自体骨泥混入骨膜碎片修复肿瘤及瘤样病变骨缺损

目的探讨自体骨泥混入骨膜碎片修复肿瘤及瘤样病变骨缺损的疗效方法对18例骨肿瘤及瘤样病变患者行病灶刮除，自体骨泥混入骨膜碎片修复骨缺损。结果经8～38个月随访，X线片显示成骨良好，骨缺损完全修复，肢体无畸形，功能基本恢复正常。结论自体骨泥混入骨膜碎片修复肿瘤及瘤样病变骨缺损效果满意，是一种值得研究的新方法     

骨膜移植修复骨缺损的实验研究及临床应用

为探寻大块骨缺损修复方法的新途径，进行了自体骨膜游离移植修复骨缺损的实验及临床研究。实验用４２只兔，于双侧胫骨作人工骨缺损模型（６ｍｍ×１８ｍｍ×５ｍｍ）。一侧随机植入自体游离骨膜片，另一侧不植入，作为对照。以组织学、Ｘ线和放射性同位素为观察指标，研究成骨过程。结果表明，骨膜植入侧骨缺损的愈合比对照侧缺损的愈合快一倍。原因可能是骨膜提供了大量成骨细胞并直接呈膜内成骨而非软骨内化骨。在此基础上，为２１例骨缺损患者应用自体胫骨骨膜片植入治疗骨缺损，面积最大１０．５ｃｍ×４ｃｍ×４ｃｍ，最小２ｃｍ×２ｃｍ×２ｃｍ；其中１７例为良性骨肿瘤，４例为骨慢性感染。骨缺损均得到修复，关节功能恢复满意。为腔洞性骨缺损的修复提供了一种新方法。     

自体骨泥混入骨膜碎片移植治疗陈旧性骨折骨不连

目的：探讨自体骨泥混入骨膜碎片移植治疗陈旧性骨折骨不连的临床效果。方法：2001年12月-2004年5月应用自体骨泥混入骨膜碎片移植治疗陈旧性骨折骨不连16例，男11例，女5例；年龄17～55岁，平均32．5岁；股骨骨折4例，胫骨骨折6例，肱骨骨折3例，桡骨骨折2例，趾骨骨折1例；骨折时间10～42个月，平均15个月；既往1次手术者8例，2次手术者3例，3次手术者2例，4次手术者1例，无手术者2例。结果：16例全部获得随访，随访时间9～38个月，平均17个月，骨折全部愈合。根据自拟疗效标准：优11例，良3例，可2例。结论：自体骨泥混入骨膜碎片移植治疗陈旧性骨折骨不连效果满意，是一种值得推荐和进一步研究的新方法。     

自体游离骨膜移植实验研究

作者选用26只本赔康犬进行自体游离骨膜移植修复缺损实验研究,通过光镜、电镜观察及力学与骨计量学测试.证明移植的自体游离骨膜能够成活、并能再生骨组织.修复骨缺损.骨膜供区4周后也有新的骨膜再生.     

带血运骨膜管移植和骨充填物修复桡骨长段缺损的研究

目的：探讨联合应用带血运骨膜管移植和骨充填物治疗兔桡骨长段缺损的效果。方法：实验分两部分，分别选用幼兔和成年兔各40只，根据填充物的不同分为4组，将兔双侧桡骨干中段切除3cm制成骨长段缺损模型，保留切骨段骨膜，重新重原缝合后作带血运骨膜管移植模型，左侧分别用自体骨，同种异体脱钙骨，磷酸三钙陶瓷和羟基磷灰石进行填充，右侧不行任何填作为对照。观察3个月。通过X线片，髓强度，骨密度和组织学检查等方法，了解骨缺损的修复效果。结果：幼兔术后6周，所有实验组双侧的骨缺损均得到修复，术后12周，磷酸三钙陶瓷和羟基磷灰石组桡骨抗弯曲强度较差与自体骨组、同种异体脱钙骨组和对照侧比较具有统计学意义（P＜0．05）；骨愈合为膜内成骨和软骨成骨，以膜内成骨为主，成年兔；各组实验侧骨缺损修复率分别为：自体骨组50％；同种异体脱钙骨组40％；磷酸三钙陶瓷和羟基磷灰石组为30％。对照侧骨缺损修复率为42．5％，结论：幼兔单行单血运骨管移植或结合应用骨充填物均可有效修复骨长段缺损，但置换较慢的骨充填物不利于再生骨强度的恢复，成年兔带血运骨膜移植联合应用骨填充物不能有效修复骨长段缺损。     

自体骨膜骨髓复合移植修复肿瘤性骨缺损

目的 介绍自体骨膜骨髓复合移植修复少儿委性骨肿瘤切除后骨缺损的方法。方法 抽取自体髂骨骨髓，自然形成凝块后植入骨缺损处，自体胫前骨膜切片１～２ｍｍ＾２邮票状，均匀植入骨髓凝块中。结果 随访４～１０个月，术后１个月新生骨形成，术后３～４个月１４例骨缺损处新生骨骨密度与周围组织一致，术后４个月恢复正常的关节功能和肢体负重功能。结论 自体游离骨膜骨髓复合移植，成骨能力强，方法简便，是治疗骨肿瘤切除后骨缺     

自体骨膜碎片血肿内植入修复骨缺损的实验研究与临床应用

为探讨骨膜移植的成骨性能和不同血肿对其成骨的影响，作者在家兔双侧桡骨中段制成１．５ｃｍ长的骨缺损模型，并在缺损区内分别填以自体外周血块和骨髓血块。然后将自体骨膜碎片分别植入一侧血肿内，另一侧不植骨膜以作对照。通过Ｘ线、组织学、缺损区新生骨钙磷含量测定、骨组织形态测量和计算机图像分析等手段检测，结果证实自体骨膜碎片有成骨作用；自体骨髓血也有成骨潜能，但成骨能力弱于骨膜成骨；单纯外周血不能成骨；若以骨髓血为载体可使成骨作用提高。自体骨膜碎片血肿内植入临床应用１２例，平均随访２年，临床效果满意。     

人工骨联合自体骨髓移植技术的骨缺损修复研究与应用

目的分析人工骨联合自体骨髓移植技术治疗骨缺损的临床疗效。方法选取2011年4月至2013年9月,来本院诊治的四肢粉碎性骨折术后骨缺损患者40例,随机分为两组（A、B组）,分别行自体髂骨植骨和人工骨联合自体骨髓移植治疗四肢粉碎性骨折所致骨缺损。术后观察两组骨折愈合时间,骨折愈合率,并发症的发生及骨缺损的修复和功能重建优良率。结果两组均行6～12个月随访,平均（9.14±1.36）月,所有患者植骨术后均无切口感染、发热等并发症。A组15例骨缺损区愈合良好,住院时间平均（19.36±2.54）天,骨折愈合时间平均（5.67±1.52）个月,骨缺损的修复和功能重建评价标准,优12例,良3例,可3例,差2例,优良率75%;B组18例骨缺损区愈合良好,住院时间平均（12.19±1.52）天,骨折愈合时间平均（3.61±1.13）个月,骨缺损的修复和功能重建评价标准,优16例,良2例,可2例,差0例,优良率90%。B组骨缺损治疗效果显著优于A组。结论人工骨联合自体骨髓移植较单纯自体髂骨移植治疗骨缺损更能促进骨痂生长,加速骨折后骨缺损愈合,更加有效地减少住院时间及骨折愈合时间,骨折愈合率更高,骨缺损修复和功能重建效果更加显著。     

骨肿瘤病段切除并骨缺损修复

目的 修复切除骨肿瘤后的骨缺损肢体,恢复其功能。方法 采用特制人工金属假体,带血管蒂游离骨、异体关节、自体骨、骨水泥等修复骨缺损。结果 26例中应用带血管蒂游离骨或自体骨植骨术愈合最佳并且无复发;异体骨移植有一定的排异反应;骨水泥堵塞只适用于特殊部位骨缺损的修复;人工假体修复,功能恢复良好。结论 对某些良性骨肿瘤及低度恶性的骨肿瘤作病段切除后,选择适当的替代物修复缺损行之有效。     

两种不同处理方法对同种异体骨移植作用的实验研究

[目的]探讨两种不同处理方法对同种异体骨移植修复大段骨缺损疗效的实验研究。[方法]选取健康成年新西兰大白兔48只,随机分2组,实验1组:血管束植入同种异体骨修复组,实验2组:带血运骨膜包裹同种异体骨修复组。观察术后组织学切片,成骨量,生物力学,X线片等变化。比较两种术式修复骨缺损的差异。[结果]术后X线片观察实验2组较实验1组骨痂增加明显,光镜组织学检查实验2组较实验1组骨痂形成早,骨髓腔再通时间短。两组成骨量均在8周时达到峰值,实验2组在各时段成骨量均大于实验1组。三点弯曲试验结果示实验2组优于实验1组。[结论]带血运骨膜瓣包裹异体骨修复骨缺损优于单纯血管束植入同种异体骨修复骨缺损,带血运骨膜瓣包裹异体骨是修复大段骨缺损的较理想的方法。     

Spinal fusions: bone and bone substitutes

Vertebral arthrodesis is one of the most commonly performed, yet incompletely understood, procedures in spinal surgery. Despite major progress in internal fixation techniques, the high rate of non-unions indicates that physiologic, biologic and molecular events that are crucial to this process are not well known. This article will analyze the general biology of bone regeneration, and particularly discuss the properties and use of various bone graft materials and graft substitutes. Received: 9 August 2000/Accepted: 11 August 2000     

跖骨感染骨外露的显微外科治疗

[目的]回顾总结跖骨骨感染骨外露的显微外科治疗方法。[方法]自1995年～2005年采用显微外科技术治疗214例跖骨骨外露骨感染患者。[结果]全部病例获得随访1～10年，平均随访3年，14例游离植皮术后皮肤成活良好，199例术后皮瓣全部成活，1例腓肠神经营养血管皮瓣移位修复术出现远端部分皮肤坏死，后经换药处理后，伤口自然愈合。皮瓣移植术后质地良好，无溃疡复发。患足均可负重走路。[结论]应用显微外科技术治疗跖骨骨感染骨外露可获得较好的疗效。     

Assessment of bone density and bone loss

Osteoporosis International - Dual-energy X-ray absorptiometry has become the standard for the evaluation of osteoporosis. It is useful both for identifying those people who are going to be at risk...     

Trabecular bone remodeling and bone balance in hyperthyroidism

In vivo tetracycline double-labeled iliac crest bone biopsies from 15 hyperthyroid patients were used for the reconstruction of curves describing the variation of resorption depth and formation thickness with time. The curves emerging were compared to curves reconstructed from 13 age- and sex-matched normal individuals (mean age 44 years). The median function period for resorptive cells in hyperthyroid patients (16 days) was about one-third the resorptive period in normals (51 days). No significant difference between the osteoclast-, mononuclear-, or preosteoblast-like cell resorption depths could be demonstrated between the two groups. Consequently, the median resorption rate in hyperthyroid patients (3.8 μm/day) was more than 3 times higher than the value in the control group (1.1 μm/day). Median Sigma_f, was shorter in the hyperthyroid group (109 days) than in the control group (151 days, P < 0.05), as was the median initial mineralization lag time (5 and 16 days, respectively, P < 0.01). No significant difference between the measured mean completed wall thickness (mcwT) values in the hyperthyroid groups and the control group could be demonstrated (58.1 and 60.5 μm respectively). Median initial mineralization rate in the hyperthyroid group (1.2 μm³/μm² per day) was not significantly higher than the value calculated in the control group (0.9 μm³/ μm² per day), but median initial matrix appositional rate in hyperthyroids (4.8 μm³/μm² per day) was 3 times higher than the value calculated for normals (1.6 μm³/μm² per day) (P < 0.01). Direct measurements of mean completed wall thickness in the hyperthyroid group gave results (58.1 μm) that were not in accordance with the mean completed wall thickness calculated from the growth curve (52.1 μm, P < 0.02). In normals no such discrepancy could be demonstrated. Using the mcwT value estimated from the growth curve, the bone formation period was calculated to 90 days for hyperthyroid patients. This maximal estimate for mcwT was also significantly lower than the mean resorption depth measured in the hyperthyroid group (61.7 μm, P < 0.05), which means that a net negative balance per remodeling cycle existed in the hyperthyroid group. Bone balance was preserved in the control group.     

骨胶原与骨质疏松骨密度及骨生物力学的相关性研究

目的探讨骨胶原含量在绝经后骨质疏松症的发生、发展及在骨质疏松性骨折中的作用。方法取7个月龄未交配雌性SD大鼠60只，随机分为四组，A组：对照组（sham组）；B组：切除卵巢组；C组：切除卵巢＋雌激素治疗组；D组：切除卵巢＋降钙素治疗组。除A组外，其他三组通过切除双侧卵巢法12周后制成骨质疏松模型，24周后分别行k的力学特性、右侧股骨三点弯曲试验、羟脯氨酸含量、k骨密度（BMD）测定，Masson三色染色法显示骨胶原形态。结果A、C、D组与B组在k羟脯氨酸含量、BMD、k压缩力学参数值、右侧股骨生物力学参数值、骨胶原染色含量及形态方面差异均有统计学意义（P〈0．05），而A、C、D组之间差异无统计学意义（P〉0．05）。统计学分析显示羟脯氨酸含量与BMD及骨生物力学参数值呈直线相关性。结论骨质疏松的发生与骨胶原含量下降有关。骨胶原含量的下降与BMD降低及骨生物力学改变呈相关性。应用雌激素和降钙素治疗去势后骨质疏松大鼠，不仅可以提高其BMD含量和骨生物力学性能，而且还可以提高骨胶原的含量。     

Repair of long bone defects with demineralized bone matrix and autogenous bone composite

Background:

Repair of diaphyseal bone defects is a challenging problem for orthopedic surgeons. In large bone defects the quantity of harvested autogenous bone may not be sufficient to fill the gap and then the use of synthetic or allogenic grafts along with autogenous bone becomes mandatory to achieve compact filling. Finding the optimal graft mixture for treatment of large diaphyseal defects is an important goal in contemporary orthopedics and this was the main focus of this study. The aim of this study is to investigate the efficacy of demineralized bone matrix (DBM) and autogenous cancellous bone (ACB) graft composite in a rabbit bilateral ulna segmental defect model.

Materials and Methods:

Twenty-seven adult female rabbits were divided into five groups. A two-centimeter piece of long bone on the midshaft of the ulna was osteotomized and removed from the rabbits’ forearms. In group 1 (n=7) the defects were treated with ACB, in group 2 (n=7) with DBM, and in group 3 (n=7) with ACB and DBM in the ratio of 1:1. Groups 4 and 5, with three rabbits in each group, were the negative and positive controls, respectively. Twelve weeks after implantation the rabbits were sacrificed and union was evaluated with radiograph (Faxitron), dual-energy x-ray absorptiometry (DEXA), and histological methods (decalcified sectioning).

Results:

Union rates and the volume of new bone in the different groups were as follows: group 1 - 92.8% union and 78.6% new bone; group 2 - 72.2% union and 63.6% new bone; and group 3 - 100% union and 100% new bone. DEXA results (bone mineral density [BMD]) were as follows: group 1 - 0.164 g/cm², group 2 - 0.138 g/cm², and group 3 - 0.194 g/cm².

Conclusions:

DBM serves as a graft extender or enhancer for autogenous graft and decreases the need of autogenous bone graft in the treatment of bone defects. In this study, the DBM and ACB composite facilitated the healing process. The union rate was better with the combination than with the use of any one of these grafts alone.