基于X线影像的骨发育成熟度自动评价系统:研究进展和挑战

本文综述近十年以来,骨发育成熟度(骨龄)自动评价系统的国内外发展进程和现状,分析了该系统在实现过程中所面临的挑战,并提出一些可能的对策.     

The periphysis and its effect on the metaphysis

The metaphyseal collar due to the periphysis is lost (in 98% of 49 subjects) as an early sign of rickets and returns with recovery. The term pseudophysis refers to that unossified metaphyseal osteoid and cartilage as in rickets. The collar is intact in metaphyseal chondrodysplasias (a helpful sign in differential diagnosis from rickets), is shortened in achondroplasia, and frequently is spared in osteomyelitis, luetic bone disease, and Caffey infantile cortical hyperostosis. The periphyseal bone bark is thinned, but often apparent, in rickets, and is not thinned in cases of tyrosinosis and phenylketonuria.     

Differences of bone healing in metaphyseal defect fractures between osteoporotic and physiological bone in rats

Discrepancies in bone healing between osteoporotic and non-osteoporotic bone remain uncertain. The focus of the current work is to evaluate potential healing discrepancies in a metaphyseal defect model in rat femora. Female Sprague-Dawley rats were either ovariectomized (OVX, n = 14) and combined with a calcium-, phosphorus- and vitamin D3-, soy- and phytoestrogen-free diet or received SHAM operation with standard diet rat (SHAM, n = 14). Three months post-ovariectomy, DEXA measurement showed a reduction of bone mineral density reflecting an osteoporotic bone status in OVX rats. Rats then underwent a 3 mm wedge-shaped osteotomy at the distal metaphyseal area of the left femur stabilized with a T-shaped mini-plate and allowed to heal for 6 weeks. Biomechanical competence by means of a non-destructive three-point bending test showed significant lower flexural rigidity in the OVX rats at 3 mm lever span compared to SHAM animals (p = 0.048) but no differences at 10 mm lever span. Microcomputer tomography (μCT) showed bridging cortices and consolidation of the defect in both groups, however, no measurable differences were found in either total ossified tissue or vascular volume fraction. Furthermore, histology showed healing discrepancies that were characterized by cartilaginous remnant and more unmineralized tissue presence in the OVX rats compared to more mature consolidation appearance in the SHAM group. In summary, bone defect healing in metaphyseal bone slightly differs between osteoporotic and non-osteoporotic bone in the current 3 mm defect model in both 3 mm lever span biomechanical testing and histology.     

外固定支架分期治疗复杂胫骨干骺端骨折

目的：探讨组合式外固定支架治疗复杂胫骨干骺端骨折的疗效。方法：自2007年1月至2012年7月采用组合式外固定支架分期治疗34例复杂胫骨干骺端骨折,其中男23例,女11例;年龄16—63岁,平均41．3岁;病程1h-8d。31例为开放性骨折,采用Gustilo分型：Ⅱ型11例,ⅢA型13例,ⅢB型7例。胫骨平台骨折19例,采用Schatzker分型：Ⅱ型6例,Ⅳ型1例,Ⅴ型5例,Ⅵ型7例。胫骨远端骨折15例（其中1例患者为双侧）,按AO分型：A2型2侧,A3型1侧,C1型1侧,C2型5侧,C3型7侧。分别采用Rasmussen和AOFAS踝-后足评分系统对患者膝、踝关节功能进行评定。结果：创面获得Ⅰ期愈合19例,Ⅱ期愈合15例。发生浅表伤口感染2例,骨不连2例（再手术后获得骨愈合）。34例患者均荻随访,时间6~38个月,平均14.3个月。末次随访时,Rasmussen评分为23．58±3．98,优5例．良11例,可3例;AOFAS踝-后足评分为80．75±14．21,优5例,良8例,可3例。结论：组合式外固定支架用于治疗复杂胫骨干骺端骨折,能有效维持骨断端的稳定性,组织感染坏死率低,对关节活动影响小,但长期使用有一定局限性。     

Prepubertal Oophorectomy Limits the Accumulation of Cancellous Bone in the Femur of Growing Rats with Long-Term Effects on Metaphyseal Bone Architecture

Bone loss after oophorectomy of adult rats is more rapid and complete in the metaphysis than in the epiphysis of the femur, particularly in the proximal region of the metaphysis distant from the growth plate. This study was undertaken to determine the effects of prepubertal oophorectomy on femoral cancellous bone acquisition during growth. Rats were oophorectomized (OVX) or sham operated at 3 weeks of age and killed at intervals up to 78 weeks for scanning electron microscopy and histomorphometry of the distal femur. Differences in cancellous bone architecture between the two groups was evident after 6 weeks of age. Relatively minor differences were found in the part of the metaphysis near the growth plate and in the epiphysis, with less trabeculae in the primary spongiosa and 1 to 2 less trabeculae/mm in the secondary spongiosa. However, as metaphyseal growth proceeded, trabeculae were present for a greater distance up the femoral shaft in controls than in OVX rats, with mean BV/TV in the proximal part of the metaphysis increasing from 1.4% at 6 weeks to 13.4% at 20 weeks in controls, with no increase in the OVX rats. We find that the lack of ovarian hormones increases the rate of destruction of trabeculae near the metaphyseal-diaphyseal junction. Received: 25 February 1997 / Accepted: 17 June 1997     

干骺端潜行截骨延长术矫正肢体短肢畸形

目的　介绍一种新的治疗肢体短肢畸形手术方法。方法　 1985年 3月～ 2 0 0 0年 10月 ,应用自行研制的“针锯”和“多平面双轨多功能延长器”对 2 88例下肢不等长患者的肢体 ,采用干骺端潜行截骨延长方法进行延长 ,矫正短肢畸形。男 16 1例 ,女 12 7例。年龄 12～ 2 9岁 ,平均 2 1.3岁。其中延长胫骨上干骺端 2 6 8例 ,股骨下干骺端 16例 ,胫骨下干骺端 4例。结果　 2 88例肢体分别延长 3.0～ 11.5 cm,延长时间 2 4～ 96天 ,平均 4 7天。全部短缩肢体获得预期延长度。延长第 2周 ,延长间隙中有骨痂形成和骨膜反应 ,6～ 8个月延长骨与断端完全达骨性结合。全部患者均未发生神经、血管损伤及骨不连等并发症。经 5个月～ 8年随访 ,延长处均骨性愈合 ,膝、踝关节功能恢复满意。结论　下肢干骺端潜行截骨延长方法安全可靠 ,无骨不连 ,骨萎缩等并发症 ,术后不需要作内固定和植骨 ,是肢体延长的理想方法     

Effect of the combination of ipriflavone and 1α-OH-D3 on debilitant bone in growing rats —Ultrastructural study of endochondral ossification—

Five-week-old male Wistar rats were used to study the effect of dietary therapy with ipriflavone combined with 1α-OH-D₃. Ultrastructural alterations in the metaphysis of debilitated tibia were observed in the growing rats.

• I.Light microscopy findings In the low-calcium diet • standard diet with supplementary ipriflavone and 1α-OH-D₃ group, calcification of the chondral matrix and ossification were active, and the tibia grew normally as in the control group.
• II.Scanning electron microscopy findings In the low-calcium diet • standard diet with supplementary ipriflavone and 1α-OH-D₃ group, dense calcospherites, distinct chondral lacunae, regularly running collagen fibers, and distinct border lines were noted.
• III.Transmission electron microscopy findings In the low-calcium diet • standard diet with supplementary ipriflavone and 1α-OH-D₃ group we found that the osteoblasts were active, the ruffled border of osteoclast was decrease, indicated this osteoclast is inactive.

In conclusion, insufficient calcium intake during the developmental period resulted in debilitated(3etaphysis tibia, whereas dietary therapy using combined ipriflavone and 1α-OH-D3 promoted recovery.     

三种不同投硒方法防治青海省贵德病区儿童大骨节病效果观察

目的比较三种不同投硒方法对早期儿童大骨节病的防治效果.方法通过对病区6～12岁儿童进行流行病学、临床、X线拍片检出X线患者,并随机分成三组.A组:口服亚硒酸钠.B组:食用1/6万硒盐.C组:食用1/6万硒盐的同时加服维生素E.结果经过1年的防治实验,发现硒对干骺端(早期)改变有肯定的治疗效果,其中C组有效率为80%,A组为60%,B组为33.3%,且对其它部位也有不同程度的修复效果.结论在无特效药防治大骨节病的前提下,硒盐 维生素E是防治大骨节病的有效措施.     

Effect of growth rate on the strength of the growth plate-shaft junction

This paper investigates the relation between metaphyseal zone fragility and growth rate. It is concluded that there are two sites of weakness, the hypertrophic zone of the plate and the metaphysis. From a study of the age incidence of traumatic plate fractures compared with that of shaft fractures, it is deduced that fragility of both zones is a non-linear function of growth rate. It is concluded that this correlation explains the occurrence and age incidence of a range of diseases in which plate fractures occur in shear, and of central Schmorl's node which is a metaphyseal fracture in compression. The mechanism of plate fragility appears to be an increase in thickness of the hypertrophic zone from any cause, including rickets as well as increased growth. No evidence is found to implicate endocrine imbalance as a necessary factor in the normal transient fragility of the growth spurt.