股骨近端三维有限元模型评价髋部骨折患者骨密度

目的：探究骨密度与老年髋部骨折股骨近端三维有限元模型密度的关系。方法：选取8 例老年髋部骨折,其中4 例股骨颈骨 折,4 例股骨转子间骨折;左侧肢体3 例,右侧肢体5 例。分别测定腰椎骨密度和双侧髋关节CT 资料,运用Mimics软件和abaqus 软件对健侧股骨近端进行重建和计算出该模型的密度。结果：股骨转子间骨折组腰椎骨密度为(-4.05± 0.24) g/cm2,三维有限元模 型密度为[(1.15± 0.02)× 106],均低于股骨颈骨折组的(-3.15± 0.54) g/cm2,[(1.34± 0.06)× 106],两组比较差异均有统计学意义（均 P<0.05）。腰椎的骨密度与三维有限元模型密度成线性正相关（r=0.881,P=0.004）。结论：骨密度与老年髋部骨折股骨近端三维有限 元模型密度成线性正相关的关系,可为进一步用有限元分析法探讨老年髋部骨折部位与骨密度的关系提供理论依据。     

Bone Load Estimation for the Proximal Femur Using Single Energy Quantitative CT Data

A density-based load estimation method was applied to determine femoral load patterns. Two-dimensional finite element models were constructed using single energy quantitative computed tomography (QCT) data from two femora. Basic load cases included parabolic pressure joint loads and constant tractions on the greater trochanter. An optimization procedure adjusted magnitudes of the basic load cases, such that the applied mechanical stimulus approached the ideal stimulus throughout each model. Dominant estimated load directions were generally consistent with published experimental data for gait. Other estimated loads suggested that loads at extreme joint orientations may be important to maintenance of bone structure. Remodeling simulations with the estimated loads produced density distributions qualitatively similar to the QCT data sets. Average nodal density errors between QCT data and predictions were 0.24 g/cm(3) and 0.28 g/cm(3). The results indicate that density-based load estimation could improve understanding of loading patterns on bones.     

腓骨柱植骨支撑固定防治股骨颈骨折术后股骨头坏死的机理和临床疗效

目的:探讨腓骨柱植骨支撑固定防治股骨颈骨折术后股骨头坏死机理研究和临床疗效。方法:随访符合标准的56例患者,记录骨折的Garden分型、内固定的全程稳定性、股骨头坏死的发生和演变等指标,并采用SPSS18.0进行统计分析。结果:56例患者均恢复解剖复位,在术后3-6月骨折愈合,平均4个月,愈合率为100%;Harris功能评分51-100分,平均分为84.6分,其中优者(≥90.0分)37髋,良者(80.0~89.9分)14髋,中者(70.0~79.9分)者1髋,差者(70.0分)4髋,Harris功能评分优良率为91.10%,没有发生内固定失效和骨折不愈合;22例根据MRI表现出股骨头坏死症状,坏死率39.30%,其中17例影像学坏死能够在随访期内维持为ARCOⅠ-Ⅱ期或者完全修复。其余的5例进展为临床坏死;晚期出现塌陷4例(7.15%)。Garden Ⅰ、Ⅱ级和GardenⅢ、Ⅳ级相比较,两组股骨头坏死率有统计学差异(P0.05),且两组的晚期塌陷率比较也有统计学差异(P0.05)。结论:空心加压螺钉与腓骨柱的所具有的生物力学稳定效能,能提供全程可靠的抗挤压、抗拉伸及抗旋转三维度稳定性,可以提供强大的机械稳定性;同时腓骨柱具有较强的生物学修复能力,为股骨头骨头血运重建和坏死区修复持续稳定的血供及持续有效的生物学修复能力。生物学愈合后腓骨柱在软骨下形成一个较大接触面积的支撑效果,可以预防股骨头坏死后塌陷。     

扩髓更换髓内钉治疗髓内钉固定后股骨干肥大性骨不连

目的:评价扩髓更换髓内钉治疗髓内钉固定后股骨干肥大性骨不连的临床疗效及手术适应症。方法:自1998年4月至2009年6月采用扩髓更换髓内钉治疗11例髓内钉固定后股骨干肥大性骨不连,其中男9例,女2例,年龄23-61岁。平均36.2岁,骨折部位在股骨上1/3者2例;中1/3者6例;下1/3者3例,原始骨折Winquist-Hansen分型:I型2例,II型3例,III型4例,IV型2例。结果:11例患者均获随访,时间:11～56个月,平均27.4个月,2例患肢短缩1 cm。另4例未获得骨性愈合,3例再次采用附加钢板合并自体髂骨植骨,1例远端锁钉动力化,再次干预后获得骨性愈合,愈合时间6～16个月,平均8.3个月。结论:扩髓更换髓内钉是治疗髓内钉固定后股骨肥大性骨不连的传统方法,基于力学稳定和临床观察,更适用于股骨中段骨不连。     

重组合异种骨治疗股骨非感染性骨不连的长期疗效观察

目的:探讨重组合异种骨治疗股骨非感染性骨不连的长期临床疗效。方法:对2000年1月至2006年9月间我院应用重组合异种骨(RBX)治疗的37例股骨非感染性骨不连患者进行回顾性分析,其中男26例,女11例;年龄4～70岁,平均31.6岁。骨折部位:股骨近端4例,中段30例,远端3例。骨不连类型:肥大型9例,营养不良型6例,萎缩型22例。固定方式:加压钢板24例,髓内钉11例,外固定架2例。结果:37例患者获得51-131个月的随访,平均90.2个月,骨不连一次手术愈合率:94.6%,4例股骨近端骨不连患者采用Harris评分系统评定疗效,优3例,良1例,差0例,优良率100%。3例股骨远端骨不连患者采用美国膝关节协会评分系统(KSS)评定疗效,优1例,例良1例,差1例,优良率66.7%。30例股骨干骨不连患者采用Harris评分系统和KSS评定疗效,优21例,良8例,差1例,优良率96.7。总优良率94.6%。长期观察均无免疫排斥反应表现。结论:RBX用于治疗股骨非感染性骨不连具有材料充足、骨折愈合率高、组织兼容性好长期应用无免疫排斥反应等优点,是一种良好的自体骨替代材料。     

Formation of double contour as a repair reaction in the human femoral head

Thirty-two femoral heads from autopsy material with arthrotic changes and 12 surgical specimens of femoral heads with different diseases have been examined with respect to their ability to form a 'double contour'. An additional bony plate within the cartilage, giving rise to the double contour, occurred only in the non-pressure zone of the articular cartilage. There were no major differences between autopsy and surgical material and these changes could also not be found in normal femoral heads. The origin of a double contour could be traced to tissue elements penetrating the subchondral bone from the bone marrow, and was the result of a gradual transformation with chondroid tissue as the starting material. We observed a similar transformation leading to lamellar bone in association with pannus.     

Expression of osteoprotegerin and receptor activator for the nuclear factor-κB ligand in XACB/LV-bFGF/MSCs transplantation for repair of rabbit femoral head defect necrosis

The aim of this study is to observe the changes in osteoprotegerin (OPG) and receptor activator for the nuclear factor-κB ligand (RANKL) in a rabbit model, and to explore the therapeutic effect of tissue engineering bone on femoral head necrosis. A total of 60 rabbits were randomly divided into 5 groups. The necrosis model of femoral head defects was created by dexamethasone combined with a horse serum injection. The model of femoral head necrosis was reconstructed by tissue engineering bone. The protein expressions of OPG and RANKL were detected by Western blot analysis. The expression of OPG and the RANKL protein in group E was higher than that in the other 4 groups (P < .05); there was no significant difference between groups C and D ( P > .05). The expression of OPG protein in the rabbit femoral head necrosis group was improved by xenogeneic antigens of cancellous bone/lentiviral-basic fibroblast growth factor/mesenchymal stem cells, which were expected to be used as an effective tissue engineering material to repair the necrosis of the femoral head.     

Consideration of multiple load cases is critical in modelling orthotropic bone adaptation in the femur

Functional adaptation of the femur has been investigated in several studies by embedding bone remodelling algorithms in finite element (FE) models, with simplifications often made to the representation of bone’s material symmetry and mechanical environment. An orthotropic strain-driven adaptation algorithm is proposed in order to predict the femur’s volumetric material property distribution and directionality of its internal structures within a continuum. The algorithm was applied to a FE model of the femur, with muscles, ligaments and joints included explicitly. Multiple load cases representing distinct frames of two activities of daily living (walking and stair climbing) were considered. It is hypothesised that low shear moduli occur in areas of bone that are simply loaded and high shear moduli in areas subjected to complex loading conditions. In addition, it is investigated whether material properties of different femoral regions are stimulated by different activities. The loading and boundary conditions were considered to provide a physiological mechanical environment. The resulting volumetric material property distribution and directionalities agreed with ex vivo imaging data for the whole femur. Regions where non-orthogonal trabecular crossing has been documented coincided with higher values of predicted shear moduli. The topological influence of the different activities modelled was analysed. The influence of stair climbing on the properties of the femoral neck region is highlighted. It is recommended that multiple load cases should be considered when modelling bone adaptation. The orthotropic model of the complete femur is released with this study.     

Exercise,smoking, and calcium intake during adolescence and early adulthood as determinants of peak bone mass. Cardiovascular Risk in Young Finns Study Group.

OBJECTIVE--To evaluate the contribution to peak bone mass of exercise, smoking, and calcium intake in adolescents and young adults. DESIGN--Prospective cohort study with end point measurement (bone mineral density) after 11 years'' follow up for lifestyle. SETTING--Five university hospital clinics. SUBJECTS--264 (153 females, 111 males) subjects aged 9 to 18 years at the beginning of the follow up and 20 to 29 years at the time of measurement of bone mineral density. MAIN OUTCOME MEASURE--Bone mineral density of lumbar spine and femoral neck by dual energy x ray absorptiometry; measures of physical activity and smoking and estimates of calcium intake repeated three times during follow up. RESULTS--In the groups with the lowest and highest levels of exercise the femoral bone mineral densities (adjusted for age and weight) were 0.918 and 0.988 g/cm2 for women (P = 0.015, analysis of covariance) and 0.943 and 1.042 g/cm2 for men (P = 0.005), respectively; at the lumbar spine the respective values were 1.045 and 1.131 (P = 0.005) for men. In men the femoral bone mineral densities (adjusted for age, weight, and exercise) were 1.022 and 0.923 g/cm2 for the groups with the lowest and highest values of smoking index (P = 0.054, analysis of covariance). In women the adjusted femoral bone mineral density increased by 4.7% together with increasing calcium intake (P = 0.089, analysis of covariance). In multiple regression analysis on bone mineral density of the femoral neck, weight, exercise, age, and smoking were independent predictors for men; with weight, exercise, and age for women. These predictors together explained 38% of the variance in bone mineral density in women and 46% in men. At the lumbar spine, weight, smoking, and exercise were predictors for men; and only weight for women. CONCLUSIONS--Regular exercise and not smoking is important in achieving maximal peak bone mass in adolescents and young adults.     

伊班膦酸盐预防肝移植术后骨质疏松症的临床效果观察

目的:观察每月口服伊班膦酸盐、维生素D3及钙剂预防肝移植术后骨质减少及骨质疏松症的临床疗效。方法:选择我院2011年1月至2013年8月收治的50例终末期肝病行尸体原位肝移植的患者,患者肝移植术后每月口服伊班膦酸钠(150mg)、维生素D3(800IE)及钙剂(1g/日),采用双能X线吸收测定法评估移植术后3个月、6个月、1年、2年腰椎及股骨颈的骨密度,同时评估骨的代谢物碱性磷酸酶(BAP)、尿吡啶诺林(PYD)、尿脱氧吡啶诺林(DPYD)的变化。结果:肝移植术后3个月患者的腰椎骨和股骨颈骨密度T值及测量值较移植前均有所下降,在持续治疗后12个月及后上升较为明显,骨密度较基线值的百分比从移植后的3个月到24个月呈稳定的上升趋势,差异有统计学意义(P0.05)。移植术后3个月的骨碱性磷酸酶较移植前明显的下降,在6、12个月时较前增加,但在24个月时再次下降。而移植术后的3、6个月的尿吡啶诺林、尿脱氧吡啶诺林上升,在12、24个月时与移植前比较无明显变化。移植后2年骨折发生率为4%。结论:每月口服1次伊班膦酸盐能显著提高肝移植术后患者第1年及第2年的骨密度,降低骨折的发生率。     

Study of serological and biological markers in viral hepatitis. 157 hemophiliacs

We observed for a two years period 157 hemophiliacs (138 with hemophilia A whose 13 were severe and 19 with hemophilia B whose 13 were severe) and we studied the incidence of liver dysfunction and the role played by HB and non-A, non-B, viruses. Whereas 32 patients not related had no evidence of serological HB virus markers (by radioimmunoassay), 88 (70,4 %) among the 135 hemophiliacs with large or small exposure to blood products were "HB positive". 90,9 % were positive for anti-HBs and anti-HBc antibodies and only two patients had persistent antigenemia. These results appeared independent of the kind of treatment (factor VIII or factor IX concentrates). Six among 17 children born since 1974, when the antigen was detected by RIA, had the serological HB virus markers, showing that this method is not sufficient to completely eliminate the HB virus. However the amount of viruses injected is too small to induce an acute hepatitis and rather produces specific antibodies which protect hemophiliacs against reinfection. An elevated level of serum transaminases (SGPT) was observed in 9,4 % of non treated hemophiliacs, 15,1 % of treated hemophiliacs with no serological markers of HB virus and 27,7 % of treated hemophiliacs "HB positive". This shows that the use of concentrates and the occurring of HB virus in the patients are not the only factors producing liver dysfunction. The role of non-A, non-B viruses has been recognized in 7 patients out of 9 with transient elevation of serum transaminase levels, by Trepo with an immunodiffusion technique.     

A laboratory simulation for morselized bone graft fusion: apparent modulus under operatively based femoral impaction kinetics

The purpose of this study was to determine the apparent modulus changes accompanying a novel procedure for simulating in situ fusion of morselized cancellous bone femoral impaction grafts. An experienced surgeon's habitual intra-operative impaction grafting protocol was first quantified in human cadaver femurs, using a customized impulse force hammer. A corresponding standardized impaction procedure was then defined, and was used to prepare impaction grafts in axisymmetric metallic fixturing designed to replicate the nominal geometry of femoral canal confinement. Impaction graft fusion was simulated by mixing morselized cancellous bone with an amine-based epoxy adhesive before the impaction, then allowing the mixture to fuse after the impaction (J. Biomech. 34 (2001) 811). Force/deflection behavior of the unfused and fused impaction grafts was measured for both the (tapered) proximal and (untapered) distal portions of the grafts. Apparent modulus was then calculated from force/deflection stiffness. The impaction graft fusion simulation increased apparent modulus by an order of magnitude over the unfused state, for mixture parameters appropriate to have the fused graft apparent modulus be comparable to the compressive modulus of intact femoral cancellous bone.     

强骨胶囊对老年股骨头近段骨折延迟愈合患者血清BMP-2 及IGF-1水平的影响

目的:探究强骨胶囊对老年股骨头近段骨折延迟愈合患者血清骨形态发生蛋白-2(BMP-2)及胰岛素生长因子-1(IGF-1)水平的影响。方法:选择我院收治的股骨近端骨折延迟愈合的老年患者41例,随机分为实验组及对照组。对照组19例予钙片;实验组22例予强骨胶囊。对比两组的临床疗效及治疗前后血清BMP-2及IGF-1水平的改变。结果:实验组总有效率(95.5%)高于对照组(78.9%),差异具备统计学意义(P0.05)。两组血清BMP-2及IGF-1水平均较治疗前显著升高(P0.05),且实验组血清BMP-2和IGF-1水平较对照组高(P0.05)。治疗后,两组血浆粘度均下降、骨密度值(BMD)均升高(P0.05);与对照组相较,实验组血浆粘度降低、BMD较高(P0.05)。结论:强骨胶囊能够有效改善老年股骨头近段骨折延迟愈合,促进骨折断端的愈合,推测其机制与增加患者血清BMP-2及IGF-1水平有关。     

Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation

Thirty-seven consecutive free anterolateral thigh flaps in 36 patients were transferred for reconstruction of head and neck defects following cancer ablation between January of 1997 and June of 1998. The success rate was 97 percent (36 of 37), with one flap lost due to a twisted perforator. The anatomic variations and length of the vascular pedicle were investigated to obtain better knowledge of anatomy and to avoid several surgical pitfalls when it is used for head and neck reconstruction. The cutaneous perforators were always found and presented as musculocutaneous or septocutaneous perforators in this series of 37 anterolateral thigh flaps. They were classified into four types according to the perforator derivation and the direction in which it traversed the vastus lateralis muscle. In type I, vertical musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 56.8 percent of cases (21 of 37), and they were 4.83 +/- 2.04 cm in length. In type II, horizontal musculocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 27.0 percent of cases (10 of 37), and they were 6.77 +/- 3.48 cm in length. In type III, vertical septocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 10.8 percent of cases (4 of 37), and they were 3.60 +/- 1.47 cm in length. In type IV, horizontal septocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 5.4 percent of cases (2 of 37). They were 7.75 +/- 1.06 cm in length. The average length of vascular pedicle was 12.01 +/- 1.50 cm, and the arterial diameter was around 2.0 to 2.5 mm; two accompanying veins varied from 1.8 to 3.0 mm and were suitable for anastomosis with the neck vessels. Reconstruction of one-layer defect, external skin or intraoral lining, was carried out in 18 cases, through-and-through defect in 17 cases, and composite mandibular defect in two cases. With increasing knowledge of anatomy and refinements of surgical technique, the anterolateral thigh flap can be harvested safely to reconstruct complicated defects of head and neck following cancer ablation with only minimal donor-site morbidity.     

Cranberry juice improved antioxidant status without affecting bone quality in orchidectomized male rats

BACKGROUND: We reported that drinking citrus juice improves bone quality in orchidectomized senescent male rats. Because cranberry juice, like citrus, is rich in nutrients and phenolic compounds, beneficial effects of citrus juice might also be seen with cranberry juice. An experiment evaluated effect of drinking cranberry juice on bone quality in orchidectomized rats. METHODS: Thirty-two 1-year-old male rats were randomized to two groups: a sham-control group (n=8) and an orchidectomized group (n=24). The treatments for the 4 months duration of the study were SHAM, orchidectomy (ORX), ORX+drinking either 27% or 45% cranberry juice concentrate added to drinking water. At the termination of the study, the rats were euthanized, blood was collected for plasma antioxidant status and IGF-I. The femur, tibia and the 4th lumbar were evaluated for bone quality. Total calcium and magnesium concentration in the femurs were also evaluated. RESULTS: ORX did not affect red blood cell (RBC)-induced hemolysis despite lowering (p<0.05) plasma antioxidant capacity; reduced (p<0.05) plasma IGF-I, femoral density, femoral strength, time-induced femoral fracture, bone mineral content, bone mineral area; numerically (p=0.07) lowered 4th lumbar density; decreased (p<0.05) trabecular connectivity, trabecular number, femoral ash; increased (p<0.05) trabecular separation in comparison to the SHAM group. Drinking cranberry juice increased (p<0.05) plasma antioxidant status, protected RBC against hemolysis, but had no positive effect on bone quality or bone mineral status. CONCLUSIONS: Cranberry juice increases plasma antioxidant status without affecting bone quality.     

Blood flow in different regions of bone marrow after short-term exercise

Total and regional blood flow was studied in femoral bone marrow of rats exposed to a short-term exhaustive exercise. The 10 micron microspheres labeled with 58Co were injected into femoral artery and the subsequent radioactivity yield was measured in 3 regions of the bone marrow (proximal metaphysis, diaphysis and distal metaphysis). Following exercise a rise of blood flow in the metaphyseal regions was accompanied by a fall in the diaphyseal area. The changes did not alter, however, the total blood flow rate in bone marrow which remained constant irrespective of the heavy exercise load.     

甲亢低骨量患者131I治疗后干预治疗效果的评价

目的:研究甲亢低骨量患者131I治疗后干预治疗的效果。方法:对100例甲亢低骨量患者,随机分为两组:A组50例,131I治疗后口服钙尔奇D及罗盖全治疗;B组50例,131I治疗后骨质自然恢复。另设C组50例为正常对照组。于131I治疗前、治疗后3、6及12个月测定A、B两组骨密度(BMD),观察其骨质变化并评价治疗效果。结果:(1)A组随治疗时间延长BMD逐渐升高,具有一定的规律性,腰椎(L2-4)骨密度3个月提高明显(t=-2.111,P=0.04)且12个月时达到与C组无统计学差异(t=-2.290,P=0.202)。(2)B组3个月时腰椎BMD有所降低,12个月时升高明显(股骨颈t=-2.327,P=0.043;腰椎(L2-4)t=-2.798,P=0.000)。(3)6个月时两组腰椎骨密度改善幅度出现统计学差异(t=-2.416,P=0.018),12个月时差异显著(t=-3.259,P=0.002)。结论:131I联合钙尔奇D与罗盖全治疗甲亢低骨量患者,其恢复时间及疗效均用131I治疗,能有效防止骨量的进一步下降及减少骨质疏松症的发生。     

Study on Bone Density at Various Skeletal Sites for the Diagnosis of Primary Osteoporosis

The objective of this study was to evaluate the diagnostic value of bone density changes in lumbar vertebrae and femoral necks in patients with primary osteoporosis (OP) at various ages. Dual-energy X-ray absorptiometry (DXA) scans were performed on patients who had their primary visits between March 2008 and February 2009. The bone mineral density (BMD) of the lumbar vertebrae 1-4 (L1-L4) in anteroposterior projection and the proximal femoral neck in lateral projection were measured. If the BMD values (T score) of any site is -2.5 or less (T ≤?-2.5), the patients were diagnosed as primary OP, and the T scores were statistically analyzed. The 81 patients who had lumbar vertebrae with a T ≤?-2.5 led to a positive rate of 80.1?% in the diagnosis of primary OP; the 47 patients who had femoral neck with a T ≤?-2.5 gave a positive rate of 47.0?%. The patients with type I or type II primary OP were divided into two age groups of ≤70 and ≥71?years old. The comparison of lumbar spine T score values did not show significant statistical difference (P?>?0.05) between the age groups, while the result of the femoral necks revealed significant difference between the two groups (P?相似文献   

Effect of low or high dietary calcium on the morphology of the rat femur

The present study compared the effect of a calcium deficit or surfeit on femurs. Young female rats were fed with the normal (1.18%), low (0.05%), or high (2.00%) calcium diet for 3, 7, 15 or 30 days. Two groups received the low calcium diet for the first 15 days and then were followed by the normal (L-N) or high calcium diets (L-H) for the sequential 15 days. The morphology of the femur was studied together with serum calcium, parathyroid hormone (PTH), calcitonin and bone mineral density (BMD). We did not find any significant changes in the serum PTH level and bone morphology in the high calcium group. In the low calcium group, the serum PTH level increased, BMD of the whole body, the femoral weight and the femoral trabecular bone decreased as compared with the normal calcium group. There was a greater proportion of resorbing surface, less resting surface and larger vascular canal openings in the femoral endosteal surfaces in the low calcium group. In the L-N or L-H group, the femoral trabecular bone increased and the femoral resorbing surface decreased as compared with those of the low calcium group. These findings suggest that high calcium intakes do not affect the bone mass, and low calcium intakes have a deleterious effect on bone status, which may be related to vascular alternations of the bone. Reversing the low income calcium intake by a higher calcium diet can partially improve the bone alternations induced by low calcium intake.