刺老苞根皮黄酮类化合物对维甲酸致大鼠骨质疏松的影响

目的研究刺老苞根皮黄酮类化合物对维甲酸致大鼠骨质疏松的影响。方法将60只大鼠随机分成对照组,模型组,刺老苞根皮黄酮类化合物高、中、低剂量(10、20、30 mg/kg)组和仙灵骨葆胶囊(20 mg/kg)阳性对照组,每组10只。各组以ig维甲酸70 mg/kg造模后,各给药组分别ig给予相应药物,每日1次,连续8周。取血清检测相关生化指标,进行骨组织切片检查和骨生化指标检测,测定股骨长度、宽度及质量。结果与对照组比较,模型组大鼠股骨质量、尺骨羟脯氨酸(Hyp)和骨钙的量明显降低,胫骨骨髓腔中脂肪组织增多(P<0.01),血浆胆固醇(TC)水平升高、碱性磷酸酶(ALP)和高密度脂蛋白-胆固醇(HDL-C)水平降低(P<0.01)。与模型组比较,刺老苞根皮黄酮类化合物各剂量组能有效增加骨质量和提高骨质的量(P<0.01),减少骨髓腔中脂肪的量,升高ALP和HDL-C的量(P<0.01)。结论刺老苞根皮黄酮类化合物可有效对抗维甲酸引起的大鼠骨生长抑制及骨丢失。     

骨折愈合的应力适应性研究

目的 探讨骨折端受力、肌肉动力、骨痂密度与骨折愈合的关系。方法 通过传感器电测技术与X线灰度分析的方法，从三个方面对骨折愈合的应力适应性进行了研究：①分别对14只1岁龄山羊进行了断端受力与骨折愈合的关系的研究；②对10只健康成年家兔进行了肌肉动力与骨折愈合的关系的研究；③对56只健康成年家兔进行了骨痂密度与骨折愈合的关系的研究。结果与结论 ①理想的骨折愈合与最佳的应力状态相适应；②肌肉动力是应力适应的反馈调节因素；③骨痂密度是应力适应的反馈结果。     

Blockage of Src by Specific siRNA as a Novel Therapeutic Strategy to Prevent Destructive Repair in Steroid‐Associated Osteonecrosis in Rabbits

Vascular hyperpermeability and highly upregulated bone resorption in the destructive repair progress of steroid‐associated osteonecrosis (SAON) are associated with a high expression of VEGF and high Src activity (Src is encoded by the cellular sarcoma [c‐src] gene). This study was designed to prove our hypothesis that blocking the VEGF‐Src signaling pathway by specific Src siRNA is able to prevent destructive repair in a SAON rabbit model. Destructive repair in SAON was induced in rabbits. At 2, 4, and 6 weeks after SAON induction, VEGF, anti‐VEGF, Src siRNA, Src siRNA+VEGF, control siRNA, and saline were introduced via intramedullary injection into proximal femora for each group, respectively. Vascularization and permeability were quantified by dynamic contrast‐enhanced (DCE) MRI. At week 6 after SAON induction, proximal femurs were dissected for micro–computed tomography (μCT)‐based trabecular architecture with finite element analysis (FEA), μCT‐based angiography, and histological analysis. Histological evaluation revealed that VEGF enhanced destructive repair, whereas anti‐VEGF prevented destructive repair and Src siRNA and Src siRNA+VEGF prevented destructive repair and enhanced reparative osteogenesis. Findings of angiography and histomorphometry were consistent with those determined by DCE MRI. Src siRNA inhibited VEGF‐mediated vascular hyperpermeability but preserved VEGF‐induced neovascularization. Bone resorption was enhanced in the VEGF group and inhibited in the anti‐VEGF, Src siRNA, Src siRNA+VEGF groups as determined by both 3D μCT and 2D histomorphometry. FEA showed higher estimated failure load in the Src siRNA and Src siRNA+VEGF groups when compared to the vehicle control group. Blockage of VEGF‐Src signaling pathway by specific Src siRNA was able to prevent steroid‐associated destructive repair while improving reconstructive repair in SAON, which might become a novel therapeutic strategy. © 2015 American Society for Bone and Mineral Research.     

Exogenous phytoestrogenic molecule icaritin incorporated into a porous scaffold for enhancing bone defect repair

This study was designed to develop a bioactive scaffold to enhance bone defect repair in steroid‐associated osteonecrosis (SAON). Icaritin, a metabolite of the herb Epimedium, has been identified as an angiogenic and osteogenic phytomolecule. Icaritin was homogenized into poly lactic‐co‐glycolic acid/tricalcium phosphate (PLGA/TCP) to form an icaritin‐releasing porous composite scaffold (PLGA/TCP/icaritin) by fine‐spinning technology. In vitro, high performance liquid chromatography was used to determine the release of icaritin during degradation of PLGA/TCP/icaritin. The osteogenic effects of PLGA/TCP/icaritin were evaluated using rat bone marrow mesenchymal stem cells (BMSCs). In vivo, the osteogenic effect of PLGA/TCP/icaritin was determined within a bone tunnel after core decompression in SAON rabbits and angiography within scaffolds was examined in rabbit muscle pouch model. In vitro study confirmed the sustainable release of icaritin from PLGA/TCP/icaritin with the bioactive scaffold promoting the proliferation and osteoblastic differentiation of rat BMSCs. In vivo study showed that PLGA/TCP/icaritin significantly promoted new bone formation within the bone defect after core decompression in SAON rabbits and enhanced neovascularization in the rabbit muscle pouch experiment. In conclusion, PLGA/TCP/icaritin is an innovative local delivery system that demonstrates sustainable release of osteogenic phytomolecule icaritin enhancing bone repair in an SAON rabbit model. The supplement of scaffold materials with bioactive phytomolecule(s) might improve treatment efficiency in challenging orthopedic conditions. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:164–172, 2012     

脊髓II号治疗大鼠脊髓损伤的病理组织学研究

目的 观察脊髓Ⅱ号方剂对大鼠损伤脊髓神经元修复再生的影响。方法 制作１８只Ｔ１２右半横断的Ｗｉｓｔａｒ大鼠模型，随机分为３组：脊髓Ⅱ号组、氢化可的松组、空白对照组，分别给予脊髓Ⅱ号药液、激素、生理盐水。４周后取材，作神经病理组织学检查。结果 脊髓Ⅱ号方剂具有明显疗效，可缩小损伤区域，抑制继发损伤，促进神经元胞体及神经纤维的修复再生。结论 脊髓Ⅱ号方剂可以促进损伤神经元的修复再生，具有良好的临床应用     

正常人的软组织张力测定

目的 :探讨正常人的软组织张力测定和生物力学特点。方法 :本组 30名健康成年人 ,男 19例 ,女 11例 ,年龄 10～ 5 6岁 ,平均 35岁 ,选取合谷、肩井、三阴交三穴进行垂直于皮肤平面测出 1、2、3、4、6……毫米张力计刻度位移所对应的张力数值。结果 :据所测数值绘出三个部位曲线 ,三处软组织服从大致相同的力学曲线 ,即大体分为皮肤段、皮下组织段、肌内段、深层组织段。结论 :软组织是一种非线性粘弹性材料 ,三处软组织综合刚度合谷穴 <肩井穴 <三阴交穴 ,皮肤刚度小于肌肉的刚度。     

兔坐骨神经钳夹伤后的电生理研究

本文对兔坐骨神经钳夹伤后的电生理研究结果表明：１．神经损伤后第１０天肌电图（ＥＭＧ）表现有插入电位延长，延长时间随神经再生而逐渐缩短。２．损伤后第２０天可记录到再生小电位。３．诱发肌肉收缩电位于神经损伤后３０天可记录到，４．推算神经再生速度平均为２．８３ｍｍ／日，最快可达４ｍｍ／日。本研究旨在对神经再生的临床判断及有关研究提供参考。     

Clinical outcomes of open reduction and internal fixation for intra-articular complex tibial plateau non-union with 3-year minimum follow-up

BackgroundA tibial plateau fracture is one of the most challenging fractures for both knee and trauma surgeons because of the high incidence of post-traumatic knee osteoarthritis. To our knowledge, there has been no study concerning the clinical outcomes after surgery in patients with non-union of complex intra-articular tibial plateau fractures. Thus, the present study aimed to assess and report the clinical outcomes in them.MethodsThe study included four patients with non-union of complex tibial plateau fractures who underwent failed initial fixation treatment or could not undergo initial fixation owing to concomitant injury and who were followed up with a diagnosis of non-union for a minimum of 6 months. At the latest follow-up, patient-reported outcome measures, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford 12-item Knee Score (OKS), were assessed. Additionally, the knee range of motion (ROM) was evaluated.ResultsThe mean duration from the initial surgery to revision surgery was 8.8 months, and the mean duration from the revision surgery to fracture union was 4.8 months. At the latest follow-up, the mean WOMAC score was 9.8 and the mean OKS was 43.5. Additionally, the mean knee ROM values were ?11 degrees of extension and 100 degrees of flexion. All four patients had become able to walk without any aid after averaged 4.5-years follow up.ConclusionFavorable clinical outcomes can be achieved following revision surgery involving open reduction and IF in patients with non-union of complex tibial plateau fractures after failed initial treatment.Level of evidenceLevel IV, Case report.     

Evaluation and manipulative therapy of patellar malalignment: a clinical review and preliminary report

Patellar malalignment is difficult to diagnose, but can respond well to conservative care. This paper discusses the clinical and radiographic diagnostic features of patellar malalignment, as well as conservative care for this condition.     

Comparing the rates and modes of failure of two third generation cephalomedullary nail systems in the treatment of intertrochanteric hip fractures

IntroductionCephalomedullary (CMN) implants are commonly used to address elderly intertrochanteric hip fractures. Multiple CMN implant systems exist with subtle variation between manufacturers. Multiple modes of CMN failure have been described in the literature. The present study assessed the local modes and rates of construct failure (nail fracture, cut-out and non-union) of two such implants, after a change in implant supply provided the opportunity for retrospective comparison. Additional investigation was undertaken to assess whether any predictors of failure could be identified based on common radiographic measurement parameters.MethodsBased on local implant records, all consecutive patients who suffered an intertrochanteric fracture, treated at a tertiary care hospital with a cephalomedullary nail from January 2014 to January 2018 were included. Patients were excluded if they received a CMN for pathologic fracture. Within the collection period all patients received either a Synthes Trochanteric Fixation Nail (TFN) or Zimmer Natural Nail (ZNN). Patients were retrospectively assessed for fracture reduction and implant technique parameters at the time of initial surgery. Radiographic data were assessed at minimum two years post-operatively to assess for union. Patient demographic data was followed to assess rate and mode of failure.ResultsSix hundred and sixty-two patients were included in the study, from which a propensity matched cohort was derived. Comparing across equivalent cohorts, no differences in the rate or mode of construct failure were identified between the TFN and ZNN.When assessing the entire cohort we observed 39 construct failures (5.9%), which included 31 instances of nail cutout (4.7%), 4 episodes of nail fracture (0.6%) and 4 failures related to non-union (0.6%). Tip to apex distance, sagittal malalignment and Cleveland zone were identified as significant predictors of nail failure.ConclusionNo difference in rates or modes of failure were identified between the TFN and ZNN constructs. Similar to previous reports we again identified the impact of tip to apex distance on construct failure and further identified Cleveland zone and sagittal malalignment as significant risks for failure.