肱骨小头冠状面骨折治疗进展

肱骨小头冠状面骨折是肱骨小头前半部分的冠状面劈裂骨折，可累及肱骨滑车的外侧髁凸，并不越过滑车中线。肱骨小头冠状面骨折在临床上比较少见，由于此骨折属于关节内骨折，如果处理不当，会严重影响肘关节的功能，故在临床上具有非常重要的治疗意义。近年来，随着对肱骨小头冠状面骨折认识的加深，新固定材料和新技术也不断涌现。现就肱骨小头冠状面骨折的治疗进展综述如下。

维生素K2与骨质疏松症的研究进展

骨质疏松症是一种骨量降低，骨组织微结构破坏，以骨脆性增加，骨强度下降，骨折风险增加为特征的全身骨骼系统疾病。近年来，随着老龄化人数的增加，骨质疏松症已经严重威胁了中老年人身体健康，成为人类社会共同关注的重要健康问题。据一项全国性流行病学调查显示，50岁以上男性骨质疏松症患病率为14.4%，女性升高到20.7%，60岁以上人群的患病率进一步升高[1]。目前治疗骨质疏松症的药物包括骨形成促进剂(甲状旁腺激素等)、骨吸收抑制剂(双膦酸盐类、降钙素、雌激素、雌激素受体调节剂等)和骨矿化促进剂(钙剂、活性维生素D3等)等三大类[2]。维生素K作为自然界中广泛存在的营养素，在骨质疏松症治疗过程中起到多方面的作用，引起了诸多学者的注意。

骨盆骨折临床与康复

骨盆骨折占全身骨折的2.3%～3.0%，大多数由高能量创伤导致，包括交通事故、挤压伤和高处坠落等[1]，表现为不稳定骨折，常伴发腹部或盆腔脏器、泌尿生殖系统、盆腔神经血管、腹膜后区损伤及下肢骨折等其它损伤。Wubben [2]报道骨盆骨折的病死率取决于骨盆骨折及盆腔外损伤的类型，范围在6.4%～30%，Heetveld等[3]认为骨盆骨折合并血流动力学不稳定时，病死率高达37%，急诊的快速评估和诊断以及病情稳定后的康复治疗对良好的预后至关重要。

胸腰椎爆裂骨折手术治疗的研究进展

脊柱骨折年发病率约64/100000[1]。随着交通、工业建筑事故的不断增加，胸腰椎骨折的发病率呈逐年上升趋势。脊柱胸腰段( T11～L2)处于相对固定的后凸脊柱与活动的前凸脊柱的转换区域，应力相对集中而容易受到传导暴力的直接损伤[2]，该部位骨折约占脊柱创伤75%～95%，椎体发生爆裂骨折后，后缘骨折块往往突入椎管导致脊髓或马尾损伤。近年来，随着影像学、生物力学对胸腰椎骨折研究的不断深入，在治疗方面也出现了许多新理论、新技术，但手术与否、手术时机、手术入路、术式的选择方面，仍有争议；现将研究状况综述如下。

髋臼骨折常见并发症的产生机制及治疗进展

伴随经济的飞速发展及交通运输业的日渐发达，由车祸、高空坠落及工业意外导致的高能量损伤越来越多，髋臼骨折的发生率也在逐年增加。由于髋臼解剖结构的特殊性及其生理功能的复杂性，骨折后手术难度大，并发症多，对患者的预后产生重要的影响。现对髋臼骨折常见并发症的产生机制及治疗进展作如下综述。

Objective To investigate the morbidity, clinical characteristics and treatment experience of Hangman fracture combined with tracheal injury and to discuss the classiifcation, degrees, injury mechanism, clinical manifestations, accessory examination and treatment experience of tracheal injury, so as to improve clinicians’ understanding of the disease. Methods The clinical data of 1 case of Hangman fracture combined with tracheal injury were reported.“Hangman fracture, tracheal injury and cervical spine fracture”were taken as the keywords to search for documents in the databases such as china national knowledge internet ( CNKI ) Database, Wanfang Theses and Dissertations Database, VIP Full-Text Database, Pubmed Database and so on, and then these documents were reviewed. Results At present, similar reports about the cases of Hangman fracture combined with tracheal injury had not been found at home and abroad. However, there were a large number of literature reviews about tracheal injury, and 26 articles in all. The classiifcation, degrees, injury mechanism, clinical manifestations and treatment experience of tracheal injury were mainly reported. The patient was followed up for 6 months after he left our hospital. Bone union was achieved, and his trachea was healed perfectly, without wheeze or choking sensation in chest. He was still followed up. Conclusions Hangman fracture combined with tracheal injury is very rare, and no reports have been found until now. Great attention should be paid to the patient with Hangman fracture who has lacerations of skin in the underjaw and parietal region, with serious swelling in the anterior and posterior neck, skin satiety in the anterior neck, subcutaneous ecchymoma and sense of snow grip. It should be checked carefully if there is tracheal injury. Tracheal injury can be mainly divided into 3 categories and 5 degrees. There are 3 dominant theories about the injury mechanism. Clinical manifestations mainly include skin contusion in the neck and upper chest, subcutaneous congestion, sense of snow grip in the neck, haemoptysis, hoarseness, wheeze, subcutaneous emphysema and so on. According to the trauma history and clinical manifestations, we can make a diagnosis. The auxiliary examinations mainly includes indirect laryngoscope, computed tomography ( CT ), magnatic resonance imaging ( MRI ) and so on. Tracheal injury treatment mainly includes surgical repair treatment.

应对骨质疏松维护骨骼健康

2010年我国第六次人口普查的结果显示：60岁以上人口数为1亿7千7百万，占总人口的13.26%，比2000年上升2.93个百分点；65岁以上人口数为1亿1千8百万，占总人口的8.87%，比2000年上升1.91个百分点。这个结果表明：我国已快速进入老龄社会。预计未来40年，到本世纪中叶，老龄、高龄人口数量会更加快速增长，人口形势严峻。

Cementum is critical for anchoring the insertion of periodontal ligament fibers to the tooth root. Several aspects of cementogenesis remain unclear, including differences between acellular cementum and cellular cementum, and between cementum and bone. Biomineralization is regulated by the ratio of inorganic phosphate (Pi) to mineral inhibitor pyrophosphate (PPi), where local Pi and PPi concentrations are controlled by phosphatases including tissue-nonspecific alkaline phosphatase (TNAP) and ectonucleotide pyrophosphatase/phosphodiesterase 1 (NPP1). The focus of this study was to define the roles of these phosphatases in cementogenesis. TNAP was associated with earliest cementoblasts near forming acellular and cellular cementum. With loss of TNAP in the Alpl null mouse, acellular cementum was inhibited, while cellular cementum production increased, albeit as hypomineralized cementoid. In contrast, NPP1 was detected in cementoblasts after acellular cementum formation, and at low levels around cellular cementum. Loss of NPP1 in the Enpp1 null mouse increased acellular cementum, with little effect on cellular cementum. Developmental patterns were recapitulated in a mouse model for acellular cementum regeneration, with early TNAP expression and later NPP1 expression. In vitro, cementoblasts expressed Alpl gene/protein early, whereas Enpp1 gene/protein expression was significantly induced only under mineralization conditions. These patterns were confirmed in human teeth, including widespread TNAP, and NPP1 restricted to cementoblasts lining acellular cementum. These studies suggest that early TNAP expression creates a low PPi environment promoting acellular cementum initiation, while later NPP1 expression increases PPi, restricting acellular cementum apposition. Alterations in PPi have little effect on cellular cementum formation, though matrix mineralization is affected.

The Effect of Opsteoporotic Model Rats Induced by Retinoic Acid

Objective: To study the effect of retinoic acid on inducing osteoporosis in female rat. Methods: 48SD female rats were divided randomly into experiment group and control group. Retinoic acid was administered orally to experiment group with 80mg.kg-1d-1 for 15 days. Then the rats were sacrificed on the 0th, 30th, 60th days after last administration. The serum concentration of Ca, P, BGP, E2, AKP and TRAP were detected. Components of collagen and proteoglycan in the bones and BMD were also assayed .The femoral morphometric change and epiphyseal plate cartilage histological changes were observed. Results: After a 15-day period treatment with retinoic acid, charateristics of experiment group were compared with control, it is shown that the concentration of serum E2 and BGP declined, the activity of AKP and TRAP increased while BMP decreased, the bone mass of both spongy bone and cortical bone reduced, the number of spongy bone osteoclasts and their activity increased, number of epiphyseal plate chondrocyte reduced, cartilage hypertrophic zone displayed dyscalcification, and no difference of other markers was found in the two groups. On the 30th day after the last administration, the experiment group appeared a declined number of cancellous bone osteoclast and level of serum AKP yet they were still higher than control. Number of epiphyseal chondrocyte, serum BGP and tibial BMD, though higher than before, were still lower than control. Other markers were no difference. On the 60th day after treatment, although the femoral cancellous bone mass was still less and cancellous osteoblast was more than control, the cortical bone mass, cancellous osteoclast number and level of serum Ca and P were all remained no different between two groups.Conclusion: Retinoic acid possessed a better short-term effect than long-term effect. Cancellous bone loss lasted much longer than cortical bone and more obviously; the bone matrix in this osteoporosis model was able to repair itself gradually after withdrawal of retinoic acid.