化瘀活骨汤治疗股骨头缺血坏死的实验研究

目的　研究由川芎、三棱、仙灵脾、骨碎补等药组成的化瘀活骨汤治疗股骨头缺血坏死的作用机理。方法　应用手术方法造成兔股骨头缺血坏死模型 ,观察化瘀活骨汤对其血液流变学的影响。结果　造模三周后 ,治疗组全血粘度、血浆粘度均明显下降 ,而红细胞聚集指数则上升 ,与正常组比较无显著性差异 (P <0 0 5 ) ,与股骨头缺血坏死模型组比较差异非常显著 (P <0 0 1) ;光镜观察发现治疗组6周后骨内微循环及骨坏死等病理改变有明显好转 ,而模型组骨细胞坏死及骨内微循环障碍仍非常明显。结论　化瘀活骨汤对股骨头缺血坏死的作用机理可能是改善了血流变学与股骨头缺血坏死骨内微循环的病理状态     

化瘀活骨汤治疗肌骨头缺血坏死的实验研究

研究由川芎、三棱、仙灵脾、骨碎补等药组成的化瘀活骨汤治疗股骨头缺血坏死的作用机理。方法应用于方法造成兔股骨头缺血坏死模型，观察化瘀活化汤对其血液流变学的影响。结果造模三周后，治疗组全血粘度、血浆粘度均明显下降，而红细胞聚集指数则上升，与正常组比较无显著性差异，与股骨头缺血坏死模型组比较差异非常显著；光镜观察发现治疗组６周后骨内微循环及骨坏死等病理改变有明显好转，而模型组骨细胞坏死及骨内微循环障碍仍     

激素性股骨头坏死的早期病理生理改变及治疗

1957年Ｐｉｅｔｒｏｇｒａｎｄｅ和Ｍａｓｔｒｏｍａｒｉｎｏ首次报道皮质激素诱发的股骨头坏死 ,此后该病引起了国内外学者的广泛重视 ,虽然对其早期病理生理改变及治疗作了深入的研究 ,但确切的发病机制并不清楚 ;众多治疗方法本身说明尚未找到相对有效的方法。本文着重对激素性股骨头坏死的早期病理生理改变及针对不同病理生理改变的早期治疗方法作一综述。1　激素性股骨头坏死的早期病理生理改变1.1　局部病理生理改变1.1.1　骨细胞　激素性股骨头坏死的早期组织学改变是骨细胞核固缩 ,空骨陷窝增多 ,骨髓腔内脂肪细胞增生和肥大 ,无典…     

应用血管内皮生长因子基因治疗股骨头缺血性坏死的实验研究

目的：通过建立犬股骨头缺血坏死模型，探讨应用脱蛋白骨复合转染血管内皮生长因子（vascular endothelial growth factor，VEGF）基因骨髓基质细胞植入治疗股骨头缺血坏死的可行性。方法：实验选取36只成年犬，随机分为3组，每组12只。A组为脱蛋白异体骨复合转染VEGF基因的自体骨髓基质细胞；B组为脱蛋白异体骨复合未转染基因的自体骨髓基质细胞；C组单纯植入脱蛋白骨材料。采用液氮冷冻法制作狗股骨头缺血坏死模型，将细胞骨材料复合物植入缺血坏死股骨头内。应用微循环灌注方法了解股骨头内的血运情况，组织形态学观察坏死股骨头的修复情况，免疫组化方法检测VEGF的表达，骨密度仪测定股骨头的骨密度。结果：A组4周后股骨头内有VEGF表达，12周后股骨头内有大量的树枝状血管生成，大量新骨形成，骨密度增高；B、C组均无VEGF基因表达，B组有部分新骨及血管生成，C组仅见少量类骨质形成，血管再生不明显。结论：利用脱蛋白骨复合转染VEGF基因的骨髓基质细胞可促进新骨形成与血管再生，有利于促进坏死骨的修复。     

单侧穿刺介入治疗股骨头缺血性坏死

目的评价股骨头缺血坏死介入治疗的疗效及方法。方法对48例股骨头缺血坏死患者共70个股骨头采用seldinger技术单侧穿刺股动脉插管,造影观察血液供应情况后,超选择进入到股骨头营养血管如旋股内、外侧动脉,注入溶栓药物、扩血管药物及改善微循环药物,术后再次造影观察对比股骨头供血改变情况,并行治疗前后临床表现与影像学表现对比研究。结果治疗前后血管造影对照显示治疗后血管增多,股骨头染色增强,疼痛症状及关节功能明显改善,影像检查显示骨质不同程度修复。结论股骨头缺血坏死介入治疗是安全有效的方法,能改善重建股骨头局部微循环,促进修复。     

激素性股骨头坏死动物模型的诱导和观察

采用马血清注射造成家兔过敏性血管炎，肾上腺皮质激素成功诱导出股骨头缺血性坏死的模型。墨汁动脉灌注和病理检查，显示股骨头内终末动脉损害，动脉血供中断是骨坏死的可能病因。骨坏死早期显示骨髓内生血细胞坏死，脂肪细胞增大并融合成片，灌主动脉减少，尤以软骨下骨为显著。中晚期显示骨细胞坏死，骨髓内纤维化，灌动脉逐渐增加并有修复现象。     

成人股骨头缺血性坏死保髋手术治疗现状

成人股骨头缺血性坏死是骨科常见病 ,其病因及病理过程复杂 ,最终常引起严重残疾。目前治疗方法多种多样 ,一般可分为非手术治疗及手术治疗 ,手术治疗又分为保留髋关节手术、人工关节置换术和关节融合术。诊断时疾病的分期和死骨的范围将决定着最佳处理方法的选择。当然其他因素如病因、症状、年龄、身体状况、单侧还是双侧受累也是重要因素[1] 。理想的方法应是保留而不是转换完整的股骨头。ＡＮＦＨ早期病理变化是股骨头的缺血性改变 ,后期则发生股骨头塌陷 ,因此重建及改善缺血坏死股骨头的血供 ,加强对股骨头软骨下骨的支撑 ,促进股骨头…     

激素诱导骨髓基质细胞成脂分化的实验研究

观察激素诱导骨髓基质细胞分化成脂肪细胞的作用,揭示激素性股骨头缺血性坏死的病理学机制。方法　采用原代骨髓基质细胞体外培养技术,取小鼠双侧股骨骨髓细胞,通过细胞贴壁、分离获取骨髓基质细胞。以地塞米松作为脂肪细胞分化诱导剂处理细胞,苏丹Ⅲ染色,光镜下脂肪细胞计数。结果以递增浓度（０、１× １０~－９、１× １０~－８、１× １０~－７、１× １０~－６ ｍｏｌ／Ｌ）地塞米松处理细胞并培养 ２１天后, １×１０~－６ ｍｏｌ／Ｌ组中诱导分化生成的脂肪细胞最多,对照组中脂肪细胞最少,各组脂肪细胞随地塞米松浓度增大而增多,具有一定的剂量依赖性。实验组细胞经高浓度（１×１０~－７ ｍｏｌ／Ｌ）地塞米松处理并培养１２天后,其细胞内碱性磷酸酶活性明显低于对照组,两者差异有非常显著性意义（Ｐ＜０．０１）。结论　地塞米松能够直接诱导骨髓基质细胞大量分化成脂肪细胞,其成骨分化减少,这可能是大剂量应用激素后股骨头骨髓内脂肪组织增多,骨内压升高,导致骨微循环障碍,同时骨修复过程缓慢,从而发生股骨头缺血性坏死的原因。     

骨保护素/骨保护素配体在大鼠创伤性股骨头坏死中的表达及意义

[目的]探讨大鼠创伤性股骨头坏死模型中OPG/OPGL蛋白表达及意义。[方法]6个月龄SD大鼠32只,雌雄不限。分组:实验组按术后1、2、4、6周4个时间点将动物随机分成4组,每组8只。对照组采用自身非实验侧股骨头做正常对照。采用圆韧带离断方法制备大鼠创伤性股骨头坏死动物模型;分别于术后1,2,4,6周处死动物。光镜下观察股骨头坏死病理形态学改变;采用CM IAS真彩色医学图像分析系统检测骨髓腔内脂肪组织与造血组织比值并计数骨组织内空骨陷窝百分率;免疫组化技术检测OPG/OPGL蛋白在股骨头坏死组织中的表达。[结果]成功的复制出大鼠股骨头坏死进展期模型,呈现出典型股骨头坏死不同时期病理改变;股骨头坏死不同时期实验组空骨陷窝百分率高于对照组(P0.05);实验组骨髓腔内脂肪组织与造血组织的面积比值高于对照组(P0.05);免疫组化检测结果显示实验组OPG蛋白在股骨头坏死不同时期表达的光密度值(OD值)均明显低于对照组(P0.05);OPGL蛋白表达高于对照组(P0.05)。[结论](1)本实验成功复制了大鼠股骨头坏死模型并在一定程度上反映了股骨头坏死的病理变化过程;(2)股骨头坏死局部OPG、OPGL表达水平与病变严重程度密切相关,OPG表达随病程的延长逐渐降低;而OPGL表达水平则相反。提示OPG的过度表达可抑制破骨细胞功能,减少骨吸收;反之则促进骨吸收。如能提高坏死局部OPG浓度可以抑制骨丢失,将有助于股骨头修复,可能为股骨头坏死的早期治疗提供新方法。     

急性一氧化碳中毒致股骨头骨髓水肿一例报告

 骨髓水肿综合征(bone marrow edema syndrome,BMES)是以骨基质水肿、纤维组织增生及炎性细胞浸润为主要病理表现的一种征象,也是一种影像学表现,可发生于多种疾病,如股骨头坏死、骨肿瘤、骨创伤、感染等。MRI在临床上的广泛应用为骨髓水肿提供了最敏感、也最有效的影像学检查方法,使骨髓水肿逐渐被认识及重视。股骨头骨髓水肿是可逆的,若能早期去除诱因及辅以对症治疗,症状可逐渐减轻并恢复正常;若延误治疗或治疗方案不正确,症状则可能进一步加重,严重者可能发展为股骨头坏死。急性一氧化碳中毒导致股骨头骨髓水肿,目前未见相关报道。     

股骨头缺血坏死发病机理的实验研究

目的：探讨股骨头坏死的发病机理,为正确指导临床治疗,防治股骨头缺血坏死提供一个可靠依据。方法：20只新西兰大白兔随机分为两组：模型组和空白对照组。向模型组动物腹腔内注射醋酸氢化泼尼松,造成股骨头缺血性坏死模型,在第8次注射激素后第4天模型Ⅰ组和对照Ⅰ组各取5只动物进行取材实验,于注射激素后第30天模型Ⅱ组和对照Ⅱ组各取5只进行同上实验,观察模型组和对照组的一般情况,、股骨头外观、股骨头,则定骨密度,结果：模型组动物较对照组股骨头骨质疏松,易于剖开凿切,镜下空骨陷窝数增多,脂肪细胞增多,骨小梁变细、稀疏中断、骨密度明显减低,结论：认为股骨头缺血坏死发病期经历了一个共同的病理过程,即骨质疏松。     

股骨头缺血性坏死修复重建术后与全髋关节置换术后异位骨化的比较

目的 研究股骨头缺血性坏死修复重建术后与全髋关节置换术后异位骨化的发生率。方法1994年6月～2004年12月，收治因股骨头缺血性坏死行修复重建患者共1005例，其中随机选择Ficat和AlertX线分期Ⅲ、Ⅳ期患者74例（A组），观察异位骨化的发生率；与随机从465例同期全髋关节置换患者中选取80例（B组）的异位骨化发生率进行比较。结果A、B组术后均获随访2-10年，平均6．5年。修复重建术组发生异位骨化4例，异位骨化率5．4％；全髋关节置换术组发生异位骨化18例，异位骨化率22．5％；两组差异有统计学意义（P〈0．01）。结论股骨头缺血性坏死修复重建术后异位骨化发生率较低，适用于青壮年患者。全髋关节置换术后异位骨化发生率较高，适用于老年患者。     

正常与骨内高压下骨髓微循环冷冻割断扫描电镜观察

目的 探讨骨内高压症的发病机理。方法 随机取正常家兔１６只,测量双侧胫骨近端骨内压,证明两侧压力值对比差异无显著性意义。再取家兔４０只,用塑料夹板等将其一侧后肢于膝关节伸直位固定５周,制成骨内高压动物模型,死亡１４只,取其中１４例行双侧胫骨近端骨内压测量,证明固定侧骨内压值显著高于另（对照）侧。随机取骨内高压模型家兔１２只,同时随机取正常家兔６只,对其双侧胫骨近端骨髓微循环及造血组织进行二甲基亚砜     

Diagnosis and treatment of idiopathic necrosis of the femoral head

Fourteen cases, 25 hips, of idiopathic necrosis of femoral head (INFH) were included in our series. The role of radiographs, isotopic bone scanning, intraosseous pressure measurement and intraosseous venography in diagnosis of INFH was evaluated. Radiological examination cannot reveal early case, while isotopic bone scanning was more sensitive. There was increase of intraosseous pressure in most diseased hips. Intraosseous venography was abnormal in all examined hips. These two tests could therefore detect early INFH. Core decompression was performed on 21 hips. The operated hips were followed for 3.5 months to 20 months. Functional evaluation of 18 hips were good or excellent. Radiographic re-examination of 20 hips remained unchanged. The postoperative intraosseous pressure measurement and intraosseous venography in examined hips revealed a decrease of intraosseous pressure and improvement of venous drainage. Core decompression is therefore an ideal method of treatment for early INFH.     

关节镜监视下带血管蒂大转子骨瓣转移治疗股骨头缺血性坏死

目的：报道结合应用关节镜经髋外侧入路治疗股骨头缺血性坯的显微外科手术方法。方法：在关节镜监视下经髋外侧入路应用带旋股外侧血管横支大转子骨瓣治疗早期病变的股骨头缺血性坏死26例。结果：术后随访1－3年,根据疼痛,行走距离,关节活动度,X线评价分析,取得了满意的治疗效果。结论：在关节镜监视下带血管蒂大转子骨瓣转移治疗股骨头缺血性坏死,可以在精确有效地清除病灶内坏死骨质的基础上重建股骨头的供血系统,同时经外侧入路可以进一步减少对髋周肌群及韧带的损伤。应用关节镜技术及显微方法是治疗股骨头缺血性坏死早期病变的简便有效方法。     

陈旧性股骨颈骨折的手术治疗(附62例报告)

目的应用带血管蒂髂骨瓣转移、BMP人工骨植入加空心钉内固定治疗62例陈旧性股骨颈骨折。探讨其术后骨折愈合率及骨不连、股骨头缺血性坏死发生情况。方法应用带血管蒂髂骨瓣转移、BMP人工骨植入加纯钛空心钉治疗陈旧性股骨颈骨折62例,术后随访8个月～5年6个月,对其临床功能、X线片进行评估。结果功能优良者51例(82．2％),骨折不愈合5例(8．1％),股骨头缺血性坏死6例(9．7％),骨折不愈合和股骨头缺血性坏死者均二次行全髋人工关节置换,愈合良好。结论血管蒂髂骨瓣转移、BMP人工骨植入加空心钉内固定治疗陈旧性股骨颈骨折,术后发生骨不连和股骨头缺血性坏死机率低,内固定稳定性强,手术时间短,临床并发症少,是治疗股骨颈骨折较为理想的手术方法。     

Modular megaprosthesis in metastatic bone disease of the femur

The treatment of bone metastases is frequently palliative, aiming to achieve satisfactory pain control and to prevent or treat pathological fractures. For lesions involving the femur, internal fixation frequently fails; therefore, prosthetic reconstruction may be the optimal choice for treatment. This article retrospectively reviews our experience with femoral bone metastases between 1999 and 2008. A series of 22 patients (14 men and 8 women; mean age, 61.8 years) with femoral bone metastases were treated with resection and modular megaprosthetic reconstruction. Bipolar hip prostheses were used in 19 patients, intercalary prostheses were used in 2 patients, and total knee replacement was used in 1 patient. Oncologic outcome was evaluated, and functional outcomes were obtained by the Musculoskeletal Tumor Society (MSTS) score, which assigns numerical values (0-5) for each of 5 parameters, excluding emotional status. A numerical score (maximum 25 points) and percent rating was calculated. Six-month survival was 86.4%, 1-year survival was 54.2%, and 2-year survival was 37.1%. Three patients were unable to ambulate due to acute paraplegia with spinal metastases at the perioperative period. Excluding these 3 patients, average MSTS score was 62.3%. The MSTS score in patients surviving >12 months was 70.8% compared with a score of 46.4% in those living <12 months (P<.05). Complications included 2 dislocations. Megaprosthetic reconstruction provides for optimal treatment of femoral metastatic disease in patients with a prognosis of >12 months with satisfactory functional outcomes based on lower complications.     

The effect of silicon nitride ceramic on rabbit skeletal cells and tissue. An in vitro and in vivo investigation

This article presents a morphologic assessment of the effect of silicon nitride ceramic (Si3N4) on rabbit marrow stromal cells and their differentiation when grown in vitro and in vivo. In vitro marrow stromal cells (MSC) attached initially to upper portions of ceramic discs. However, at four weeks, cells only attached to disc edges. Fresh marrow or first passage MSC, inoculated into diffusion chambers with and without Si3N4, formed cartilage, bone, and fibrous tissue after being implanted intraperitoneally for five weeks. Tissue differentiated adjacent to Si3N4 but not within the pores. In contrast, Si3N4 implants inserted into femoral marrow cavities were surrounded initially by woven bone and within three months by mature bone that had permeated implants with a pore size of 255 +/- 64 microns. Plugs having a pore diameter of 170 +/- 45 microns mainly contained vascularized fibrous tissue with occasional foci of osteoid or bone in the peripheral pores. In a pilot experiment, three femoral segmental Si3N4 endoprostheses were implanted in three adult rabbits, and the osseous reactions were monitored during their natural life. Each implant was enclosed by a stable cuff of bone within four months of implantation and remained unchanged during the rest of the animal's life. Autopsies confirmed these roentgenographic observations, and tissue appositional to each prosthesis was morphologically normal. Si3N4 has the potential of an important ceramic for use in osseous reconstruction.     

淫羊藿苷干预兔早期激素性股骨头坏死的实验研究

目的探讨淫羊藿苷对激素诱导的兔早期激素性股骨头坏死干预效果。方法50只成年新西兰兔(体质量2.5~3.0 kg)随机分为对照组(n=10)、模型组(n=20)及实验组(n=20)。模型组和实验组采用脂多糖联合甲泼尼龙注射制备早期激素性股骨头坏死模型;实验组首次注射甲泼尼龙开始每日灌服淫羊藿苷药液1次,对照组及模型组灌服等量生理盐水,连续6周。于6周后取左侧股骨头行大体观察;Micro-CT扫描观察骨小梁微结构,测量骨小梁相对体积(bone volume to total volume,BV/TV)、骨小梁数量(trabecular number,Tb.N)、骨小梁厚度(trabecular thickness,Tb.Tn)及骨小梁分离度(trabecular separation,Tb.Sp),并构建三维图像观察;HE染色观察骨小梁结构、骨细胞及骨髓脂肪细胞形态变化,按照病理学诊断标准检测股骨头坏死模型造模是否成功,计算空骨陷窝率。结果实验期间共7只动物死亡,最终对照组9只、模型组16只、实验组18只纳入研究。大体及Micro-CT扫描、三维重建显示,与对照组相比,模型组股骨头塌陷明显,骨小梁断裂、排列紊乱稀疏;实验组股骨头表面皱褶,塌陷不明显,骨小梁结构轻度退变。与对照组相比,模型组和实验组Tb.N、Tb.Tn、BV/TV下降、Tb.Sp升高;与模型组相比,实验组Tb.N、Tb.Tn、BV/TV升高、Tb.Sp降低;组间比较差异均有统计学意义(P<0.05)。HE染色示模型组骨小梁中骨细胞减少,空骨陷窝较多,骨小梁间脂肪细胞堆积,部分呈囊状融合;实验组骨小梁形态较模型组完整,骨细胞坏死及脂肪细胞肥大不明显。按照股骨头坏死病理学诊断标准,对照组无骨坏死发生,模型组骨坏死发生率为81.3%(13/16),实验组为66.7%(12/18),差异无统计学意义(P=0.448)。模型组和实验组发生坏死的股骨头标本其空骨陷窝率分别为33.1%±1.4%及18.9%±0.8%,均高于对照组12.7%±1.5%,且模型组明显高于实验组,差异均有统计学意义(P<0.05)。结论淫羊藿苷对激素诱导的兔早期激素性股骨头坏死具有保护作用,可以降低骨细胞凋亡,改善骨微结构,延缓骨坏死发生。     

Qualitative and quantitative analysis of orthotopic bone regeneration by marrow

A rat model of a femoral segmental defect was used to specifically test the hypothesis that autogenous marrow has the osteogenic capability to heal a bone defect. The variables analyzed included the ratio of the marrow volume to the defect, implantation of live or dead marrow, and remodeling of established nonunions by implantation of live marrow. The uniqueness of this model allows biomechanical evaluation of the new bone formed by the implant. When live marrow was implanted, woven bone formed at 3 weeks, progressing to early lamellar bone at 6 weeks, with subsequent remodeling for as long as 12 weeks in a volumetric fashion (p < 0.05). Bone marrow, when placed in a fresh femoral defect and given in sufficient amounts, produced a rate of union comparable with that of autologous bone grafts. Mature lamellar bone formed by marrow was evaluated biomechanically: the results were statistically comparable with those of cancellous bone grafts at 12 weeks. Significant bone formation occurred when marrow was percutaneously injected in femoral nonunions, although union and remodeling did not take place in this rat model. Implantation of dead marrow resulted in rare cellular infiltration and minimal bone formation in a manner comparable with that of autogenous cancellous bone grafts. These results indicate that bone marrow can lead to structurally functional bone regeneration in an orthotopic location.