类型多为GardenⅣ 型(Garden分型)和头下型(按骨折线分型),股骨粗隆间骨折类型多见于Evans-JensenⅢ型;2001～2006年6年中,股骨颈骨折患者357例,平均每年60例,平均住院天数为18d,平均每人所需治疗费用29793元,人均费用每年递增8%;股骨粗隆间骨折328例,平均每年55例,平均住院天数为17 d,平均每人所需治疗费用21666元,人均费用每年递增11.2%.结论 老年髋部骨折中女性明显多于男性,髋部骨折治疗费用昂贵,并且呈逐年上升的趋势.     

骨质疏松性骨折愈合的细胞超微结构观察

目的观察骨质疏松性骨折愈合过程中的细胞超微结构改变,阐明骨质疏松性骨折的细胞学愈合机制。方法8月龄雌性SD大鼠80只,体重290～340g,随机分为骨质疏松性骨折模型组(OPFM)与一般性骨折模型组(CFM),每组40只。麻醉后,OPFM组经双侧腰背侧切口进入腹腔,行双侧卵巢切除;CFM组行腰背部伪手术。术后3个月,两组均经股外侧切口切断股骨中段后行克氏针髓腔逆行内固定,建立骨质疏松性骨折与一般性骨折实验模型。实验模型建立后分别于第5d、1、2、4、6、8、12、16周每组各处死4只动物,于骨痂外取2mm×2mm组织(含连接骨痂与外骨痂),分别进行透射与扫描电镜观察。结果透射电镜观察显示,OPFM组与CFM组相比软骨细胞数目较多,但功能较低,分泌的胶原纤维数量低且排列紊乱;成骨细胞数目与功能状态均降低,胞周分泌的胶原纤丝稀疏、紊乱;破骨细胞功能状态活跃。扫描电镜观察显示,CFM组与OPFM组相比,胶原纤维致密,排列方向较为规则。结论骨质疏松性骨折愈合时,成骨细胞的成骨能力降低,破骨细胞的骨吸收能力增强,骨折愈合质量差。     

肌肉、骨骼与骨质疏松专家共识

骨质疏松症已成为全球性的公共健康问题和前沿研究难题。老年人骨骼肌肉系统的衰退会造成肌肉萎缩、骨质减少,进而引起肌力减退、运动能力、平衡能力下降、步行缓慢、骨脆性增大、易骨折,最终导致老年人生活质量下降。如何从肌肉、骨骼方面研究其与骨质疏松的关系非常迫切和重要。为此,中国老年学学会骨质疏松委员会成立了肌肉、骨骼与骨质疏松学科组,组织专家编写《肌肉、骨骼与骨质疏松专家共识》,为骨质疏松症的临床诊疗和科学研究提供参考。共识认为:骨质疏松与肌肉、骨骼密切相关。骨质疏松症和肌少症存在着很多共同的风险因素。肌骨代谢生化指标可反映肌骨代谢状态,对代谢性肌肉骨骼疾病的诊断和疗效评价有指导作用。推荐使用DXA测量肌肉质量和骨密度。肌力和平衡能力评定有助于判断跌倒风险。肌肉、骨骼存在潜在的药物作用共同靶点。肌肉骨骼运动可以增加峰值骨量,调节骨代谢信号通路,促进骨形成。骨质疏松人群应注重个体化运动锻炼。中医学认为肌肉、骨骼与脾、肝、肾关系密切,骨质疏松症的病位主要在肾、脾、经络,主要与肾虚、脾虚和血瘀有关,强调骨筋肉并重,动静结合,治疗原则宜补肾、健脾、活血。     

创伤性肘关节不稳的临床分析

目的：通过创伤性肘关节不稳的临床分析，提高该病的诊治水平。方法：对2001年1月—2002年12月收治的56例肘关节不稳病例进行回顾性分析，内容包括性别、年龄分布、受伤机制、伴发损伤、治疗方法和结果。结果：56例肘关节不稳中男22例，女34例；后外侧旋转脱位51例；50例的受伤机制是上肢过伸位的撑地伤；单纯性脱位40例，复合性脱位16例；伴发周围神经损伤4例；非手术治疗51例，手术治疗5例；随访中有3例关节功能位固定，22例有超过10。的关节伸直受限。结论：绝大多数的创伤性肘关节不稳为单纯性后外侧旋转脱位，肘过伸、旋后位的轴向应力是其主要的受伤机制，治疗以非手术外固定为主，部分复合性脱位需行骨折内固定和软组织修复与重建。     

髋部脆性骨折病人股骨近端几何形态CT评估

目的探讨CT对股骨近端几何形态的评估价值,以及股骨近端几何形态与髋部脆性骨折的相关性。方法对33例股骨颈骨折和38例粗隆间骨折老年妇女,应用CT扫描股骨近端,并测量颈干角、股骨颈轴长、股骨头直径和股骨颈直径。结果在不同骨折组间,颈干角差异有显著相关性(P<0.01)。股骨颈轴长、股骨头直径与股颈直径呈正相关(P均<0.01),在不同的骨折组间三者差异没有显著相关性(P>0.05)。结论利用CT分析股骨近端几何形态,操作简单、精确性高。颈干角与髋部骨折的类型有显著相关性,颈干角越小易发生股骨颈骨折,而颈干角越大更易发生粗隆间骨折。     

纤维多孔钛微球复合纳米锶磷灰石修复骨缺损的实验研究

Objective To evaluate the effect of titanium fiber mesh microballoons combined with nano-Sr-HAP on repair of bone defects in vivo. Methods The experimental model was set up by creating drill defects in the bilateral femoral condyle of 24 SD rats [6 months, with the mean weight of (545±22 g)]. The left femoral defects were filled with titanium fiber mesh microballoons combined with nano-Sr-HAP, and the right with pure metal scaffolds. At the 1st, 2nd, 4th, and 8th week after surgery, the specimens were killed and taken the X-ray, histology, and histomorphology observation. The results were contrasted and ana-lyzed. Results X-ray observation showed that the bone defects in both sides were repaired. Histological re-sults showed that the titanium fiber mesh microballoons allowed the new bones growing inside, and more new bones in the left implants compared with those in the right sides. The results of histomorphometrical analysis confirmed that neo-bones in the left sides gradually increased as time passed. There were statistic differences in neo-bones at the 2nd, 4th, and 8th week, and the differences between the two sides were statistically sig-nificant at the 4th and 8th week. Conclusion As titanium fiber mesh microballoons used in this experiment have good biocompatibility and osteoconduction ability, they can be used as scaffold for bone defect repair; and Nano-Sr-HAP can enhance the repair ability of titanium fiber mesh.