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全膝关节置换治疗骨关节炎合并固定性髌骨脱位的早期疗效

方超余刚陆帅王英明...

146-151页

查看更多>>摘要：目的探讨全膝关节置换治疗骨关节炎合并固定性髌骨脱位的早期疗效。方法回顾性分析2018年1月至2021年10月于攀枝花市中心医院采用全膝关节置换治疗的骨关节炎合并固定性髌骨脱位患者11例，男4例、女7例，年龄（63.45±4.76）岁（范围56~70岁），均为单侧手术，左膝5例、右膝6例，体质指数（23.20±2.02）kg/m2（范围20.8~27.6 kg/m2），病程（12.63±4.81）年（范围5~21年）。根据美国麻醉医师协会分级，Ⅱ级9例、Ⅲ级2例。全膝关节置换术中均恢复髌骨轨迹，同时采用内侧滑膜瓣转位修复外侧关节囊。比较手术前后膝关节活动度、美国膝关节协会评分（Knee Society score，KSS）、美国加利福尼亚大学洛杉矶分校（University of California Los Angeles，UCLA）活动能力评分、疼痛视觉模拟评分（visual analogue scale，VAS）。结果 11例患者均获得随访，随访时间（28.64±4.01）个月（范围24~36个月）。2例患者术后出现局部皮下脂肪液化，经换药后痊愈；2例出现肌间静脉血栓形成，经抗凝治疗后血栓溶解。所有伤口均一期愈合。膝关节活动度由术前63.18°±17.07°提高到末次随访时的104.55°±16.80°，差异有统计学意义（t=14.041，P<0.001）；KSS评分由（38.00±6.78）分提高到（80.91±5.65）分，差异有统计学意义（t=16.472，P<0.001）。UCLA活动能力评分由（3.18±1.17）分提高到（6.73±1.35）分，差异有统计学意义（t=9.694，P<0.001）；VAS评分由（6.09±0.94）分降低到（2.32±0.64）分，差异有统计学意义（t=16.600，P<0.001）。末次随访时无一例发生髌骨脱位或半脱位、膝关节伸膝装置撕裂或断裂，以及假体周围感染和松动。结论全膝关节置换治疗骨关节炎合并固定性髌骨脱位可获得满意的早期临床效果，术中采用内侧滑膜瓣转位可有效修复外侧关节囊。 Objective To systematically investigate the short-term efficacy of total knee arthroplasty in the treatment of osteoarthritis coupled with fixed patellar dislocation. Methods A retrospective analysis was conducted on a cohort of 11 patients diagnosed with knee osteoarthritis and fixed patellar dislocation who underwent total knee arthroplasty at Panzhihua Central Hospital from January 2018 to October 2021. The cohort comprised 4 males and 7 females, aged 63.45±4.76 years (range, 56-70 years), all of whom underwent unilateral surgery. There were 5 left and 6 right knees, with a body mass index of 23.20±2.02 kg/m2 (range, 20.8-27.6 kg/m2) and a disease course of 12.63±4.81 years. According to the American Society of Anesthesiologists classification, 9 cases were categorized as grade II, and 2 cases as grade III. Recovery of patellar trajectory during total knee arthroplasty, using medial synovial flap transposition to repair lateral joint capsule. Preoperative and postoperative assessments included knee joint range of motion, Knee Society score (KSS), University of California Los Angeles (UCLA) score, and visual analogue scale (VAS). Results All 11 patients were followed up for a period of 28.64±4.01 months (range, 24-36 months). Two patients exhibited subcutaneous fat liquefaction locally after surgery, which resolved following dressing changes. All wounds achieved primary healing. Two of them developed intramuscular vein thrombosis after surgery and were cured after anticoagulant treatment. The range of motion of the knee joint increased from 63.18°±17.07° before surgery to 104.55°±16.80° at the last follow-up, with a statistically significant difference (t=14.041, P<0.001). The KSS score increased from 38.00±6.78 points to 80.91±5.65 points, with a statistically significant difference (t=16.472, P<0.001). The UCLA score increased from 3.18±1.17 to 6.73±1.35, with a statistically significant difference (t=9.694, P<0.001). The VAS decreased from 6.09±0.94 points to 2.32±0.64 points, with a statistically significant difference (t=16.600, P<0.001). At the last follow-up, imaging examinations showed no cases of patellar subluxation or dislocation, no tearing or breakage of the knee extension device, and no infection or loosening around the prosthesis. Conclusion Utilizing medial synovial flap transposition for repairing the lateral joint capsule proves to be an effective technique for key capsule repair. Total knee arthroplasty for osteoarthritis combined with fixed patellar dislocation demonstrates satisfactory early clinical outcomes.

关键词：

关节成形术,置换,膝骨关节炎,膝髌骨脱位

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股骨近端内翻去旋转截骨联合改良骨盆三联截骨术治疗脑瘫髋脱位

肖健李浩闫君胡帆...

152-160页

查看更多>>摘要：目的评估股骨近端内翻去旋转截骨联合改良骨盆三联截骨术治疗脑瘫髋脱位的临床疗效。方法回顾性分析2018年11月至2022年9月接受股骨近端内翻去旋转截骨联合改良骨盆三联截骨术治疗23例（28髋）脑瘫髋脱位患者的病历资料，男17例、女6例，左侧11髋、右侧17髋，手术年龄为7.7（6.9，8.9）岁。术前8髋存在疼痛症状。对患者施行股骨转子下三维截骨矫形并应用儿童髋关节钢板内固定，经Smith-Petersen入路及会阴入路行改良骨盆三联截骨。手术前后完善临床评估，包括髋关节疼痛程度及关节活动度；影像学评估指标包括位移指数（migration percentage，MP）、髋臼指数（acetabular index，AI）、髋臼偏移（acetabular offset，AO）、颈干角（neck shaft angle，NSA）和股骨前倾角（femoral neck anteversion，FNA）。结果所有被纳入的病例均得到随访，随访时间为15（12，20）个月。手术时间为6.1（5.5，6.9）h，术中失血量为（400±153）ml（范围200~800 ml）。未观察到坐骨神经损伤、切口或深部感染的病例。术后1周MP为0%（0%，0%），与术前50.5%（38.2%，75.8%）的差异有统计学意义（Z=4.624，P<0.001）；AI为1.0°（-3.3°，11.8°），与术前29.4°（26.3°，38.0°）的差异有统计学意义（Z=4.623，P<0.001）；AO为69.8（66.0，76.0）mm，与术前72.3（69.1，81.1）mm的差异有统计学意义（Z=4.099，P<0.001)；NSA为124.3°（118.7°，129.9°），与术前145.6°（139.6°，153.5°）的差异有统计学意义（Z=4.541，P<0.001）；FNA为13.0°（5.4°，24.1°），与术前33.6°（27.8°，39.8°）的差异有统计学意义（Z=4.407，P<0.001）。术后7髋疼痛症状得到缓解、1髋残留关节疼痛。术后伸髋外展活动度增加、伸髋内旋活动度减小、伸髋外旋和屈髋活动度与术前的差异无统计学意义。2髋（7%）存在髂骨弓状线不愈合。随访期间未观察到股骨头坏死、再脱位和行翻修手术的病例。末次随访时MP为0%（0%，10.0%），与术后1周MP的差异无统计学意义（Z=0.561，P=0.575）。结论改良骨盆三联截骨术可有效矫正脑瘫髋脱位的髋臼畸形，联合股骨近端内翻去旋转截骨能有效矫正脑瘫髋脱位、缓解疼痛并保留髋关节活动度。 Objective To assess the effectiveness and postoperative stability of proximal femoral varus derotational osteotomy combined with modified triple innominate osteotomy in treating hip dislocation in cerebral palsy. Methods A total of 28 hips (11 left, 17 right) from 23 patients with cerebral palsy-induced hip dislocation who underwent the said surgical procedures were retrospectively examined between November 2018 and September 2022. The median age at the time of surgery was 7.7 years. Preoperatively, 29% of hips exhibited pain. Intraoperatively, a three-dimensional subtrochanteric osteotomy was performed with internal fixation using a Pediatric Hip Plate, alongside a modified triple innominate osteotomy via the Smith-Petersen and perineal approaches. Clinical assessments included pre- and postoperative evaluations of hip pain and joint mobility, as well as imaging evaluations, including migration percentage, acetabular index, acetabular offset, neck shaft angle, and femoral neck anteversion. Results With a median follow-up of 15 months (range: 12 months to 20 months), all patients were successfully monitored. The median surgery duration was 6.1 hours, with blood loss averaging 400±153 ml (range 200-800 ml). The difference between the median postoperative (1 week after operative) MP 0% (0%, 0%) and the median preoperative MP 50.5% (38.2%, 75.8%) was statistically significant (Z=4.624, P<0.001). The difference between the median postoperative AI 1.0° (-3.3°, 11.8°) and the median preoperative AI 29.4° (26.3°, 38.0°) was statistically significant (Z=4.623, P<0.001). The difference between the median postoperative AO 69.8 (66.0, 76.0) mm and the median preoperative AO 72.3 (69.1, 81.1) mm was statistically significant (Z=4.099, P<0.001). The difference between the median postoperative NSA 124.3° (118.7°, 129.9°) and the median preoperative NSA 145.6° (139.6°, 153.5°) was statistically significant (Z=4.541, P<0.001). The difference between the median postoperative FNA 13.0° (5.4°, 24.1°) and the median preoperative FNA 33.6° (27.8°, 39.8°) was statistically significant (Z=4.407, P<0.001). The pain was relieved postoperatively in 7 hips (88%) and residual hip pain in 1 hip. The postoperative range of motion was preserved. No case of avascular necrosis of the femoral head was observed. There were 2 hips (7%) with nonunion in the iliac arcuate line. No case of redislocation was observed at the last follow-up, and no revision was performed recently. There was no significant difference between the median MP at the last follow-up of 0% (0%, 10.0%) and the median postoperative MP (Z=0.561, P=0.575). Conclusion The modified triple innominate osteotomy proved to be an effective intervention for correcting acetabular deformity in cerebral palsy-induced hip dislocation. The combination of proximal femoral varus derotational osteotomy with the modified triple approach not only significantly corrected hip dislocation but also alleviated pain and maintained joint mobility in pediatric patients with cerebral palsy.

关键词：

脑性瘫痪髋脱位关节成形术骨盆截骨术

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髓内钉治疗AO/OTA 31-A3型股骨转子间骨折：长钉与短钉的疗效比较

陶崎峰陈春雨王洪平兰玉平...

161-168页

查看更多>>摘要：目的探讨长髓内钉与短髓内钉治疗AO/OTA 31-A3型股骨转子间骨折的疗效。方法回顾性收集2019年3月至2022年8月采用髓内钉治疗的AO/OTA 31-A3型股骨转子间骨折患者60例。接受长髓内钉治疗的长钉组34例，男16例、女18例，年龄（68.41±17.84）岁（范围31~96岁）；接受短髓内钉治疗的短钉组26例，男13例、女13例，年龄（72.23±13.97）岁（范围31~90岁）。对比两组受伤原因、骨折AO/OTA分型、术中失血量、手术时间、骨折愈合时间、影像学指标（骨折复位质量、术后颈干角、内侧支撑）、末次随访髋关节Harris评分、术后1年内死亡率及并发症的差异。结果长钉组随访时间（24.26±6.67）个月、短钉组为（24.31±5.60）个月，两组性别、年龄、致伤原因、侧别、骨折AO/OTA分型、术前实验室检查、是否合并血栓或高血压或糖尿病的差异均无统计学意义（P>0.05）。长钉组术中出血量（281.47±235.28）ml、手术时间（110.44±24.63）min，短钉组分别为（121.92±84.14）ml、（81.15±28.54）min，差异均有统计学意义（P<0.05）。长钉组住院时间为（12.35±4.81）d、骨折复位良好率为55.9%、骨折愈合时间为（120.44±16.43）d、内侧支撑存在率为67.6%、末次随访髋关节Harris评分优良率为79.4%，短钉组分别为（10.89±4.30）d、61.53%、（128.07±18.33）d、65.4%、65.4%，两组差异无统计学意义（P>0.05）。长钉组并发症为切口浅表感染、骨折延迟愈合、骨折不愈合、头钉切出各1例，短钉组包括浅表切口感染1例、骨折延迟愈合2例、骨折不愈合1例；长钉组1年内死亡率为5.3%、并发症发生率为11.7%，短钉组分别为7.1%、15.4%，差异无统计学意义（P>0.05）。结论长髓内钉与短髓内钉治疗AO/OTA 31-A3型股骨转子间骨折均能获得良好的固定效果与临床疗效，其中短髓内钉手术时间更短，术中出血量更少。 Objective To explore the efficacy of long intramedullary nails versus short intramedullary nails in the treatment of AO/OTA 31-A3 intertrochanteric fractures. Methods A retrospective analysis was conducted on 60 patients with AO/OTA 31-A3 intertrochanteric femur fractures treated between March 2019 and August 2022. The patients were randomly divided into two groups (the long nail group and the short nail group). Thirty-four patients were treated with long intramedullary nails, including 16 males and 18 females, aged 68.41±17.84 years old (range 31-96 years). Twenty-six patients were treated with short intramedullary nails, including 13 males and 13 females, aged 72.23±13.97 years old (range 31-90 years). The causes of injury, fracture classification (AO/OTA classification), intraoperative blood loss, operation time, fracture healing time, imaging indexes (fracture reduction quality, postoperative neck trunk angle, and medial support), Harris score of the hip joint at the last follow-up, one-year mortality rates and complications were compared between the two groups. Results The follow-up time was 24.26±6.67 months in the long nail group and 24.31±5.60 months in the short nail group, and the general information of the two groups were comparable. Between the long nail and short nail group, the intraoperative blood loss was 281.47±235.28 ml vs. 121.92±84.14 ml and the operation time was 110.44±24.63 min vs. 81.15±28.54 min with significant differences (P<0.05). While the length of hospital stay was 12.35±4.81 dvs. 10.89±4.30 d, the good rate of fracture reduction was 55.9% vs. 61.53%, the fracture healing time was 120.44±16.43 d vs. 128.07±18.33 d, the presence rate of medial support was 67.6% vs. 79.4%, and the excellent rate of Harris score was 65.4% vs. 65.4% with no significant difference between the two groups (P>0.05). One-year mortality rates was 5.3%vs. 7.1% and complications was 11.7% vs. 15.4% with no significant difference between the two groups (P>0.05). Conclusion Both long intramedullary nails and short intramedullary nails are effective in the treatment of AO/OTA 31-A3 intertrochanteric femur fractures. However, surgical time and intraoperative blood loss was less in the short nail group.

关键词：

髋骨折骨折固定术,髓内对比研究治疗结果

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脊柱转移瘤分离术后发生胸腔积液的危险因素分析

莫国枢李旭马宏庆姚招浓...

169-176页

查看更多>>摘要：目的探讨脊柱转移瘤分离术后胸腔积液的危险因素。方法回顾性分析2014年1月至2022年1月于浙江大学医学院附属第二医院骨肿瘤科就诊的脊柱转移瘤患者427例，男252例、女175例，年龄（59±12）岁（范围15~87岁）。所有患者均接受脊柱转移瘤分离手术。基于术后1个月内的胸部CT，采用重建软件个性化测量胸腔积液量。将胸腔积液在0~500 ml定义为少量、500~1 000 ml为中等量、1 000 ml以上定义为大量。比较各组患者的基线资料和围手术期临床结果，将差异有统计学意义的指标纳入二分类logistic回归分析，确定脊柱转移瘤分离术后发生胸腔积液的独立危险因素。绘制受试者工作特性曲线，计算各独立危险因素的曲线下面积。结果所有患者均顺利完成手术。427例患者中大量胸腔积液35例、中等量胸腔积液42例、少量胸腔积液350例。大量胸腔积液组与少量及中等量胸腔积液组的肿瘤占位（χ2=9.485，P=0.013）、术中失血量（Z=-2.503，P=0.011）、输血量（Z=-2.983，P=0.003）、术前总蛋白（Z=2.681，P=0.007）、术前白蛋白（Z=1.720，P=0.085）、术后血红蛋白（t=2.950，P=0.008）、术后总蛋白（Z=4.192，P<0.001）、术后白蛋白（t=2.268，P=0.032）的差异有统计学意义。将上述指标纳入logistic回归分析，结果显示术前白蛋白下降[OR=0.89，P=0.045]和转移瘤位于胸椎[OR=4.01，P=0.039]是导致脊柱转移瘤分离术后出现大量胸腔积液的独立危险因素。受试者工作特性曲线显示术前白蛋白、肿瘤占位及联合指标的曲线下面积及其95%CI分别为0.637（0.54，0.74）、0.421（0.36，0.48）、0.883（0.81，0.92），联合预测模型的预测价值为良。结论基于胸部CT可个性化定量测量胸腔积液体积。术前白蛋白下降和转移瘤位于胸椎是导致脊柱转移瘤分离术后出现大量胸腔积液的独立危险因素，二者联合预测具有更好的预测效能。 Objective To investigate the risk factors of pleural effusion after spinal separation surgery for patients with spinal metastatic tumors. Methods A total of 427 patients with spinal metastatic tumors from January 2014 to January 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed. There were 252 males and 175 females, with an average age of 59±12 years (range, 15-87 years). All patients underwent separation surgery. Based on the chest CT within 1 month after surgery, the volume of pleural effusion was measured individually by reconstruction software. Pleural effusion was defined as small volume (0-500 ml), moderate volume (500-1 000 ml), and large volume (above 1 000 ml). Baseline data and perioperative clinical outcomes were compared between the groups, and indicators with statistically significant differences were included in a binary logistic regression analysis to determine the independent risk factors for the development of pleural effusion after isolation of spinal metastatic cancer. Receiver operating characteristic (ROC) curves were conducted to calculate the area under the curve (AUC) for each independent risk factor. Results All patients successfully completed the operation. Among the 427 patients, there were 35 cases of large pleural effusion, 42 cases of moderate pleural effusion, and 350 cases of small pleural effusion. There were significant differences in tumor size (χ2=9.485, P=0.013), intraoperative blood loss (Z=-2.503, P=0.011), blood transfusion (Z=-2.983, P=0.003), preoperative total protein (Z=2.681, P=0.007), preoperative albumin (Z=1.720, P= 0.085), postoperative hemoglobin (t=2.950, P=0.008), postoperative total protein (Z=4.192, P<0.001), and postoperative albumin (t=2.268, P=0.032) in the large pleural effusion group versus the small and moderate pleural effusion group. Logistic regression analysis showed that decreased preoperative albumin (OR=0.89, P=0.045) and metastases located in the thoracic spine (OR=4.01, P=0.039) were independent risk factors for the occurrence of large pleural effusion after separation surgery. The ROC curve showed that the AUC and 95%CI for preoperative albumin, lesion location, and the combined model were 0.637 (0.54, 0.74), 0.421 (0.36, 0.48), and 0.883 (0.81, 0.92). The combined predictive model showed good predictive value. Conclusion The volume of pleural effusion can be measured individually and quantitatively based on chest CT. Decreased preoperative albumin and metastases located in the thoracic spine are independent risk factors for the occurrence of large pleural effusion after separation surgery. The combined prediction of the two factors has better predictive efficacy.

关键词：

脊柱肿瘤转移外科手术危险因素

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基于脊柱骨盆参数探讨腰椎峡部裂患者椎弓根-关节突的形态特点及临床意义

于江林唐一凡杜忠秋戚晓阳...

177-185页

查看更多>>摘要：目的基于脊柱骨盆参数分析腰椎峡部裂患者椎弓根-关节突形态学特点，并探讨其临床意义。方法纳入2020年5月至2023年1月于西南医科大学附属医院就诊的L5峡部裂患者121例（峡部裂组）、L4，5退行性滑脱患者108例（滑脱组）以及L4，5正常但L5S1椎间盘突出的患者100例（对照组），均行腰椎X线片及CT三维重建检查。在站立中立位腰椎侧位X线片上测量椎体滑移率（percentage of slip，SP）和脊柱骨盆参数，包括骶骨倾斜角（sacral slope，SS）和腰椎前凸角（lumbar lordosis，LL）。在腰椎CT三维重建像上测量L4和L5椎弓根-关节突关节的形态参数，包括关节突关节角（facet joint angle，FJA）、椎弓根-关节突关节角（pedicle facet angle，PFA）、关节突关节骨关节炎（osteoarthritis，OA）分级和关节突关节不对称性（facet joint tropism，FT）。比较峡部裂组、滑脱组和对照组脊柱骨盆参数、椎弓根-关节突关节形态参数的差异，分析各组组内脊柱骨盆参数和L4和L5椎弓根-关节突关节形态参数的相关性，比较各组内L4和L5椎弓根-关节突关节形态参数的差异。结果峡部裂组、滑脱组和对照组患者SS、LL的差异有统计学意义（F=21.910，P<0.001；F=22.439，P<0.001），峡部裂组患者SS、LL最大，滑脱组次之，对照组最小。三组间椎弓根-关节突关节形态参数比较结果显示，峡部裂组L4 FJA最大，对照组次之，滑脱组最小（F=344.791，P<0.001）；滑脱组L4 PFA最大，峡部裂组次之，对照组最小（F=193.725，P<0.001）；滑脱组L4关节突关节OA分级明显重于峡部裂组和对照组（H=467.925，P<0.001），而峡部裂组与对照组的差异无统计学意义（P>0.05）。Pearson相关分析表明，各组内SS、LL与FJA均呈负相关，而SS、LL与PFA均呈正相关（P<0.05）；各组内L4 FJA均小于L5，L4 PFA均大于L5，差异有统计学意义（P<0.05）；峡部裂组L4关节突关节OA分级明显轻于L5（Z=7.043，P<0.001），滑脱组L4关节突关节OA分级明显重于L5（Z=11.868，P<0.001），对照组L4与L5关节突关节OA分级的差异无统计学意义（Z=0.556，P=0.578）。结论腰椎峡部裂患者具有更大的SS和LL，其椎弓根-关节突形态学特点的明显变化提示腰椎局部受到生物应力作用更大。 Objective To delineate the morphological features of pedicle-facet joints in lumbar spondylolysis patients, correlating these with spinopelvic parameters to explore their mechanisms and clinical implications. Methods This study enrolled 121 patients with L5 spondylolysis (IS group), 108 with L4, 5 degenerative spondylolisthesis (DS group), and 100 with normal L4, 5 but L5S1 lumbar disc herniation (NL group), who underwent radiography and multislice spiral CT from May 2020 to January 2023. Parameters including vertebral slip percentage (SP) and spinopelvic alignments, such as sacral slope and lumbar lordosis, were quantified using standing lateral lumbar radiographs. Morphological parameters of the L4 and L5 facet joints were measured on 3D reconstructed lumbar CT images, including the facet joint angle (FJA), pedicle-facet joint angle (PFA), facet joint osteoarthritis (OA), and facet joint tropism (FT). Results The analysis revealed significant variances in SS and LL among the groups (F=21.910, P<0.001 F=22.439, P<0.001). The IS group exhibited the highest SS and LL, followed by the DS and NL groups. Morphological assessments showed the largest L4 FJA in the IS group, with progressive decreases in the DS and NL groups (F=344.791, P<0.001). Conversely, L4 PFA was greatest in the DS group (F=193.725, P<0.001). Notably, L4 OA was markedly more severe in the DS group compared to IS and NL groups (H=467.925, P<0.001), with no significant disparity between IS and NL groups (P>0.05). Correlation analyses within each cohort highlighted a negative association of sacral slope and lumbar lordosis with facet joint angles, yet a positive correlation with pedicle-facet joint angles both with statistical significance (P<0.05). Furthermore, L4 facet joint angles were consistently smaller than those at L5, and L4 pedicle-facet joint angles were larger than L5 (P<0.05). Osteoarthritis at L5 was more pronounced in the IS group compared to L4 (Z=7.043, P<0.001), a trend inversely observed in the DS group (Z=11.868, P<0.001), while the NL group showed no significant osteoarthritic variance between levels (Z=0.556, P=0.578). Conclusion Patients with lumbar spondylolysis demonstrate elevated sacral slope and lumbar lordosis, indicative of increased localized biomechanical stress in the lumbar spine. These alterations in the morphology of the pedicle-facet joints highlight the distinctive structural adaptations and potential strain distributions within this cohort.

关键词：

腰椎脊椎滑脱椎关节突关节生物力学现象

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脂肪棕色化调节骨代谢的研究进展

王柯懿曲昊王文姚招浓...

186-192页

查看更多>>摘要：骨代谢包括骨形成和骨吸收两个过程，两者维持体内骨代谢稳态。脂肪棕色化是将体内储存能量的白色脂肪转化为产热的棕色脂肪的生物学过程，受环境、运动、营养素及信号分子诱导。脂肪棕色化能调节体内骨代谢，通过分泌脂肪因子，如成纤维生长因子-21、脂联素、胰岛素样生长因子-1、骨形态发生蛋白等影响成骨、破骨能力。脂肪棕色化也可通过肠道微生物群介导，经免疫途径影响骨代谢。衰老机体脂肪棕色化能力降低，与骨质疏松状态下骨代谢失调有关；而儿童和青少年脂肪棕色化活跃，骨代谢维持健康状态。通过运动、补充营养素（辣椒素、白藜芦醇、槲皮素等）等方式可促进脂肪棕色化并维持棕色脂肪组织，对机体骨代谢起到积极作用。未来，明确脂肪棕色化与骨代谢之间具体的调节模式，对干预脂肪棕色化治疗骨代谢相关疾病具有重要意义。 Bone metabolism includes the processes of bone formation and bone resorption, both of which maintain bone metabolic homeostasis in the body. Adipose browning is a biological process that converts energy-storing white fat into thermogenic brown fat, which is induced by environment, exercise, nutrients, and signaling molecules. Adipose browning regulates bone metabolism in vivo and affects osteogenic and osteoblastic capacity through the secretion of adipokines such as fibroblast growth factor-21, adiponectin, insulin-like growth factor-1, and bone morphogenetic proteins. Adipose browning can also affect bone metabolism through immune pathways mediated by the gut microbiota. The browning ability of fat decreases in the aging body, which is related to the imbalance of bone metabolism in the state of osteoporosis. In children and adolescents, fat browning is active and bone metabolism is maintained in a healthy state. Exercise and supplementation of nutrients (capsaicin, resveratrol, quercetin, etc.) can promote the browning of adipose tissue and maintain brown adipose tissue, which plays a positive role in bone metabolism. In the future, it is of great significance to clarify the specific regulatory mode between adipose browning and bone metabolism for the treatment of bone metabolism-related diseases by intervening adipose browning.

关键词：

骨代谢脂肪组织,棕色综述

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脂肪棕色化调节骨代谢的研究进展

刘泽民王栋吕欣张永红...

186-192页

查看更多>>摘要：骨代谢包括骨形成和骨吸收两个过程，两者维持体内骨代谢稳态。脂肪棕色化是将体内储存能量的白色脂肪转化为产热的棕色脂肪的生物学过程，受环境、运动、营养素及信号分子诱导。脂肪棕色化能调节体内骨代谢，通过分泌脂肪因子，如成纤维生长因子-21、脂联素、胰岛素样生长因子-1、骨形态发生蛋白等影响成骨、破骨能力。脂肪棕色化也可通过肠道微生物群介导，经免疫途径影响骨代谢。衰老机体脂肪棕色化能力降低，与骨质疏松状态下骨代谢失调有关；而儿童和青少年脂肪棕色化活跃，骨代谢维持健康状态。通过运动、补充营养素（辣椒素、白藜芦醇、槲皮素等）等方式可促进脂肪棕色化并维持棕色脂肪组织，对机体骨代谢起到积极作用。未来，明确脂肪棕色化与骨代谢之间具体的调节模式，对干预脂肪棕色化治疗骨代谢相关疾病具有重要意义。 Bone metabolism includes the processes of bone formation and bone resorption, both of which maintain bone metabolic homeostasis in the body. Adipose browning is a biological process that converts energy-storing white fat into thermogenic brown fat, which is induced by environment, exercise, nutrients, and signaling molecules. Adipose browning regulates bone metabolism in vivo and affects osteogenic and osteoblastic capacity through the secretion of adipokines such as fibroblast growth factor-21, adiponectin, insulin-like growth factor-1, and bone morphogenetic proteins. Adipose browning can also affect bone metabolism through immune pathways mediated by the gut microbiota. The browning ability of fat decreases in the aging body, which is related to the imbalance of bone metabolism in the state of osteoporosis. In children and adolescents, fat browning is active and bone metabolism is maintained in a healthy state. Exercise and supplementation of nutrients (capsaicin, resveratrol, quercetin, etc.) can promote the browning of adipose tissue and maintain brown adipose tissue, which plays a positive role in bone metabolism. In the future, it is of great significance to clarify the specific regulatory mode between adipose browning and bone metabolism for the treatment of bone metabolism-related diseases by intervening adipose browning.

关键词：

骨代谢脂肪组织,棕色综述

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椎弓根螺钉内固定的生物力学强度影响因素的研究进展

何宝强冷叶波钟德君李洋...

193-198页

查看更多>>摘要：椎弓根螺钉内固定系统在脊柱外科手术中扮演着关键角色，具有增加脊柱稳定性的优势，但存在内固定松动和螺钉拔出等潜在并发症。目前常采用轴向拔出力评估内固定的短期生物力学特性、疲劳试验评估内固定的长期生物力学特性、扭矩评估螺钉与脊椎骨质的相互作用。影响椎弓根螺钉生物力学特性的因素包括脊椎相关因素（骨密度）和螺钉相关因素（螺钉尺寸、螺钉设计和螺钉增强材料）。在高骨密度的骨骼中螺钉轴向拔出力可显著增加，而通过增加螺钉直径和长度、改进螺钉设计并使用螺钉增强材料也可以提高螺钉的固定强度。椎弓根螺钉内固定的生物力学研究为实现个体化和功能性最优通道选择提供了关键信息，设计具有最佳固定强度的螺钉通道有望降低螺钉松动的风险，减少手术并发症的发生，提高手术效果。 The pedicle screw internal fixation system plays a crucial role in spinal surgery, with the advantage of enhancing spinal stability. However, potential complications such as internal fixation loosening and screw pullout still exist clinically. Currently, pullout of strength is commonly used to evaluate the short-term biomechanical properties of internal fixation, fatigue test is performed to evaluate the long-term biomechanical properties of internal fixation, and torque is used to evaluate the interaction between screws and spinal bone. Factors that influence the biomechanical properties of pedicle screws include spine-related factors (bone density) and screw-related factors (screw size, screw design, and screw augmentation materials). In bones with high bone density, pullout of strength is significantly increased, and fixation strength can also be improved by increasing screw diameter and length, improving screw design, and using screw augmentation materials. Biomechanical research on pedicle screw internal fixation provides key information for achieving individualized and functional optimal channel selection. Designing screw channels with optimal fixation strength is expected to reduce the risk of screw loosening and the occurrence of surgical complications, and improve surgical effects.

关键词：

椎弓根钉骨密度生物力学

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椎弓根螺钉内固定的生物力学强度影响因素的研究进展

房彦名何达范明星张琦...

193-198页

查看更多>>摘要：椎弓根螺钉内固定系统在脊柱外科手术中扮演着关键角色，具有增加脊柱稳定性的优势，但存在内固定松动和螺钉拔出等潜在并发症。目前常采用轴向拔出力评估内固定的短期生物力学特性、疲劳试验评估内固定的长期生物力学特性、扭矩评估螺钉与脊椎骨质的相互作用。影响椎弓根螺钉生物力学特性的因素包括脊椎相关因素（骨密度）和螺钉相关因素（螺钉尺寸、螺钉设计和螺钉增强材料）。在高骨密度的骨骼中螺钉轴向拔出力可显著增加，而通过增加螺钉直径和长度、改进螺钉设计并使用螺钉增强材料也可以提高螺钉的固定强度。椎弓根螺钉内固定的生物力学研究为实现个体化和功能性最优通道选择提供了关键信息，设计具有最佳固定强度的螺钉通道有望降低螺钉松动的风险，减少手术并发症的发生，提高手术效果。 The pedicle screw internal fixation system plays a crucial role in spinal surgery, with the advantage of enhancing spinal stability. However, potential complications such as internal fixation loosening and screw pullout still exist clinically. Currently, pullout of strength is commonly used to evaluate the short-term biomechanical properties of internal fixation, fatigue test is performed to evaluate the long-term biomechanical properties of internal fixation, and torque is used to evaluate the interaction between screws and spinal bone. Factors that influence the biomechanical properties of pedicle screws include spine-related factors (bone density) and screw-related factors (screw size, screw design, and screw augmentation materials). In bones with high bone density, pullout of strength is significantly increased, and fixation strength can also be improved by increasing screw diameter and length, improving screw design, and using screw augmentation materials. Biomechanical research on pedicle screw internal fixation provides key information for achieving individualized and functional optimal channel selection. Designing screw channels with optimal fixation strength is expected to reduce the risk of screw loosening and the occurrence of surgical complications, and improve surgical effects.

关键词：

椎弓根钉骨密度生物力学

原文链接:

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