骺板软骨细胞复合三维支架体外构建组织工程软骨的研究

目的探讨将骺板软骨细胞复合三维支架经体外培养,构建组织工程软骨的效果及其生物学特点. 方法将3周龄幼兔第1代骺板软骨细胞与液态的生物凝胶混合,接种于聚磷酸钙纤维/L-聚乳酸(CPPF/PLLA)三维支架材料,构建组织工程软骨组织块,连续培养4周.行大体、倒置显微镜及组织学、Ⅰ型和Ⅱ型胶原免疫组织化学光镜观察,定量检测硫酸糖胺多糖(GAG)含量. 结果构建的组织工程软骨块在培养过程中能保持其初始外形,种子细胞呈稳定的三维均相分布,外观逐渐呈乳白色、半透明,硬度亦不断增加.培养1周有软骨细胞陷窝形成,2周后形成富含Ⅱ型胶原和蛋白聚糖、具有典型软骨组织结构的工程化软骨,且Ⅰ型胶原逐渐转为阴性.4周时构建软骨的组织结构与天然骺板软骨相类似,硫酸GAG含量平均为天然骺板软骨的34%以上. 结论骺板软骨细胞复合三维支架体外培养可生成典型软骨,且可形成类似天然骺板软骨的组织结构,能满足修复骺板缺损的基本要求.体外培养1～2周可能是植入体内修复骺板缺损的较佳时机.     

改良上颌平面导板矫正青少年深覆颌的临床观察

目的观察改良上颌平面导致矫正青少年深覆颌的效果。方法制作上颌平面导板,下颌双侧尖牙与其接触,后牙抬高3.0 mm。分为昼夜戴用导板及仅夜间戴用导板两组,观察疗效。结果深覆颌总矫正率72.2%,昼夜戴用该改良上颌平面导板组的深覆颌矫正率100%。结论改良上颌平面导板制作简单,戴用方便,效果明显。     

旋入式髓内钉与加压钢板治疗股骨骨折的临床研究

目的观察用旋入式髓内钉和加压钢板治疗股骨骨折的疗效,探求一种更好的治疗方法。方法2001年1月至2002年6月间对18例股骨中段新鲜骨折及骨折不愈合行旋入式髓内钉治疗。与20例采用加压钢板治疗股骨骨折的疗效进行对比、分析。结果旋入式自锁髓内钉固定术后骨折全部临床愈合,愈合时间5～10个月,平均8个月,髋、膝关节伸屈功能及行走正常,未发生感染、无延迟和不愈合,无髓内钉断裂及再骨折发生。用加压钢板内固定术后,出现骨折不愈合1例,内固定松动拔钉1例,钢板断裂1例。两种方法对比,差异有统计学意义(P<0.05)。结论旋入式自锁髓内钉具有轴向加压、抗分离和抗旋转的功能,手术操作简便,不损伤骨外膜,疗效可靠,是治疗股骨中段骨折一种有效的手段。     

髓内植骨加压钢板固定治疗下肢骨折不愈合

本文报告采用自体半侧腓骨髓内植骨、髂骨充填骨缺损区、梯型加压钢板固定的术式治疗21例下肢骨不愈合.随访6～49个月,疗效满意.通过动物实验证明,长节段自体皮质骨髓腔内移植后,6～12周血运恢复,12～24周与宿主骨愈合并被新骨取代.其固定作用由最初的单纯机械固定逐渐自然转变为生物性固定.     

The extracellular matrix of cartilage in the growth plate before and during calcification: Changes in composition and degradation of type II collagen

Summary Calcification occurs in the extracellular matrix of the hypertrophic zone of the growth plate when the extra-cellular matrix volume is reduced to a minimum and alkaline phosphatase content is maximal. The present study shows that significant quantitative and qualitative changes occur in the composition and structure of macromolecules in the extracellular matrix before and during calcification in the proximal tibial growth plate of the bovine fetus. These were detected in part by using microchemical and microimmuno-chemical analyses of sequential transverse frozen sections at chemical analyses of sequential transverse frozen sections at defined sites throughout the growth plate. Concentrations of matrix molecules in the extracellular matrix have not previously been determined biochemically. They were measured per unit matrix volume by using combined immunochemical/chemical-histomorphometric analyses. The concentrations within the extracellular matrix of the C-propeptide of type II collagen, aggregating proteoglycan (aggrecan), and hyaluronic acid all progressively increased in the maturing and hypertrophic zones, being maximal (or near maximal) at the time of initiation of mineralization. These results for proteoglycan are contrary to some earlier reports of a loss of proteoglycan prior to mineralization which measured the tissue content of proteoglycan rather than that present in the extracellular matrix, the volume of which is progressively reduced as the growth plate matures. The C-propeptide data provides a quantitative confirmation of previous immunohistochemical studies. Total collagen concentration (measured as hydroxyproline) in the extracellular matrix initially increased through the proliferating and maturing zones but then rapidly decreased in the hypertrophic zone. Immunohistochemical studies revealed that this is associated with the unwinding of the triple helix of type II collagen (previously shown to result from cleavage) which starts in pericellular sites in the zone of maturation (when type X collagen is first synthesized) and then extends throughout the hypertrophic zone. The significance of these matrix changes in the development and mineralization of the growth plate is discussed.     

Capacitively coupled electrical stimulation of bovine growth plate chondrocytes grown in pellet form

Pellets formed from isolated bovine growth plate chondrocytes were grown in various capacitively coupled electrical fields. The signals chosen were 0, 10, 100, 250, 500, 750, 1,000, and 1,500 V peak-to-peak, 60 kHz. The effect on cell proliferation and matrix production of these different voltages was determined by [3H]thymidine and [35S]sulfate uptake, respectively, Cyclic AMP assays were done to determine if increases in either thymidine or sulfate uptake were associated with changes in cAMP levels. Significantly increased cell proliferation occurred at 500, 750, and 1,000 V peak to peak. The calculated electric fields were 1.5 to 3.0 x 10(-2) V/cm. Proliferation was significantly inhibited at 1,500 V peak-to-peak with a calculated field of 4.5 x 10(-2) V/cm. Little if any change was seen in cAMP levels at 30 or 60 min following application of the appropriate electric signals.     

颈椎侧块钢板在脊髓型颈椎病治疗中应用

目的 对15例脊髓型颈椎病患者行后入路椎管减压、椎板成型术的同时使用颈椎侧块钢板固定，探讨和分析该手术方法的优点和手术治疗效果。方法 从自2000年3月—2002年12月，对15例脊髓型颈椎病患者(术前颈椎MR显示有三个节段颈椎椎间盘水平病变并有黄韧带增厚突入椎管)，行颈椎后入路双开门椎板成型术加双侧颈椎侧块钢板固定。按JOA评分法评定患者手术前后恢复情况。结果 本组患者男10例，女5例，随访5个月—1年2个月，平均9个月，术后2—7天(平均3．5天)可戴颈围坐起，颈围外固定时间12周，融合时间3—5个月，(平均为3．5个月)，术后JOA评分明显提高，所有病人无术中血管、神经根损伤，无植骨不愈合，无内固定断裂。结论 行颈椎后入路双开门椎板成型术联合应用颈椎侧块钢板固定，从后方扩大椎管容积，对脊髓进行减压，辅助以侧块钢板对减压后的颈椎行即时的稳定的固定，增加后方所植髂骨的融合成功率，大大地减少颈椎术后后突畸形发生和术后卧床并发症的发生率。     

颈椎前路钢板在脊髓型颈椎病前路手术中的作用

目的 评价内固定在脊髓型颈椎病前路减压中的作用。方法 143例脊髓型颈椎病患者经前路减压后自体髂骨植骨，带锁钢板内固定。获得随访病例132例，随访时间平均20个月，观察术后神经功能恢复情况，植骨融合率，椎间高度及颈椎生理曲度恢复情况。结果 单节段与两节段病变者术后3月均获得骨性愈合，融合率为100％，16例3节段病变者融合体为81．3％，内固定并发症为5／132(3．8％)。术后椎间高度与生理曲度均获得满意重建。JOA记分平均改善率65．8％。结论 在脊髓型颈椎病前路减压手术中应用带锁钢板内固定可有效维持椎间高度和生理曲度，并有助于后路间接减压。     

基于组合不变量配准的数字减影算法

在现代医学中，DSA是X光片血管可视化技术的重要组成部分之一，在DSA中图像配准对消除运动伪影起着关键作用。运用一种基于组合不变量的相似度测量的模板匹配和弹性TPS算法配准减影方法，并根据实际情况有所改进。经过试验证明这种方法可以自动并有效地去除运动伪影，其速度和血管图像质量均比较理想。     

生物胶复合物加解剖钢板内固定治疗胫骨平台骨折

目的探讨生物胶复合物加解剖钢板内固定治疗胫骨平台骨折的临床效果。方法采用切开复位、生物胶复合物植骨加解剖型支撑钢板内固定治疗胫骨平台骨折28例,受伤至手术时间5～10d,植入复合物量为3～8g。结果所有患者均获随访,随访6～24个月,全部骨折均获得临床愈合,未见关节面下陷,生物胶复合物中羟基磷灰石未见移动及吸收,治疗效果参照M echant评分标准,优13例,良11例,可3例,差1例,总优良率达85.3%。结论生物胶复合物加解剖钢板内固定治疗胫骨平台骨折的临床效果良好。生物胶复合物具有较强的成骨能力,可修复骨缺损。