同种异体骨的骨诱导活性研究现状

因创伤、感染及骨肿瘤等原因造成大段骨缺损、骨不连的治疗是修复重建外科领域较为普遍而又棘手的问题。虽然自体骨移植有快速愈合、无免疫反应的特点，但来源有限，而同种异体骨来源丰富，不受形态、大小限制，并具有良好的骨传导性、生物学特性和形态结构与自体骨相近、可以长期储存等优点，是替代自体骨移植最常用的材料^[1]。同种异体骨移植可追溯到17世纪，     

同种异体骨移植的研究进展

创伤、感染及骨肿瘤等原因造成大段骨、关节缺损的修复是修复重建外科领域较为普遍而又棘手的问题。虽然自体骨移植有无免疫反应、快速愈合的特点 ,但来源有限 ;人工假体虽能修复损伤部位 ,恢复一定的功能 ,但缺乏生物活性。同种异体骨来源丰富 ,不受形态、大小限制 ,并有生物活性 ,在临床上有较好的应用前景。随着同种异体骨移植保存技术的发展和国内外众多骨库的建立 ,同种异体骨的临床应用日益增多 ,已取得了较成熟的经验。笔者就同种异体骨移植的研究进展 ,从保存、灭菌、愈合机制、免疫原性及处理方法等方面综述如下。一、同种异体骨的…     

硫酸钙颗粒结合同种异体植骨术后高压氧治疗对四肢良性骨肿瘤缺损重建的影响

目的:探讨硫酸钙颗粒结合同种异体植骨术后高压氧(HBO)治疗四肢良性骨肿瘤患者的临床疗效。方法:收集2013年7月至2019年7月烟台山医院骨科和毓璜顶医院关节骨科行植骨重建修复术的129例四肢良性骨肿瘤患者的临床资料。按照治疗方法分为3组,A组( n＝42)采用同种异体植骨术治疗;B组( n＝...     

同种异体骨移植治疗骨缺损的临床应用

目的：应用同种异体骨移植治疗骨缺损，并评价疗效。方法：新鲜同种异体骨在-80℃保存3w，经过超声清洗脱脂等一系列破坏细胞并降解抗原性的处理，再经辐射灭菌、复温后，将同种异体骨植入缺损区。植入长度大于缺损医长度，外固定架加压固定，术后抗感染。结果：术后3个月植骨与骨交界处有骨小梁通过，6个月骨折线模糊，1～1.5年植骨骨化。结论：同种异体骨移植治疗骨缺损，植入1～1．5年后，异体骨骨化，疗效显著，是治疗骨缺损的良好方法。     

脉冲电磁场结合自体红骨髓移植治疗创伤性骨缺损的疗效

 目的 探讨脉冲电磁场(pulsed electromagnetic fields,PEMFs)结合自体红骨髓移植治疗骨缺损的疗效。方法 将四肢新鲜骨折患者随机分为3组,对照组手术过程中植入同种异体骨后行内固定,2 Hz、15 Hz治疗组植入同种异体骨与自体红骨髓复合体后内固定,术后分别配合2 Hz、15 Hz脉冲电磁场治疗;3组患者分别于术后4、12、24、40周复查X线片并进行疗效评定。结果 30例患者治疗后均获得随访,对照组、2 Hz、15 Hz治疗组治愈率分别为80%、100%、90%;在相同时间点上,治疗组骨痂生长情况明显优于对照组(P<0.05);2 Hz治疗组骨痂生成较15 Hz治疗组明显增多(P<0.05);3种治疗方式下肢体的功能恢复情况差异无统计学意义(P>0.05)。结论 联合运用脉冲电磁场、自体红骨髓复合同种异体骨移植能明显促进骨痂生长,修复骨缺损有显著效果。     

同种异体块状骨植骨支撑治疗跟骨骨折的疗效

目的 探讨同种异体块状骨植骨支撑治疗跟骨骨折的疗效.方法 选取2017-04至2019-12医院收治的52例跟骨距下关节面塌陷伴明显骨缺损骨折患者,根据治疗方法分为切开复位内固定(open reduction and internal fixation,ORIF)+同种异体块状骨植骨组(观察组)和ORIF+同种异体小骨...     

记忆合金骨卡环结合钢板、髓内钉治疗胫骨多段粉碎性骨折疗效分析

目的 探讨记忆合金骨卡环结合钢板、髓内钉治疗胫骨多段粉碎性骨折的疗效。方法 对12例胫骨多段粉碎性骨折患者采取记忆合金骨卡环结合钢板固定7例、结合髓内钉固定5例。结果 12例患者经10~18个月随访,骨折愈合时间6~13月,平均l0.8月。骨卡环无松动、脱落及断裂,固定牢稳有效,肢体无短缩。结论 记忆合金骨卡环结合钢板、髓内钉治疗胫骨多段粉碎性骨折,骨卡环能作为钢板、髓内钉固定后的辅助固定。骨卡环的持续加压环抱力可坚强固定碎骨块,能有效防止骨折端的移位和短缩,加强骨折固定后的稳定性,有利于骨缺损的修复,可避免钢丝环扎的弊病和单纯髓内钉复位不理想、固定不稳定、术后短缩等并发症。     

用同种异体骨移植治疗四肢骨缺损(附18例报告)

因火器伤、骨髓炎早期手术处理不当、骨折后多次手术损伤骨膜或术后感染引起的骨缺损以及低度恶性或良性骨肿瘤等,在治疗上比较困难。目前应用显微外科技术进行骨移植,在治疗上有了一大进步,但对下肢股骨大块骨缺损仍无较理想的治疗方法。1972年始我们用同种异体骨移植治疗骨缺损共18例并作了分析研究。为了减轻免疫排斥反应。     

21例下肢长骨内固定取出后再骨折的治疗分析

探讨21例下肢长骨骨折内固定取出后再骨折的原因、治疗方法和预防措施。第1次手术使用加压钢板内固定、梅花针、Ending氏钉、交锁髓内钉;再次骨折手术采用交锁髓内钉固定及自体骨/复合异体骨植骨。     

异体骨冷冻贮存及同种异体移植

自Mankin等从1971年至1976年对19例恶性骨肿瘤进行广泛切除,应用冷冻异体骨移植以来,冷冻异体骨及其应用已逐步引起人们的重视,本文仅就异体骨的冷冻贮存和移植综述如下。     

CT-guided bone biopsy: Initial experience with a commercially available hand held Black and Decker drill

PURPOSE: To describe the use of a simple commercially available Black and Decker hand based drill in performing CT-guided bone biopsies. MATERIALS AND METHODS: Three international institutions were enrolled in the study. In each centre, a fellowship trained musculoskeletal radiologist directed the assessment of a hand based commercial drill for performing CT-guided bone biopsies. A specially designed component was engineered which allowed the connection of a standard bone biopsy set to a commercial drill. The component was distributed to the three centres involved. Over a 3-year period, data from all three institutions was collected. Information regarding technical success, diagnostic data and complication rates were all collated to assess the technical feasibility of this technique. RESULTS: In total 68 patients underwent bone biopsy using a hand held commercial drill. Technical success was achieved in 65 patients. Diagnostic material was obtained in 53 patients. Non-diagnostic material was obtained in 12 patients. Five out of the 12 patients with non-diagnostic material had repeat biopsies with diagnostic material obtained in 2 of these. No major complications occurred in any patient. CONCLUSION: CT-guided bone biopsy using a hand held commercial drill has a technically high success rate with minimal complications.     

骨矿含量及血清骨钙素测定对性早熟儿童骨骼发育诊治及疗效考核的价值

为探讨骨矿含量（ＢＭＣ）及骨钙素（ＢＧＰ）测定在性早熟儿童骨骼发育状况的诊断、治疗及疗效考核上的价值，对８２例特发性性早熟女孩，采用单光子吸收法测定桡骨的ＢＭＣ，放射免疫分析法测定血清ＢＧＰ含量。于治疗前及治疗３～４个月后分别测定ＢＭＣ和ＢＧＰ，并与正常同龄儿进行对比。结果：性早熟女孩的ＢＭＣ及血清ＢＧＰ浓度大多较同龄儿显著增高。性早熟Ⅱ～Ⅲ期者ＢＭＣ为０４５２±００８０ｇ／ｃｍ，Ⅳ～Ⅴ期者为０５８５±００９８ｇ／ｃｍ（ｔ＝５３６２，Ｐ＜０００１），示病情越重、病程越长，增高也越明显。治疗后Ⅱ～Ⅲ期者ＢＭＣ降为０３９９±００９３ｇ／ｃｍ，Ⅳ～Ⅴ期者降为０５１９±００７０ｇ／ｃｍ，与治疗前相比，ｔ＝４１４１，Ｐ＜００１。血清ＢＧＰ浓度也均明显降低。表明经过治疗，随着病情缓解，这些指标会有明显改善。因此，ＢＭＣ及ＢＧＰ对性早熟患儿诊治及疗效考核有一定的临床价值。     

Pellet gun trauma: An unusual and unexpected type of bone lesion

Non-powder guns in general, and especially pellet guns are acknowledged to cause important injuries, also on bone tissue. However, pellet gun-related injuries have been poorly analyzed in forensic literature and scientists may have no idea of what signs a pellet gun can leave on bone. Moreover, since such lesions are not commonly encountered in everyday forensic practice, they could be misdiagnosed. For this reason, the present study was performed to investigate and illustrate the qualitative effects of pellet guns on human bone. An experiment was performed by shooting single pellets on four adult human feet belonging to the anatomical collection of the University of Milan and CAL (Collezione Antropologica Labanof), that is the anthropological collection of the forensic anthropology lab (Labanof). An Umarex – “Beretta type 92 S″ CO₂ gun was used, loaded with pellets of 4.5 mm caliber of different designs: wadcutter, round-nosed, and sharp-pointed. The shots were fired from a constant distance of 20–30 cm and with different directions and angles. X-ray analysis was carried out and three feet were later skeletonized and observed with an episcopic microscope. Macroscopically, a high penetrative capacity of all the used pellets was observed: with the only exception of the wadcutter ones, all the other types were associated with bone lesions, such as abrasions of the cortical bone, chipping and/or fractures, which in some cases were even comminuted. Microscopically, metallic traces, bone spicules, and striae-like irregularities on the bottom of all the bone abrasions were found. Finally, we provide forensic pathologists and anthropologists with some considerations and illustrations that may help in the correct diagnosis in case of need.     

原发性骨横纹肌肉瘤(附8例报告及29例文献分析)

目的：探讨原发性骨横纹肌肉瘤的临床与Ｘ线特点，材料与方法；对本组８例及文献中２９例共３７例临床和Ｘ线资料进行了分析。结果：３７例中男２８例，女９例，年龄９～６１岁，平均３７．４岁，病程２～１４个月，平均７．５个月，病变位于胫骨１３例，占３５．１％，股骨１０例，占２７％，肱骨５例，占１３．５％；胸椎２例，占５．４％，骶骨２例，占５．４％，颅骨２例，占５．４％，腓骨１例，占２．７％，腰椎１例，占２．７     

Recognition of cortical bone resorption in metabolic bone disease in vivo

This is an outline of radiologic assessment of cortical bone resorption for improved diagnosis of metabolic bone diseases by simple radiographic means: microradioscopy and morphometry. The methodology permits separate assessment of endosteal, intracortical, and periosteal resorption and an evaluation of both the quantity and the quality of cortical bone.     

CT导向躯干骨病变穿刺活检

躯干骨病种多,特征性表现少,虽经化验,核素骨扫描,X线平片,普通断层及CT扫描等多项检查,仍有一些难以确诊。本文对14例疑难病案,行CT引导下经皮穿刺骨活检,结果13例组织学定性,仅1例为坏死组织。为临床采取正确治疗方案提供依据。本文重点介绍穿刺方法、途径、取材部位,根据结果初步认为此法操作简单、安全可靠、无并发症;即可弄清病变性质又可明确病变范围及其与周围组织结构的关系。     

成人骨与胎儿骨的骨诱导活性实验比较

目的：比较成人骨与胎儿骨的骨诱导活性．方法：按Ｕｒｉｓｔ等的方法制备成人和胎儿骨基质明胶，分别植入ＢＡＬＢ／ｃ裸鼠左右股部肌肉，４周后行组织学观察和碱性磷酸酶活性检测．结果：成人骨基质明胶和胎儿骨基质明胶均在动物体内诱导异位软骨形成，两种植入物的组织碱性磷酸酶活性均明显高于正常肌肉组织（Ｐ＜０．０１），但成人骨基质明胶与胎儿骨基质明胶植入物的组织碱性磷酸酶活性无显著性差异（Ｐ＞０．０５）．结论：成人骨与胎儿骨的骨诱导活性无显著性差异．     

清创后Ⅰ期改良开放式松质骨移植治疗慢性骨髓炎

目的 缩短慢性骨髓炎的疗程，提高其治疗效果。方法 设计并采用清创后Ⅰ期改良开放式松质骨移植对39例患者进行治疗。结果 39例患者中，37例(95％)治疗成功，2例感染复发。结论 (1)清创后Ⅰ期植骨的疗效与Ⅱ期植骨相似。(2)改良开放植骨创面小、愈合时间短、不需要植皮或皮瓣移植，与Papineau方法相比优势显著。     

肝移植五年存活者骨密度和血清骨代谢指标检测

目的观察肝移植后长期存活者骨矿物质密度和骨代谢状态的变化。方法采用双能Ｘ线骨密度仪（ＤＥＸＡ），测量３１例肝移植后５年存活者腰椎Ｌ２～Ｌ４和股骨颈骨密度（ＢＭＤ），同时检测成骨细胞活性指标：骨钙素、骨特异性碱性磷酸酶（ＢＡＰ）和Ⅰ型前胶原羧基末端前肽（ＰＩＣＰ）；破骨细胞功能指标：Ⅰ型胶原交联羧基末端肽（ＩＣＴＰ），２５－ＯＨ－维生素Ｄ和甲状旁腺素（ＰＴＨ），并与３４例肝移植前慢性肝功能衰竭患者（ＣＬＦ）和３８例正常健康者作比较。结果肝移植后５年存活者Ｌ２～Ｌ４ＢＭＤ（Ｚｓｃｏｒｅ）水平明显高于ＣＬＦ患者，其骨质疏松（Ｚｓｃｏｒｅ＜－２０）发生率明显降低。与正常健康者比较，５年存活者存在成骨细胞活性和破骨细胞功能增高，但无继发性甲状旁腺功能亢进和维生素Ｄ代谢异常；而与肝移植前ＣＬＦ患者比较，５年存活者血清骨钙素水平增高，ＢＡＰ和ＩＣＴＰ降低，ＰＩＣＰ无明显变化，血清２５－ＯＨ－维生素Ｄ和ＰＴＨ正常。结论肝移植后５年存活者骨质丢失减轻，骨质疏松发生率减少和骨代谢有改善。