继发性甲旁亢的锁骨骨吸收

１８例慢性肾衰继发性甲旁亢病人发现有锁骨骨吸收。发病部位包括锁骨内端、外端、外１／３下缘及内段下缘４个部位。其中锁骨内、外端骨吸收属软骨下骨吸收，内、外段下缘骨吸收属韧带下骨吸收。作者对锁骨骨吸收的Ｘ线表现及发病机制作了讨论。认为锁骨骨吸收是继发性甲旁亢的重要Ｘ线征象，对诊断肾性骨病具有重要的意义。     

Alpha2-HS glycoprotein phenotypes and quantitative hormone and bone measures in postmenopausal women

Summary It has been suggested that inherited traits play a role in the development of osteoporosis by providing a background for the modulation of gene expression. In this study, we examine the influence of the different alleles of alpha₂-HS glycoprotein (AHSG), a protein of the bone matrix, on quantitative estrogens, estrone and estradiol, and bone measures, bone area and density. Estrogens provide a protective effect against fractures in older women and were thus included in the analyses. Isoelectric focusing of AHSG from sera followed by immunoblotting was used to type 163 white post-menopausal women participating in a clinical trial of the effects of walking on bone loss. Plasma hormones were measured by a combination of extraction, column chromatography, and radioimmunoassay; bone measures on the dominant radius were determined with computerized tomography. Analysis of variance was done on estrogen and bone measures after controlling for the effects of age and body mass index. The two major alleles of AHSG result in three phenotypes, designated AHSG 1-1, AHSG 2-1, and AHSG 2-2. The AHSG 1-1 homozygote showed a decreased concentration of estradiol, the AHSG 2-2 homozygote showed an increased concentration, and the AHSG 2-1 heterozygote was intermediate (P=0.001). Estrone demonstrated a similar pattern in residual analysis although it did not reach statistical significance.     

Histological study of effect of bone morphogenetic protein derived from bovine tooth on periosteum in rats

Summary In this study, we examined histologically the effect of a bone morphogenetic protein (BMP) derived from bovine tooth on the periosteum. Supraperiosteal injection of crude BMP into femurs of Wistar rats (28 day old) resulted in periosteal cell proliferation with subsequent bone and cartilage formation. Moreover, proliferating periosteal cells migrated into injected BMP, and formed both cartilage and bone. These observations show that exogenous BMP stimulates mesenchymal cells of the periosteum to proliferate and differentiate into osteoblasts, and therefore BMP may be one of factors which are involved in differentiation of osteoblasts in the periosteum.     

Effect of cortisone on cells at the bone-marrow interface

Summary A study of the association between the rate of proliferation of marrow fibroblast-like stromal cells (in vitro) and the rate of endosteal bone mineralization (EsMR) (in vivo) was undertaken in an osteopenic rat model. We report than 200 g male rats treated with cortisone acetate (5 mg/day for 7 days) exhibit decreases in marrow fibroblast colony-forming units (FCFU) and tetracycline-based measurements of EsMR at the level of the femoral midshaft. In cortisone-treated rats recovering for 1–3 weeks, the FCFU census and EsMR normalized during the first posttreatment week, remained at control levels after 2–3 weeks, and exhibited a relapse in the third week which signified only partial recovery. These changes were unrelated to patterns of body weight gain. The data indicate that the FCFU census can serve to index endosteal osteoblast vigor.     

Electron microscopy of developing calvaria reveals images that suggest that osteoclasts engulf and destroy osteocytes during bone resorption

Summary It is generally accepted that osteoclasts are responsible for the breakdown and removal of bone matrix constituents. However, very little is known about the fate of osteocytes during bone resorption. In the present study we have examined sites of bone destruction in calvaria of young rats aged 4–9 days in the hope of obtaining information on the fate of osteocytes. Decalcified glutaraldehyde-formaldehyde-fixed specimens were prepared for ultrathin section electron microscopy. When sequentially arranged, the images obtained suggest that osteoclasts engulf and destroy osteocytes during bone degradation. We propose that the following sequence of events takes place when a lacuna is opened up by an osteoclast: (1) When the osteoclast comes in contact with an osteocyte, the villi of the ruffled border become flat and broad. (2) Long osteoclastic extensions surround the osteocyte. (3) The osteocyte is subsequently internalized with apparent degradation.     

Osteoporosis and Coronary Atherosclerosis in Asymptomatic Postmenopausal Women

Estrogen deficiency is a risk factor for osteoporosis and coronary artery disease. Osteoporosis can be evaluated by measuring bone mineral density (BMD). Coronary atherosclerotic burden can be evaluated by measuring coronary calcium using electron beam computed tomography (EBT) of the heart. We compared coronary calcium scores in 45 asymptomatic postmenopausal women with normal and low BMD. BMD of the lumbar spine and proximal femur was measured by dual X-ray absorptiometry (DXA), and coronary calcium was measured quantitatively by EBT. Women were divided into control, osteopenia, and osteoporosis groups based on the T score of the lumbar spine. Women were similar in age, years since menopause, height, weight, and body mass index (BMI). BMD ± SD (g/cm²) of L1–L4 was 0.96 ± 0.11, 0.83 ± 0.03, and 0.73 ± 0.05, in control, osteopenia, and osteoporosis group, respectively. The total coronary calcium score ± SD (relative units) was 41.9 ± 83.1, 115.1 ± 181.9, and 221.7 ± 355.4 for control, osteopenia, and osteoporosis group, respectively; the score was significantly higher in the osteoporosis than in the control group. This study provides initial data suggesting that women with osteoporosis may have a higher risk of developing coronary atherosclerosis.     

小儿先天性髋关节脱位近年来应用术式的演变及其评估

本文介绍本院近４年来小儿先天性髋脱位治疗应用术式的演变。由２０多年来一直喜欢用骨盆截骨术演变为近１年来用得最多的是造盖术。近４年共手术４６３例，５６５髋。实践证明：比起骨盆截骨术，造盖术显得更简便，侵袭小，不需二次手术拔除内固定针。因在我国大龄髋脱位偏多，造盖术更适合我国国情。经过一些改进，可以克服造盖折断和吸收问题。     

Utilisation des implants biodégradables dans le traitement chirurgical des fractures et au cours des ostéotomies

Résumé L'utilisation de matériaux d'ostéosynthèse biodégradables a l'avantage d'éviter la réintervention pour extraire le matériel. Les biomatériaux de polymères polyglycolides ont été expérimentés sur plus de 3 600 animaux de laboratoire avant leur introduction en pratique clinique. Depuis 1984 nous les avons utilisés comme matériau d'ostéosynthèse dans près de 1 700 cas parmi lesquels 880 cas de fracture malléolaire, 226 cas d'ostéotomie en chevron pour hallux valgus, 65 cas de fracture de la tête radiale et 54 cas de fracture de l'olécrane. Parmi les 800 premiers cas traités par broches biodégradables nous avons obtenu des résultats favorables et sans incidents dans 91 pour cent des cas. Il y eut 7 cas de fixation défaillante nécessitant une réintervention. Il y a eu 7 cas d'infection superficielle et 3 cas d'infection profonde. Nous avons observé la formation d'une collection séreuse sous-cutanée sans influence sur le résultat radiologique ou clinique dans 52 cas (6,5 %). Au vue de ces résultats et compte tenu des avantages économiques et psychologiques des matériaux biodégradables (pas de réintervention), on peut penser que l'usage de biomatériaux rivalise favorablement avec l'usage de matériaux conventionnels dans certains types d'ostéosynthèse.

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Utilization of biodegradable implants in the surgical treatment of fractures and osteotomies

Summary The utilization of biodegradable implants instead of metals in orthopaedic surgery abolishes the need to remove the fixation material. For this study biodegradable rods and screws of self-reinforced polyglycolide, polylactide and lactide-glycolide copolymer were developed and manufactured. The clinical introduction of these implants was preceded by thorough experimental studies with 3 600 animals. From November 1984 the developed biodegradable method of osteofixation was used in 1 700 operations. These included 880 displaced malleolar fractures, 226 chevron-osteotomy for hallux valgus, 65 displaced fracture of the radial head, 54 displaced frature of the olecranon and other fresh fractures or orthopaedic operations. In the first 800 cases operated on using self-reinforced polyglycolide rods the postoperative course was uneventful (91%). Because of failure in the fixation reoperation was needed in 7 cases. A superficial wound infection was observed in 7 cases, deep infection in 3 and transient fluid accumulation in 52 cases (6,5%). Fluid accumulation did not influence the radiological or clinical end-result. The advantages of biodegradable fixation are many-sided. There is a costbenefit and clinical capacity is free for other use, and psychological advantages must be emphasised because removal of implants is not needed. The over all results of this study were considered favourable.

     

Precision of dual-photon absorptiometry

Summary Precision of dual-photon absorptiometry (DPA) measurements was determined in a lumbar spine phantom and in humans. Approximately half of the measurements were made before and half after a¹⁵³gadolinium source change. The phantom was measured with different amounts of acrylic, which simulates human soft tissue, in order to evaluate the influence of body thickness on bone mineral density (BMD). Results of scans analyzed with two software versions from Lunar Radiation Corp., the widely used 08B and a prototype 08C, are compared. DPA with a cold source significantly overestimated BMD in the phantom in the presence of large amounts (more than 25 cm) of soft tissue equivalent with version 08B but not with the newer version 08C. Similiarly, in nine subjects, there was a significant decrease in spine BMD after a source change when scans were analyzed with version 08B (mean difference 0.026 g/cm²,P=0.002) but not with 08C (0.01 g/cm²,P=0.234). No systematic effect of source change on femoral BMD measurements was observed. The SD of the mean difference of two measurements of the nine subjects was 0.019 g/cm² (1.6% of the mean value) for the spine with software version 08B and 0.024 g/cm² (2.0%) with version 08C, 0.03 g/cm² (3.3%) for the femur neck, 0.03 g/cm² (4.0%) for the greater trochanter, and 0.04 g/cm² (4.9%) for Ward's triangle region of the proximal femur. The spine phanton was scanned on two other commercial bone densitometers in order to assess inter-instrument variation. Phantom measurements of L2-4 BMD made on two Lunar Radiation Corp model DP3 scanners which differed by 2% were 10 and 12% higher than those with a Norland Corp. model 2600 scanner.     

The effect of high-dose salmon calcitonin on bone mineral metabolism in the normal rat

Summary The paucity of information on the effect of long-term high-dose salmon calcitonin administration on normal bone mineral metabolism and histology prompted an investigation of the influence of high-dose synthetic calcitonin in the rat. Serum ionized calcium, osteocalcin or BGP (bone gla protein), and immunoreactive PTH were measured serially during calcitonin administration and bone histomorphometry analyzed at 6 weeks (after sacrifice). Daily injections of salmon calcitonin, 0.4 IU/100 g (group B) and 2 IU/100 g (group C), resulted in significant hypocalcemia at 4 hours for both experimental groups (P<0.004). Serium iPTH was significantly higher over the study period for both groups administered calcitonin. Serum BGP levels were significantly lower than controls during the study in group C (P<0.002) and to a lesser extent in group B (P<0.05). In group C, bone histomorphometry revealed increased resorption (onteoclast count), decreased trabecular bone volume, and decreased double-labeled tetracycline surface (bone formation). In group B an increase in osteoclast count but no alteration in bone formation was observed. To assess the role of PTH in the above findings, high-dose calcitonin was administered to parathyroidectomized rats. All of the above changes in bone histomorphometry were not observed in this group of animals. In conclusion, high doses of calcitonin promote hypocalcemia, secondary hyperparathyroidism, and osteoclastosis in the normal rat in a dose-dependent manner with very high-dose calcitonin impairing bone formation.