99Tcm-S2-51对兔骨水泥髓腔灌注后肺血栓形成及其干预措施的放射免疫显像研究

目的 应用99Tcm-S2-51检测骨水泥灌注后兔肺血栓的形成,并探讨预防肺栓塞发生的干预措施.方法 大耳白兔16只,体重2.5～3.0 kg,随机分为4组.A组(未干预组):骨髓腔灌注骨水泥并加压;B组(盐酸肾上腺素组):骨髓腔内用盐酸肾上腺素盐水(1:10 000)冲洗髓腔后灌注骨水泥并加压;C组(生物蛋白胶组):用生物蛋白胶喷洒骨髓腔后灌注骨水泥并加压;D组(空白对照组):骨髓腔不灌注骨水泥.每组动物在骨水泥灌注前耳缘静脉注入99Tcm-S2-51 2 ml,骨水泥灌注后60、120和180min进行核素显像,测定活体肺放射活性后,立即处死动物,取出完整肺组织,测定离体肺放射活性后肺组织固定进行病理学检测.结果 骨水泥髓腔灌注并加压后60、120和180 min,肺组织的放射活性,A组分别为(11.48±2.35)、(14.41±3.10)和(18.25±5.01) ID/pixels,B组分别为(8.21±3.21)、(10.19±2.40)和(11.32±3.12) ID/pixels,C组分别为(4.06±1.04)、(5.68±2.80)和(7.40±1.12) ID/pixels,各时间点组间差异有统计学意义.病理学检查显示肺部有血栓形成,骨水泥髓腔灌注前应用盐酸肾上腺素或生物蛋白胶,肺部放射活性明显下降.结论 99Tcm-S2-51可以用于骨水泥灌注后兔肺血栓形成的动态观察.应用盐酸肾上腺素和生物蛋白胶可以降低骨水泥肺栓塞的发生率.     

下腔静脉过滤器对骨水泥植入综合征的预防作用研究

目的 研究下腔静脉过滤器(rvcr)对骨水泥植入综合征(BCIS)的预防作用. 方法雄性绵羊10只,体质量25～30 kg,随机分为A组(不植入IVCF)和B组(植入IVCF)(n=5).麻醉后B组绵羊先在1250 mA透视机透视下,由颈内静脉经右心房在.肾下极5 cm处下腔静脉内植入IVCF.后将两组绵羊离断股骨颈扩髓腔,植入10 mL骨水泥,并逐渐增加髓腔内压,同期观测血压、心率、中心静脉压(CVP)和血气变化,心前区超声心动图动态实时显示心腔内情况改变.术毕分离肺脏,油红染色观察肺组织病理变化.结果 A组绵羊植入骨水泥后,当将股骨髓腔压力增加至120mm Hg时,右心房、右心室内即出现了点状不均匀回声,且随髓腔压力继续增加,点状回声变成大量雪花状叫声影,并伴血压、PaO2明显下降,25 min后收缩压下降至(80±11)mm Hg(P＜0.01),Pa02降至最低(P＜0.05),而心率、CVP进行性升高,血气分析示呼吸性酸中毒合并代谢性酸中毒,病理提示肺动脉血管内广泛散布大量脂肪栓子,血管腔阻塞;而B组绵羊在植入骨水泥后,在股骨髓腔内压升至400 mm№时尚未观察到右心腔出现脂肪栓子回声影,且血压、PaO2、心率、CVP较植入前未见明显降低或升高(P＞0.05),血气分析结果示通气正常,肺组织脂肪油红染色阴性. 结论 IVCF可有效预防骨水泥植入而引起的BCIS的发生.     

骨水泥封堵股骨髓腔对全膝关节置换术围手术期失血量的影响

目的探讨骨水泥封堵股骨髓腔对全膝关节置换术(TKA)围手术期失血量的影响。方法回顾性分析陕西省人民医院2014年1月至2016年12月因骨关节炎行单侧初次TKA的患者173例,具有完整的影像学资料、血液学检验报告且伴发疾病不影响凝血或血流动力学的患者共116例,其中男53例,女63例,年龄平均(64±5)岁。65例患者使用自体截骨块制成的塞子填塞股骨髓腔口(A组),51例患者在使用自体骨塞的基础上采用面团期骨水泥封堵残存的股骨髓腔裂隙(B组)。采用卡方检验比较两组患者的性别、麻醉方式、异体输血率及深静脉血栓(DVT)发生率,采用独立样本t检验比较两组患者的年龄、身体质量指数(BMI)、手术时间、术中出血量、截骨厚度、术后引流量及围手术期显性出血量及隐性出血量。结果所有患者均顺利完成手术,两组患者在性别(X~22=0.161,P0.05)、年龄(t=-8.38,P0.05)、BMI(t=1.837,P0.05)、麻醉方式(X~22=0.91,P0.05)、手术时间(t=1.714,P0.05)及截骨厚度(t=0.448,P0.05)方面差异无统计学意义。A组的显性出血量为(237.7±58.7)ml,B组的显性出血量为(225.5±68.1)ml,2组之间差异无统计学意义(P0.05);A组的隐性出血量为(624.6±77.1)ml,B组的隐性出血量为(543.1±63.3)ml,A组的隐性出血量明显高于B组(t=6.104,P0.05)。A组的异体输血率为35%,B组的异体输血率为21%,经比较二者之间差异有统计学意义(X~22=4.861,P0.05)。A组和B组下肢DVT的发生率分别为6.1%与3.9%,差异无统计学意义(P0.05)。结论使用骨水泥封堵股骨髓腔可有效减少TKA围手术期隐性失血量。     

低频脉冲型超声治疗起始时间对载万古霉素骨水泥药动及药效特性的影响

目的 研究低频脉冲型超声治疗的起始时间对载万古霉素骨水泥的药物释放动力（药动）特性与抗菌性能的影响及其机制。方法 在新西兰大白兔的髋关节植入载万古霉素骨水泥并接种标准菌株。超声A组于植入后0．5h治疗12h，超声B组于植入后12h治疗12h，对照组不予超声治疗。取超声A组及超声B组动物各2只，测定超声治疗时髋关节腔内渗血量。余动物于植入后定时测定髋关节引流液的药物浓度，计算药动及药效参数。植入后48h采集髋关节腔渗液及股骨近端髓腔组织，计数活菌量。结果超声B组有效抑菌浓度持续时间（T〉MIC）较对照组和超声A组分别延长20．51、21．81h。超声A组及B组的髋关节腔细菌密度分别较对照组下降lg^-1 1．62、lg^-1 2．77CFU／ml。超声B组股骨髓腔内细菌密度较对照组下降lg^-1 1．29CFU／g。超声B组髋关节渗血量显著低于超声A组。回归分析中，T〉MIC及低频脉冲型超声与载万古霉素骨水泥的协同抗菌效应差异有统计学意义。结论 与术后即刻超声治疗相比，组织渗血减轻时予以超声治疗能有效延长局部T〉MIC，提高载万古霉素骨水泥的抗菌性能。     

骨水泥振动器的运用对骨水泥-骨界面微嵌合的影响

目的 评价骨水泥振动器对提高骨水泥-骨界面的整合效果及临床意义. 方法 取新鲜成猪股骨16根,随机分成两组,实验组(A组)与对照组(B组)模型各8根.猪股骨髓腔内应用骨水泥振动器进行骨水泥灌注后(对照组灌注骨水泥不经振动),对每组实验模型进行硬组织切片,每根股骨模型等距选取3个层面,HE染色后在体视显微镜下观察,经电脑Motic Med 6.0数码医学图像分析系统分析测量骨水泥渗透入松质骨腔的厚度,记为渗透厚度,将所得数值进行统计学分析,对比振动组与对照组的骨水泥灌注效果. 结果 体视显微镜下显示实验组骨水泥与骨小梁之间结合紧密,骨水泥在松质骨腔内充填均匀一致,骨水泥与骨小梁之间的结合紧密.对照组骨水泥向松质骨腔内渗透欠佳,在松质骨腔内充填不均匀.结果显示实验组骨水泥渗透厚度高于对照组,差异均具有统计学意义(P＜0.05). 结论 骨水泥振动器能够使骨水泥在骨髓腔内弥散更加均匀,能够促进骨水泥向骨小梁内渗透,从而增加骨水泥与骨小梁之间的微嵌合.     

初次全髋置换术前的假体选择

骨水泥与非骨水泥假体各有优缺点,就具体病人而言,选择何种固定类型的假体更为合适,是骨科医生在术前必须明确的问题。本文就不同固定方法的假体作一综述,希望对初次全髋置换术前的假体选择有所帮助。1骨水泥假体骨水泥股骨假体:在假体植入之前,以骨水泥充填股骨髓腔,插入股骨柄后使骨水泥均匀分布于股骨假体与股骨髓腔内壁之空隙间(约2mm),等骨水泥硬化后,股骨柄就会牢固地固定于髓腔内。因此,骨水泥固定可提供假体的即刻机械稳定,允许早期负重而不必担心早期的松动和下沉。然而采用第一代骨水泥灌注技术(手持填塞技术)的全髋关节置换,后期…     

丹参注射液在脂肪栓塞综合征防治中的作用

实验用同种异体犬长骨骨髓脂肪静脉注射法产生脂肪栓塞综合征的实验模型。对照组单纯注射骨髓脂肪，而用药组在注射骨髓脂肪的同时注射丹射注射液。检测动脉氧分压，游离脂肪酸，血栓素／前列腺环素，超氧化物歧化酶／丙二醛，血凝块冰冻切片等，结合眼球结膜微循环观察，９９ｍ锝肺扫描等方法，来探讨丹参注射液防治脂肪栓塞综合征的作用及机制，实验表明：９９ｍ锝肺核素扫描对脂肪栓塞综合征的早期诊断有一定的作用；脂肪栓塞综合     

血管内皮细胞生长因子促进激素性股骨头坏死修复

[目的]探讨应用血管内皮细胞生长因子治疗激素性股骨头坏死的方法。[方法]新西兰兔30只，22只兔耳缘静脉注射马血清，臀肌注射醋酸泼尼松龙，制造激素性股骨头坏死动物模型。动物随机分为3组：A组：VEGF治疗组，B组：对照组，C组：正常对照组。治疗组骨穿刺针行经皮注射血管内皮细胞生长因子脂质体至股骨头。于治疗后5周，采用影像学方法观察股骨头结构变化，病理组织学观察股骨头骨组织、骨髓造血组织及血管的变化。[结果]VEGF治疗组，X线及CT检查显示：模型股骨头结构变清晰，骨质破坏明显修复；HE染色结果：VEGF治疗组可见软骨细胞修复性增生，骨髓腔造血组织出现增生，栓塞的血管旁边出现新生的血管。[结论]VEGF治疗股骨头坏死能促进新血管生成及骨修复。     

微管仿生人工骨对犬骨髓基质细胞生物学行为的影响

[目的]研究不同微管结构仿生人T骨对犬骨髓基质细胞（BMSCs）增殖和分化的影响。[方法]仿生人工骨分为正交结构（A组）和同心结构（B组），以磷酸钙骨水泥（CPC）／重组人骨形成蛋白2（rhBMP-2）（C组）、单纯CPC（D组）为对照组：梯度密度离心法获取犬骨髓单个核细胞，取第3代与人工骨复合培养。通过荧光显微镜、扫描电镜观察细胞在人工骨表面附壁和生长情况；以MTT实验检测各组细胞增殖能力；测定碱性磷酸酶（ALP）检测BMSCs的成骨活性：[结果]细胞在各组人工骨表面黏附、生长，以A、B组数量较多；MTT法检测显示A、B、C组吸光度（A）值大于D组（P〈0．05）、A、B、C组A值相似（P〉0．05）；ALP测定显示ALP活性A、B组〉C组〉D组（P〈0．05），A、B组间差异无统计学意义（P〉0．05）。[结论]微管结构仿生人工骨与犬BMSCs有良好的生物相容性，是BMP的良好缓释载体，可以促进犬骨髓基质细胞向成骨方向分化.     

肺叶支气管填塞通气对食管癌根治术患者肺内分流的影响

目的 评价肺叶支气管填塞通气对食管癌根治术患者肺内分流的影响。方法 择期行食管癌根治术患者24例，随机分为2组（n=12）：A组为双腔支气管导管组。B组为肺叶支气管填塞气囊组。麻醉诱导后，A组插入双腔支气管导管，B组先插入单腔气管导管，再在纤维支气管镜引导下插入支气管填塞气囊。两组均先行双肺通气30min，再行肺隔离通气至少30min，A组为单肺通气。B组为肺叶支气管填塞通气。术中监测气道压。分别于清醒仰卧位自主呼吸空气时（L）、侧卧位双肺通气30min（T1）和肺隔离通气30min（T2），抽取桡动脉血和中心静脉血标本，测定血气和血红蛋白，计算肺内分流率（Qs／Qt），采用放免法测定动脉血浆血栓素B2（TXB2）和6-酮-前列腺素F1α（6-k-PGF1α）浓度。结果 与A组比较。仅T2时B组PaO2升高，气道压、Qs／Qt及TXB2浓度均降低（P〈0．05）。与Tn比较，T1时两组Qs／Qt均升高（P〈0．05），TXB2浓度变化无统计学意义（P〉0．05）；与T1比较，R时A组Qs／Qt和TXB2浓度升高（P〈0．05），而B组变化无统计学意义（P〉0．05）。两组6-k-PGF1α浓度组内及组间比较差异均无统计学意义（P〉0．05）。结论 肺叶支气管填塞通气可以通过降低开胸手术期间的肺内分流来提高机体的氧合功能。     

骨水泥对血液流变学影响的实验研究

目的通过动物实验研究探讨骨水泥对血液流变学变化的影响。方法将24只新西兰白兔随机分为两组试验组和对照组,每组12只,试验组股骨髓腔内填充骨水泥而对照组不填充骨水泥,术前、术后10min、1h、3h、24h采集颈内静脉血,测定血液流变学指标,用SPSS17．0统计学软件将结果进行统计学分析。结果手术前后血液流变学指标改变有统计学差异（P〈0．05）,而实验组与对照组则无统计学差异（P〉0．1）。结论骨水泥对术后24h内兔血液流变学变化无显著影响。     

The effect on cortical bone of reaming and filling of canine tibial diaphysis with inert bone wax.

In canine studies the effect of intramedullary reaming on tubular bone was investigated in 4 dogs. Intramedullary reaming was further compared with reaming and intramedullary filling with bone wax in 6 dogs. Bone blood perfusion was measured by a microsphere technique and bone remodelling activity by 99mTc-MDP uptake. From histological sections bone necrosis and remodelling activity were estimated. The biological response increased with the surgical trauma. If the medullary cavity was only reamed, endosteal apposition was the predominant reaction. Obturation of the medullary cavity resulted in more vigorous subperiosteal and cortical reaction. It is concluded that the remodelling processes differ significantly between reamed bone and bone where the medullary cavity is reamed and blocked. Thus when testing bone cement the studies should include a control operation with obturation of the medullary canal in a way simulating bone cement.     

不同运动方式兔胫骨应力骨折的实验研究

18只兔分二组在电笼中进行每日2h连续跑跳运动.甲组兔在平地跑动,胫骨在高应力持续作用下第7天出现破骨细胞和骨吸收,10天后即有镜下微骨折,而骨膜下成骨细胞12天后才增多,21天大量新骨形成.乙组兔隔日改变笼底坡度,结果胫骨骨破坏较甲组出现晚、程度轻,但成骨过程仍然出现.认为应力骨折的预防应着眼于减少和延迟骨的吸收破坏过程,维持破骨与成骨的新的平衡,使骨组织通过内部结构的改建以适应应力的变化.     

Modern cementing techniques. An experimental study of vacuum insertion of bone cement

The results of these experiments show that an increase in the intramedullary pressure (IMP) can lead to embolization of bone marrow contents via the venous drainage system along the linea aspera. A vacuum applied distally to the medullary canal is very effective for filling the diaphyseal tube with cement. The cancellous bone honeycombs of the proximal metaphysis, however, can only be filled if the bone sponge is tunneled at the level of the femoral calcar; a proximal vacuum then yields filling of the cancellous bone framework with bone cement. In order to fill the weight-bearing spongious framework of the pelvic bone with cement, the acetabular cavity should be sealed with a rubber ring and vacuum applied proximo-laterally to the ilium, thereby giving an extremely high suction pressure.     

丹参与骨碎补注射液防治激素诱发股骨头坏死的实验研究

目的探讨丹参和骨碎补对激素性股骨头坏死的防治机理及其交互作用.方法选用家兔50只,随机分成五组:模型组、丹参组、骨碎补组、丹参 骨碎补组、对照组.8周后观察五组家兔血液流变学、脂代谢、股骨头组织学等指标的改变.结果与对照组相比,模型组股骨头疏松,易于凿切,血液粘度和血脂升高,骨小梁变细、稀疏,空骨陷窝率增高,髓腔脂肪细胞增多;而其余各组上述病变有不同程度的减轻,其中以丹参 骨碎补组病理改变最轻.结论①丹参、骨碎补均能预防激素所致的高粘滞血症和高脂血症;②骨碎补能提高血钙血磷,激活成骨细胞,提高股骨头的骨密度,能预防激素性骨质疏松;③两药在预防SANFH方面有协同作用.     

A new model of bone infection used to evaluate the efficacy of antibiotic-impregnated polymethylmethacrylate cement

An animal model of bone infection was designed for evaluation of the benefits of adding antibiotics to polymethylmethacrylate (PMMA) cement. Femora of New Zealand albino rabbits were exposed at the knee; the medullary canals were entered and the contents aspirated. A known number of bacteria was added to each femur before it was filled with either normal Surgical Simplex P bone cement or Surgical Simplex P antibiotic bone cement. The presence or absence of bone infection was documented by quantitative bacteriologic, roentgenographic, and histologic techniques. Simplex antibiotic bone cement prevented infection, even in the presence of 10(7) bacteria. The effectiveness of the antibiotic bone cement was correlated with the rapid release of high levels of erythromycin (14.1 micrograms/g) and colistin (11.3 micrograms/g) specifically at the site of bacterial contamination.     

Effects of Pore Size on the Osteoconductivity and Mechanical Properties of Calcium Phosphate Cement in a Rabbit Model

Calcium phosphate cement (CPC) porous scaffold is widely used as a suitable bone substitute to repair bone defect, but the optimal pore size is unclear yet. The current study aimed to evaluate the effect of different pore sizes on the processing of bone formation in repairing segmental bone defect of rabbits using CPC porous scaffolds. Three kinds of CPC porous scaffolds with 5 mm diameters and 12 mm length were prepared with the same porosity but different pore sizes (Group A: 200–300 µm, Group B: 300–450 µm, Group C: 450–600 µm, respectively). Twelve millimeter segmental bone defects were created in the middle of the radius bone and filled with different kinds of CPC cylindrical scaffolds. After 4, 12, and 24 weeks, alkaline phosphatase (ALP), histological assessment, and mechanical properties evaluation were performed in all three groups. After 4 weeks, ALP activity increased in all groups but was highest in Group A with smallest pore size. The new bone formation within the scaffolds was not obvious in all groups. After 12 weeks, the new bone formation within the scaffolds was obvious in each group and highest in Group A. At 24 weeks, no significant difference in new bone formation was observed among different groups. Besides the osteoconductive effect, Group A with smallest pore size also had the best mechanical properties in vivo at 12 weeks. We demonstrate that pore size has a significant effect on the osteoconductivity and mechanical properties of calcium phosphate cement porous scaffold in vivo. Small pore size favors the bone formation in the early stage and may be more suitable for repairing segmental bone defect in vivo.     

Mechanical effects of reaming and implantation of acrylic cement into the medullary cavity of bones

Changes in the mechanical properties of the rat femur caused by intramedullary application of bone cement were studied. In one group of animals reaming of the medullary cavity was performed, and bone cement was injected. In a control group only reaming was performed. At various intervals from day 0 to day 180 following operation the mechanical characteristics of the bone were evaluated. Reaming of the medullary cavity provoked a temporarily reduced bending moment of the femur at 40 days after operation. Intramedullary bone cement caused no significant changes in the bending moment of the femora until day 180 after operation. At this time, the bending moment of the cemented femora was significantly greater than that of the contralateral bones. This may be attributed to more periosteal bone being deposited, as implantation of bone cement induced a significant increase in periosteal reaction. The elastic stiffness of the bone was not altered either by reaming or the implantation of bone cement. It is concluded that reaming and implantation of bone cement into the medullary cavity do not impair the mechanical properties of the femur in the young rat.     

19例股骨颈原发溶骨性损害的手术治疗

目的：总结股骨颈原发溶骨性损害的手术治疗结果。方法：自1973－1999年共收治股骨颈原发溶骨性病损19例,其中瘤样样病变11例,良性肿瘤4例,恶性骨肿瘤2例,骨梗死2例,采用瘤段切除,人工股骨头置换1例,肿瘤刮除,骨水泥和髓内钉填塞,接骨板固定2例,肿瘤刮除植骨16例。结果：随访6个月－20年,平均5．8年,骨肉瘤患者术后2年死于肿瘤肺转移,软骨肉瘤患者术后1．5年肿瘤局部复发,行股骨近端置换,1例骨水泥和三翼钉植入者8年后患侧股骨粗隆部骨折,再次手术安装接骨板,3个月后骨折愈合,余患者4－8个月植骨融合,无股骨头坏死或塌陷,肿瘤无复发征象,结论：原发股骨颈溶骨性损害以瘤样病变居多,良性病变无论病变范围的大小,采用病灶清除,腔内植骨骨或骨水泥填塞均取得良好效果。     

No efficacy of silver bone cement in the prevention of methicillin‐sensitive Staphylococcal infections in a rabbit contaminated implant bed model

Data from literature showed that a new type of metallic silver PMMA cement had good results in infection prophylaxis. This study investigated the in vivo efficacy of silver cement in the prevention of methicillin‐sensitive Staphylococcal infections, compared to plain and tobramycin‐containing cement. In 48 rabbits, 0.6% silver, 1% silver, plain, or tobramycin PMMA cement was injected into the femoral medullary canal after contamination with 10⁵, 10⁶, or 10⁷ colony forming units (CFU) Staphylococcus aureus. After 14 days, bone was collected for bacteriology and histopathology. All plain and silver cement rabbits were infected, whereas only two tobra rabbits were infected (p < 0.001). The number of bacteria cultured (¹⁰logCFU) from bone adjacent to the cement, was 6.4 ± 0.3 and 6.1 ± 0.3 for the 0.6% and 1% silver rabbits. For the rabbits with plain and tobra cement, this was 6.2 ± 0.2 (p > 0.95) and 0.0 ± 0.0 (p < 0.001), respectively. Two tobra rabbits had a positive culture of a distal bone sample. Histological sections of plain, 0.6%, and 1% silver rabbits all showed signs of infection; these signs were absent in the tobra rabbits. Silver and plain cement were not effective in preventing infection, whereas tobra cement was effective. As silver cement predominantly exhibits an antimicrobial effect at the direct cement surface, this cement seems less useful in situations where there are bacteria present in surrounding tissues, like revision surgery. Whether silver cement has relevance in the prevention of bacterial colonization of cement remains to be determined. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 1002–1007, 2009