髋关节外科脱位死骨清理打压植骨治疗ⅢA、ⅢB期股骨头无菌性坏死

目的 探讨髋关节外科脱位死骨清理打压植骨治疗ⅢA、ⅢB期股骨头无菌性坏死(ANFH)的临床疗效。方法 回顾性分析2012年6月—2014年12月南京中医药大学附属医院骨伤科关节组收治的6例8髋ⅢA、ⅢB期ANFH患者的临床资料。其中男3例5髋,女3例3髋;年龄26～44岁,平均36岁。均采用髋关节外科脱位死骨清理打压植骨治疗;术后观察股骨头有无塌陷、截骨块愈合情况,及手术前后Harris评分改变情况;术后6个月采用Harris评分标准评定疗效。结果 6例患者均顺利完成手术。并得到随访,随访时间5～29个月,平均18.6个月。1例(1髋)患者术后2个月出现不明原因发热及手术切口周围肿痛,予抗感染、镇痛治疗后症状完全缓解。1例(1髋)患者术后12个月出现股骨头塌陷>4 mm且疼痛伴活动受限,准备行人工关节置换手术;其余患者截骨块均愈合。Harris评分由术前的(54.57±8.16)分提高到术后的(80.53±7.62)分,差异有统计学意义(t=12.797, P<0.01)。术后6个月评定疗效:优,4例5髋;良,1例2髋;差,1例1髋。结论 髋关节外科脱位死骨清理打压植骨治疗ⅢA、ⅢB期ANFH可以取得良好的短期临床疗效,尤其对于年轻患者是一种可以选择的保髋方法。     

假体周围骨折与骨质疏松

骨质疏松与假体周围骨折的发生密切相关。骨质疏松状态下假体周围骨折的预防需从改善局部骨量和预防跌倒入手。检测关节假体周围的骨密度可用于评估假体周围骨折的风险。在对骨质疏松状态下假体周围骨折进行手术治疗时,可使用骨移植替代材料来增加骨折部位固定的强度,也可使用改进型的内固定材料或翻修假体来提高手术的成功率。     

重度牙周炎致牙齿松动脱落患者前牙美学区综合治疗1例报告及文献复习

目的：探讨重度牙周炎致前牙松动脱落患者的治疗和美学修复,阐明多学科综合治疗对前牙美学区的治疗效果,为其临床应用提供参考。方法：患者,男性,57岁,因上下前牙松动不适半年余就诊。专科检查见11、21、22、41松动Ⅲ°,42松动Ⅱ°。经多学科会诊后,行牙周基础治疗,炎症控制后,拔除11、21、22、41、42并行即刻种植,富血小板纤维蛋白（PRF）联合引导骨再生（GBR）技术修复种植体周围骨缺损。因患者美学要求,12、13、23、31、32、33、43根管治疗后行牙体预备,13-23、33-43行固定修复。结果：种植术后显示种植体位置良好,种植体周围骨量充足,口内见牙龈软组织愈合良好,牙槽嵴丰满度较好;修复完成后较好地恢复了患牙的咀嚼发音功能,患者对美学效果满意。结论：通过多学科综合治疗的应用,成功实现了对重度牙周炎患者前牙美学区的种植修复,为前牙美学区的诊疗开辟了新途径。     

全膝关节置换治疗严重膝关节疾病

背景：膝关节畸形施行人工全膝关节置换难度大,涉及面多,包括手术入路、术中截骨、软组织松解顺序、方法及程度、软组织平衡等,专家学者各不相同,意见不统一,争议较多。 目的：探讨全膝关节置换治疗成人严重膝关节疾病的手术方法和临床疗效。 方法：纳入42例(48膝)严重膝关节疾病合并畸形患者,均采用后稳定型假体进行全膝关节置换,由髌骨内侧入路,正确截骨,选择性的软组织松解,恢复膝关节正常的力线和软组织平衡,获得膝关节稳定,置换后采取针对性的康复训练,定期随访检查膝关节活动度、最大屈曲度并进行HSS评分、WOMAC 评分。 结果与结论：所有患者均获得随访,随访时间为25-84个月,平均35.5个月。所有患者置换治疗后膝关节活动度、膝关节最大屈曲度、HSS评分、WOMAC评分较置换前比较,均显著提高,差异有显著性意义(P < 0.01)。置换后切口均Ⅰ期愈合,无膝关节僵硬、血管及神经损伤、髌骨骨折、髌骨低位、假体松动等并发症发生,下肢力线均恢复正常。说明成人严重膝关节畸形经全膝关节置换,置换后畸形均得到纠正,功能较前明显改善,临床效果满意。     

手术室全程无菌管理预防无菌手术感染的效果及影响因素分析

目的：观察分析手术感染的影响因素,探析手术全程无菌管理预防无菌手术感染的效果。方法回顾性分析2014年1月至2015年10月行无菌手术治疗患者的临床资料,分析2014年度手术感染发生情况及影响因素,据此制定并完善手术室全程无菌管理方案,于2015年1月实施并分析效果。结果术前住院时间、抗菌药物应用不规范、参观人数(≥3人)、手术类型、切口类型、手术植入物、手术时间、手术室空气含菌量、接台手术、手卫生不达标、侵入性操作不规范、手术器械和手术室物品清洁不达标、无菌操作不严格、手术室温度和湿度不适宜、一次性医疗用品处理不合理等均为手术感染的影响因素( P<0.05);2015年1月至10月手术感染率明显低于2014年1月至12月(χ2=36.1912,P=0.0000)。结论手术全程无菌管理后无菌手术术后感染率明显降低,预防效果良好,可在手术室管理中推广应用。     

Osteogenesis,angiogenesis and anti-aseptic loosening of europium-doped calcium polyphosphate bone tissue engineering scaffold北大核心

BACKGROUND: The clinical success of bone grafts depends not only on osteogenesis, but also on angiogenesis, and the ability to inhibit osteoclast-mediated bone resorption. Therefore, it is particularly important to develop bio-scaffold materials with multiple functions. OBJECTIVE: To improve various problems of traditional bone repair materials, such as low mechanical strength, poor vascular promoting ability, and insufficient osteoinductive ability through the doping of trace elements. METHODS: A series dose of Eu (0%, 1%, 3%, 5% and 7%, molar ratio) was incorporated into calcium polyphosphate scaffolds by high temperature sintering to achieve a multifunctional europium-doped calcium polyphosphate. Infrared spectroscopy, X-ray diffraction analysis, X-ray photoelectron spectroscopy, scanning electron microscopy, mercury intrusion method and compressive strength test were used to characterize its structure, crystal form, element composition, pore size distribution, and mechanical properties. The europium-doped calcium polyphosphate scaffold was co-cultured with mouse embryonic osteoblast precursor cells and human umbilical vein endothelial cells. Biological performance was evaluated through cell proliferation detection, scanning electron microscope, laser scanning confocal microscope, and enzyme-linked immunosorbent assay. RESULTS AND CONCLUSION: (1) The doping of Eu3+ did not change the main chain structure and crystal form of calcium polyphosphate, but it could stabilize the pore size distribution within 200-400 μm, which was conducive to bone ingrowth. (2) Compared to pure calcium polyphosphate materials, the crystal grains of europium-doped calcium polyphosphate scaffolds were bonded more closely and ranged well-ordered, which were beneficial to improve mechanical strength of materials. (3) The surface roughness of europium-doped calcium polyphosphate scaffolds was conducive to cell adhesion and spreading. Mouse embryonic osteoblast precursor cells and human umbilical vein endothelial cells seeded on europium-doped calcium polyphosphate scaffolds presented better proliferation and migration, especially 5% group. (4) The secretion of four growth factors (alkaline phosphatase and osteopontin, and human umbilical vein endothelial cells secreted vascular endothelial growth factor and matrix metalloproteinase 9) from co-cultured cells seeded on europium-doped calcium polyphosphate scaffolds was enhanced, which was conducive to the proliferation and differentiation of osteoblasts, especially 5% group. (5) 5% europium-doped calcium polyphosphate significantly up-regulated the ratio of osteoprotegerin/nuclear factor kappa B receptor activator ligand from osteoblast so that it had a potential efficacy to inhibit bone resorption, thus acted as an effect of alleviating aseptic loosening. (6) The above results show that the 5% europium-doped calcium polyphosphate scaffold has the potential to accelerate angiogenesis/osteogenesis and inhibit bone resorption, which is a promising multifunctional biomaterial. © 2022, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

Laminar periostitis and multiple osteonecrosis in systemic lupus erythematosus

Summary Bone affectation in systemic lupus erythematosus (SLE) is caused both by the disease itself and by the treatment used. We report the case of a woman diagnosed of SLE, who, in the course of her illness, develops multiple aseptic osteonecrosis (AON) and laminar periostitis, radiologically compatible with the diagnosis of hypertrophic osteoarthropathy (HOA), with no evidence of acropaquia. In this case, the patient shows all the risk factors involved in the pathogenesis of the development of ischemia in bone microcirculation.     

介入治疗股骨头无菌性坏死的疗效观察

目的：探讨介入治疗股骨头无菌性坏死的疗效。方法：采用经外周动脉穿刺插管的方法，经血管造影明确供血血管的位置，经导管向其内灌注扩张血管药、舒筋活血中药和溶栓药物，以改善股骨头供血状况；并追综随访1—3年，根据杨白明评定标准从疼痛、功能、X片3个方面进行判定，观察其临床症状的改善。结果：Ⅰ～Ⅲ期股骨头无菌性坏死病人的临床症状减轻，甚至消失；痊愈50％、显效25％、有效15％，（p〈O．05）。结论：通过对介入治疗股骨头无菌性坏死的疗效观察，发现其介入治疗Ⅰ～Ⅲ期股骨头无菌性坏死的疗效显著。     

Shear fatigue micromechanics of the cement–bone interface: An in vitro study using digital image correlation techniques

Loss of fixation at the cement–bone interface is known to contribute to aseptic loosening, but little is known about the mechanical damage response of this interface. An in vitro study using cement–bone specimens subjected to shear fatigue loading was performed, and the progression of stiffness changes and creep damage at the interface was measured using digital image correlation techniques. Stiffness changes and creep damage were localized to the contact interface between cement and bone. Interface creep damage followed a three‐phase response with an initial rapid increase in creep, followed by a steady‐state increase, concluding in a final rapid increase in creep. The initial creep phase was accompanied by an increase in interface stiffness, suggesting an initial locking‐in effect at the interface. Interface stiffness decreased as creep damage progressed. Power law models were reasonably successful in describing the creep and stiffness damage response and were a function of loading magnitude, number of loading cycles, and contact area at the interface. More microcrack damage occurred to the cement when compared to the bone, and the damage was localized along the interface. These findings indicate that damage to the cement–bone interface could be minimized by improving cement–bone contact and by strengthening the fatigue resistance of the cement. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:340–346, 2009