自控微动带锁髓内钉内固定对骨折愈合影响的扫描电镜观察与生化分析

目的观察自控微动带锁髓内钉[AMLN]内固定对骨折愈合的影响及机制.方法对12只山羊两侧股骨干横断截骨,分别采用AMLN和GK钉固定,术后7、14、28、56d分批处死,行生物化学测量,扫描电镜观察.结果(1)电镜观察术后7～14d AMLN固定组骨痂丰富、层叠状有序排列,骨小梁的吸收陷窝内有胶原纤维不断形成;术后28～56d骨胶原纤维在吸收陷窝内外形成丰富,互相平行束状排列,与骨干主应力轴相一致,骨吸收和骨生成活跃,骨塑形改建迅速,哈佛氏系统结构完整,结构网架在骨质钙盐结晶沉积下十分坚韧;而GK钉固定组则无上述特征现象发生;(2)AMLN钉固定组的骨痂胶原、不溶性胶原、钙、磷含量均高于GK钉固定组(P＜0.05).结论AMLN钉固定使骨折端局部稳定、有轴向生理性应力刺激与应力传导,增加了成骨细胞的代谢活性,使骨小梁沿压应力轴线发育,促进了骨胶原生成、骨盐的沉积及转化、骨痂的形成和强度的提高,加快了骨质重建的速度.     

自控微动带锁髓内钉内固定对骨折愈合影响的扫描电镜观察与生化分析

目的:观察自控微动带锁髓内钉[AMLN]内固定对骨折愈合的影响及机制.方法:对12只山羊两侧股骨干横断截骨,分别采用AMLN和GK钉固定,术后7、14、28、56d分批处死,行生物化学测量,扫描电镜观察.结果(1)电镜观察术后7～14d AMLN固定组骨痂丰富、层叠状有序排列,骨小梁的吸收陷窝内有胶原纤维不断形成;术后28～56d骨胶原纤维在吸收陷窝内外形成丰富,互相平行束状排列,与骨干主应力轴相一致,骨吸收和骨生成活跃,骨塑形改建迅速,哈佛氏系统结构完整,结构网架在骨质钙盐结晶沉积下十分坚韧;而GK钉固定组则无上述特征现象发生;(2)AMLN钉固定组的骨痂胶原、不溶性胶原、钙、磷含量均高于GK钉固定组(P＜0.05).结论:AMLN钉固定使骨折端局部稳定、有轴向生理性应力刺激与应力传导,增加了成骨细胞的代谢活性,使骨小梁沿压应力轴线发育,促进了骨胶原生成、骨盐的沉积及转化、骨痂的形成和强度的提高,加快了骨质重建的速度.     

自控微动带锁髓内钉内固定促进骨折愈合的扫描电镜观察

目的观察采用自控微动带锁髓内钉（autocontrol micromotion locking nail,AMLN）固定对骨折愈合的影响及机制。方法对14只山羊两侧股骨干横断截骨,分别采用AMLN和GK钉内固定,术后1、2、4、8周分批处死,采用扫描电镜观察骨折愈合过程中细胞的超微结构变化。结果术后1～2周AMLN固定组骨痂丰富、排列有序,骨小梁的吸收陷窝内有胶原纤维不断形成;术后4～8周骨胶原纤维在吸收陷窝内外形成丰富,互相平行束状排列,与骨干主应力轴相一致,骨吸收和骨形成活跃,骨塑形改建迅速,哈佛氏系统结构完整,结构网架在骨质钙盐结晶沉积下十分坚韧;而GK钉固定组则无上述特征现象发生。结论AMLN钉固定使骨折端局部稳定、有轴向生理性应力刺激与应力传导,增加了成骨细胞的代谢活性,使骨小梁沿压应力轴线发育,骨折边愈合边塑形,给骨折愈合提供了较佳的力学环境。     

自控微动带锁髓内钉内固定对骨折愈合影响的组织学实验研究

目的 :探讨自控微动带锁髓内钉 (AMLN )固定后骨折局部的组织学改变对骨折愈合的影响及机制。方法 :对 1 2只山羊两侧股骨干横断截骨 ,分别采用AMLN和GK钉内固定 ,术后 1、 2、 4、 8周分批处死 ,行组织学观察。结果 :AMLN钉能以微动间歇性应力方式促进骨折愈合 ,骨外膜骨痂、桥梁骨痂能早期加速形成 ,并逐渐连接骨痂、封闭骨痂 ,使皮质骨松化 ,骨小梁坚韧 ,提高了骨的结构力学特性 ,缩短了愈合周期 ,明显优于GK钉固定。骨痂的定量分析表明 ,两者具有显著性差异 (P <0 .0 5)。结论 :AMLN钉内固定所建立的局部有应力、应变产生及轴向应力传导的生物力学环境 ,可以调控成骨细胞与破骨细胞的活性平衡 ,骨折边愈合边改建边塑形 ,增加了骨折愈合的速度和质量     

自控微动带锁髓内钉内固定对骨折愈合影响的X线平片及微血管造影观察

目的 :探讨自控微动带锁髓内钉 (AMLN )固定对骨折愈合的影响及机制。方法 :对 12只山羊两侧股骨干横断截骨 ,分别采用AMLN和GK钉固定 ,术后 7、 14、 2 8、 5 6d分批处死 ,行X线平片、微血管造影及皮质骨的血流量变化检测。结果 :AMLN固定组 ,骨痂早期数量多 ,密度高连续无中断 ,中、后期骨痂质量好 ,成熟程度高 ,骨折边愈合边改建边塑形 ,与此功能相适应 ,皮质骨骨痂内血管丰富 ,5 6d后血管基本恢复正常 ,血管均匀且扩张消失。GK钉固定组 ,骨痂数量少 ,密度低不连续有中断现象 ,骨痂内血管管径细 ,排列紊乱 ,吻合程度比较差。血液流量前者明显优于后者 ,14d后两者相差 43 % (P <0 .0 5 )。结论 :AMLN内固定所建立的有间歇性动应力刺激与传导的生物力学环境 ,使皮质骨骨痂内血管形成及血运丰富 ,骨痂的形成和强度提高 ,加快了骨质重建的速度。     

天鹅型形状记忆合金接骨器对实验性骨折愈合中皮质骨胶原构筑与力学性能的影响

目的探讨天鹅型形状记忆合金接骨器(SMC)对实验性骨折愈合中皮质骨胶原构筑和力学性能的影响。方法45只新西兰大白兔双侧肱骨干截骨后,随机选取一侧用SMC固定,另一侧用4孔动力加压接骨板(DCP)固定;分别于术后2、4、8、16、32周各处死9只动物取材,4只用于扫描电镜观察固定段皮质骨胶原构筑的变化,5只用于骨干扭转生物力学性能的测定。结果SMC组在整个固定过程中,皮质骨结构与正常对照组相比无明显变化。而DCP组术后4周,胶原排列出现稀疏,局部有小吸收陷窝形成;术后8周时,胶原排列紊乱,且有多个吸收腔形成;术后16周时,胶原纤维出现中断;术后32周,骨质疏松化更加明显。术后2周时,两组肱骨骨断端尚未形成骨性连接,不能测得力学数据。术后4～32周,SMC组骨折愈合部位的扭转刚度明显优于DCP组,差异有统计学意义(F= 5．468,P＜0．05)。术后16周,SMC组骨折愈合部位的力学性能即接近正常,而DCP组术后16周扭转刚度即不再增加。结论SMC具有材料特性和几何构型上的优势,对骨干不产生应力遮挡效应,而且能有效防止骨质疏松的发生,使骨的力学性能尽早恢复。     

骨质疏松症患者骨小梁破骨细胞性骨吸收的扫描电镜观察

对７例因股骨颈囊内骨折而行人工股骨头置换术的老年妇女（平均年龄７２．４岁）的股骨头，经制备行扫描电镜检查，观察骨小梁的破骨细胞骨吸收。同年轻成年人的股骨头骨小梁相比，老年妇女股骨头的柱状骨小梁相继发生明显的骨吸收，表现为骨小梁的变细、变尖、穿孔、断裂，进而变圆钝，最后仅剩下颗状突起。骨小梁间的空隙因此明显增大。高倍镜下，可见骨小梁上卵圆形、狭长卵圆形或梭形的吸收陷窝。陷窝的大小、深浅及内容物都不一致，但都有凿缘状的边缘。陷窝四周原来具完整胶原纤维层的静止骨面也先后出现骨吸收。骨吸收过程中，无机盐可以先吸收，残剩粗糙不规则的胶原纤丝；也可以先降解胶原，使由此释放出来的无机盐结晶及不规则的骨颗粒残剩下来。最后，在陷窝内出现新形成的胶原纤丝以及新生骨组织，反映骨吸收以后的骨形成。但在老年人中骨形成现象较少见到，使骨转换处于负平衡状态。     

骨质疏松合并颈椎病病人的颈椎椎体

目的　探讨颈椎椎体骨质疏松在颈椎病发病中的作用。方法　分3组。正常组5例,颈椎间盘突出组(颈椎组)8例,骨质疏松合并颈椎管狭窄(疏松组)8例。标本取自C5椎体上1/4的松质骨。所取标本分别进行光镜和扫描电镜观察。结果　随病情发展,光镜下,骨小梁逐渐变细,间隙大小不一;电镜下见椎体松质骨逐渐丧失了原有海绵样结构,大量骨陷窝形成,造成骨小梁变细、穿孔、吸收甚至消失。骨小梁未见微骨痂形成。结论　骨质疏松是颈椎病发病因素之一,颈椎椎体骨小梁异常改建是以不断增多的吸收陷窝导致骨小梁穿孔、变细、吸收甚至消失完成的,是造成椎体变形的主要原因,而微骨折在颈椎变形中可能不起作用。     

骨质疏松合并颈椎病病人的颈椎椎体病理观察

目的：探讨颈椎椎体骨质疏松在颈椎病发病中的作用。方法：分3组。正常组5例，颈椎间盘突出组（颈椎组）8例，骨质疏松合并颈椎管狭窄（疏松组）8例。标本取血C5椎体上1/4的松质骨。所聚标本分别进行光镜和扫描电镜观察。结果：随病情发展，光镜下，骨小梁逐渐变细，间隙大小不一；电镜下见椎体松质骨逐渐丧失了原有海绵样结构，大量骨陷窝形成，造成骨小梁变细、穿孔、吸收甚至消失。骨小梁未见微骨痂形成。结论：骨质疏松是颈椎病发病因素之一，颈椎椎体骨小梁异常改建是以不断增多的吸收陷窝导致骨小梁穿孔、变细、吸收甚至消失完成的，虽造成椎体变形的主要原因，而微骨折在颈椎变形中可能不起作用。     

生骨再造散对兔骨折愈合影响的实验研究

目的探讨中成药生骨再造散对兔实验性骨折愈合的影响. 方法将30只青紫蓝家兔制成双侧桡骨骨膜下3 mm骨缺损模型,随机分为生骨再造散组(A组)、仙灵骨葆组(B组)及对照组(C组),每组10只,于术后14天和31天每组各处死5只兔,按规定时间进行四环素双标记(即14天处死的兔于术后4、5天行第1次标记,术后11、12天行第2次标记;31天处死的兔于术后20、21天行第1次标记,术后28、29天行第2次标记),并分别取材,进行骨组织形态学计量检测. 结果术后14天A组与C组比较,类骨质面积密度、矿化骨痂均宽及活性成骨面、矿化表面及动态参数等差异均有统计学意义(P＜0.01);术后31天,活性成骨面、矿化骨痂均宽及吸收陷窝均深等差异均有统计学意义(P＜0.01).B组与C组比较,结果与A组和C组比较类似;但与A组比较,术后14天破骨细胞指数、矿化表面及骨形成率[组织水平(tissue level)及BMU水平(basic multicellular unit level)]差异均有统计学意义(P＜0.05),术后31天类骨质表面、吸收陷窝均深、骨形成率(BMU水平)差异均有统计学意义(P＜0.05). 结论生骨再造散在兔桡骨骨折14天前可促进类骨质分泌,加快矿化沉积速度,提高骨形成率,缩短矿化延迟时间;14～31天后则可增加矿化骨痂宽度,提高破骨细胞活性,对骨折愈合有促进作用.     

Effect of autocontrol micromotion intramedullary interlocking nail on fracture healing： an experimental study

Objective: To investigate the effect of autocontrol micromotion locking nail ( AMLN ) on experimental fracture healing and its mechanism. Methods: 16 goats undergoing both sides of transverse osteotomy of the femoral shafts were fixed intramedullary with AMLN and Gross-Kempf (GK) nail, respectively. The follow-up time was 7, 14, 28 and 56 days. Roentgenographic, biomechanical, histological, scanning electromicroscopic and biochemical analyses were done. Results: (1) The strength of anticompression, antiflexion and antitorsion in the fractural end in the AMLN-fixed group was higher than that of GK nail-fixed group; whereas, the rate of stress shelter in the fractured end decreased significantly (P<0.01). (2) The content of the total collagen, insoluble collagen, calcium and phosphate in the AMLN-fixed group was higher than that in the GK nail-fixed group (P<0.05). (3) Histological observation and quantitative analysis of calluses revealed that AMLN could promote the growth of bridge calluses and periosteum calluses. Hence the facture healing and remolding process achieved early, which was much better than traditional GK nail fixation. (P<0.05). (4) 7-14 days postoperation, the calluses of AMLN-fixed group was flourish and camellarly arranged and the collagen fibril formed constantly in the absorption lacuna of bone trabecula. 28-56 days postoperation, the collagen fibril was flourish around the absorption lacuna and was parallel to the bone's longitudinal axis. Active bony absorption and formation were seen, so was remolding and rebuilding. Haversian system was intact and the bony structural net was very tenacious because of the deposition of calcium salt. None of the above findings was observed in the GK nailfixed group. Conclusions: The design of AMLN accords well with the plastic fixation theory. As the geometry ametabolic system constituted by the intramedullary fixation instruments and the proximal and distal end of the fracture is very firm and stable, the disturbance to the physical stress distributed in the fractural end is light. The generation and conduct of the intermittent physical stress between the fractural parts could reach the balance between stress conduct and stress protection. The feature that the healing and remolding take place at the same time speeds up the fractural healing process.     

仙灵骨葆胶囊联合阿仑膦酸钠对骨质疏松骨折大鼠骨痂血管形成的影响

目的探讨仙灵骨葆胶囊联合阿仑膦酸钠对骨质疏松性骨折大鼠骨痂血管形成及VEGF、BMP-2表达的影响。方法50只雌性SD大鼠随机分为假手术组(SHAM组)、模型组(MODEL组)、仙灵骨葆组(XLGB组)、阿仑膦酸钠组(ALLSN组)、联合药物组(LHYW组),10只/组,构建骨质疏松性骨折大鼠模型,放射性X线观察评估骨折愈合,双能X线检测骨密度,Mirco-CT检测骨结构形态学参数,番红O固绿染色观察骨痂组织形态学,免疫组化检测骨痂VEGF和BMP-2蛋白表达。结果所有实验大鼠均进入结果分析。与SHAM组比较,MODEL组大鼠骨折愈合评分、骨密度、骨组织形态学参数、骨痂VEGF和BMP-2表达均显著降低(P0.05),与MODEL组比较,XLGB组、ALLSN组和LHYY组骨折愈合评分、骨密度、骨组织形态学参数、骨痂VEGF和BMP-2表达均显著升高(P0.05),尤以LHYY组最高。SHAM组骨小梁结构正常,几乎均为骨性骨痂。MODEL组骨小梁明显稀疏、断裂,未见明显骨性骨痂。XLGB组和ALLSN组骨小梁增多,排列稍紊乱,大部分为骨性骨痂。LHYW组骨小梁明显增多,排列密集整齐,大量骨性骨痂。结论仙灵骨葆胶囊联合阿仑膦酸钠可能通过介导提高骨质疏松性骨折大鼠骨生长因子VEGF和BMP-2表达,促进骨痂血管形成,加速骨痂形成,增加骨密度,改善骨结构形态,促进骨折愈合。     

阿仑膦酸钠和强骨胶囊单用与合用对大鼠骨质疏松性骨折骨愈合影响的实验研究

目的通过骨质疏松性骨折动物模型,观察阿仑膦酸钠、强骨胶囊单用及合用对骨折愈合的影响,以探讨中西医结合治疗骨质疏松性骨折的意义。方法 70只SD大鼠给予维甲酸灌胃,制造骨质疏松性骨折模型成功后分别予以阿仑膦酸钠、强骨胶囊及两药合用,于2周、4周和6周处死5只试验鼠,进行骨痂大小的测量及组织学研究。结果 2周时合用组骨痂大小较其他组无显著差异;4周时合用组骨痂大小较阿仑膦酸钠组小,较强骨胶囊组大;6周时各组骨痂大小无异。组织学检测发现阿仑膦酸钠组破骨细胞数目最少,骨小梁成熟较其他组缓慢;强骨胶囊组成骨细胞数目最多,小梁骨成熟最快;强骨胶囊联合阿仑膦酸钠组与对照组无差别。结论强骨胶囊与阿仑膦酸钠联合使用治疗维甲酸所致大鼠骨质疏松性骨折疗效并不显著。     

The 3D structure of the collagen fibril network in human trabecular bone: Relation to trabecular organization

Trabecular bone is morphologically and functionally different from compact bone at the tissue level, but both are composed of lamellae at the micrometer-scale level. We present a three-dimensional study of the collagenous network of human trabecular lamellar bone from the proximal femur using the FIB-SEM serial surface view method. The results are compared to human compact lamellar bone of the femoral shaft, studied by the same method. Both demineralized trabecular and compact lamellar bone display the same overall structural organization, namely the presence of ordered and disordered materials and the confinement of the canalicular network to the disordered material. However, in trabecular bone lamellae a significant proportion of the ordered collagen fibril arrays is aligned with the long axis of the trabecula and, unlike in compact bone, is not related to the anatomical axis of the whole femur. The remaining ordered collagen fibrils are offset from the axis of a trabecula either by about 30° or 70°. Interestingly, at the tissue scale of millimeters, the most abundant angles between any two connected trabeculae — the inter-trabecular angles - center around 30° and 70°. This implies that within a framework of interconnected trabeculae the same lamellar structure will always have a significant component of the fibrils aligned with the long axes of connected trabeculae. This structural complementarity at different hierarchical levels presumably reflects an adaptation of trabecular bone to function.     

Gene therapy to improve osteogenesis in bone lesions with severe soft tissue damage

Background Ex vivo gene therapy can induce bone formation when delivery cells carrying the bone morphogenetic protein (BMP) gene are used. The hypothesis for this study was that the cell-mediated gene therapy could improve the healing of bony lesions with severe soft tissue damage.Method An animal model with a femoral osteotomy lesion associated with soft tissue damage was developed in rats. Muscle-derived cells, genetically engineered to express BMP4, were inserted within the osteotomy gap. Cells genetically engineered to express LacZ were used for the control group. The groups were subdivided with regard to the fixation method: stable and unstable fixation. The rats were killed for histological and radiographic evaluation 3 and 6 weeks post-surgery.Results No callus formation was found in the control group at any time point, whereas sufficient callus formation appeared in the treatment group after 6 weeks. A bridging callus with woven bone and hypertrophic chondrocytes was achieved in the treatment group when a stable fixation was used, but failed to appear in unstable fixation.Conclusion The combination of muscle-derived cells expressing BMP4 and a stable fixation were able to bridge the bone defect within 6 weeks, but with prolonged osteochondral ossification. Therefore, the ex vivo gene therapy could be an efficient biological approach to improve the treatment of bone lesions with severe soft tissue damage.     

应用自控微动带锁髓内钉治疗股骨干骨折

目的观察自控微动带锁髓内钉(A M L N)治疗股骨干骨折的临床效果。方法采用A M LN钉治疗股骨干骨折29例,其中横形13例,短斜形4例,螺旋形1例,粉碎性11例。结果所有患者随访8～22个月,骨折全部愈合,按K lem m功能恢复分级标准优26例,良3例。结论A M LN钉具备了坚强与弹性两类内固定器械的优点,解决了临床上坚强内固定骨折端应力传导不够或没有应力传导,弹性固定不易控制骨折端弯剪扭旋应力这一矛盾。所设计的自控微动装置使骨折局部始终处于有生理性应力传导与刺激的生物力学环境中,骨痂边生长边塑形,避免了骨折不愈合及骨折病的发生。A M LN钉及配套器械设计合理,手术操作简便,易于推广。     

Effect of recombinant human osteogenic protein-1 on the healing of a freshly closed diaphyseal fracture

Osteogenic protein-1 (OP-1), or bone morphogenetic protein-7, is an osteoinductive morphogen that is involved in embryonic skeletogenesis and in bone repair. In bone defect models without spontaneous healing, local administration of recombinant human OP-1 (rhOP-1) induces complete healing. To investigate the ability of rhOP-1 to accelerate normal physiologic fracture healing, an experimental study was performed. In 40 adult female goats a closed tibial fracture was made, stabilized with an external fixator, and treated as follows: (1) no injection; (2) injection of 1 mg rhOP-1 dissolved in aqueous buffer; (3) injection of collagen matrix; and (4) injection of 1 mg rhOP-1 bound to collagen matrix. The test substances were injected in the fracture gap under fluoroscopic control. At 2 and 4 weeks, fracture healing was evaluated with radiographs, three-dimensional computed tomography (CT), dual-energy X-ray absorptiometry, biomechanical tests, and histology. At 2 weeks, callus diameter, callus volume, and bone mineral content at the fracture site were significantly increased in both rhOP-1 groups compared with the no-injection group. As signs of accelerated callus maturation, bending and torsional stiffness were higher and bony bridging of the fracture gap was observed more often in the group with rhOP-1 dissolved in aqueous buffer than in uninjected fractures. Treatment with rhOP-1 plus collagen matrix did not result in improved biomechanical properties or bony bridging of the fracture gap at 2 weeks. At 4 weeks there were no differences between groups, except for a larger callus volume in the rhOP-1 plus collagen matrix group compared with the control groups. All fractures showed an advanced stage of healing at 4 weeks. In conclusion, the healing of a closed fracture in a goat model can be accelerated by a single local administration of rhOP-1. The use of a carrier material does not seem to be crucial in this application of rhOP-1.     

Osteoporosis influences the middle and late periods of fracture healing in a rat osteoporotic model

Osteoporosisischaracterizedbydecreasedbonemass, increasedbonefragilityinducedbydemolitionofbonemicrostructureandincreasedsusceptibilitytofracture. Currentstudiesmainlyfocusonthepreventionoffracture. However, theinfluenceofosteoporosisonthefracturehealingremainspoorlyunderstoodandcontroversial.Inourpreviousstudy, wehaveevaluatedtheeffectofosteoporosisontheearlyperiodoffracturehealing, andfoundthatosteoporosisinfluencesthequantityandqualityofcallusduringtheearlyperiodofracturehealing.1 Incurrent…