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1.
带旋股外侧动脉升支阔筋膜张肌髂骨与骨膜瓣移位治疗陈旧性股骨颈骨折 总被引:1,自引:0,他引:1
李光宪 《中国修复重建外科杂志》1994,(3)
带旋股外侧动脉升支阔筋膜张肌髂骨与骨膜瓣移位治疗陈旧性股骨颈骨折20例。由于手术不游离血管束,减少了对血管的刺激;骨瓣植入再加骨膜包绕股骨颈,改善了骨折端的血循环及股骨头血运,有利于骨折愈合;防止了股骨头缺血性坏死的发生。 相似文献
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带血管蒂髂骨瓣转移术治疗成人股骨头无菌性坏死 总被引:1,自引:0,他引:1
目的观察带旋股外侧动脉升支血管蒂髂骨瓣转移加游离植骨术治疗成人中晚期股骨头无菌坏死的疗效。方法采用带旋股外侧动脉升支血管蒂髂骨瓣转移加游离植骨术治疗中、晚期股骨头无菌坏死32例38髋。术中在膝关节镜下彻底清除坏死骨.切取带血管蒂骨瓣及用游离植骨将坏死腔填满充实。结果32例38髋随访24~72个月。按成人股骨头无菌性坏死的疗效百分评价法,优良率达94.7%(36/38)。结论应用带旋股外侧动脉升支血管蒂髂骨瓣转移加游离植骨术治疗成人股骨头无菌性坏死具有以下优点:①青壮年患者避免行人工髋关节置换术后假体下沉、关节附近骨破坏等并发症;②彻底清除坏死骨及减压;③重建股骨头血运,形成自体骨的股骨头有利于股骨头的修复与重建。该术式适用于50岁以下股骨头坏死FicatⅡ、Ⅲ期患者,Ⅱ期病例远期效果更佳。 相似文献
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青壮年股骨头缺血性坏死的显微外科治疗 总被引:8,自引:1,他引:7
目的 探索青壮年股骨头缺血坏死的新的治疗方法及临床效果。方法 手术刮除股骨头坏死骨,采用带旋髂深血管的髂骨骨膜-髂骨移植术治疗共23例,25个髋。结果 术后随访3~9年,按照中华医学会骨坏死组拟定推荐的疗效标准评价治疗结果,结果达优15例,良6例,可2例,优良率91.3%。结论 带旋髂深血管的髂骨骨膜-髂骨移植术可使坏死股骨头重建血运,形成新骨取代死骨,使股骨头得以修复,重建骨小梁结构,防止塌陷, 相似文献
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带血管蒂骨膜瓣移植治疗幼犬股骨头坏死实验研究 总被引:1,自引:1,他引:0
目的 评价幼犬带血管蒂骨膜成骨能力及对股骨头无菌性坏死的修复效果.方法 结扎、破坏幼龄家犬股骨颈动脉环、液氮冷冻股骨头,建立股骨头坏死动物模型.建模4周后通过X线、MRI、ECT及组织学检查评价动物模型建立成功与否;然后实验动物随机分成3组,实验组(12只)植入带旋股外侧动脉横支为蒂大转子骨膜瓣;对照组(9只)植入带旋股外侧动脉横支为蒂大转子骨瓣:空白组(8只)不予治疗,以观察股骨头坏死的病程进展.分别于手术后第4、8、12周进行大体形态、X线、MRI、ECT观测,12周处死所有动物行组织学检查,观察不同时期股骨头坏死修复情况.结果 术后12周实验组X线股骨头形态基本正常,MRI股骨头信号不均,ECT放射性核素与健侧相比稍减低,苏木精-伊红(HE)染色毛细血管及成骨细胞大量增殖,新生骨小梁成熟.对照组X线股骨头轮廓欠规则,MRI股骨头高低信号混杂,ECT股骨头放射性核素明显减低,HE染色成骨细胞活跃,可见新生骨小梁,脂肪细胞.空白组X线股骨头塌陷变形,MRI表现T1、T2加权低信号,ECT见放射性缺损.苏木精-伊红染色骨小梁崩解,大量空虚的骨陷窝.术后12周实验组、对照组移植骨膜/骨瓣区ECT扫描核素计数差异有统计学意义(P<0.01).结论 带血管蒂骨膜移植较带血管蒂骨瓣移植具有更强的成骨能力.能够有效地修复幼犬股骨头无菌性坏死. 相似文献
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目的评价骨形态发生蛋白2(BMP-2)基因强化的组织工程骨联合显微外科方法修复长段骨缺损的效果。方法分离培养兔骨髓基质干细胞,经BMP-2基因转染后复合异种骨支架体外构建基因强化的组织工程骨(GEB)。建立兔双侧桡骨缺损(2.5cm长)模型,采用5种方法修复。A:GEB加带血管蒂骨膜移植;B:GEB加血管束植入;C:GEB加游离骨膜移植;D:GEB;E:单纯支架。术后4、8、12周行X线、组织学、生物力学测定和微血管墨汁灌注等观察血管形成及成骨情况。结果A组血运建立最快,B组血管束早期即发出分支向移植骨内长入,C组4周时游离骨膜成活并发出微小血管,D组在BMP-2基因诱导下成骨速度和质量优于E组,12周时骨缺损部分修复,但中央区成骨不良,而E组12周时形成骨不连,缺损区内被纤维组织填充。在细胞成活率、生物力学性能、VEGF表达水平等方面,均表现为A〉B〉C〉D〉E,差异有统计学意义(P〈0.05)。结论BMP-2基因强化的组织工程骨联合显微外科方法修复长段骨缺损,既提供了血运,又提供了有效的成骨诱导因子,是治疗长段骨缺损较为理想的方法。其中,带血管蒂骨膜联合移植修复效果最佳;血管束植入法血供重建较快,方便临床应用。 相似文献
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带血管骨移植治疗股骨头无菌性坏死进展 总被引:2,自引:0,他引:2
股骨头无菌性坏死是骨科临床较常见的疾病,如能早期做出诊断(股骨头塌陷前),可采用钻芯减压(植骨或不植骨)、截骨、以及带或不带血管的骨移植治疗,尽力保存髋关节功能。局部带蒂骨移植与和游离带血管的骨移植能将带血运的骨组织植入股骨头骨坏死区,除用健康骨组织替代坏死骨外,还重建了股骨头新的血供来源。经5年观察,对各期患者治疗成功率为80%。应用游离带血管的骨移植治疗股骨头无菌性坏死,可获得较高的成功率。 相似文献
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目的 比较带血运骨瓣移植术和全髋关节置换术治疗中晚期股骨头缺血性坏死的优缺点及临床疗效。方法 1986年7月。1991年1月间,作者采用带血运骨瓣移植术和全髋关节置换术治疗中晚期股骨头缺血性坏死患者81例89髋,通过追踪复查、问卷调查等手段共收集59例64髋患者的相应临床资料。其中采用带血运骨瓣移植术治疗36髋,全髋关节置换术治疗28髋。结果 随访时间12年3个月~16年7个月,平均15年4个月。术后早期Harris评分全髋组优于骨瓣组;后期Harris评分低龄骨瓣组及高龄全髋组相对较高,而再次手术率则相对较低。结论 对于中晚期股骨头缺血性坏死,带血运骨瓣移植术适合于年轻患者;全髋关节置换术适合于高龄患者。 相似文献
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bBMP/胶原/珊瑚复合人工骨修复股骨头骨缺损的实验研究 总被引:22,自引:0,他引:22
目的 研究用复合人工骨治疗股骨头坏死的效果。方法 建立双侧股骨头内骨缺损模型 ,并分为 4组 :bBMP/胶原 /珊瑚复合人工骨组 (6侧 )、肌骨瓣组 (6侧 )、单纯珊瑚组 (2例 )、对照组 (14例 ) ,为上各组的对侧。对植入后 3周、 16周的股骨头行病理学检查、计量组织学分析及四环素荧火标记。结果 16周后 ,复合人工骨的骨缺损大小、缺损区骨小梁体积、荧光带宽度均与对照组有统计学显著性 ,但 5侧中有 1侧出现继发性骨关节炎。结论 该复合人工骨有较强的传导成骨及诱导成骨作用 ,是修复股骨头骨缺损的良好移植材料 ,但它不能改善缺血坏死股骨头的血供。该股骨头内骨缺损加用 95 %酒精灌注 ,模型近似于股骨头坏死囊性变 ,对于研究股骨头坏死的治疗有较大价值 相似文献
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带血供骨瓣加骨形态发生蛋白在青壮年股骨颈骨折中的应用 总被引:3,自引:2,他引:1
青壮年股骨颈骨折因所受暴力较大,血运破坏严重,易致骨折不愈合及股骨头缺血坏死,是骨科临床难题之一。自1997~2003年,笔者采用带旋髂深血管髂骨瓣或股方肌骨瓣加骨形态发生蛋白(BMP)治疗32例,效果满意,报告如下。 相似文献
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Sydney Nade 《Acta orthopaedica》1977,48(6):572-579
An experimental study was done in rabbits to investigate the fate of allogeneic iliac cancellous bone, both non-decalcified and decalcified with hydrochloric acid, transplanted to a muscular site for up to 14 days. Some of the treated allografts were impregnated with autologous bone marrow cells, obtained from the femoral medulla by aspiration, and each was compared with allografts alone. Combined myelo-osseous grafts produced bone after 7 to 8 days implantation, as did marrow autografts alone. In addition non-decalcified implants stimulated the production of multinucleated giant cells. Three different types of wash solution were used but these did not influence the cell population seen, nor the new bone formation. It is concluded that the critical events in bone formation after transplantation occur less than 8 days after the transplantation and that marrow cells have osteogenic capacity. This has relevance to the clinical aspects of bone grafting. 相似文献
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Bo Nivbrant Johan Kärrholm Stefan Röhrl Helén Hassander Bengt Wesslén 《Acta orthopaedica》2013,84(6):572-584
Bone cement with reduced amount of monomer and low curing temperature may improve implant fixation due to reduced toxicity. We analyzed the mechanical, chemical and thermal properties of such a cement (Cemex Rx) using Palacos R as control. The in vivo performance of the 2 cements was also evaluated in a prospective randomized study of 47 hips, where either of the cement types was used to fixate Lubinus SP2 prostheses with the stem made of titanium alloy. Cemex Rx had a reduced tensile strength, probably because this cement was manually mixed, as recommended by the manufacturer. A standardized laboratory test showed lower curing temperature for Cemex, but measurements at 37° and with prechilled Palacos R and Cemex Rx, as in clinical work, showed no difference. In the clinical study radiostereometric measurements of cup and stem migration showed similar values in the 2 groups up to 5 years after the operation. The cement mantle was stable in both groups, but the stems migrated similarly inside the cement mantle regardless of the type of cement used. Proximal wear was low (0.04-0.05 mm/year) and tended to be lower in the Cemex group (p = 0.02). Aluminum and vanadium levels in serum increased 5 years after the operation, but no difference was noted between the 2 groups. Collagen markers (PICP, ICTP) showed similar increases in bone turnover 6 weeks and 6 months after operation in both groups. 相似文献
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《Journal of orthopaedic research》2017,35(9):1855-1864
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Melonie Burrows Danmei Liu Sarah Moore Heather McKay 《Journal of bone and mineral research》2010,25(6):1423-1432
Bone is a complex structure with many levels of organization. Advanced imaging tools such as high‐resolution (HR) peripheral quantitative computed tomography (pQCT) provide the opportunity to investigate how components of bone microstructure differ between the sexes and across developmental periods. The aim of this study was to quantify the age‐ and sex‐related differences in bone microstructure and bone strength in adolescent males and females. We used HR‐pQCT (XtremeCT, Scanco Medical, Geneva, Switzerland) to assess total bone area (ToA), total bone density (ToD), trabecular bone density (TrD), cortical bone density (CoD), cortical thickness (Cort.Th), trabecular bone volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular spacing standard deviation (Tb.Sp SD), and bone strength index (BSI, mg2/mm4) at the distal tibia in 133 females and 146 males (15 to 20 years of age). We used a general linear model to determine differences by age‐ and sex‐group and age × sex interactions (p < 0.05). Across age categories, ToD, CoD, Cort.Th, and BSI were significantly lower at 15 and 16 years compared with 17 to 18 and 19 to 20 years in males and females. There were no differences in ToA, TrD, and BV/TV across age for either sex. Between sexes, males had significantly greater ToA, TrD, Cort.Th, BV/TV, Tb.N, and BSI compared with females; CoD and Tb.Sp SD were significantly greater for females in every age category. Males' larger and denser bones confer a bone‐strength advantage from a young age compared with females. These structural differences could represent bones that are less able to withstand loads in compression in females. © 2010 American Society for Bone and Mineral Research 相似文献
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感染性骨缺损的治疗及研究进展 总被引:1,自引:0,他引:1
感染性骨缺损由于存在感染及骨缺损双重病变,治疗棘手,疗程长,且易出现肌肉萎缩、局部瘢痕而致肢体功能受到严重影响.近年来随着外固定技术、显微外科技术、生物材料技术及骨组织工程技术等的发展,感染性骨缺损的治疗取得明显进步,短缩了治疗时间,且效果显著,笔者对其研究进展综述如下. 相似文献
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《Journal of orthopaedic research》2017,35(6):1176-1182
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Hirotaka Koyanagi Keisuke Ae Hidetsugu Maehara Masato Yuasa Tomokazu Masaoka Tsuyoshi Yamada Takashi Taniyama Masanori Saito Yuki Funauchi Toshitaka Yoshii Atsushi Okawa Shinichi Sotome 《Journal of orthopaedic research》2013,31(8):1308-1316
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The penetration of lincomycin into normal bone was studied in 10 patients with fracture of the neck of the femur, a separate determination being made of the lincomycin concentration in serum, bone marrow, spongy bone and compact bone. The concentration of lincomycin in bone marrow was found to be at the same level as that in the serum. The concentration in spongy bone amounted in most cases to 50 to 75 per cent of the concentration in the serum, whereas the concentration in compact bone varied from 0 to 15 per cent of that in the serum. 相似文献
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《Acta orthopaedica》2013,84(3):267-270
Background and purpose In detection of glenoid labrum pathology, MR arthrography (MRA) has shown sensitivities of 88-100% and specificities of 89-93%. However, our practice suggested that there may be a higher frequency of falsely negative reports. We assessed the accuracy of this costly modality in practice. Patients and methods We retrospectively reviewed MRA reports of 90 consecutive patients with clinical shoulder instability who had undergone shoulder arthroscopy. All had a history of traumatic anterior shoulder dislocation and had positive anterior apprehension tests. All underwent arthroscopy and stabilization during the same procedure. We compared the findings, using arthroscopic findings as the gold standard in the identification of glenoid labrum pathology. Results 83 of the 90 patients had glenoid labrum tears at arthroscopy. Only 54 were correctly identified at MRA. All normal glenoid labra were identified at MRA. This gave a sensitivity of 65% and a specificity of 100% in identification of all types of glenoid labrum tear. 74 patients had anterior glenoid labral tears that were detected at an even lower rate of sensitivity (58%). Interpretation The sensitivity of MRA in this series was substantially lower than previously published, suggesting that MRA may not be as reliable a diagnostic imaging modality in glenohumeral instability as previously thought. Our findings highlight the importance of an accurate history and clinical examination in the management of glenohumeral instability. The need for MRA may not be as high as is currently believed. 相似文献