牛骨形态形成蛋白复合物的临床应用：附13例初步报告

１９８９～１９９３年作者应用牛骨形态形成蛋白（ｂＢＭＰ）与预制的微孔煅石膏复合后，应用于骨不连的治疗，从而避免了煅石膏遇水产热对ＢＭＰ活性不利影响。临床应用１３例，术后早期出现骨愈合征象，临床检查及Ｘ线评价效果良好，无合并症发生，结果表明，异种ＢＭＰ植入人体，临床上未显其免疫排斥反应。能明显促进骨愈合过程，可作为骨折及骨不连治疗的一种新型材料。     

NNB/BMP复合物在胫骨骨折不愈合治疗中的应用

目的：验证天然型无机骨（ＮＮＢ）与骨形态形成蛋白（ＢＭＰ）复合物取代自体松质骨移植治疗胫骨陈旧性骨折及骨折不愈合为研究对象，本次手术到受伤时间平均８．５个月（４￣２４个月），平均年龄３５岁，随机分为对照组３０例，治疗组５０例，依治疗方法不同随机分为甲、乙二组，分别在骨折区域植入自体松质骨与ＮＮＢ／ＢＭＰ，观察术后全身及切口局部反应及连续Ｘ线片表现。随访平均１９个月（１３￣３６个月）。按Ｊｏｈｎｅｒ     

纯化天然骨唾液蛋白的体内成骨活性

目的 评价骨唾液蛋白（ｂｏｎｅ ｓｉａｌｐｒｏｔｅｉｎ,ＢＳＰ）在大 本内的成骨活性。方法 应用从牛骨中提取纯化的ＢＳＰ与经盐酸胍处理诱导活性的不溶性骨基质（ｉｎｓｏｌｕｂｌｅ ｂｏｎｅ ｍｔｒｉｘ,ＩＢＭ）或提纯的１型胶原形成共价交联的复合物,将ＢＳＰ－ＩＢＭ复合物和ＢＳＰ－１型胶原复合物分别植入直径８ｍｍ的大鼠颅骨骨缺损和胸部皮下组织内。不含ＢＳＰ的ＩＢＭ或１型胶原也分别植入上述部位作为对照。     

活性锻烧骨的临床应用

把骨形态发生蛋白（ＢｏｎｅＭｏｒｐｈｏｇｅｎｅｔｉｃＰｒｏｔｅｉｎ，ＢＭＰ按１：２０的重量比例，与煅烧异种松质骨（ＴｒｕｅＢｏｎｅＣｅｒａｍｉｃ，ＴＢＣ）组成活性煅烧骨（ＢＭＰ／ＴＢＣ复合物）经动物实验揭示该复合体具有良好的填充修复骨缺损的能力，临床应用５３例病人，４８例随访８个月～３．５年，平均１８．６月，均取得满意疗效，作者认为自制煅烧骨是理想的载体。活性煅烧骨（ＢＭＰ／ＴＢＣ复合物）具有高效     

活性煅烧骨的临床应用

把骨形态发生蛋白（ＢｏｎｅＭｏｒｐｈｏｇｅｎｅｔｉｃＰｒｏｔｅｉｎ，ＢＭＰ）按１∶２０的重量比例，与煅烧异种松质骨（ＴｒｕｅＢｏｎｅＣｅｒａｍｉｃ，ＴＢＣ）组成活性煅烧骨（ＢＭＰ／ＴＢＣ复合物），经动物实验揭示该复合体具有良好的填充修复骨缺损的能力，临床应用５３例病人，４８例随访８个月～３．５年，平均１８．６月，均取得满意疗效。作者认为自制煅烧骨是理想的载体。活性煅烧骨（ＢＭＰ／ＴＢＣ复合物）具有高效的诱导成骨能力，不引起免疫排斥反应，来源丰富，易于大量加工贮存，有广阔的临床应用前景。     

异种脱蛋白BMP复合骨修复骨缺损实验研究

异种骨移植常由于强烈的免疫排斥反应失败。本文报告将小牛骨经脱蛋白处理（即脱去主要的抗原物质），后再复合进去骨形成蛋白（ｂｏｖｉｎｅＢｏｎｅＭｏｒｐｈｏｇｅｎｅｔｉｃｐｒｏｔｅｉｎ，简称ｂ－ＢＭＰ）使其成为既无抗原性，又利于骨形成的异种脱蛋白ＢＭＰ复合骨。将其植入新西兰白兔尺骨缺损（２ｃｍ），观察愈合结果。免疫学、放射学和组织学检查表明，植入异种脱蛋白ＢＭＰ复合骨，各组实验动物术后无任何免疫反应。４周均显示植入骨与骨床界线模糊，８周植入骨内可见大量成片新生骨细胞及新生血管长入。实验结果表明经处理后的大块异种骨移植，不但无任何免疫排斥反应，且可达到预期修复骨缺损的目的。     

bBMP植入治疗儿童股骨头缺血性坏死

儿童股骨头缺血性坏死常引起病残。其病因不完全清楚，临床上治疗方法较多，疗效各有优劣。我院从１９９４年应用ｂＢＭＰ（牛骨形态形成蛋白）植入治疗该病，取得了满意的临床效果。１临床资料１１本组３８例，男２３例，女１５例。年龄４～１２岁，平均７２４岁。３...     

多孔磷酸三钙与自体红骨髓复合移植修复骨缺损的临床应用

为观察多孔磷酸三钙（ｔｒｉｃａｌｃｉｕｍｐｈｏｓｐｈａｔｅ，ＴＣＰ）与自体红骨髓（ｂｏｎｅ－ｍａｒｒｏｗ，ＢＭ）复合移植修复骨缺损的临床应用效果，应用ＴＣＰ－ＢＭ复合移植，修复骨缺损２１例，其中肿瘤性骨缺损１７例，陈旧性骨折骨缺损４例。术后定期拍摄Ｘ线片复查。术后６周，植入人工骨与周围骨组织界面间已有明显新骨形成；术后３个月，植入材料与周围骨组织愈合成一体。随访１～３年，结果显示植入材料的成骨作用明显，效果满意。ＴＣＰ－ＢＭ具有骨传导和骨诱导双重成骨作用，能促进新骨形成和加快骨缺损修复，是治疗骨缺损较理想的方法之一     

成纤维细胞生长因子增强骨形态发生蛋白在小鼠体内骨诱导作用

在啮类动物体内植入骨形态发生蛋白后，引起细胞内一系列生化和形态学变化，在植入物内和其周转形成新骨。这过程受多因素影响。本实验将重组人成纤维细胞生长因子与部分纯化的ＢＭＰ悬液混合后注入小鼠肌肉，观察成骨反应。单独注射牛骨ＢＭＰ组和ｂＦＧＦ组为对照。     

重组合异种骨在脊柱外科的应用

重组合异种骨在脊柱外科的应用穆希胜１杜鸿章１闫乔生１重组合异种骨是骨形成蛋白（ＢＭＰ）与去除抗原特性后的异种松质骨的复合物，是近年来医学研究的一项新成果。它既有ＢＭＰ的高度诱导成骨作用，又有松质骨的支架作用。根据这一原理，我们对１３例椎体滑脱、椎弓根...     

乳腺癌骨转移模型的建立

目的 介绍三类制作乳腺癌骨转移模型的方法及采用该模型所开展的研究现状。方法 综述国内外的进展。结果 经左心室注射制作的骨转移模型应用最广泛;经局部注射制备骨转移模型最简便,但与临床状况相差较大;经外科原位接种制作骨转移模型为骨转移机理及治疗方法的研究提供了较为理想的工具。结论 各种骨转移模型各有其应用价值,建立与人体乳腺癌骨转移过程完全相同的人乳腺癌动物模型是发展的方向。     

FREQUENCY OF INTERMEDIATE ADMISSIONS AND PLACE OF DEATH OF PATIENTS WITH ADVANCED COLORECTAL CANCER

An analysis was made of the place of death and the degree of institutional support required following surgery in patients with colorectal cancer (CRC) who had distant metastases. There was a high incidence of intermediate admissions to an acute hospital, and most patients died in an acute hospital bed. The number of readmissions and the place of death were not influenced by the patients' age, sex, site of tumour or their home situation at the time of diagnosis. In view of the high demand for acute surgical beds, there is a need to develop more appropriate facilities to care for patients in the terminal phase of this disease.     

关节镜下半月板损伤修复的治疗方法

目的探讨关节镜下半月板损伤缝合修复术的治疗方法和效果。方法1998年6月~2003年5月,收治110例膝半月板损伤患者。其中男78例,女32例。年龄14~66岁,平均27.5岁。半月板滑膜缘纵裂93例,横裂12例,潜行撕裂5例。半月板损伤部位侧缘损伤78例,近前角部损伤23例,近后角部损伤9例。术前Lysholm评分为57±12分。均在关节镜下应用可吸收缝线缝合修复损伤的半月板,其中2针91例,4针13例,6针4例,8针2例。术后行康复训练及随访观察效果。结果术后关节无血肿、伤口期愈合。全部获随访12~67个月,平均26个月。3例患者劳累后出现膝关节胀痛,1例半月板损伤症状再出现,再手术探查见半月板缝合处未完全愈合,行半月板部分切除,术后痊愈。其余患者症状消失,关节功能良好。术后Lysholm评分为92±7分。结论关节镜下半月板损伤缝合修复术安全、可靠、操作简便。缝线吸收后,避免对半月板的制约,使愈合的半月板更好地发挥其生理和生物力学功能。     

CARCINOMA OF THE AMPULLA OF VATER

A consecutive series of 36 Japanese patients with ampullary carcinoma who underwent a pancreatoduodenec-tomy at the Department of Surgery I, Kyushu University Hospital during the past 20 years were reviewed clinicopathologically to study prognostic factors. A univariate generalized Wilcoxon test showed that pre-operative serum carcinoembryonic antigen (CEA) concentration, venous invasion, lymphatic permeation and perineural invasion were significant parameters. A multivariate Cox regression analysis showed that venous invasion was the only significant variable. In a sequential serum CEA follow up of 10 patients, an elevation of serum CEA levels was seen to correspond to the clinical development of a recurrence in six, while a high concentration of serum CEA was not evident despite the clinical manifestation of a recurrence in two, and serum CEA levels remained within the normal limits with no evidence of a recurrence in two others. According to the death certificates of 15 patients, where an exact site of metastasis was available, 11 died from liver metastasis, three from lung metastasis and one from peritoneal dissemination. These findings suppon the theory that a histologic invasion of the venous space is an independent prognostic factor and close attention should be paid to any signs of haematogenous metastasis, such as to the liver and lung, as well as to a serial serum CEA follow up.     

深部冷冻治疗颈肩痛

根据颈脊神经后支的解剖，经皮穿刺，冷冻治疗颈肩痛２４例，２１例（８７．５％）达到立即止痛，１８例随访１周至１３个月，止痛１周以上１４例（７７．８％）。随访１年以上的４例，其中３例仍有止痛效果。认为深部冷冻治疗颈肩痛是一种有前途的方法。     

MISPLACEMENT OF SUBCLAVIAN VENOUS CATHETERS: IMPORTANCE OF HEAD POSITION AND CHOICE OF PUNCTURE SITE

We have investigated the frequency of misplacement of subclaviancatheters in 200 consecutive patients admitted to the IntensiveCare Unit. The patients were allocated randomly to an attemptat infraclavicular cannulation of the right or left subclavianvein with the head turned either towards or away from the selectedside, giving four groups. Catheterization was successful in185 (92.5%) patients. Misplacement into the internal jugularvein occurred in 10 (5.4%) patients. No statistically significantdifference (P < 0.05) was demonstrated between the four groups.     

EFFECT OF CRICOID PRESSURE ON EASE OF INSERTION OF THE LARYNGEAL MASK AIRWAY

We have evaluated the effects of cricoid pressure on laryngealmask airway (LMA) insertion after an elective rapid sequenceinduction in 100 patients allocated randomly to two groups.An attempt was made to insert the LMA after application of cricoidpressure in one group and with no pressure in the other. Theanaesthetist was blinded to the application of cricoid pressure.Insertion was successful in 45 of 50 patients in the cricoidpressure group and in 49 of 50 patients in the non-cricoid group(P <0.1) We discuss the implications of these findings forfailed intubation in the non- fasted patient. (Br. J. Anaesth.1993; 71: 800–802)     

PENETRATING INJURIES OF THE AXILLARY ARTERY

This is a retrospective study of 32 patients with penetrating injury of the axillary artery. There was an overall mortality of 6% entirely accounted for by associated injuries. Pre-operative angiography was used in 12 of these patients either to confirm the presence of an injury or to define its location. Twelve patients underwent lateral arteriorrhaphy or an end-to-end anastomosis and 19 patients had an interposition graft. No immediate problems were experienced with polytetrafluoroethylene grafts compared with autogenous vein grafts. There were 14 patients with a concomitant venous injury; 13 were repaired and only transient arm oedema was experienced. Eleven patients had a brachial plexus injury and, of these, nine underwent a secondary nerve repair with a poor outcome. Axillary artery injury has a good prognosis with a morbidity related mainly to associated nerve injury and a mortality accounted for by injuries to other body systems.     

残耳组织在小耳畸形外耳再造中的应用

目的 总结外耳再造术中对残耳进行的不同处理,探讨合理应用残耳的方法. 方法 2005年9月-2006年7月,对128例单侧小耳畸形患者采用分期手术进行矫治.男79例,女49例;年龄5～21岁,平均11岁.左耳44例,右耳84例.残耳呈花生状56例,腊肠状35例,舟状27例,贝壳状10例.外耳道正常存在5例,狭窄11例,闭锁112例.患耳按耳廓发育情况分为Ⅰ度17例,Ⅱ度98例,Ⅲ度13例.一期手术时植入50 mL肾形扩张器1枚.对于残耳上端距发际线较近者,同期将残耳中上部纵行切开,去除多余的残耳软骨,切口直接缝合.二期手术时利用残耳中上部覆盖软骨支架下部,根据残耳的具体位置,应用"V-Y"推进、"Z"成形术和残耳向上逆转等方法矫正残耳位置.三期手术时利用保留的残耳再造耳轮脚或覆盖再造耳修整时形成的创面. 结果 患者残耳经改形或移位后血运良好,全部成活.切口Ⅰ期愈合.患者均获8～15个月随访.以残耳形成的耳垂外形丰满自然,再造耳与健侧耳基本对称.再造耳耳垂存活良好,无破溃.再造的耳轮脚清晰可见,耳轮、对耳轮及三角窝结构清晰,患者及家属均满意. 结论 合理应用残耳是成功施行外耳再造术、保证再造耳与健侧耳对称的重要环节.     

腕关节神经支切断与假体置换治疗月骨缺血性坏死

目的防止月骨缺血性坏死后腕骨排列进行性紊乱，缓解腕痛，增加握力，改善功能。方法１９９２年１月～１９９７年１月，采用腕关节神经支切断，月骨假体置换术治疗月骨缺血性坏死６例。结果术后随访最短１０个月，最长５４个月，平均随访时间３２个月，优良率８３．３％。结论骨间前、后神经腕关节支切断术联合月骨假体置换术治疗月骨缺血性坏死，术后能获得无痛的关节。腕关节神经支切断联合假体置换是治疗月骨缺血性坏死的一种效果较好的方法