Bisphosphonate-associated peri-implant fractures: a new clinical entity?: A series of 10 patients with 11 fractures

Background and purpose

The current definition of atypical femoral fractures (AFFs) associated with bisphosphonate use includes only de novo fractures. However, in recent years reports of bisphosphonate-associated periprosthetic fractures involving stemmed arthroplasty implants have emerged. In a case series of peri-implant fractures in femurs with plate/screw constructs, we aimed to assess similarities with classical AFFs and how their location may have implications for the pathogenesis and management of AFFs.

Patients and methods

We retrospectively identified 10 patients with 11 peri-implant fractures.

Results

The patients were ambulant women, mean age 80 (70–92) years. Mean duration of bisphosphonate use was 5 (1–10) years. The peri-implant fractures were sustained an average of 4 years (6 months to 9 years) from the time of index surgery. They were all associated with low-energy mechanisms. 8 fractures occurred near the tip of a plate, while 3 traversed the penultimate screwhole of a plate. The peri-implant fractures showed clinical and radiological features of atypicality such as lateral cortical thickening, simple fracture pattern, and lack of comminution. The patients underwent revision surgery, with bone grafting used in all but 1 case. Radiological union was evident after 2–4 months.

Interpretation

Atypical peri-implant fractures of the femur associated with bisphosphonate use may be a new entity. Stress lesions and atypical fractures may tend to develop over stress risers along the operated femur. This finding has implications for the pathogenesis and clinical management of AFFs.Bisphosphonates form the cornerstone of antiresorptive therapy in the management of post-menopausal osteoporosis. They are used in the treatment of malignant and osteoclast-mediated metabolic bone disease. Their use in patients who have undergone total joint arthroplasty of the lower limb is associated with higher periprosthetic bone mineral density and longer implant survival (Bhandari et al. 2005). Bisphosphonates exert their therapeutic effect by reducing bone turnover and increasing overall mineralization. This translates to increased bone mineral density and bone strength, corresponding clinically to reduced risk of vertebral and non-vertebral fragility fractures (Black et al. 1996).In recent years, several published reports have described atypical femoral fractures (AFFs) of the proximal femoral diaphysis and subtrochanteric region, in association with bisphosphonate use (Goh et al. 2007, Neviaser et al. 2008, Isaacs et al. 2010). Bisphosphonates are associated with a higher age-adjusted relative risk of AFF in women than in men, which is higher in alendronate users than in risedronate users (Schilcher et al. 2015). Bisphosphonates may cause changes in bone matrix composition and bone mechanical properties, increasing the propensity for accumulation of microdamage. Impaired target remodeling would contribute to the progression of macrocracks. High interfragmentary strain from physiological loads at a thin fracture line may be a mechanical factor in lack of bone healing (Aspenberg et al. 2010).Periprosthetic/peri-implant fractures are currently excluded from the definition of AFFs. We suggest that peri-implant fractures of the femur with features of atypicality may be linked to bisphosphonate use and that they should be recognized as a clinical entity.     

柴芍六君汤加味治疗慢性肾脏病3-4期的疗效评价

目的:观察以补肾益脾、升阳化气为主要治法的柴芍六君汤加味治疗慢性肾脏病(CKD)3-4期的临床疗效。方法:收集浙江中医药大学附属温州中医院肾内科住院或门诊CKD3-4期非透析患者共72例,随机分治疗组、对照组各36例,均接受常规治疗,治疗组加用口服柴芍六君汤加味,疗程3个月;比较2组的临床症状积分、肾功能、血红蛋白和临床疗效。结果:2组治疗均可改善患者的临床症状,治疗组优于对照组,差异有统计学意义(P<0.05);治疗组患者肾功能、血红蛋白改善情况优于对照组,差异有统计学意义(P<0.05);治疗组总有效率优于对照组,差异有统计学意义(P<0.01);2组治疗均无不良反应。结论:柴芍六君汤加味治疗,可以改善CKD患者的临床症状、肾功能及血红蛋白,延缓终末期进展。     

黄连多糖不同组分抗氧化活性比较研究

目的研究黄连粗多糖和带电量不同的黄连多糖组分的抗氧化活性。方法用二乙氨乙基纤维素(阴离子交换柱层析)分离纯化除蛋白后的黄连粗多糖,用Fenton法、邻苯三酚自氧化法和2,2-二苯基-1-苦味肼基(2,2-diphenyl-1-picrylhydrazyl,DPPH)分析法测定黄连粗多糖及纯化后带电量不同的多糖组分体外抗氧化作用。结果经阴离子交换柱层析,可获得4种带电量不同的黄连多糖组分,且这4种组分和黄连粗多糖对羟自由基、超氧阴离子和DPPH都有一定的清除作用,其中带电量高的组分对不同抗氧化模型均具有较高的清除作用。结论黄连多糖有一定的抗氧化活性,其抗氧化活性和其带电量具有正相关性。     

氢醌对K562细胞着色性干皮病基因D甲基化的影响

目的：了解不同剂量苯代谢物氢醌（ HQ）对人白血病细胞株K562细胞着色性干皮病基因D（ XPD）甲基化水平的影响。方法：分别以终浓度为0、15、30和60μmol/L HQ溶液重复处理K562细胞48 h,采用MTT比色法检测K562细胞增殖能力,采用亚硫酸氢盐处理后测序法检测XPD甲基化水平;观察各组细胞存活率及甲基化率。结果：HQ 0、15、30、60μmol/L 处理后,K562细胞存活率分别为（100.00±0.00）％、（85.46±0.60）％、（63.46±7.02）％和（51.20±6.49）％,15μmol/L 组与0μmol/L 组比较,差异无统计学意义（ P ＞0.05）,30μmol/L和60μmol/L组与0μmol/L组比较,差异有统计学意义（P＜0.05）;XPD基因甲基化水平分别依次为1.03％（3/290）、0.34％（1/290）、0.34％（1/290）和0.70％（2/290）,15、30、60μmol/L组与0μmol/L组比较,差异无统计学意义（χ2=1.531,P＞0.05）。结论：HQ对K562细胞生长有明显的抑制作用,但对细胞中XPD基因甲基化水平无影响。     

二甲双胍对2型糖尿病伴非酒精性脂肪肝大鼠的治疗作用研究

目的 观察二甲双胍对2型糖尿病(T2DM)伴非酒精性脂肪肝(NAFLD)大鼠肝功能及肝组织病理形态学的影响,并探讨其可能的作用机制. 方法 按随机数字表法将36只Wistar大鼠分成正常组(12只)和造模组(24只),采用小剂量链脲佐菌素腹腔注射加高脂饲料喂养建立T2DM伴NAFLD模型. 将造模成功的大鼠随机分为单纯模型组(14 只)和二甲双胍组(10只),比较各组大鼠血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、甘油三酯(TG)、总胆固醇(CHO)和低密度脂蛋白胆固醇 (LDLC-)水平,肝组织TG、CHO、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、一氧化氮(NO)和一氧化氮合酶(NOS)水平. 结果 与正常对照组比较,单纯模型组血清ALT、AST、TG、CHO、LDL-C水平均显著升高(P<0.05);肝组织TG、CHO、NO、NOS水平显著升高(P<0.05),SOD及CAT水平降低(P<0 0.5 ). 与单纯模型组比较,二甲双胍组血清ALT、AST、TG、CHO、LDL-C 水平均显著降低(P <0.05),肝组织 TG、CHO、NO、NOS 水平显著降低(P<0.05);SOD 及CAT水平升高(P<0.05). 结论 二甲双胍治疗可显著改善T2DM伴NAFLD大鼠的脂肪肝,其机制可能与二甲双胍改善肝脏组织应激有关.     

320排螺旋CT对多发性肋骨骨折的诊断价值

目的 收集整理2012年1月～2013年12月我院收治的重症多发性肋骨骨折患者临床资料,分析并探讨320排螺旋CT在多发性肋骨骨折诊断中的临床应用价值。方法 对86例多发性肋骨骨折的患者进行320排螺旋CT扫描,重建全肋骨三维图像,并与胸部X线检查和普通螺旋CT的三维重建图像进行分析比较。结果 所有患者均顺利完成320排螺旋CT扫描,扫描时间均在3~5 s以内。与普通螺旋CT相比,320排螺旋CT重建的三维图像更加清晰细腻,且在线性骨折、凹陷性骨折以及肋软骨骨折的显示上存在显著统计学差异(p < 0.01)。结论 相对于普通螺旋CT,320排螺旋CT具有扫描速度更快、放射剂量更低、图像质量更好等特点,在一定程度上提高了肋骨骨折检出率,使诊断的准确性更高,具有明显的优势。     

High Physical Activity is Associated with an Improved Lipid Profile and Resting Heart Rate among Healthy Middle-aged Chinese People

Objective To investigate the effects of physical activity (PA) on dyslipidemia and elevated resting heart rate (RHR) in a large-scale cross-sectional study in China. Methods We recruited community-based individuals who were 40-60 years old using a cluster sampling method. The PA levels of the participants were classified as low, moderate, or high, using the International Physical Activity Questionnaire. Dyslipidemia was defined as the detection of abnormalities in lipid indicators, and 4 lipid parameters were evaluated using fasting blood samples. Multivariate logistic regression analyses were used to evaluate the associations of PA with dyslipidemia and RHR. Results A total of 10,321 participants (38.88% men) were included in this study. The percentages of individuals with high, moderate, and low PA levels were 46.5%, 43.9%, and 9.6%, respectively. In both men and women, high PA provided odds ratios of 0.88 [95% confidence interval (CI): 0.83, 0.94] for dyslipidemia and 0.82 (95% CI: 0.73, 0.92) for elevated RHR, compared to participants with low PA. Conclusion Our data suggested that substantial health benefits (related to dyslipidemia and elevated RHR) occurred at higher intensity PA, with greater energy consumption, in middle-aged Chinese people, and particularly in men.     

脑利钠肽与糖尿病大鼠胃肠排空的关系

目的观察糖尿病大鼠血浆、胃窦平滑肌中脑利钠肽(BNP)的变化并探讨其与胃肠排空的关系。方法将大鼠随机分为糖尿病组、单纯肥胖组和对照组,通过高糖高脂饮食结合腹腔注射小剂量链脲佐菌素的方法建立糖尿病大鼠动物模型;用葡萄糖酚红溶液灌胃30 min后处死大鼠,取胃和小肠近、中、远各段留取内容物后使用分光光度计测定胃肠各段酚红残留率;放射免疫法测定血浆N-末端脑利钠肽原(NT-pro BNP)的浓度;免疫组化检测胃窦平滑肌内BNP的表达。结果糖尿病组大鼠胃和近段小肠内酚红残留率均多于对照组和单纯肥胖组(P<0.05),而中段和远段小肠酚红残留率均少于对照组和单纯肥胖组(P<0.05);12周后糖尿病组大鼠血浆NT-pro BNP的浓度较对照组和单纯肥胖组显著升高(P<0.05);胃窦平滑肌层中BNP免疫反应阳性细胞各组间比较无明显差异;糖尿病大鼠血浆NT-pro BNP浓度与胃内、近段小肠内酚红残留率呈正相关。结论糖尿病大鼠液体胃肠排空减慢可能与血浆NT-pro BNP浓度增加有关。