载双磷酸盐骨水泥的静态机械强度和疲劳极限

目的:研究载双磷酸盐骨水泥的疲劳极限和静态机械强度及相关影响因素.方法制备不同载荷的载双磷酸盐纯粉骨水泥试件,根据纯粉载荷及试件的贮存环境进行分组,检测抗压强度、压缩弹性模量、抗张强度、抗弯强度和疲劳极限,威布尔频率函数分析疲劳极限,激光散射法测定双磷酸盐纯粉的粒径.结果:增加纯粉载荷可提高试件的抗压强度极限、抗张强度极限,降低疲劳极限.体液浸泡可降低试件的抗压强度极限、压缩弹性模最、抗张强度极限及疲劳极限.结论:双磷酸盐纯粉的粒径及分布范围较小,载入后丙烯酸骨水泥的静态机械强度高于美国材料实验协会/国际标准化组织标准,但疲劳极限有一定程度下降.与文献报道双磷酸盐的液剂或片剂磨粉相比,纯粉对骨水泥疲劳极限和静念机械强度的影响最小.     

唑来膦酸对维吾尔族绝经后妇女骨质疏松性骨折骨代谢指标的影响

目的：探讨注射用唑来膦酸对骨质疏松性骨折维吾尔族绝经后妇女骨代谢指标的影响。方法将2011年6月-2013年1月新疆维吾尔族自治区人民医院收治的105例骨质疏松性骨折维吾尔族绝经后妇女纳入本随机对照试验,其中对照组50例,给予口服钙尔奇600 mg/d及阿尔法D30.25μg/d,治疗时间6个月;治疗组55例,在对照组治疗的基础上予唑来膦酸5 mg,静脉滴注30 min。观察治疗前后两组患者血清骨碱性磷酸酶（BAP）、骨钙素（BGP）、抗酒石酸酸性磷酸酶（TRACP）-5b水平及L2～L4、股骨颈骨密度（BMD）的变化。结果3例患者失访,102例患者获得随访。治疗组与对照组用药前后BAP、BGP水平比较差异无统计学意义（P＞0.05）;两组用药前TRACP-5b水平比较,差异无统计学意义（P＞0.05）,但用药后治疗组TRACP-5b水平显著低于对照组（P＜0.05）;治疗组用药6个月后患者L2～L4、股骨颈BMD均显著高于对照组（P＜0.05）。治疗组8例患者注射唑来膦酸后出现发热、头痛及流感样症状,对症治疗后3d内缓解,未见肾损害、消化道不适、下颌骨坏死等严重不良反应。结论对于骨质疏松性骨折维吾尔族绝经后女性患者,唑来膦酸注射液可能通过抑制破骨细胞活性、阻止骨吸收来发挥作用,能够有效增强患者骨密度,治疗安全有效,值得推广。     

内分泌治疗对乳腺癌患者骨密度影响的研究进展

雌、孕激素受体（ER、PR）阳性的浸润性乳腺癌患者,均应接受内分泌治疗。内分泌治疗疗效好,但有其相应的不良反应,骨密度（bone mineral density,BMD）降低是内分泌治疗的主要不良反应之一。本文主要介绍乳腺癌内分泌治疗对患者骨密度的影响方面研究进展。     

Effect of etidronate disodium on bone turnover following surgical menopause

Summary A longitudinal study was performed to document the effect of surgical menopause and postmenopausal etidronate disodium therapy on several nonhistomorphometric indices of bone turnover. Twenty healthy, premenopausal women undergoing oophorectomy for nonmalignant conditions were studied preoperatively and at 3 monthly intervals postoperatively. Sequential measurements of serum calcium (Ca), alkaline phosphatase (AP), bone Gla protein (BGP), and urinary calcium and hydroxyproline excretion, expressed as a ratio of urinary creatinine (UCa/Cr and UOHp/Cr, respectively) were obtained. Twenty-four-hour whole body retention of diphosphonate (WBR) and radial bone density were also measured. When a postoperative increase in bone turnover was observed, patients were randomized to receive either 400 mg etidronate disodium daily or placebo for 3 months. Oophorectomy was associated with a significant increase in WBR, Ca, AP, and BGP and an insignificant rise in UCa/Cr. A variable pattern of UOHp/Cr was seen. Patients on placebo maintained these elevated levels of Ca, BGP, and UCa/Cr. WBR and AP continued to rise. Etidronate disodium therapy resulted in a fall towards premenopausal levels in WBR, Ca, and UCa/Cr. AP and BGP were unchanged. Three months after stopping etidronate, BGP fell significantly and the decrease in Ca was maintained; however, WBR and UCa/Cr had returned towards pretreatment values. Bone density measurements did not change significantly. An increase in several of the indices of bone turnover was seen following oophorectomy. Etidronate disodium suppressed this increase, affecting indices of both resorption and formation. This effect on formation may be an unavoidable consequence of normal resorption-formation coupling. The ability of etidronate alone to maintain postmenopausal bone mass has yet to be established. However, the suppressive effect of this diphosphonate on the accelerated bone turnover found after oophorectomy suggests that etidronate may have a potentially useful role as an inhibitor of resorption in a pulsed regimen.     

The binding of pyrophosphate and two diphosphonates by hydroxyapatite crystals

The binding on hydroxyapatite has been studied of inorganic pyrophosphate (PP_j) and two diphosphonates, disodium ethane-1-hydroxy-1,1-diphosphonate (EHDP) and disodium dichloromethylene diphosphonate (Cl₂MDP). The binding is greatest for PP_i, less for EHDP and least for Cl₂MDP. The binding of all three is accompanied by a release of orthophosphate into the solution and an uptake of calcium by the crystals. A competition exists between EHDP and PP_i, EHDP being more potent in displacing PP_i than the reverse. An analysis with Scatchard plots suggests that the binding is not restricted to one class of binding sites with equal affinity and that the affinity of the first site is in the order EHDP>PP_i>Cl₂MDP. The results correlate well with previous data on the effect of these compounds on apatite crystal formation and dissolutionin vitro and on bone formation and resorptionin vivo To Prof. F. Leuthardt to his 70th birthday.     

AMINOHYDROXYPROPYLIDENE DIPHOSPHONATE TREATMENT OF HYPERCALCEMIC CRISIS DUE TO PRIMARY HYPERPARATHYROIDISM

A 43 year old man was known to have had mild primary hyperparathyroidism for several years. Nine days following surgery for acute cholecystitis he developed a hypercalcemic crisis with a plasma calcium level of 4.23 mmol/l, despite intravenous and oral hydration. The hypercalcemia was corrected by a single intravenous dose of (3-amino-1-hydroxypropylidene)-1,1-diphosphonate (15 mg), allowing parathyroidectomy to be performed electively and on a well patient.     

Effect of diphosphonates on hydroxyapatite formation induced by calcium-phospholipid-phosphate complexes

Summary The diphosphonates disodium ethane-1-hydroxy-1, 1-diphosphonate (EHDP) and disodium dichloromethylene diphosphonate (Cl₂MDP) prevent hydroxyapatite (HA) formation in metastable calcium phosphate solutions, induced by calcium-phospholipid-phosphate complexes and by the acidic phospholipids phosphatidyl serine and phosphatidyl inositol. The diphosphonates appear to act not only as HA crystal poisons but also as surfactants which probably change the nature of the lipid micelle and the charge and conformational properties of the lipid molecules. The surfactants sodium dodecyl sulfate (SDS) and Non-Idet P-40 (NP-40), like the diphosphonates, prevent HA formation by the acidic phospholipids and complexed lipids, but do not act as HA surface poisons. The lipid surfactant lyso-phosphatidyl serine did not induce HA formation from solution. The relevance of the ability of the diphosphonates to act as lipid surfactants to the in vivo use of these agents is discussed.     

唑来膦酸改善骨质疏松患者后路腰椎椎间融合术后腰痛

目的了解唑来膦酸对骨质疏松患者行后路腰椎椎间融合术(PLIF)后腰痛的影响,评价唑来膦酸的安全性与有效性。方法选取2013年6月—2015年6月在中国人民解放军西部战区总医院因腰椎退行性疾病接受PLIF治疗的63例骨质疏松症患者,按照随机数字表法分为对照组和治疗组,术后均给予相同的抗骨质疏松基础治疗(口服碳酸钙D3片),治疗组联合应用唑来膦酸治疗。记录并比较2组患者术前及术后随访期疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)。结果术前及术后1周,2组腰痛VAS评分无显著差异;术后各时间点2组腰痛VAS评分较术前均明显下降,差异有统计学意义(P 0.05);治疗组术后1、3、6和12个月的腰痛VAS评分低于对照组,差异有统计学意义(P 0.05)。术前2组ODI无明显差异;术后各时间点2组ODI均较术前明显改善,且治疗组优于对照组,差异均有统计学意义(P 0.05)。结论骨质疏松患者PLIF后应用唑来膦酸,有助于减轻患者术后中远期腰痛,改善患者术后腰椎功能。     

阿仑膦酸钠引发食管炎的探讨

目的探讨绝经后妇女口服阿仑膦酸钠引发食管炎对患者耐受性的影响。方法采用临床配对平行对照研究。计划入组病例60例,评估后,入选患者均经胃镜检查,经配对分入试验组或对照组。试验治疗疗程为12个月,在治疗前、6个月末和12个月末对阿仑膦酸钠引发食管炎的安全性进行评估。结果治疗后骨密度明显上升,阿仑膦酸钠组与碳酸钙组比较差异有统计学意义(P<0.01)。食管炎的发生率两组差异无统计学意义(碳酸钙组:14.17%、阿仑膦酸钠组:15.83%)。结论阿仑膦酸钠在增加骨密度、减少骨折的同时,并无增加食管炎甚至食管溃疡的风险。     

Binding of the bone-seeking agent99mTc-1-hydroxyethylidene-1,1-diphosphonic acid to cartilage and collagen in vitro and its stimulation by Er3+ and low pH

Summary The bone-seeking agent^99mTc-labeled 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP) unexpectedly binds to particles of human articular cartilage as well as cortical bone in vitro. Collagen also sequesters this compound, suggesting that collagen contributes to the uptake of^99mTc-HEDP by cartilage and bone. Particles of the bone mineral calcium hydroxyapatite also bind^99mTc-HEDP in vitro. Pretreatment of particles with Er³⁺ stimulates binding in each case. Lowering the pH of incubation to pH 2 has this effect for bone, cartilage, and collagen, but not for calcium hydroxyapatite. Mechanisms additional to the simple ionic attraction between the phosphonate groups of HEDP and metal cations such as Ca²⁺ are responsible for the uptake of^99mTc-HEDP by body tissues.