Total and regional bone mineral content in healthy Spanish subjects by dual-energy X-ray absorptiometry.

DESIGN: This is an observational cross-sectional study. OBJECTIVE: The aim of the present study was to describe and analyze patterns of change in total and regional bone mineral content in relation to age and gender in a sedentary Spanish sample population (from the Community of Madrid). The age range of the sample population was from birth to 80 years. MATERIALS AND METHODS: One thousand one hundred twenty healthy subjects were recruited and divided into 16 groups according to age. Each subject underwent whole-body densitometry using dual-energy X-ray absorptiometry. An analysis was made of the amount of bone mineral content (BMC) in the whole body and in different regions: the head, trunk, upper limbs, and lower limbs. RESULTS: Gender differences in mean values for upper limbs and lower limbs are statistically significant between 16 and 70 years of age. For the head and trunk, the mean BMC values show the most significant gender differences between 16 and 25 years of age (p

Body composition: evaluation methods

Many different techniques have been used sincethe initiation of the first anthropometric studies.Analysis of body composition is based on differenttypes of body partitioning, ranging from thetraditional model, which considers that there aretwo body compartments, through multicompartmentalmodels. There are essentially two typesof analytical methods: direct methods, or thosebased on cadaver dissection, and indirect or “invivo” methods. The first techniques used andintended to measure body fat are fundamentallyanthropometry and hydrodensometry. Based onthe body’s electric conductance, bioelectricalimpedance is used, but the possibility of measuringthe absorption of energy particles by tissueshas given way to absorptiometry techniques, firstusing an isotopic and then a radiological source.Currently, the advantages offered by DXA photonicdual absorptiometry make it the mostappropriate and widely-used technique, for measuringbody composition in individuals of differentages and sexes (AU)

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Análisis isocinético de la flexo-extensión de la rodilla y su relación con la antropometría del miembro inferior / Isokinetic analysis of flexion-extension of the knee and its relationship with the anthropometry of the lower limb

En este trabajo estudiamos la fuerza muscular isocinética de la articulación de la rodilla y las variables antropométricas más significativas de los individuos analizados. La muestra fue de 60 sujetos jóvenes voluntarios y sanos (30 hombres,30 mujeres). Se determinaron: 1º) Momento máximo de fuerza (Nm) y momento máximo/peso corporal ( por ciento), en la extensión y en la flexión a 60º/s en ambos miembros inferiores mediante test isocinéticos (dinamómetro Biodex). 2º) Perímetro de muslo, perímetro de pierna y longitud de miembro inferior. Se realizó un estudio comparativo entre extremidad derecha e izquierda (t de Student) y entre sexos (ANOVA), además se analizaron las correlaciones entre variables isocinéticas y antropométricas. Aparecieron diferencias estadísticamente significativas en todas las variables a favor del lado derecho menos en la variable longitud del miembro inferior. Igualmente el factor sexo determinó diferencias en todas las variables a excepción del perímetro del muslo, siendo estas mayores en los varones. Por último, el análisis de correlación entre las distintas variables, permitió constatar algunas interdependencias entre las variables morfológicas y de actividad muscular que pueden ser aplicadas en el campo clínico. (AU)

Muscular function and bone mass after knee arthroplasty.

We report a study of 28 women with severe primary gonarthrosis followed for 1 year. Variations in bone mineral density and in functional behaviour of knee extensors and flexors were studied before and after implantation of uncemented total knee prosthesis. A functional deficit was noted in the extensor apparatus, which increased in the first 6 months following surgery. This strength was not improved 1 year following the arthroplasty, but it was more efficient as shown by the reduction of muscle fatigue. Flexor strength was conserved and a pathological muscle balance was maintained, reaching maximum efficiency over a smaller joint range.

The role of growth hormone in bone response for implant treatment. Experimental study using presenile animals / El papel de la hormona de crecimiento en la respuesta ósea para el tratamiento con implantes. Estudio experimental utilizando animales preseniles

Many factors can modify osteointegration, among them the subject's age and the possibility of using hormone treatment to improve the phenomenon. In the present study we used a histological technique that permits study not only of interface, but also bone response in distant areas. Growth hormone (GH) was used topically in aged animals that had received a titanium plate as an implant in their tibiae. A similar degree of osteointegration was observed in both, the control and treated groups. Distantly located bone issue urderwent certain modifications in its osteocyte lacunae in the treated group but not in the control group (AU)

Muchos factores son capaces de modificar la osteointegración, entre ellos la edad del sujeto y la posibilidad de emplear tratamiento hormonal para mejorar el fenómeno. En este estudio utilizamos una técnica histológica que permite el estudio no sólo de la interfase sino también de la respuesta ósea en áreas distantes. Se aplicó tópicamente hormona de crecimiento (GH) en animales viejos que habían recibido una placa de titanio como implante en sus tibias. Se observó un grado similar de osteointegración en los grupos control y tratados. El tejido óseo localizado a distancia sufrió ciertas modificaciones en las lagunas de los osteocitos en el grupo tratado, pero no en el de animales controles (AU)

Muscle arrangement in the initial portion of the canaliculi lacrimalis / Disposición de los músculos en la porción inicial de los canaliculi lacrimalis

The vertical portion of the canaliculi lacrimalis is surrounded by a muscular framework with the morphology of a sphincter. This framework is built from three different components: a first component of vertical direction placed in front, laterally and dorsally to the vertical portion of the canaliculi, which proceeds from the external face of the os lacrimale and belongs to the pars lacrimalis (pars lacrimalis, fasciculus coronalis); a second component of transversal-lateral direction, which derives from the crista lacrimalis posterior and belongs to the pars lacrimalis (pars lacrimalis, fasciculus caudalis); and a third component of transversal-medial direction, which proceeds from the ligamentum palpebrale laterale and belongs to the pars ciliaris of the musculus orbicularis oculi. The synchronized contraction of these muscular fibres performs a collapsible function on the initial portion of the canaliculi lacrimalis (AU)

La porción vertical de los conductos lagrimales está rodeada por una red muscular que tiene la morfología de un esfínter. Esta red está construida por tres componentes distintos: un primer componente de dirección vertical, localizado delante, lateralmente y dorsalmente a la porción vertical de los conductos, la cual pasa desde la cara exterior del hueso lagrimal y pertenece a la porción lagrimal (porción lagrimal, fascículo coronal); un segundo componente con una dirección transversal-lateral, que deriva de la cresta lagrimal posterior y que pertenece a la porción lagrimal (porción lagrimal, fascículo caudal); y un tercer componente con dirección transversal-medial, que surge del ligamento palpebral lateral y que pertenece a la porción ciliar del músculo orbicular de los ojos. La contracción sincronizada de estas fibras musculares lleva a cabo una función abatible sobre la porción inicial de los conductos lagrimales (AU)

Isokinetic relations at the shoulder joint / Relaciones isocinéticas en la articulación del hombro

Our aim with the present study was to determine relationships between the isokinetic variables, force and work, during the abduction-adduction movement of the shoulder articular complex. A further goal was to relate these variables between both limbs and to speeds and movements. With this in mind, and using a sample of 40 healthy young people (20 men and 20 women), all of them right-handed, a muscular evaluation was carried out by means of an electromagnetic dynamometer (Biodex), following a strict protocol for test performance. Peak torque and the total work of each limb were quantified during the abduction-adduction movement on the frontal plane. Statistical correlations were analysed and each corresponding correlation coefficient calculated. Our results reflect evident statistical correlations between isokinetic peak torque and total work. Likewise, a constant interrelationship of such variables between both limbs appeared, along with interdependence in their abductor-adductor behaviour and between speeds of 60°/s and 120°/s. Since there was a statistically significant linear relationship, the statistic r2 (determination coefficient) was also high and, as a consequence, a large percentage of the isokinetic behaviour of one variable could be explained with respect to the other (AU)

El objetivo de este estudio ha sido determinar relaciones entre las variables isocinéticas de fuerza y trabajo durante el movimiento de abducción-adducción del complejo articulatorio del hombro. Otro fin fue el relacionar estas variables entre ambas extremidades con velocidades y movimientos. Con este trasfondo, utilizando una muestra de 40 sujetos sanos (20 hombres y 20 mujeres), todos diestros, se llevó a cabo una evaluación de los músculos empleando un dinamómetro electromagnético (Biodex), siguiendo un protocolo estricto para la realización del test. El punto de fuerza máximo así como el trabajo total de cada miembro fueron cuantificados durante el movimiento de abducción-adducción sobre el plano frontal. Se analizaron las correlaciones estadísticas y se calculó cada coeficiente de correlación correspondiente. Nuestros resultados reflejan correlaciones estadísticas entre el punto de fuerza máximo isocinético y el trabajo total. Igualmente, se apreció una interrelación constante de dichas variables entre ambos miembros, junto con una interdependencia en su comportamiento abductor-adductor y entre velocidades de 60º/S y 120º/S. Puesto que se observó una relación lineal significativa, la estadística r2 (coeficiente de determinación) también era alta y, como consecuencia, un porcentaje alto del comportamiento isocinético de una de las variables pudo ser explicado con respecto a la otra (AU)

Influence of osteoporosis on osseointegration: an experimental study / Influencia de la osteoporosis en la oseointegración: estudio experimental

The purpose of the present study was to evaluate the quality of osseointegration in osteoporotic animals, receiving implants with hydroxyapatite coating. Wistar rats. aged 20 weeks were used. Two groups, control and experimental, were established. The second group was subjected to bilateral ovariectomy to induce osteoporosis. Both groups received intramedullary implants in one of their femora at the age of 36 weeks, the other femur remaining without implant, 12 weeks later, all the animals were sacrificed. Densitometric, histological and morphometric analyses were performed. All the results confirmed a poorer bone response to the implant in the osteoporotic group. However, the bone mineral density and morphometrical values for the implanted osteoporotic group were higher than those observed for the osteoporotic group without the implant, suggesting that the implant stimulates new bone formation and slows down the process of osteoporosis (AU)

El objetivo de este estudio ha sido evaluar la calidad de oseointegración en animales osteoporóticos que recibieron implantes con un revestimiento de hidroxiapatita. Se utilizaron ratas de la cepa Wistar, de una edad de 20 semanas. Se establecieron dos grupos: el control y el experimental. Para inducir la osteoporosis, los animales del segundo grupo fueron sometidos a ovariectomía bilateral. Simultáneamente, ambos grupos recibieron implantes intramedulares en uno de sus fémures a la edad de 36 semanas, quedando el otro fémur sin implante. A las 12 semanas fueron sacrificados todos los animales. Se llevaron a cabo análisis densitométricos, histológicos y morfométricos. Todos los resultados confirmaron una peor respuesta ósea al implante en el grupo de animales osteoporóticos. No obstante, los valores respecto a la densidad mineral del hueso así como los morfométricos encontrados en los animales del grupo osteoporótico eran más altos que aquellos observados en el caso del grupo osteoporótico sin implantes, sugiriendo que el implante estimula la formación de hueso nuevo y que ralentiza el proceso de osteoporosis (AU)

Artroplastia de rodilla: calidad de vida para la vejez / Knee arthroplasty: quality of life for elderly

La artroplastía de rodilla es la intervención de cirugía ortopédica actualmente más demandada, superando incluso a la artroplastía de cadera, debido a sus buenos resultados clínicos. Los progresos técnico-quirúrgicos y anestésicos han permitido beneficiar de esta compleja intervención a edades avanzadas donde la artropatía degenerativa supone una pérdida de autonomía y de calidad de vida irrecuperable con tratamiento médico y rehabilitador. En este trabajo se realiza una revisión clínica y un estudio evolutivo de masa ósea regional mediante densitometría de doble fotón, de la función muscular mediante dinamometría electromagnética y de la marcha mediante plataformas de fuerza, en una serie de 30 mujeres, donde la frecuencia de gonartrosis es mayor, mayores de 70 años, con el objeto de valorar el impacto biológico en esta edad avanzada de la cirugía protésica de rodilla. El resultado clínico obtenido fué bueno en el 93 porciento de los casos, con conservación de la masa ósea y de la fuerza muscular y con recuperación parcial de un patrón de marcha más fisiológico. Los beneficios de esta intervención en pacientes mayores justifican los riesgos y los costso derivados de la misma (AU)

Diferencias de fuerza muscular para la extensión y la flexión de la rodilla mediante estudio isocinético / Differences in muscular strength for extension and flexion of the knee through isokinetic study

Se ha realizado un estudio isocinético analizando la fuerza muscular que proporcionan los grupos musculares extensores y flexores de la rodilla, con el fin de establecer los parámetros de normalidad de fuerza muscular isocinética, en una muestra de población española joven, así como comparar las diferencias de fuerza entre ambos grupos musculares, a distintas velocidades, en ambos miembros inferiores y según el sexo. Hemos utilizado un dinamómetro isocinético Biodex 2000. Los test se efectuaron en 60 sujetos (30 varones y 30 mujeres) voluntarios, estudiantes universitarios, con edades comprendidas entre 18-20 años, sanos y sin patología aparente del aparato locomotor. Tras un riguroso protocolo de evaluación, fueron realizadas cinco repeticiones a 60°/s y 15 a 120°/s. Se analizaron las variables: momento máximo de fuerza y momento máximo/peso corporal, para cada movimiento de extensión y de flexión, en las velocidades de 60°/s y 120°/s, en el lado derecho y en el izquierdo. Observamos que los valores normales obtenidos fueron similares a los presentados en otras poblaciones de las mismas características. Asimismo, en el análisis de comparaciones de medias de las variables analizadas entre los movimientos de extensión y flexión se presentaron diferencias estadísticamente significativas siendo mayores las del grupo extensor, independientemente del sexo, velocidad y lado analizado (AU)

Long-term results of the treatment of severe osteoarthritis and rheumatoid arthritis with 193 total knee replacements.

We undertook a clinical and surgical study with evaluation of the long-term results (average 5 years, range 1-9 years) of 193 stabilized posterior cemented total knee replacements (TKRs) type Insall-Burstein in patients with severe osteoarthritis (OA) and rheumatoid arthritis (RA), carried out consecutively by the same surgeon from January 1986 to January 1995, at our COT Unit at the Central Military Hospital "Gomez Ulla" in Madrid, in collaboration with the Departments of Traumatology and Morphological Sciences of the University of Alcala de Henares (Madrid). The principal purpose was to examine the success rate of this type of prothesis implanted during primary surgery, according to severity of the case. Six methodology protocols were produced in this study (exploratory, surgical technique in primary surgery, revision surgery, rehabilitation, evaluation and clinical revisions), and satisfactory statistical results (SPSS/PC+) were obtained with the three scales of evaluation: Harris Galante, The Hospital for Special Surgery and Knee Society. These were: 90.5% +/- 0.8% excellent and good results for the OA series, and 83.9% +/- 5% for the RA series. The analysis of survival after long-term monitoring was also statistically significant, with a 96.95% survival rate. Complications arose in 3.10% of cases (6 revisions: 4 aseptic loosenings and 2 loosenings due to infection), which were treated with a constrained prosthesis, and in cases of infection with an arthrodesis. After undertaking a comparative study with other series, we conclude that the Insall-Burnstein stabilized posterior total knee prosthesis, is an excellent Primary replacement associated with long-term survival in patients with a severe degree of articular destruction and functional incapacity, and we give some specific recommendations to reduce complications.

Densitometric analysis of the human calcaneus.

A densitometric study was performed on 50 dry calcanei to assess bone mineral density (BMD) in the constituent regions of the bone. In the lateral projection, the area with the highest BMD was the anterosuperior region, where the greatest concentration of trabeculae occurs. The areas with the least BMD were the intermediate or retrothalamic and the anteroinferior regions, where the neutral triangle is situated. In the dorsoplantar projection, a greater BMD was observed in the intermediate and middle regions, whereas the anterior region showed the lowest BMD. These results conform to the arrangement previously described for the trabecular system. It is concluded that bone densitometry, measured by dual x-ray absorptiometry, is useful for assessing trabecular architecture of the calcaneus.

Changes in walking pattern between five and six years of age.

A study was carried out of the parameters of the ground reaction forces and temporal and spatial walking parameters of 62 children aged between five and six years. The children were evaluated barefoot, walking freely at normal speed over the surface of two platforms. The aims were to establish normal parameters for children of this age and to identify any differences existing between these ages. Differences were noticeable in the kinetic and temporal and spatial walking parameters, indicating that maturation has not yet been completed at these ages.

Venous segmentation of the spleen.

The authors conducted a study of the human splenic venous system by corrosion cast. The existence of two main venous territories or lobes separated by an avascular plane is confirmed. Smaller territories or segments, drained systematically by segmentary veins, and also separated by avascular planes, are defined in them. Their number ranged from four to eight, the mean being five segments. Four different ways of confluence of intrasplenic vessels forming the splenic vein are described.

Osteometry of the human iliac crest: patterns of normality and its utility in sexing human remains.

We recorded nine measurements and one index of the iliac crest in 42 human hip bones from a Spanish skeletal collection. Common values of seven of these parameters and index are reported. We could detect statistically significant differences of means depending on side for two of these parameters (iliac crest rise, distance from the upper point of the iliac crest to the anterior superior spine) and for the iliac crest index, and relating to sex for three parameters (iliac crest arch, iliac crest rise, distance from the upper point of the iliac crest to the anterior superior spine) and for the index. These measurements and index are useful for sexing human remains.

Biometry of the anterior border of the human hip bone: normal values and their use in sex determination.

Sixteen different variables and 3 indices for the anterior border of 42 human hip bones from a Spanish skeletal collection were studied. Values for 15 of these variables and for the 3 indices are reported. We were unable to detect statistically significant differences between means relating to side in any of the variables and indices studied. Statistically significant differences were detected between means in relation to sex for 4 variables (distance from the anterior superior iliac spine to the pubic tubercle, distance from the anterior inferior iliac spine to the iliopubic eminence, distance from the anterior inferior iliac spine to the pubic tubercle, length of the notch between the anterior inferior iliac spine and the iliopubic eminence). These variables could be used for sex determination from the human hip bone or its fragments.

Functional anatomy of the human saccus lacrimalis.

The relations between the saccus lacrimalis and different portions of the musculus orbicularis oculi were studied in orbital regions of human fetuses sectioned into numbered series. No insertions of the pars lacrimalis or Horner's muscle on the saccus were found. These muscular fibres pass along the dorsal wall of the saccus and are separated from it by the reflex tendon of the ligamentum palpebrale mediale. The only muscular fibres that insert on the saccus are those that approach the anterior face of the saccus and the fornix. The fibres that insert on the anterior face proceed from the deep bundles of the pars preseptalis of the lower eyelids, and those that insert on the fornix derive from the deep bundles of the pars preseptalis of the upper eyelid.

Foot morphology development with age.

We studied the podogram from both feet in 1676 school-children of both sexes (663 boys and 1013 girls), aged between 3 and 17 a using 3 footprint measures (footprint angle: Clarke [1933]; footprint index of Chippaux [1947] and Smirak [1960]; arch index [Staheli et al. 1987]) and found clear differences according to age. Our findings showed a tendency in both sexes in early childhood to present a low internal arch until the age of 5 and 6a.

Talar articular facets (facies articulares talares) in human calcanei.

The variations of the talar articular facets in 176 calcanei were studied and classified. Three types were considered: type A = calcanei with two articular facets for the talar head, with four subtypes; type B = calcanei with one articular facet for the talar head, and two subtypes, and type C = unique articular facies in the superior surface of the calcaneus for the talus. We found 53% (94 cases) type B calcanei and 46% (82 cases) type A calcanei. No calcanei of type C were seen.

[Radius of the curvature of the femur in the sagittal plane]. / Radius der Curvatur des Femur in der Sagittalebene.

The degree of anterior curvature was measured on 30 cadaveric human femora, of unknown age and sex, by a spherometer. The mean anterior curvature radius was (1381.28 +/- 118.63) mm with a considerable interspecimen variation, the maximal value was 3262.66 mm and the minimal 695.54 mm.