骨内植入式药物缓释系统载体材料研究现状及进展

植入式药物缓释系统在治疗骨科感染、肿瘤等方面具有良好的作用。随着组织工程学的进展,研制了不同的材料作为骨内植入式药物缓释系统的载体,拟对骨内植入式药物缓释系统载体材料研究现况及进展进行综述。     

日间手术结合移动医疗模式在医院管理运行中的探索———骨科前交叉韧带损伤的疗效分析

目的以膝关节前交叉韧带（ACL）损伤病例的疗效为切入点，探讨日间手术结合移动医疗模式在医院管理运行中的可行性。方法150例ACL损伤患者按随机数字表法分成两组，分别采取日间手术+移动医疗模式（观察组）、传统住院手术（对照组）治疗，每组75例。术后随访12个月，比较两组患者手术效果、住院时间及医疗费用。结果两组患者术后均未发生膝关节僵硬、膝关节感染、血管损伤、神经损伤等并发症，轴移试验均阴性。观察组术后膝关节前后及旋转的稳定性均较好71例，前抽屉试验阳性2例，Lachman试验阳性2例；对照组术后膝关节前后及旋转的稳定性均较好69例，前抽屉试验阳性1例，Lachman试验阳性5例；两组患者术后膝关节试验结果比较，差异无统计学意义（P＞0.05）。观察组、对照组术后12个月Lysholm膝关节评分均明显高于术前（均P＜0.05），手术前后两组间比较差异均无统计学意义（均P＞0.05）。观察组住院时间及医疗费用均低于对照组，其中医疗费用两组间比较差异有统计学意义（P＜0.05）。结论临床上应用日间手术结合移动医疗模式是可行的，能降低患者住院时间及医疗费用，提高医疗资源利用率。     

载药型骨修复材料研究现状与展望

载药型骨修复材料是由多种药物与骨修复材料相复合而构成,通常填充于各种原因所致的骨组织缺损,发挥修复骨缺损和局部释放药物治疗的作用,具备药物释放时局部浓度高、全身血药浓度低、降低药物不良反应等优点,因此受到广泛关注并应用于骨科感染、肿瘤、骨折和人工关节置换等领域.     

Biocompatibility of KLD-12 peptide hydrogel as a scaffold in tissue engineering of intervertebral discs in rabbits

KLD-12 peptide with a sequence of AcN-KLDLKLDLKLDL-CNH2 was synthesized and its biocompatibility was assessed in animals. Rabbit MSCs were cultured in the hydrogel for 2 weeks. Live cells were counted by using Calcein-AM/P1 fluorescence staining. MTT was employed to assess the viability of MSCs cultured in KLD-12 peptide solution of 0.01%, 0.03%, and 0.05%. Hemolysis test, skin irritation test and implantation test were conducted to evaluate its biocompatibility with host tissues. Our results demonstrated that the MSCs in hydrogel grew well and maintained round shape. Cell survival rate was 92.15% （mean： 92.15%±1.17%） at the 7th day and there was no difference in survival rate between day 7 and day 14. Cell proliferation test showed that the A value of the KLD-12 solutions was not significantly different from that of control groups （complete culture media） （P〉0.05） at the 24th and 48th h. The hemolysis rate of KLD-12 solution was 0.112%. Skin irritation test showed that the skin injected with KLD-12 solution remained normal and the score of skin irritation was 0. The histological examination with HE staining exhibited that the skin layers were clear and there was no infiltration with neutrophilic granulocytes and lymphocytes. It is concluded that KLD-12 peptide hydrogel bad a good biocompatibility with host rabbit and MSCs, and KLD-12 pep- tide hydrogel can provide an appropriate microenvironment for MSCs.     

蝙蝠葛碱对大鼠局灶性脑缺血及线粒体氧化损伤的保护作用

目的 观察蝙蝠葛碱(dauricine，Dau)对大鼠局灶性脑缺血及线粒体氧化损伤的保护作用。方法 用尼龙线栓阻塞大脑中动脉(MCAO)24h制备大鼠局灶性脑缺血模型，红四氮唑(TTC)染色法测定脑梗死体积，干湿重法测定脑组织含水量，5级评分法判定神经功能缺损，同时记录缺血前、缺血5min及24h脑电图(EEG)波形；用双侧颈总动脉反复结扎3次再灌注30min制备大鼠不完全脑缺血模型，生化法测定脑皮层细胞线粒体氧化损伤指标的变化。结果 Dau(21、42及84mg／kg)明显缩小局灶性脑梗死体积，减少脑组织含水量，改善神经功能缺损及脑电图波幅下降；提高反复脑缺血再灌注损伤后大鼠脑皮层线粒体超氧化物歧化酶(Cu-ZnSOD)及谷胱甘肽过氧化物酶(GSH-Px)活性，降低丙二醛含量。结论 Dau对大鼠局灶性脑缺血及线粒体氧化损伤具有保护作用。     

基于三维打印技术的多药控释型载药人工骨生物学评价

目的 评价三维打印技术制备的多药控释型载药人工骨的生物相容性.方法 利用三维打印技术制备多药控释型载药人工骨,并进行急性毒性试验、热源试验、皮肤刺激试验、溶血试验、微核试验和肌肉埋植试验等检测评价其生物相容性.结果 该多药控释型载药人工骨无全身急性毒性反应、无热源效应;皮肤刺激实验局部皮肤未见红斑、水肿反应;溶血率为0.29%,有良好的血液相容性;微核实验未见致突变现象.无细胞遗传毒性作用;肌肉埋植实验未见局部组织变性、坏死或排斥现象.结论 三维打印技术制备的多药控释型载药人工骨具有良好的生物相容性,符合医用生物材料的性能要求. Abstract： Objective To evaluate the biocompatibility of porous drug implant scaffolds prepared by 3D printing technique. Methods Porous drug implant scaffolds were fabricated by 3D printing technique, and a series of tests were carried out to validate the biocompatibility, including acute systemic toxicity, hot source test, local irritation reaction, micronucleus test, muscle implant test and so on. Results The porous drug implant scaffolds showed no acute systemic toxicity, no pyrogenetic effect, no local erythema and edema in local irritation re-action, hemolysis rate of 0.29%, no cellular genetoxic. No local tissue denaturation, necrosis and exclusion were found in intramuscular implant test. Conclusion With good biocompatibility, the porous drug implant scaffold fabricated by 3D printing technique can meet the clinical requirement for biomaterial.     

髌股关节置换术治疗单纯髌股关节骨关节炎

 目的 探讨髌股关节置换术治疗单纯髌股关节骨关节炎的疗效和影响因素。方法 回顾性分析2006年3月至2014年12月,采用髌股关节置换术治疗并获得随访的18例单纯髌股关节骨关节炎患者资料,男3例,女15例;年龄46~74岁,平均54岁;术前美国特种外科医院膝关节评分（hospital for special surgery knee score,HSS）为44~63分,平均（53.28±5.71）分;疼痛视觉模拟评分（visual analogue scale, VAS）为4~7分,平均（5.33±0.99）分。术前根据临床症状、体征和影像学资料严格把握手术指征,其中11例采用AVON髌股关节假体（Stryker公司）,7例采用Gender Solutions髌股关节假体（Zimmer公司）。术后第1天患膝即开始行主动和被动功能康复锻炼。结果 18例患者术后均获得随访,随访时间6~104个月,平均63.98个月。VAS,术后1个月（1.17±0.79）分（范围,0~3 分）,术后3个月（0.72±0.67）分（范围,0~2 分）,术后9个月疼痛基本消失;HSS,术后1个月（70.06±6.33）分（范围,61~80分）,术后3个月（86.06±5.12）分（范围,77~95分）,术后9个月（91.39±4.83）分（范围,82~97分）,末次随访（92.06±4.05）分（范围,84~97分）,其中优15例、良3例,优良率100%,较术前有明显改善。患者主观满意率94.4%（17/18）。1例患者术后2年再次出现上下楼梯时膝前疼痛,给予非甾体类抗炎药和适当减少活动后症状缓解。随访期间无一例患者出现切口感染、髌骨脱位、假体松动等并发症。结论 髌股关节置术后疗效与手术适应证、假体设计、手术技巧等因素密切相关,在选用合适的髌股关节假体、严格把握手术适应证、掌握好手术技巧及积极术后康复功能锻炼等基础上,采用髌股关节置换术治疗单纯髌股关节骨关节炎可以获得良好的疗效。     

Repair of Rabbit Femoral Defects with a Novel BMP2-derived Oligopeptide P24

In this study, the bioactivity of a novel BMP2-derived oligopeptide P24 was investigated by using the model of rabbit femoral defect after loaded in the biodegradable poly （lactic acid / glycolic acid / asparagic acid-co-polyethylene glycol） （PLGA-[ASP-PEG]）. A 1.5-cm unilateral segmental bone defect was created in the left femoral diaphysis in each of the 30 new zealand white rabbits. The defects of 18 legs filled with BMP2-derived peptide P24 combined with PLGA-[ASP-PEG] scaffold serves as the experimental group, and the defects in the rest 12 rabbits filled with （PLGA-[ASP-PEG]） without P24 as control group. The bone-repairing capability in the target region of the two group was grossly, radiologically, histopathologically and biomechanically evaluated 4, 8 and 12 weeks after the operation. Our results showed that in each group, primary healing of incision was achieved in the two groups. Radiographically, in experimental group, defects were filled with induced callus within 8 weeks, and a cortical bone-like structure was observed in some animals at the 12th week. According to the standardized stage of bone defect repair, 9 （64.28%） achieved grade-4 healing. In contrast, little bone formation was seen in the defects even 12 weeks after the operation, and 5 （62.50%） had grade 0 healing in this group. Histologically, tissue engineering material was mostly absorbed and cartilage was found around implants in the experimental group at the 4th week; 8 weeks after operation, the engineering material was completely absorbed, and formation of woven bone was observed and typical trabecular bone structure could be seen. In control group, 8 weeks after operation, the defect was filled with fibrous tissues, and no bone-like structure was observed. Statistical analysis showed very significant difference in biomechanical indicators between the two groups （P〈0.05）. It is concluded that new oligopeptide P24 can induce excellent bone regeneration and promote bone repair.     

快速成型技术在骨科的应用研究进展

快速成型技术是20世纪80年代中期发展起来的,它是在计算机控制下,根据物体的CAD模型或CT等数据,不借助其他设备,通过材料的精确堆积,制造原型的一种基于离散、堆积成型原理的新的数字化成型技术;近年来通过与螺旋CT或核磁共振等检测手段的三维图像重建功能相结合,在骨科领域显示出良好的应用前景。综述了该技术在骨科领域内的器官模型制备和手术策划、个体化假体制备、骨组织工程多孔支架制备等主要应用方向的研究进展。     

组织工程多孔支架材料制备技术的研究进展

组织工程多孔支架材料作为组织工程学的三大要素之一,除本身的性质外,支架材料的形状、孔径大小和孔隙率都直接影响着种子细胞的黏附、增殖和分化,因此如何制备具有高孔隙率、孔径大小合适且内部联通的多孔支架材料.为种子细胞的生长提供良好的微环境是非常重要的.回顾了近年来发展的组织工程多孔支架材料制备技术:纤维粘接法、乳液冷冻干燥法、溶液浇注,沥滤法、气体发泡法、热致相分离法及静电纺丝法.并重点介绍了目前国内外研究较多的快速成形技术;总结分析认为各种基本制备技术的联合应用和具备结构高度可控性、个体化制备特点的快速成形技术将是今后组织工程多孔支架材料制备技术的发展方向.