非创伤性股骨头坏死血管内皮生长因子mRNA与骨形态发生蛋白-2表达的研究

非创伤性股骨头坏死的发病机制至今尚未明确,缺乏有效的治疗方法,目前仍为骨科领域的疑难病症.我们运用免疫组织化学及原位杂交技术对非创伤性股骨头坏死患者的股骨头标本中血管内皮生长因子(VEGF)mRNA与骨形态发生蛋白-2(BMP-2)的表达进行研究.     

激素治疗SARS患者中期随访的髋部MRI表现

目的 对应用激素治疗的严重急性呼吸综合征(severe acute respiratory syndrome,SARS)患者进行中期髋部MRI随访,探讨早期股骨头坏死和未发生股骨头坏死即正常股骨头的MRI特征.方法 2003年6月至2004年1月对539例(1078髋)应用激素治疗的SARS患者行MR及X线榆查,诊断股骨头坏死210髋,无股骨头坏死868髋.2007年2至11月对510例(1020髋)SARS患者再行MR及X线复查.观察早期股骨头坏死和未发生股骨头坏死股骨头的MRI表现及其变化.结果 末次随访时无新发股骨头坏死病例,应用激素冲击治疗的SARS患者MRI影像上的股骨头坏死均出现在激素治疗后的6个月内.股骨头塌陷或手术后,股骨头坏死的信号类型发生改变,表现为T1加权像低信号,对应STIR序列上高信号.3髋出现坏死范围减小.正常股骨头在T1加权像上有四种MRI影像类型.24髋初次诊断无股骨头坏死者T1加权像出现异常表现,但STIR序列均无异常高信号.这些信号类型在随访的MRI上发生了改变.结论 应用激素冲击治疗的SARS患者,MRI影像上出现股骨头坏死均发生在激素治疗后的6个月内,少数早期坏死股骨头的坏死范围会减小.正常股骨头的MRI影像存在变异.T1加权像上低信号带、对应STIR序列上高信号可作为股骨头坏死的诊断标准.     

282例患者住院治疗股骨头坏死相关因素的分析

目的探讨非创伤性股骨头坏死的临床流行病学以及股骨头坏死发生的相关危险因素、治疗,以期对我国股骨头坏死发病及治疗现状进行分析,提高股骨头坏死早期筛查、诊断及治疗整体水平。方法设计相关调查表格,对2010年1月至2010年12月间入住四川大学华西医院骨科的282例股骨头坏死患者进行相关因素调查,包括一般情况,危险因素及诊断、治疗情况。在此基础上,对上述因素进行分析、总结。结果期间共收治非创伤性股骨头坏死患者282例,其中男210例,女72例,年龄19—80岁,平均42．6岁。股骨头坏死相关危险因素分析,激素性股骨头坏死50例,平均激素（强的松）摄入10mg／d,平均持续4年;酒精性股骨头坏死202例,平均酒精摄入量2413ml／周,饮酒时间平均20年。双侧发病142例（50．5％）。初次诊断股骨头坏死分期,FicatⅠ期17髋占4％,Ⅱ期79髋占18％,Ⅲ期123髋占29％,Ⅳ期215髋,占49％。双侧同时发生股骨头坏死142例占50．5％。78例（28％）患者既往曾接受过药物治疗;其中27例（27髋）为无症状股骨头坏死。结论四川地区股骨头坏死男：女为2．92：1;发病年龄在42．6岁。酒精摄入和大剂量糖皮质激素的应用是诱发股骨头坏死的主要原因。除关节置换术外,股骨头髓芯钻孔减压术是最常采用的保留股骨头的外科治疗措施。此股骨头坏死临床流行病学及相关研究分析,将对更好的认识我国股骨头坏死发病情况疾病因研究,对股骨头坏死早期预防、诊断和治疗提供可靠的数据和依据。     

预测早期激素性股骨头坏死的生物标志物研究进展

激素性股骨头坏死是一种进展性疾病，往往发生较为隐匿且进展迅速，如若不及时进行早期干预通常会进展为股骨头坏死和进一步塌陷，最终导致全髋关节置换，严重影响患者的生活质量。目前，虽然对激素性股骨头坏死的病因、发病机制、诊断和治疗已进行广泛地研究，但仍未找到理想的诊疗措施来治愈该疾病，关于激素性股骨头坏死的早期诊断和预防仍是当前面临的一个具有挑战性的问题。本文将近年来可能预测激素性股骨头坏死发生的潜在生物标志物进行综述，为临床激素性股骨头坏死的早期诊断和预防提供新思路。     

股骨头缺血性坏死组织差异表达蛋白质的鉴定和功能蛋白质组学初步研究

目的应用组织蛋白质组学方法寻找与成人股骨头缺血性坏死（ONFH）相关的蛋白质。方法于非创伤性ONFH患者股骨头中分别采集坏死骨组织样品与正常骨组织样品各12份,采用四步溶剂法提取骨组织中的总蛋白,应用多维液相色谱与串联质谱联用技术和生物信息学方法对组织蛋白进行分离鉴定和功能蛋白质组学分析。结果坏死组织样本和正常组织样本中鉴定二肽段以上的高可信度蛋白质数量分别为1302个和999个,假阳性率为0．9％。通过与对照组的质谱计数,在坏死骨组织中鉴定了141个高表达蛋白和56个低表达蛋白。基因本体论蛋白功能分析发现34种蛋白质与ONFH密切相关。本实验在股骨头坏死组织中证实ChST2基因（硫酸软骨素蛋白聚糖合成过程中的关键蛋白）和GPCR26基因（介导细胞内钙离子动员的蛋白质）的低表达。结论非创伤性ONFH存在复杂的信号传导通路。硫酸软骨素蛋白聚糖的生物合成和多种离子的转运、动员可能参与ONFH发病机制中的关键过程。研究发现的差异表达蛋白可能成为ONFH早期临床诊断的候选生物学标志物。     

X线平片彩色化对缺血性股骨头无菌坏死的诊断价值

股骨颈骨折后股骨头缺血性坏死发生率较高,而服用激素类药物后引起医源性股骨头坏死率又占一定比例,迄今尚无一种快速有效的早期诊断及治疗方法。近年来我们采用X线平片彩色化电子计算机处理技术,对股骨颈骨折后股骨头缺血性坏死和医源性股骨头坏死的早期诊断治疗进行了研究。     

早期非创伤性股骨头坏死诊断及治疗的研究现状

正目前临床上对股骨头坏死多采用非手术疗法、保髋手术治疗股骨头早期坏死。而晚期股骨头坏死的主要通过全髋关节置换缓解临床症状,彻底治愈股骨头坏死。现将早期非创伤性股骨头坏死诊断及治疗的研究现状综述如下。1股骨头坏死病因的研究现状股骨头坏死又称股骨头缺血坏死。其发病机制常常是由于骨内血液循环障碍,骨细胞凋亡,随病情发展股骨头负重区骨小梁结构发生变化,最终导致股骨头变形、塌陷,临床多以髋关     

成人股骨头缺血性坏死患者眼底荧光血管造影的研究

目的探讨早期股骨头缺血性坏死的发病机制及眼底微循环的变化,为早期诊断股骨头缺血性坏死提供一种新的方法。本研究的目的在于了解早期股骨头缺血性坏死患者眼底微循环的变化与早期股骨头坏死发病机制的关系。方法选择2000--2007年我院磁共振确诊的早期股骨头缺血性坏死患者,共40例。40例（共56髋）,拍片并进行Ficat分期,对每一位患者进行荧光素眼底血管造影,拍摄不同时期的眼底照片,分析眼底血管变化。同时以同期40例健康查体者作为对照,用SPSS13．0软件处理所得数据。结果40例股骨头坏死患者中,视网膜微循环均有变化,最常见的视网膜病变为微循环静脉期时间延长及血管渗漏,与对照组40例正常人比较,差异有统计学意义。结论股骨头坏死系全身微循环障碍在股骨头的局部表现,主要为静脉淤滞及渗漏造成;股骨头坏死患者的眼底变化,为诊断早期股骨头坏死患者提供了一种新的办法。     

基因治疗非创伤性股骨头坏死的研究进展

非创伤性股骨头坏死早期保守治疗方法甚多,但尚缺乏一种成熟有效的治疗方法。基因治疗非创伤性股骨头坏死是近年来新型的治疗方法,本文就该病的发病机制、分子生物学基础、外源性治疗基因与载体选择等方面研究的相关进展及存在问题展开综述,讨论了研究的有关问题及对策,并就研究前景进行了展望。     

蛋白质组学在骨科的应用现状

蛋白质组学可以在蛋白质水平对各种生理、病理过程进行整体而全面的认识,近年来在医学领域得到广泛应用,本文就其在骨科的应用现状进行综述,包括股骨头坏死的病理机制研究、骨质疏松发生机制研究、骨肉瘤发生机制、早期诊断和治疗筛选研究、骨性关节炎生物标记物筛选和发生机制研究、类风湿关节炎发生机制研究、诊断和预后、脊髓损伤发生及修复机制研究、骨折愈合过程研究和骨折风险评估、椎间盘退变机制研究等。     

Traumatic dislocation of hip joint with fracture of shaft of femur on the same side.

Four cases of traumatic dislocation of the hip joint with fracture of the shaft of femur on the same side, and one case of bilateral hip joint dislocation with a fracture of shaft of femur on one side are reported. Pitfalls in diagnosis and hazards of delayed treatment are emphasized. Methods of treatment are outlined. Complications such as avascular necrosis of the head of the femur and sciatic nerve palsy are discussed. Avascular necrosis of the head of the femur is not inevitable even after reduction of the joint has been delayed for several days.     

多孔钽块置入治疗股骨头缺血性坏死的生物力学及三维有限元分析

[目的]对比研究三种治疗成人股骨头缺血性坏死的生物力学方法;探讨髓芯减压对股骨头机械支撑力的影响及钽块置入治疗股骨头缺血性坏死的独特优势.[方法]选择健康成人右侧股骨为研究对象,经层厚2.0mm的螺旋CT扫描得各断面图像,输入计算机识别和提取股骨轮廓并行三维重建.按生理状态下股骨力载荷的三维空间分布,施加髋关节接触力1620N,外展肌合力1061N,髂胫束力1720N.对股骨头三维有限元模型进行计算,求出股骨头受力模型在不同坏死角度,不同减压位置股骨头负重区表面的塌陷值.[结果]股骨头髓芯减压后的塌陷值明显增大,以负重区最为明显(P＞0.05),且随着坏死角度的增大股骨头的塌陷值也随着增大.[结论]髓芯减压虽能清除死骨,但减压本身则进一步降低了股骨头的力学性能,单纯的植骨并不能增加股骨头的机械支撑力;髓芯减压基础上以多孔钽金属块为股骨头及软骨下骨板提供安全而有效的力学支撑,能有效防止塌陷,并为骨组织的修复提供条件.     

Aseptic necrosis of head of femur and disturbance of fat-metabolism type IIa after Fredrickson (author's transl)]

The history of aseptic necrosis of the head of femur is given. Following publication of osteonecrosis in hyperlipoproteinemia type IV after Fredrickson, now for the first time the relation between aseptic necrosis of the femoral head and the primary disturbance of fat metabolism type II is revealed. There exists a hypercholesterinemia, more exactly a hyperbeta-cholesterinemia. The subgroups type IIa and type IIb are explained. Type II is of particular importance since it produces early arteriosclerosis which demands early diagnosis, since this condition can be treated by drugs and diet. In the writers' opinion further differentiation of dys-and hyperlipidemiae in aseptic necrosis of the femoral head will enable us to define signs of disturbances of lipid metabolism. The group of "idiopathic" necroses of the femoral head will become steadily smaller. According to this basic concept the hypothesis might be put forward that this type of aseptic osteonecrosis is a late complication of a differentiated fat-metabolic disturbance.     

Chiari骨盆截骨术治疗包容不良性股骨头骺坏死症

目的　通过临床总结 ,寻求一种治疗股骨头骺坏死症可靠有效的方法。方法　对我院 1980～ 1997年间采用Chiari骨盆截骨术治疗该疾患 32例的长期随访 ,对临床及影像学与相关术式作一对比。结果　Chiari骨盆截骨术损伤小、成功率高、并发症少 ,优良率达 93 75 %。结论　Chiari骨盆截骨术是治疗髋臼包容不良性股骨头骺坏死症疗效可靠的术式。     

钽棒植入治疗成人早期股骨头坏死

目的：探讨一种简单有效治疗成人早期股骨头缺血性坏死的新方法,以避免股骨头进一步塌陷和坏死,改善临床症状。方法：自2009年1月至2010年6月采用钽棒植入治疗9例（10髋）成人早期股骨头坏死,男7例,女2例;年龄29～63岁,平均44.1岁。术前均摄髋关节正侧位X线片,行CT和MRI扫描。按Steinberg分期：Ⅰ期1例1髋,Ⅱa期4例5髋,Ⅱb期4例4髋。手术在C形臂X线机定位下进行,从股骨大转子下钻入导针到股骨头坏死区中心,空心钻沿导针扩髓,刮除坏死区死骨,必要时植骨,选择合适长度的钽棒拧入,支撑坏死区关节面。术后3、6、9个月随访,采用JOA评分标准评价临床疗效,摄髋关节正侧位X线片,观察股骨头变化。结果：手术时间40～60min,平均50min;出血量60～100ml,平均80ml。术后无感染、骨折及下肢深静脉血栓形成等并发症,全部病例获得随访,时间9个月及以上,定期行X线检查未发现股骨头塌陷和坏死加重。JOA评分从术前平均（31.30±19.63）分增加至术后3个月平均（54.10±13.20）分,术后6个月（69.90±15.04）分,术后9个月（87.00±8.83）分。结论：钽棒植入治疗成人早期股骨头坏死手术简单易行,能有效避免坏死区股骨头塌陷,近期疗效满意。     

Tc-SN-pyrophosphate scintigraphy following traumatic posterior dislocation of the hip

Avascular necrosis of the head of the femur is a serious complication of traumatic dislocation of the hip joint; therefore ^99mTc-SN-pyrophosphate scintigraphy was carried out 10 to 14 weeks (average 12 weeks) after the injury on 12 patients to determine whether it was possible to demonstrate reduced or no activity of the head of the femur before development of radio-logical avascular necrosis of the head of the femur.

Increased activity was observed in 9 of 11 hips with fracture-dislocation of the head of the femur, acetabulum or both, and normal activity was demonstrated in the contralateral hip of all patients.

During the follow-up period avascular necrosis of the head of the femur developed in four hips from 6 to 20 months after the accident.

It is concluded that ^99mTc-SN-pyrophosphate scintigraphy 12 weeks after traumatic dislocation of the hip was unable to identify hips at risk of later development of avascular necrosis of the head of the femur.     

Avascular necrosis of the femoral head in children with acute lymphoblastic leukemia: a 4- to 9-year follow-up study

Avascular necrosis of the femoral head is usually seen in children aged 1.5 to 10 years, reaching a peak incidence between the ages of 4 and 9. Avascular necrosis of the femoral head is a known complication of corticosteroid therapy in acute lymphoblastic leukemia. There are few reports in the literature regarding the natural history of this condition, and there is no consensus on its management. This study examined the natural history of avascular necrosis of the femoral head in children with leukemia. From 1993 to 2006, a total of 865 children with acute lymphoblastic leukemia were admitted to the hematology-oncology ward of a children's hospital. The diagnosis of acute lymphoblastic leukemia was established by bone marrow aspiration. Based on clinical and radiographic findings, avascular necrosis of the femoral head was found in 7 patients; these patients underwent follow-up for 4 to 9 years. Avascular necrosis of the femoral head was clinically symptomatic in all of the children, and they had advanced radiographic collapse of the femoral head. However, the head of the femur was not at risk in any patient based on clinical and radiographic findings. Patients received supportive treatment such as abduction brace and physiotherapy. After 4 to 9 years of follow-up, clinical and radiographic results were satisfactory. Provided that the head of the femur is not at risk, avascular necrosis of the femoral head in children with acute lymphoblastic leukemia may be successfully managed with nonoperative care.     

Osteonecrosis of the femoral head after osteosynthesis of a proximal femur fracture with a 95° condylar plate

Summary Avascular necrosis of the femoral head is a frequent complication after osteosynthesis of femoral neck fractures. It is rarely seen after proximal femur fractures with intact trochanteric area. The choice of the implant varies from different blade systems (DHS, DCS and condylar plates) to intramedular nailing systems (gamma nail, classic nail). The complication of avascular necrosis of the femoral head after internal fixation of subtrochanteric and proximal femur fractures is reported following intramedullary nailing. We report a case of a femoral head necrosis after osteosynthesis of a proximal femur fracture with a 95 degree condylar plate.      

Comparative studies on cadmium, chromium, nickel and lead accumulation in coxarthrosis and idiopathic femur head necrosis

Possible heavy-metal toxicity due to cadmium, chromium, nickel and lead in coxarthrosis and idiopathic necrosis of the head of the femur is reported on for the first time. Studies are made in the diseased head of the femur by means of ICP emission spectroscopy and atom absorption spectrophotometry. Whereas the blood and bone analyses in the own control group and in the coxarthrosis patients show normal values, a statistically significantly elevated element concentration in the head of the femur in the case of idiopathic necrosis of the head of the femur could be demonstrated with regard to the heavy-metal toxicity due to cadmium, nickel and lead. The analysis of the necrotic zone itself also shows considerable accumulations both for chromium and for nickel and lead. Since the analysed trace elements are strongly toxic in high concentrations, further clarification of a possible causal relationship between toxic trace element concentration and idiopathic necrosis of the head of the femur appears necessary.     

Osteonecrosis of the femoral head after osteosynthesis of a proximal femur fracture with a 95° condylar plate

Avascular necrosis of the femoral head is a frequent complication after osteosynthesis of femoral neck fractures. It is rarely seen after proximal femur fractures with intact trochanteric area. The choice of the implant varies from different blade systems (DHS, DCS and condylar plates) to intramedular nailing systems (gamma nail, classic nail). The complication of avascular necrosis of the femoral head after internal fixation of subtrochanteric and proximal femur fractures is reported following intramedullary nailing. We report a case of a femoral head necrosis after osteosynthesis of a proximal femur fracture with a 95 degree condylar plate.