Treatment of osteoporosis in men

Osteoporosis in men is recognised worldwide as an important and increasing public health problem. The causes are more heterogeneous than those in women. About 50% are diagnosed as secondary cases. In some secondary forms of osteoporosis the specific diagnosis results in additional therapeutic options (e.g. androgen therapy in proven hypogonadism). The basic therapy for osteoporosis in men is no different to that in postmenopausal women, namely recommendations for counteracting modifiable risk factors, especially with regard to diet, physical exercise, and calcium and vitamin D supplementation. Concerning specific drug medications, however, even today there is still a therapeutic dilemma in male osteoporosis. While older substances (e.g. calcitonin, fluoride, alfacalcidol) are approved for both sexes, all newer medications have primarily been approved for the treatment of postmenopausal osteoporosis. Health authorities request studies in purely male populations. For new drugs, fracture data are necessary while for new substances within a class (e.g. bisphosphonates), at the very least consistent effects on bone mineral density (BMD) and bone turnover markers are requested. Due to these regulatory rules, ibandronate, teriparatide and strontium ranelate are not approved in the European Union. Some years ago, alendronate was the first bisphosphonate that was approved for the treatment of men with osteoporosis, based on consistent results from two independent male studies using a daily 10 mg dosage. Very recently risedronate was approved by the FDA and EMEA. A randomised, placebo-controlled multicentre trial of 285 male patients showed, after 2 years, a 5.8% increase in lumbar spine BMD in the risedronate 35 mg once weekly group vs 1.2% in the placebo group. In a prospective controlled study on 316 men with primary or secondary osteoporosis we found, after 12 months, a lumbar spine BMD of +4.7% vs +1.0% in controls. The number of patients with one or more new vertebral fractures was 8 in the risedronate group and 20 in the placebo group (a fracture reduction of 60%). Furthermore, we found a significantly smaller decrease in height and a steeper decrease in back pain in the risedronate group. Risedronate is the first oral bisphosphonate available for men with the more comfortable once weekly dosage.     

经皮椎体成形术中骨水泥对老年骨质疏松症患者凝血功能的影响

目的 观察经皮椎体成形术(PVP)中骨水泥对老年骨质疏松症患者凝血功能的影响.方法 于椎弓根穿刺前10 min、注入骨水泥后1、20 min、2 h分别抽血检测11例患者的凝血功能相关指标,包括血浆凝血酶原时间(PT)、活化的部分凝血酶原时间(APTT)、血浆纤维蛋白原(FIB)和鱼精蛋白副凝固实验(3P实验),并汇总数据进行统计学分析.结果 PVP中骨水泥注入后20 min,PT缩短、FIB增高、3P实验阳性率升高(P<0.05),骨水泥注入2 h后基本恢复至注入前水平.除1例患者PTA术后2 h稍高于正常值(126%),其余患者各个时间点的各项指标均在正常参考值范围内.结论 PVP术中注入骨水泥对于凝血功能正常的患者基本安全,但在注入后会产生一过性轻微的高凝倾向.     

前后路联合三维矫形手术治疗青少年特发性僵硬型胸椎侧凸

目的:评价前路松解联合后路三维矫形治疗青少年特发性僵硬型胸椎侧凸的效果,探讨术中、术后并发症的预防措施。方法:青少年特发性僵硬型胸椎侧凸34例,男5例,女29例;年龄8～21岁,平均14.7岁。均为右侧凸。均采用经前路松解植骨融合联合后路三维矫形内固定治疗,其中前路经胸入路26例,胸腔镜前路松解植骨融合矫形术8例。随访时均摄全脊柱X线片。术前、术后所摄X线片进行以下各项测量指标比较:Cobb角、顶椎的旋转度、下融合椎旋转度、躯干偏移距离。随访时观察有无脊柱失平衡、假关节形成及其他并发症的发生。结果:全部病例均获随访,时间12～39个月,平均22个月。所有患者Cobb角术后平均矫正率80.62%,其中18例患者出现矫正度数丢失,丢失度数3°～10°,平均4.3°(术后平均14.2°,1年后随访平均18.5°)。所有患者术后胸椎生理性后凸得到重建。术后胸椎融合弯顶椎的旋转改善率62.91%,下融合椎旋转改善率47.60%,躯干偏移平均距离3.3mm,未见脊柱失平衡现象。围手术期并发症包括低氧血症1例,胸腔积液2例,均经保守治疗后痊愈。术后6个月肺功能检查,未见有明显下降。脊柱胸弯融合段未发现假关节形成。结论:前路松解联合后路矫形内固定植骨融合治疗青少年特发性僵硬型胸椎侧凸可明显改善顶椎的旋转度,得到满意的三维矫形效果。术前积极准备、合理手术设计,术中严格操作,术后重视预防并发症能减少手术并发症的发生。     

Bone marrow punctures and pain

We prospectively analysed pain in 263 patients induced by a frequent diagnostic procedure for oncologists, specifically the bone marrow puncture. Substantial pain (5 and more out of 10 on a numerical rating scale) was reported by 30.4% of patients, but physicians did not realize this procedure-related pain of patients in more than 50% of such punctures. The necessity for improved analgesia is emphasized by the fact, that at least 50% of patients experiencing substantial pain wished to receive concomitant medication in future punctures. Duration of the procedure was identified as sole independent predictive factor for patients’ pain intensity, while patients’ characteristics like gender, age and body-mass index (BMI) played only a minor role. As premedication with analgesics or anxiolytics may be associated with significant side-effects and an early identification of patients prone to experience severe pain is therefore difficult, further studies are warranted to establish an adequate approach in terms of pain control and feasibility in an ambulatory setting. In the meantime, daily physicians’ practice should be changed, as a pain-focused patient interview and presented indicators can be used in order to increase physicians’ awareness to procedure-related pain and augment their application of analgesics.     

手法治疗肘关节错缝86例

2000年1月-2005年10月共治疗肘关节错缝86例,临床效果满意,现报告如下。1临床资料86例中男61例,女25例;年龄13~46岁。受伤机制:均为跌倒时手掌着地,肘关节过伸导致。摄X线片未见骨折及关节异常。肘关节伸屈活动障碍,伸20°~40°,屈90°~110°,屈伸平均(70·57°±3·01°)的活动范围。肘关节轻度肿胀,以内后方为甚,压痛点为尺骨半月切迹的内侧,强作旋后活动时会引起剧烈疼痛,肘三角正常。受伤至就诊时间1~3 d,平均1·5 d。2治疗方法2·1复位左肘错缝者坐于靠背椅上,助手立于患者侧背后方,紧握患者上臂,术者于患者前侧,左手握患者腕部,右手…     

快速富集骨髓干细胞复合羟基磷灰石三钙在胸腰椎骨折中的应用

胸腰椎骨折在临床上是脊柱骨折的好发部位,后路手术多采用椎弓根钉系统复位固定加椎板间或横突间植骨融合。后外侧融合是降低内固定失败、减少纠正丢失等并发症的有效措施。传统植骨采用自体髂骨,也有运用同种异体骨,但有一定并发症发生率。近年来有单纯运用骨髓移植治疗骨缺损     

过氧化物酶体增殖物激活受体γC161T基因多态性与糖皮质激素性骨质疏松症的关系

目的 探讨中国人过氧化物酶体增殖物激活受体γ(PPARγ)基因外显子6 C161T多态性与糖皮质激素性骨质疏松症(GIO)的相关关系。方法 应用聚合酶链反应-限制性片段长度多态性(PCR-RELP)方法测定208例正常健康人（Ⅰ组）、168例非GIO患者（Ⅱ组）和104例GIO患者（Ⅲ组）PPARγ基因外显子6 C161T的基因型。应用双能X线骨密度仪(DEXA)测定股骨、腰椎等部位的骨密度。 结果 外显子6 C161T有CC、CT、TT 3种基因型。GIO组CC基因型频率显著低于正常对照组；CT和TT基因型频率显著高于正常对照组。非GIO组、应用激素组（GIO组＋非GIO组）与正常对照组比较，各基因型频率差异均无统计学意义。正常对照组C161T的CC基因型组各部位的骨密度有高于CT和TT基因型组的趋势，但差异无统计学意义。非GIO组和GIO组C161T的CC基因型组腰椎的骨密度明显高于CT和TT基因型组 (P ＜ 0.05)，分别为非GIO组CC型（1.04±0.17） g/cm2，CT+TT型（1.02±0.07） g/cm2；GIO组CC型（0.94±0.12） g/cm2，CT+TT型（0.83±0.08） g/cm2。经年龄、体重指数等因素校正后，差异仍有统计学意义(P ＜ 0.05）。 结论 PPARγ基因C161T基因型在正常人和应用激素患者之间无明显差异，它可能与肾小球肾炎的发病无关。C161T基因型在GIO组和正常对照组之间差异有统计学意义，它可能与糖皮质激素性骨质疏松症的发病有关。PPARγ基因C161T多态性与应用糖皮质激素患者腰椎的骨密度有关。等位基因C可能是骨量的保护因子，它可能与应用糖皮质激素后骨量的丢失有关。     

An inexpensive ex-vivo porcine laparoscopic Nissen fundoplication training model.

BACKGROUND: We recently implemented the use of an ex-vivo porcine model to teach residents the fundamentals of performing a laparoscopic Nissen fundoplication. METHODS: Residents were trained using intact porcine esophagus, stomach, and spleen placed in a standard video-trainer. They were later asked to complete a survey containing a course evaluation. RESULTS: Sixteen residents (R1-R4) completed the survey. They agreed that (1) the exercise was a valuable use of their limited time, (2) repeating the exercise will be of additional benefit, (3) it will improve their ability to perform or assist in an actual case in the OR, and (4) the surgical principles learned using the model will transfer to other laparoscopic cases. Significant subjective improvements were reported in resident comfort level in assisting in or performing a laparoscopic Nissen fundoplication. CONCLUSIONS: The use of an inexpensive ex-vivo porcine training model increases resident comfort level in performing a Nissen fundoplication in the operating room.     

生长板软骨细胞促进骨髓基质干细胞血管内皮生长因子的表达

目的观察骨髓基质干细胞(BMSCs)在生长板软骨细胞旁分泌作用下血管内皮生长因子(VEGF)的表达规律及其与成骨分化的相关性。方法大鼠BMSCs与生长板软骨细胞进行间接共培养,培养终末期做细胞化学染色,定量测定碱性磷酸酶(ALP)活性,用RT-PCR方法半定量检测VEGFmRNA的表达。结果生长板软骨细胞持续高表达VEGF。BMSCs随共培养时间的延长,ALP活性升高,BMSCs的VEGF的表达也逐渐增强。培养液加入两种分泌型VEGF中和抗体后,VEGF表达趋势不变,ALP活性仍为升高趋势,也不影响培养终末期钙化结节的形成。培养终末期BMSCs的CD31和CD34均阴性。结论BMSCs成骨分化过程中VEGF的表达符合成骨细胞分化基因的表达规律,与成骨细胞特征性基因的表达趋势一致,体外条件共培养条件下,中和VEGF后并不能阻碍BMSCs的成骨分化。     

骨髓输液在PICU的应用探讨

目的　探讨骨髓输液在PICU的适应证、方法及临床效果。方法　选择PICU危重症建立静脉通道困难患儿 30例 ,采用 7号骨穿针或 7～ 9号头皮针于胫骨粗隆下 1～ 2cm穿刺、固定 ,接入医嘱液体 ,记录穿刺所需时间、入液速度及生命体征变化、并发症等。结果　 2 8例 1次成功 ,2例用头皮针者有堵塞 ,换针后重新穿刺成功 ,穿刺、固定到接入液体平均时间 (30± 10 )s。速率 :一般压力 (8± 3)ml (kg体重·h) ,加压下 (17± 6 )ml (kg体重·h) ,所有病例均达到了医嘱要求。骨髓输液持续时间 3～ 2 2h ,无 1例出现并发症。结论　骨髓输液在PICU危重症抢救中可迅速建立液体通道 ,争取抢救时间。头皮针比骨髓穿刺针易于固定 ,使用更方便