Cardiovascular Safety and Effectiveness of Bisphosphonates: From Intervention Trials to Real-Life Data

Both osteoporosis with related fragility fractures and cardiovascular diseases are rapidly outspreading worldwide. Since they are often coexistent in elderly patients and may be related to possible common pathogenetic mechanisms, the possible reciprocal effects of drugs employed to treat these diseases have to be considered in clinical practice. Bisphosphonates, the agents most largely employed to decrease bone fragility, have been shown to be overall safe with respect to cardiovascular diseases and even capable of reducing cardiovascular morbidity in some settings, as mainly shown by real life studies. No randomized controlled trials with cardiovascular outcomes as primary endpoints are available. While contradictory results have emerged about a possible BSP-mediated reduction of overall mortality, it is undeniable that these drugs can be employed safely in patients with high fracture risk, since no increased mortality has ever been demonstrated. Although partial reassurance has emerged from meta-analysis assessing the risk of cardiac arrhythmias during bisphosphonates treatment, caution is warranted in administering this class of drugs to patients at risk for atrial fibrillation, possibly preferring other antiresorptives or anabolics, according to osteoporosis guidelines. This paper focuses on the complex relationship between bisphosphonates use and cardiovascular disease and possible co-management issues.     

改良双钢板法对比微创内固定系统治疗复杂胫骨平台骨折的疗效综合评价

目的对改良双钢板法与微创内固定系统（uss）治疗复杂胫骨平台骨折的疗效进行对比分析。方法168例复杂胫骨平台骨折患者按照治疗方法不同分为改良双钢板组（89例,采用改良双钢板法治疗）和LISS组（79例,采用LISS法治疗）,对两种治疗方法的优缺点及疗效进行比较分析。结果改良双钢板组患者治疗效果优良率（89．9％,80／89）略大于LISS组患者的优良率（86．1％,68／79）,两组比较差异无统计学意义（P〉0．05）。两组患者均未出现深部感染及严重的神经损害、静脉血栓等并发症。改良双钢板组手术时间（89．2±13．6）min,术中出血量（188．4±45．6）ml,住院时间（16．5±1．8）d,愈合时间（13．3±2．1）个月,LISS组手术时间（74．3±12．5）min,术中出血量（236．5±65．5）ml,住院时间（16．7±2．1）d,愈合时间（11．4±1．5）个月,两组比较差异无统计学意义（P〉0．05）。结论对于复杂胫骨平台骨折患者的治疗,LISS与改良双钢板法的治疗效果无显著差异。     

后路小切口人工全髋关节置换术

目的 观察后路小切口人工全髋关节置换术（total hip arthroplasty，THA）的临床效果。方法 将70例患者按年龄、性别、体重指数、病种、髋关节功能配对分为两组进行前瞻性研究。35例小切口组，术前Harris评分52．21（24～76），35例标准后路手术组（简称标准组），术前Harris评分51．6（33～68）。分析手术时间、术中出血＋术后12h引流量、并发症、切口长度、疼痛评分、Harris评分等。结果 平均随访11.5个月（6～14个月）。两组手术时间相近。小切口组平均切口长9．0cm（7．0～12cm），标准组16cm（12—20cm），两组差异有统计学意义（P〈0．01）；小切口组平均出血500ml（270～700m1），29％（10／35）需输血，输血量约400ml，而标准组平均出血约950ml（600～1200m1），100％需输血，平均输血650ml，小切口组明显比标准组具有优势（P〈0．05）；小切口组疼痛评分平均为4．8分，标准组为6．8分（P〈0.01）。术后6个月，小切口组Harris评分94．0（84～100），标准组Harris评分90．5（82～94）。结论 后路小切口微创技术具有创伤小、出血少、疼痛小、恢复快的特点，可获得与常规后路手术相同的冶疗效果。     

介入治疗激素性股骨头坏死的实验研究

目的评价介入治疗股骨头坏死的可行性。材料与方法采用中国白兔２０只，随机分成３组。Ａ组为注射激素组，Ｂ组为注射激素后进行介入治疗组，Ｃ组为对照组。介入治疗是将溶栓药物、扩血管药物及改善微循环药物直接注入股骨头供血动脉。对股骨头进行Ｘ线摄片和显微镜观察，研究股骨头的Ｘ线平片表现及病理变化。结果Ｂ组股骨头空缺的骨陷窝数及骨髓腔内脂肪细胞平均直径虽没达到正常水平，但有明显的改善，软骨下区血管数目基本达到正常，血管直径明显增大，Ｘ线平片可见股骨头明显修复。结论通过介入方法治疗股骨头坏死是一种能在临床上广泛应用的新方法。     

胫骨结节撕脱性骨折的治疗

1997年8月～2010年9月,我科手术治疗32例胫骨结节撕脱性骨折患者,效果良好,报道如下。1材料与方法1.1病例资料本组32例,男27例,女5例,年龄14～19岁31例,52岁1例。左侧19例,右侧13例。骨折按Watson-Jones分型[1]:Ⅰ型4例,Ⅱ型19例,Ⅲ型9例。伤后至就诊时间50min～2 d。     

中老年股骨颈骨折全髋关节置换术和中空加压螺钉内固定术临床比较

目的比较全髋关节置换术和中空加压螺钉固定术治疗中老年股骨颈骨折的疗效。方法对55～65岁有移位新鲜股骨颈骨折患者85例的治疗情况进行回顾分析，其中51例行中空加压螺钉内固定术，34例行全髋关节置换术，进行了住院情况，术后1年，术后3年功能评估。结果全髋关节置换组在手术时间，术后早期下床活动等方面具有一定的优越性，但全髋关节置换假体费用较贵，3年后有2例出现假体松动。中空加压螺钉固定组有45例3年后无任何并发症发生，髋关节功能活动良好，且能够从事正常体力劳动。结论中老所股内颈骨折患者手术治疗应首选中空加压螺钉内固定术治疗。     

双钢板垂直和平行放置治疗C型肱骨远端骨折的对比研究

Background Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus. However, there is still controversy concerning dual plate positions in terms of providing optimal stability. The purpose of this retrospective study was to compare the clinical outcomes in patients with type C intra-articular distal humeral fractures using perpendicular and parallel plating methods.

Methods Between March 2008 and June 2011, a total of 45 patients with type C distal humerus fractures were treated using two different dual plating methods. Of them, 24 patients were treated by perpendicular plating (group I) and 21 patients were treated by parallel plating (group II). The surgical time, blood loss, and union time were compared between the two groups. The flexion-extension arc, the total range of flexion and extension at the end of follow-up were compared between the two groups. The Mayo Elbow Performance Score (MEPS) was used to determine the elbow functional results.

Results All patients were followed up. The mean duration of follow-up was 16 months (range 12–25 months) in group I and 15.5 months in group II (range 12–25 months). There were no significant differences in the surgical time, blood loss, and the bone union time between the two groups. In group I, the mean elbow flexion-extension arc was 101° and the mean MEPS was 85 points. The rate of excellent and good results was 87.5%. In group II, the mean flexion-extension arc was 100° and the mean MEPS was 86.1 points. The rate of excellent and good results was 90.5%. There were no significant differences in the MEPS, flexion-extension arc, and the total range of flexion and extension between the two groups.

Conclusions Perpendicular and parallel plate configurations with the appropriate surgical techniques can provide anatomical reconstruction and stable fixation of type C intra-articular distal humeral fractures and allow early mobilization of the elbow after an operation. The occurrence of post-operative elbow stiffness can be reduced and good outcomes can be obtained.

     

髂筋膜间隙阻滞对股骨粗隆间骨折患者体位改变的镇痛效应

目的 探讨术前髂筋膜间隙阻滞对股骨粗隆间骨折手术患者体位改变的镇痛效应.方法 选择80例股骨粗隆间骨折行择期手术治疗的患者,美国麻醉医师协会麻醉风险评分(ASA)Ⅰ～Ⅱ级,随机分为髂筋膜间隙阻滞组(F组)和静脉注射地佐辛组(D组),每组40例.于入室前60 min,F组以0.4％罗哌卡因30 ml行髂筋膜间隙阻滞,D组以地佐辛注射液5 mg静脉注射.记录第1次过床(T1)、第2次过床(T2)、麻醉体位摆放(T3)时间点被动活动的视觉模拟评分(VAS)和局麻药毒性反应情况.结果 F组T1、T2、T3的VAS评分分别为(4.5±1.4)分、(3.8±1.2)分、(3.9±0.7)分,明显低于D组各时间点VAS评分[(7.9±1.2)分、(7.5±0.8)分、(7.0±1.1)分,P均＜0.05].F组无局麻药中毒发生;D组在静脉注射地佐辛60 min内,恶心3例(7.5％),头晕2例(5.0％).结论 髂筋膜间隙阻滞可以安全有效地用于股骨粗隆间骨折手术患者的转运及椎管内麻醉前体位的摆放.     

低强度脉冲超声对兔下颌骨骨折愈合中OPG/OPGL及COX-2表达的影响

目的通过观察低强度脉冲超声(low intensity pulsed ultrasound,LIPUS)治疗新西兰大白兔下颌骨骨折后骨保护素(osteoprotegerin,OPG)、骨保护素配体(osteoprotegerin ligand,OPGL)、环氧合酶-2(cyclooxygenase-2,COX-2)蛋白及mRNA的动态变化,探讨LIPUS促进骨折愈合的作用机制。结论健康雄性新西兰大白兔84只,随机分为对照组(42只)和实验组(42只),建立下颌骨骨折模型,用LIPUS治疗,分别于术后1、3、14、21、28、56d各取相同例数动物(n=6)处死取样。采用免疫组织化学、RT-PCR技术检测OPG、OPGL、COX-2蛋白及mRNA动态变化。结果 LIPUS治疗兔下颌骨骨折后,OPG、OPGL、COX-2蛋白浓度和mRNA及OPGL/OPG比值在不同时间点均有不同程度上调(P<0.05),但各指标上调幅度最大(P<0.01)的时间点不同,且上调幅度无相关性,只有OPG的上调幅度与OPGL比较差异有统计学意义(P<0.05)。结论 LIPUS能促进兔下颌骨骨折部位OPG、OPGL、COX-2的表达,从而促进骨折愈合。     

胫骨平台骨折Schatzker分型与膝关节功能相关性分析

目的：探讨胫骨平台骨折Schatzker分型与术后膝关节功能相关性。方法选取2010年1月至2014年12月收治的胫骨平台骨折患者120例,根据X线片、CT及三维重建进行Schatzker分型,分为6组,对各组术后膝关节功能进行随访并进行统计学分析。结果经Kruskal‐Wallis检验,6组膝关节功能评价优良等级分布比较差异有统计学意义（P＜0．01）,进一步两两比较,1、2组分别与4、5、6组比较,差异有统计学意义（P＜0．05）。结论胫骨平台骨折Schatzker分型与术后膝关节功能密切相关,Ⅳ、Ⅴ、Ⅵ型骨折术后膝关节功能评分明显较差。