左旋多巴促进骨折愈合的实验与临床研究

作者选用30只羊,随机分为实验组及对照组各15只。每只羊均行同侧股骨中段及胫骨中段截断造成横形骨折,股骨用梅花针、胫骨行斯氏针内固定。实验组口服左旋多巴,两组均于术后2、4、6、8、12周分别行X线检查、肉眼观察、组织学检查、扫描电镜检查和血液化学检查。结果表明实验组骨痂形成早、生长快、骨折愈合明显优于对照组。在此研究基础上将左旋多巴用于临床治疗骨折210例治疗结果优于对照组。文章讨论、分析了左旋多巴促进骨愈合的机理、临床应用价值及用药剂量与疗程。     

细微运动对长骨干骨折愈合的作用——动物实验系列研究初步总结

新西兰兔108只,造成股骨中段骨折用髓针内固定86只;胫骨中段骨折用钢板螺钉内固定22只,随机分成三组。A组用脉冲电流刺激仪刺激肌肉收缩,B组用脉冲机械振动仪振动骨折段,C组是对照组。实验结果显示:骨折肢体的血流,骨痂的钙和镁元素,GH、B_2m、AKP和低分子蛋白定量,以及骨折愈合的刚度和强度,实验组A、B均较对照组高,骨折愈合快。临床启示:骨折内固定后接受细微运动而产生骨折段内应变,能促进骨折愈合。     

细微运动对长骨干骨折愈合的作用

新西兰兔１０８只，造成股骨中段骨折用髓针内固定８６只，胫有折用钢板螺钉内固定２２只，随机分成三组。Ａ组用脉冲电流刺激仪刺激肌肉收缩，Ｂ组用脉冲机械振动仪振动骨折段，Ｃ组是对照组。实验结果显示：骨折肢体的血流，骨痂的镍和镁元素，ＧＨ、Ｂ２ｍ、ＡＫＰ和低分子蛋白定量，以及骨折愈合的刚度和强度，实验组Ａ、Ｂ均较对照组高，骨折愈合快、临床启示、骨折内后接受细微运动而产生骨折段内应变，能促进骨折愈合。     

NiTi记忆合金弹性固定对家兔骨折愈合的影响

目的观察弹性内固定材料对骨折愈合的影响。方法15只青紫蓝兔随机分为A组（弹性内固定组）10只，B组（坚强内固定组）5只。制成股骨中段横形骨折模型，分别用上述材料固定，2、4周分别行放射学检查，4周后取骨折局部骨痂碱性磷酸酶（AKP）、骨钙素（BGP）及肿瘤坏死因子（TNF）免疫组织化学检查，并进行骨痂内矿物质含量测定。结果A组与B组比较，AKP、Ostcalcin差异有显著性（P〈0．05），NTF两组之间比较差异无显著性（P〉0．05）；A组4周后骨痂的形成量大于B组，骨痂内矿物质含量测定两组差异无显著性。结论弹性内固定能促进骨折愈合；钛合金环抱器提供的弹性模量适合于骨折愈合。     

多层粗大孔隙表层股骨柄假体联合自体植骨的生物学固定研究

目的 观察股骨柄假体表层改为多层粗大孔隙结构联合自体植骨的生物学固定效果。方法 自行设计完成犬骨重建型股骨柄假体，将股骨柄假体近2／3段表层改成粗大、多层立体孔隙结构。对24只成年杂种犬随机分成两组，行右侧人工股骨头置换术。实验组将假体表面孔隙内充填自体股骨头颈骨质制成的骨泥后，再行人工股骨头置换术；对照组不填充碎骨泥。术后1、3和6个月行大体观察、X线片、组织学检查及生物力学测试，以了解假体内外成骨和固定情况。结果 与对照组相比，实验组3、6个月标本大体观察可见大量骨质重建现象；X线检测亦明显优于对照组；组织学观察显示多孔层孔隙内最大骨长入深度（μm）与新生骨平均充盈率（％）均明显高于对照组；生物力学测试假体一骨界面最大剪切强度明显高于对照组（P〈0．01）。结论 将股骨柄假体表层制成多层粗大孔隙结构联合自体植骨能显著加强生物学固定强度。     

探讨综合治疗对去势家兔骨质疏松模型股骨上端骨折愈合的影响

目的　探讨应用雌激素、降钙素、维生素 D3和钙剂对去势家兔骨质疏松模型股骨上端骨折愈合的作用。方法　 16只雌性青紫兰家兔去势复制骨质疏松模型 ,行股骨上端骨折克氏针内固定。术后随机分为两组 ,实验组给予益钙宁、尼尔雌醇、维生素 D3及钙剂观察对骨折愈合的影响。结果　X射线片示实验组较对照组外骨痂生成量多 ,骨折愈合时间缩短。股骨的极限扭矩和最大刚度增加。QCT检测腰 2～ 4椎体松质骨骨密度皆增加。结论　骨质疏松并骨折除内固定外 ,还要联合应用抑制骨吸收 ,并促进骨形成的药物 ,加速了骨折的愈合     

探讨综合治疗对去势家兔骨质疏松模型股骨上端骨折愈合？…

目的 探讨应用雌激素、降钙素、维生素Ｄ３和钙剂对去热家兔骨质疏松模型股骨上端骨折愈合的作用。方法 １６只雌性青紫兰家兔支势复制骨质疏松模型，行股骨上端骨折克氏针内固定。术后随机分为两组，实验组给予益钙宁、尼尔雌醇、维生素Ｄ３及钙剂观察对骨折愈合的影响。结果 Ｘ射线片示实验组较对照组外骨痂生成量多，骨折愈合时间缩短。股骨的极限扭矩和最大刚度增加。ＱＣＴ检测腰２～４椎体松质骨骨密度皆增加。结论 骨质疏     

伊利扎诺夫外固定支架行骨延长2例

例１，男，３１岁。１９９７年１２月１７日以左股骨下１／３骨不连住院。１９９６年１２月曾因车祸致左股骨下１／３骨折，经某医院急诊手术，３片小钢板内固定。术后一直畸形不能行走。入院后专科检查：左大腿向前外侧成角畸形，比右大腿短缩约３ｃｍ。Ｘ线显示：骨折断...     

负载重组人骨形态发生蛋白-2的超高相对分子质量聚-DL-乳酸接骨板修复骨折的研究

目的利用可吸收超高相对分子质量聚-DL-乳酸（PDLLA）接骨板作为缓释重组人骨形态发生蛋白-2（rhBMP-2）的载体，通过体内活性实验来评估其固定骨折及修复缺损的效果。方法新西兰大白兔32只，制成双侧尺骨中段2．5mm骨及骨膜缺损模型，右侧为实验组，左侧为对照组，实验组采用复合rhBMP-2的PDLLA接骨板固定，对照组采用普通PDLLA接骨板固定。随机分为四组，每组8只，分别于术后2、4、8、12周行大体观察、X线片、组织病理切片观察及计算机图像分析观察，比较两种不同方法在不同时段对骨折与缺损的修复情况，以及固定效果与体内降解情况。结果术后2、4、8、12周行大体观察及X线片检查示两种生物活性接骨板均固定牢固，骨折端无移位，对位、对线良好。结合组织病理切片观察，术后8周，7只动物实验侧骨折及缺损区获得骨折修复，2只动物对照侧存在较少量骨痂相连，其余动物骨缺损主要由纤维结缔组织填充；术后12周，8只动物两种不同方法固定的骨折及缺损区均获得修复，但实验组固定板材与周围组织的相容性、成骨速度、骨再生量、再生髓腔结构等方面均优于对照组，计算机图像分析结果显示同时期内实验组骨小梁的生成数量和质量均显著优于对照组（P〈0．01）。结论复合rhBMP-2的可吸收PDLLA接骨板生物相容性好，对X线等成像检查无干扰，并具有良好骨诱导性和骨缺损修复能力，无需二次手术取出。     

股骨干骨折合并股骨颈骨折的临床特点及手术治疗

目的：探讨股骨干骨折合并股骨颈骨折的损伤机制，骨折特点及手术治疗。方法：回顾分析自1994年1月～2001年12月具有完整资料，经手术治疗的11例股骨干骨折合并股骨颈骨折患作为研究对象，其中男10例，女1例；平均年龄36．7岁。交通伤9例，高处坠落伤2例。全部在硬膜外麻醉下手术切开复位、内固定加股骨颈植骨，一期完成手术。其中松质骨螺钉(股骨颈) 普通接骨板2例；松质骨螺钉 AO接骨板3例；Richards钉 AO接骨板1例；股骨重建髓内钉内固定5例。全组术后3，6，12个月进行临床和影像学检查，判断疗效。结果：股骨干骨折除1例普通接骨板内固定出现钢板断裂，骨不连外，全部在3．5个月内获得愈合。股骨颈骨折均在1年内愈合。1例拆内固定3个月后出现股骨头变扁、塌陷。应用股骨重建髓内钉内固定患的临床和影像学检查优良率明显高于其它内固定的患。结论：股骨干骨折合并股骨颈骨折属高能量损伤，股骨颈骨折的症状隐匿，易造成漏诊。对高能量所致的股骨中段骨折患应常规摄骨盆后前位片，以免漏诊；对行股骨干交锁钉内固定术的患，应警惕发生医源性股骨颈骨折。内固定物中以股骨重建髓内钉为优。拆除内固定后要追踪摄片检查1a，警惕股骨头无菌性坏死的发生。     

比较钢板与桥接组合式内固定系统对犬胫骨骨折愈合的影响

[目的]对比钢板和桥接组合式内固定系统对骨折愈合的影响。[方法]选取20条家犬,分为4、8、12、16周亚组,建立双侧胫骨骨折模型,分别以桥接组合式内固定系统(实验组)和钢板(对照组)进行固定,术后4、8、12、16周分别处死动物,通过不同时段的大体标本、X线片、光镜观察研究骨折愈合情况。[方法]术后对照组分别出现骨折劈裂、钢板松脱和钢板断裂各1例,而实验组仅内固定变形弯曲1例;X线片显示实验组骨痂生长早于对照组,各时期评分实验组均高于对照组,16周时有显著统计学意义(P<0.05);光镜观察显示,实验组纤维母细胞、新生毛细血管及骨痂的生长均早于对照组,各时期评分均高于对照组,8、16周时有显著统计学意义(P<0.05)。[结论]与钢板相比,桥接组合式内固定系统有利于骨折稳定和骨折端血管长入,可促进骨折愈合。     

Promoting effect of L-dopa on experimental fracture healing

This study was planned to investigate the effect of oral administration of L-Dopa, made in China, on fracture healing and to look into its activity or metabolic influence on biomechanical healing process. Both the tibia and fibula of left leg of 185 Wistar rats were manually fractured, but left alone without fixation, and were treated for 15 days. For the experimental group of animals, L-Dopa in suspension, 0.4 gm/kg BW, was given daily; for the control one, only the same amount of saline solution. 12 to 24 hours following intraperitoneal injection of radioisotope tracers, 35S-sodium sulfate and 45Ca-calcium chloride non-carrier solution, were used. The animals in group were put to death at the 5 10 15 20 30- and 40-th day respectively after fracture. The fracture specimens were taken and processed for examination and quantitative assessment. The data showed that the amount of sulphur in the primary callus was increasing up to the peak on the tenth day; it was greater, statistically significant, in the test group (0.19 +/- 0.05 DPM%) than in the control one (0.13 +/- 0.05 DPM%). They showed too that the amount of calcium incorporated in the callus was also increasing up to a top point but at the 15-th day; it was as well greatly, statistically significant in the test group (4.50 +/- 1.16 DPM%) than in the control one (2.65 +/- 1.90 DPM%).(ABSTRACT TRUNCATED AT 250 WORDS)     

不同类型胫腓骨骨折对胫骨远侧关节面的影响

目的 通过对不同类型胫腓骨骨折及胫骨远侧关节面变化的分析,探讨不同类型小腿骨折对踝关节的影响.方法 对1997～2001年5年间住院病人中病历资料齐全的144例X线片做回顾性分析,测量胫骨远侧关节面与胫骨纵向中心线夹角.结果 小腿下段螺旋形及斜形骨折时胫骨远侧关节面与胫骨纵向中心线夹角变小,与正常对照比较明显变小（P＜0.01）,小腿中段螺旋形及斜形骨折时胫骨远侧关节面与胫骨纵向中心线夹角变小,与正常对照比较变小（P＜0.05）.结论 小腿中、下段螺旋形及斜形骨折时易引起胫骨远侧关节面外侧角压缩,致使踝关节的运动轴线发生改变,易出现踝关节损伤.     

Lisfranc fracture dislocation in a child

A case of Lisfranc fracture dislocation complicated by compartment syndrome is reported in a 9-year-old boy who fell from a 5 ft high wall which subsequently collapsed onto him crushing his lower limbs. The patient also sustained an undisplaced, open fracture of the contralateral tibia. The Lisfranc fracture dislocation was treated with open reduction and internal fixation using Kirschner wires (K-wires). Fasciotomy was performed to decompress the foot. The open tibia fracture was treated with wound debridement and plaster cast. The K-wires were removed at 10 weeks follow up. The patient had no complaints on examination and radiographs revealed good evidence of healing. We emphasize the importance of prompt diagnosis and treatment.     

实验性骨折愈合的血运重建

本实验对骨折愈合局部血液循环的重建进行了研究.8只山羊分为两组:正常组.用于观察骨微血管;实验组,观察骨折血运重建,线锯造成胫骨中段横骨折,6周后处死.两组动物均在股动脉插管,注射中国墨汁,连续切片观察.结果表明;(1)滋养动脉供应骨干骨髓,骺——干骺动脉供应骺、干骺端骨髓;皮质深层2/3由滋养动脉分支供应,而皮质浅层1/3由骨膜动脉供应;(2)当骨折损伤滋养动脉,干骺部血管、骨膜血管扩张,增多.提示这些动脉在骨折愈合血运重建中起重要作用.     

Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia

This study was performed to compare the effects of reamed and unreamed locked intramedullary nailing on blood flow in the callus and early strength of union in a fractured sheep tibia model. After the creation of a standardized short spiral fracture by three-point bending with torsion, each tibia was stabilized by the insertion of a locked intramedullary nail. Ten animals were allocated randomly into two groups: one that had reaming prior to nail insertion and one that did not. Blood flow was measured in real time with use of laser Doppler flowmetry. Endosteal perfusion was determined at the fracture site before and after nail insertion. Perfusion of the callus was measured at three locations (proximal diaphysis, fracture site, and distal diaphysis) and at three time intervals (2, 6, and 12 week follow-up). All animals were killed 12 weeks postoperatively, and the tibiae were tested to failure in four-point bending. Nailing with reaming resulted in a larger decrease in overall endosteal perfusion than nailing without reaming (p < 0.015). The presence or absence of reaming did not affect blood flow within fracture callus. Perfusion of callus was greatest at 6 weeks of follow-up. Bending strength and stiffness were the same in both groups at 12 weeks. The study demonstrated that perfusion of callus and early strength of union are similar following intramedullary nailing with or without reaming.     

Nuclear magnetic resonance studies of experimentally induced delayed fracture union

Delayed fracture union was produced in the rat tibia with parenteral administration of prednisolone. Phosphorus nuclear magnetic resonance spectroscopy was used to monitor the local pH changes that occurred at the fracture site throughout repair. During the fracture healing in control animals, the pH of the fracture site changed from 7.2 on Day 2 to 7.5 on Day 20 following fracture, i.e., alkaline with respect to the pH of normal extracellular fluid. Deposition of radioopaque callus occurred mainly during the alkaline phase. In the steroid-treated rats the rate and extent of pH change were significantly less and the fracture site became alkaline five to ten days later than in the control animals. Because radiopaque callus deposition still occurred predominantly in the alkaline phase, union was also delayed by about the same interval of time. The rat prednisolone model differs significantly from the human condition of delayed union. Clinical investigations are indicated to ascertain whether abnormalities of fracture site pH occur in delayed union in humans.     

苯妥英促进骨折愈合的临床观察

目的　观察苯妥英对骨折愈合的促进作用。方法　选择40 例胫腓骨闭合性骨折患者,随机分为两组,治疗组用苯妥英和接骨丹口服,对照组仅用接骨丹口服。术后分期观察一般情况,纵向叩击痛,骨折临床愈合时间,X线片骨痂生长情况。结果　全部患者骨折均在伤后3个月内愈合,但治疗组纵向叩击痛、临床愈合时间及X线片骨痂生长均明显优于对照组。结论　口服苯妥英有明显的促进骨折愈合的作用。由于中成药接骨丹含有钙成分,避免了单用苯妥英使血钙降低的可能性     

Apparent absence of local response to bone screws in guinea pigs with contact sensitivity

Guinea pigs sensitized to nickel, cobalt, or chromium were used to study if impaired fixation occurred as a result of allergy against metal implants in bone. Screws made from stainless-steel (ASTM F55, F138-139) or cobalt chromium (ASTM F75-76) were inserted in the right and left proximal tibiae, and the mechanical strength of the fixation to the bone was evaluated after 4 months. In addition, we studied the histology on decalcified sections of the implant bone interface from the distal femur where the same type of screws had been inserted. To see if changes in bone density occurred in the proximal tibia as a result of allergy, the amount of ash was determined. Although the animals maintained their contact sensitivity throughout the experimental period, there were no differences between allergic and control animals for any of the parameters studied. All screws were well fixed in the tibia at the end of the experiment, and histologically we did not find any significant differences between allergic and control animals by qualitative examination. The experiment supports our earlier results from a 6-week experiment and indicates that contact allergy may be unimportant for the fate of orthopedic implants.     

小鼠胫骨中段1/3不同缺损直径单层骨皮质缺损模型比较研究

目的比较研究不同缺损直径对小鼠胫骨中段1/3单层骨皮质缺损模型愈合的影响,为组织工程材料研究、骨缺损修复及其分子机制研究和骨缺损基因治疗研究等提供动物模型。方法取8周龄雄性C57BL/6J小鼠10只,体重(20±2)g,随机分为A、B两组,每组5只。利用牙科磨钻分别制备直径为0.8 mm(A组)和1.0 mm(B组)小鼠胫骨中段1/3单层骨皮质缺损模型。于造模后7、21、28 d摄钼靶X线片观察缺损修复情况;28 d对骨缺损修复行Micro CT扫描及骨组织三维成像;28 d取材行HE染色观察。结果 B组5只小鼠造模7 d内均发生二次骨折,A组无骨折发生。X线片、Micro CT和HE染色均显示A组胫骨单层骨皮质缺损可在28 d达骨性愈合。Micro CT定量分析骨小梁示,A组骨小梁数目、骨小梁密度、骨体积显著高于B组,骨质密度显著低于B组,差异均有统计学意义(P<0.05);两组骨小梁分离度、骨小梁厚度差异无统计学意义(P>0.05)。结论小鼠胫骨中段1/3单层直径0.8 mm骨皮质缺损模型是研究胫骨缺损无外固定缺损修复机制和骨替代植入材料的理想动物模型。