组织工程肌腱修复陈旧性跟腱断裂伴缺损的疗效观察

目的探讨应用组织工程肌腱修复陈旧性跟腱断裂伴缺损的手术方法及临床效果。方法1999年8月～2002年6月,采用同种异体肌腱来源的成纤维细胞,以5×106/ml细胞密度接种在医用碳纤维与聚羟基乙酸纤维制作的编织带上,体外培养5d后,修复跟腱缺损7例,缺损长度为5～7cm。术后踝跖屈外固定4～6周后开始功能锻炼。结果7例均获随访22～56个月,平均46.9个月。除1例术后伤口延迟愈合外,其余6例均期愈合。无全身及局部不良反应,无跟腱粘连再手术患者。按尹庆水疗效评定标准,优5例,良1例,可1例。结论组织工程肌腱修复跟腱缺损可获较好临床效果,是一种可选择的新治疗方法。     

The utilization of decellularized tendon slices to provide an inductive microenvironment for the proliferation and tenogenic differentiation of stem cells

The extracellular matrix (ECM) microenvironment for the stem cell niches, including but not limited to the biochemical composition, matrix topography, and stiffness, is crucial to stem cell proliferation and differentiation. The purpose of this study was to explore the capacity of the decellularized tendon slices (DTSs) to induce stem cell proliferation and tenogenic differentiation. Rat adult stem cells, including tendon-derived stem cells (TDSCs) and bone marrow-derived stem cells (BMSCs), were identified to have universal stem cell characteristics. The DTSs were found to retain the native tendon ECM microenvironment cues, including the inherent surface topography, well-preserved tendon ECM biochemical composition and similar stiffness to native tendon. When the TDSCs and BMSCs were cultured on the DTSs respectively, the LIVE/DEAD assay, alamarBlue^® assay, scanning electron microscopy examination and qRT-PCR analysis demonstrated that the DTSs have the capacity to support these stem cells homogeneous distribution, alignment, significant proliferation and tenogenic differentiation. Taken together, the findings of this study indicate that the DTSs can provide a naturally inductive microenvironment for the proliferation and tenogenic differentiation of TDSCs and BMSCs, supporting the use of decellularized tendon ECM as a promising and valuable approach for tendon repair/reconstruction.     

闭合性桡骨远端骨折手法复位小夹板固定临床路径的病例对照研究

目的:探讨以手法复位小夹板固定治疗闭合性桡骨远端骨折在保证临床疗效的基础上,缩短治疗时间,减轻患者医疗费用,创建中医优势病种门诊诊疗的临床路径。方法:自2007年7月至2009年12月,共200例患者,年龄40～80岁,分为提前拆除小夹板组(CP治疗组)和常规治疗组,各100例。CP治疗组男21例,女79例;年龄(62.98±0.85)岁;常规治疗组男20例,女80例;年龄(63.19±0.88)岁。均采用手法复位小夹板固定后,常规治疗组30d拆除小夹板,CP治疗组在第25天拆除小夹板,两组定期摄X线片复查及内服中药(早期口服玄胡片、创伤宁片,中期口服归香正骨丸,后期口服双龙接骨丸)至骨折临床愈合,拆除夹板后指导功能锻炼。患者在治疗中评定复位情况,了解骨位,采用Gartland-Werley腕关节评分标准评估腕关节功能,进行疗效观察。结果:CP治疗组患者的实际治疗时间从原来的(30.08±3.06)d下降到(25.06±1.07)d,治疗费用由(2100.00±332.12)元下降到(1644.00±125.20)元。两组在复位、腕关节功能恢复方面比较差异无统计学意义,说明中医门诊治疗的疗效可以保证。结论:在中医骨科门诊实施临床路径后,促进了诊疗行为的规范化及治疗时间的缩短,为广大病患减轻了医疗经济负担,值得推广应用。     

Osteogenesis response to implanted materials in endocortical bone in rat femora

BackgroundOrthopedic surgeons and dentists often implant materials to repair bone tissue defects and restore physiological functions of bone organs. The clinical success depends on adequate bone formation in operation sites. However, the real cause of osteogenesis has not yet been fully elucidated. To investigate the bone response to implanted materials, this study examined the bone tissue reaction in rat femoral medullary canal, which received gelatin and collagen as foreign-body materials.MethodsA total of 36 six-month-old Sprague-Dawley rats were randomly and meanly divided into three groups. In the gelatin group, the bilateral femora received gelatin material; in the collagen group, they were implanted with type I collagen, and in the control group, the femora suffered from sham operation with no materials inserted. After 2, 4, 8, and 12 weeks, specimens were harvested and subjected to a series of examinations.ResultsAfter 2 weeks of healing, a significant upregulation of both alkaline phosphatase and osteocalcin by both kinds of implanted materials relative to the control (sham implantation group) was seen in gene expression analysis. Strong reactivity of osteoprotegerin and receptor activator of NFκB ligand was detected in the two test groups in immunohistochemistry at 4 weeks of healing. Also, micro-CT revealed an increase in cortical bone thickness in the two test groups as compared to the control group. Densitometry showed increased bone mineral density in the bone receiving materials after 12 weeks, leading to the enhanced maximum load in the test groups.ConclusionsThese results indicated that the implanted materials led to an osteogenesis response in rat femoral medullary canal. Thus, we probably should reconsider the potential cascades of tissue reaction when utilizing orthopedic and dental implants and other materials to recover bone related-organ function and repair bone defects.     

颗粒骨打压植骨结合多孔非骨水泥臼杯在AAOSⅢ型髋臼大面积骨缺损翻修中的应用

背景：颗粒骨打压植骨是修复髋臼骨缺损的重要方法,对大面积髋臼骨缺损采用打压植骨结合非骨水泥臼杯重建仍然存在争议。目的：探讨同种异体颗粒骨打压植骨结合多孔非骨水泥臼杯髋臼重建术修复AAOSⅢ型髋臼大面积骨缺损的方法及近期疗效。方法：随访2005年6月至2010年4月收治的28例（28髋）AA0SⅢ型髋臼大面积骨缺损患者。男18例,女10例,年龄34-74岁,平均53．8岁。髋关节置换术后感染醐翻修9例,骨溶解及髋臼假体松动翻修19例。本组AAOSⅢ型髋臼骨缺损面积大,术中见髋臼骨缺损超过髋臼关节面的50％。全部采用同种异体颗粒骨打压植骨结合多孔非骨水泥臼杯髋臼重建术。术后定期随访,观察臼杯有无松动、植入骨与宿主骨整合情况,髋关节功能评分采用Harris评分。结果：28例均获得随访,术后随访时间为13-70个月,平均43个月。Harris评分由术前32-48分,平均41分,提高至末次随访时86-95分,平均90分。28例髋臼假体均固定牢固无松动征象,植入骨逐渐与宿主骨整合,无感染及坐骨神经损伤。结论：在获得臼杯初始稳定固定的情况下,大面积颗粒骨打压植骨（臼杯与宿主骨接触面积〈50％）结合多孔非骨水泥臼杯髋臼重建术修复AAOSⅢ型髋臼大面积骨缺损近期疗效较好,远期疗效尚待进一步随访。     

使用颈椎动态稳定器非融合颈椎的早期疗效分析

目的 随访评价颈椎动态稳定器非融合颈椎治疗颈椎间盘突出症的早期疗效.方法 回顾性分析13例使用颈椎动态稳定器治疗颈椎间盘突出症的临床资料.采用JOA评分及PSI评分对患者术前及术后1周、1个月、6个月疗效情况进行记录和分析,根据颈椎x线片观察患者术前、术后DCI植入节段及相邻节段的运动范围.结果 13例病例获6个月随访.术前JOA评分7.8～11分,平均（8.82±0.78）分,术后6个月评分12.3～16分,平均（15.13±0.52）分,术后与术前相比,差异有统计学意义（P=0.001）;术后平均PSI为1.6分;术前邻近节段的平均活动范围为（8.38±4.62）°,术后为（7.72±3.62）°,与术前相比,平均减少了（0.66±0.36）°,但差异无显著性（P＞0.05）.疗效评定：优10例,良3例,手术有效率为100％.结论 使用颈椎动态稳定器非融合颈椎,在非融合的情况下提供颈椎动态稳定性,同时未明显改变手术邻近节段的活动度,具有良好的早期临床疗效.     

复合胶原的组织工程肌腱力学性能的实验研究

目的探讨胶原在组织工程肌腱的构建中对力学强度的影响. 方法裸鼠75只,制成跟腱缺损的动物模型,随机分为5组,分别将人发(hair,H)、碳纤维(carbon fiber,CF)、聚羟基乙酸(polyglycolic acid,PGA)、H PGA和CF PGA复合外源性Ⅰ型胶原,与标准转化人胚腱细胞株联合培养制成组织工程肌腱.植入裸鼠右后肢修复跟腱缺损,为实验组(A组);将未复合胶原的上述各种材料植入裸鼠左后肢修复跟腱缺损,为对照组(B组).术后于2、4、6、8和12周进行生物力学测定,观察并比较其变化. 结果实验组2～4周力学强度高于对照组,差异有统计学意义(P＜0.05),但6～12周两组差异无统计学意义(P＞0.05);时间与力学强度呈正相关,差异有统计学意义(P＜0.05).其中以人发的力学强度最佳,CF次之,PGA最差. 结论外源性胶原在肌腱修复的早期能增强组织工程肌腱的力学强度,对患肢功能的恢复有一定的作用.     

关节镜下切除软组织囊肿的微创技术应用初探

目的：探讨关节镜下切除软组织囊性病变的临床价值。方法：1998年2月--2001年2月对软组织囊肿26例行关节镜下刨削方法切除病变囊壁治疗。结果：26例获随访6月--12月，平均8．6月，总有效率96．2％(25／26)，术后无并发症，仅1例右腕背腱鞘囊肿术后复发。结论：关节镜下切除软组织囊性病变手术创伤小，并发症少，成功率高，术后恢复快。     

后方入路治疗胫骨平台后髁冠状位骨折的疗效分析

目的探讨后方入路治疗胫骨平台后髁冠状位骨折的临床疗效,分析该类骨折形态、手术入路的选择以及对Schatzker分型的再认识。方法回顾分析2003年6月-2009年6月23例采用后方入路治疗胫骨平台后髁冠状位骨折患者的临床资料。男15例,女8例;年龄32～56岁,平均38岁。均为闭合性骨折。致伤原因:高处坠落伤5例,交通事故伤15例,运动损伤3例。骨折按Moore分型:Ⅰ型10例,Ⅱ型9例,Ⅳ型4例。常规行膝关节正侧位X线片、CT扫描及三维重建。患者受伤至手术时间为3～14d,平均6d。结果骨折获解剖复位17例,一般复位6例。术后切口均Ⅰ期愈合。23例均获随访,随访时间12～36个月,平均24个月。骨折于术后6～9个月达临床愈合,平均7.6个月。无神经、血管损伤、内固定失效、关节僵硬、创伤性骨关节炎、畸形愈合等并发症发生。末次随访时根据Rasmussen评分系统评定膝关节功能,获优14例,良7例,可2例,优良率为91.3%。结论胫骨平台后髁冠状位骨折少见,有其独特的形态特点,Schatzker分型不能完全涵盖该类骨折。采用后方入路可在直视下复位关节面,固定牢靠,术后可早期行功能锻炼,并发症少,是较好的手术治疗方...     

经枕颈后外侧入路治疗寰枕区腹侧病变的安全性评估

目的 对经枕颈后外侧入路手术治疗寰枕区腹侧病变的不良事件作统计,评估该术式的安全性.方法 1999～2006年,对74例寰枕区以腹侧病变压迫为主的患者进行治疗,手术经枕颈后外侧入路,先行枕骨大孔扩大及寰椎后弓切除减压,再经枕颈区硬脊膜侧方显露齿突及C2椎体做相应压迫因素切除,达到脊髓前后方同时减压,并同期完成枕颈植骨...