软组织多种细菌混合感染3例

软组织多种细菌混合感染系机体生态失调,多种致病菌侵犯软组织,扩散蔓延,液化坏死.利用常规的抗炎、清创、截肢不能控制病情的发展.本症国内外尚未见报道.继"杨晓霞疑难病"在本院治愈后,先后又收治类似患者2例,均细菌学确诊,经本院综合治疗痊愈,长期随访未复发.现报告如下:     

组织工程方法异体骨复合物修复关节置换时骨缺损

目的：观察植入骨形态发生蛋白红骨髓异体骨复合物修复关节置换时骨缺损的疗效。方法：15例因多种疾患施行初次髋、膝或肩关节置换术，假体受区有骨包容性缺损需植骨。将骨形态发生蛋白、红骨髓、异体松质骨体外构建成复合物，即刻植入骨缺损区，然后再置入假体。结果：平均随访40个月。术后移植骨新骨替代较快，无吸收，骨缺损修复满意，假体无松动。结论：骨形态发生蛋白、红骨髓、异体骨构建成复合物，使坏死区成骨能力增强，可作为修复关节置换时骨缺损的一种选择。     

双动半髋关节成形术7年随访

在缺乏确实有效预防办法的情况下,股骨颈骨折的处理仍有赖于矫形外科。因此,有必要研究一种最有效,也是最经济的治疗方法,半关节成形术是一些学者喜用的处理老年人囊内股骨颈骨折的方法。但以往的报道中,都有一定比例的髋臼磨损,这种并发症导致5～24％的病例施行假体修整术。为减少髋臼磨损,在Batmen(1974)设计的基础上应用双动关节假     

富集自体骨髓干细胞移植治疗早期股骨头缺血性坏死

目的观察移植富集的自体骨髓干细胞＋异体骨＋骨形态发生蛋白治疗青壮年股骨头缺血性坏死的疗效。方法将富集的自体骨髓干细胞＋异体腓骨＋部分纯化制品牛骨形态发生蛋白（bBMP）植人股骨头减压区,治疗FicatⅠ、Ⅱ、Ⅲ期青壮年股骨头缺血性坏死。共50例（86髋）采用该治疗方法。结果随访时间3个月-10年,平均54个月。其中45例（80髋）FicatⅠ、Ⅱ期患髋无明显疼痛及功能受限,CT显示形成密度较高的新骨,病变范围及程度无发展。在5例（6髋）FicatⅢ期病例,其中2例无明显疼痛及活动受限,病变无进展,3例因症状无明显改善而行人工关节置换术。结论富集自体骨髓干细胞＋异体骨＋骨形态发生蛋白植入治疗青壮年股骨头缺血性坏死,增强股骨头缺血性坏死负重区软骨下骨机械支撑力和成骨能力,以防止股骨头进一步塌陷,达到促进青壮年股骨头缺血性坏死区域进行修复与重建目的,为早期股骨头缺血性坏死的治疗提供了另一新的更为有效的治疗途径。     

BMP调控成骨细胞生物活性的实验研究

目的 探讨骨形态发生蛋白（bone morphogenetic protein,BMP）对培养的正常人成骨细胞主要生物学行为的影响。方法分别以0．02、0．1、1μg/m3种浓度的BMP作用于成骨细胞,通过MTY法了解BMP的效应。以0．1μg/ml浓度的BMP作用于成骨细胞,测定BMP对成骨细胞碱性磷酸酶（alkaline phospbatase,ALP）活性及骨钙素（bone gla protein,BGP）合成等主要生物学特性的影响。结果BMP作用于成骨细胞,能促进ALP活性及BGP的合成。结论BMP能促进成骨细胞活性,并且其促进成骨增殖的效能具有浓度依赖性。     

Effect of nano-hydroxyapatite／collagen composite and bone morphogenetic protein-2 on lumbar intertransverse fusion in rabbits

Objective: To investigate the effect of nanohydroxyapatite/collagen (nHA/collagen) composite as a graft extender and enhancer when combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) on lumbar intertransverse fusion in rabbits. Methods: Sixty-four adult female New Zealand white rabbits, aged 1 year and weighing 3.5-4.5kg, underwent similar posterolateral intertransverse process arthrodesis and were randomly divided into 4 groups based on different grafts: autogenous cancellous bone alone (ACB group), nHA/collagen alone ( HAC group ), half autogenous cancellous bone and half nHA/collagen (ACB HAC group) and nHA/collagen combined with rhBMP-2 (HAC BMP group ). The fusion masses were analyzed by manual palpation, radiography, biomechanical testing and histological examination. Results: Fusion was observed in 4 cases in the 6th week and in 5 cases in the 10tb week after surgery in ACB group. No case showed fusion in HAC group. In ACB HAC group, there was fusion in 3 cases in the 6th week and in 4 cases in the 10th week after surgery. In HAC BMP group, fusion in 1 case was found in the 4th week, in 5 cases in the 6th week and in 6 cases in the 10th week after surgery. It suggested that ACB, ACB HAC and HAC BMP groups showed similar fusion ratio and mechanical strength in the 6th and 10th week after surgery. According to the microstructure analysis of the samples, nHA/collagen had no negative effect when implanted together with ilium autograft. In HAC BMP group, new bone-like tissue was observed in the 2nd week postoperatively, and nearly all of the implanted composites were replaced by mature bone matrix and new bones in 10th week postoperatively. Conclusions：The nHA/collagen, especially combined with rhBMP-2, is a promising bone substitute, for it has quick biodegradation, fine bone-bending ability, and high osteoconductivity on posterolateral spinal fusion in rabbits.     

先天性无痛症并发下肢夏科氏关节1例

病例:男,11岁,三岁时被发现双足踝关节无痛性肿胀,曾在多家医院就诊,先后被诊断为“双踝关节结核”及“踝部骨折”,分别给予抗痨药物治疗及石膏外固定制动,病情减轻。其后双踝关节随生长发育反复肿胀。1992年3月患儿又因双踝关节无痛性肿胀入我院。详询病史,患儿2岁时被发现对疼痛不     

儿麻髋部畸形的矫治

近廿年来,我国广大医务工作者坚持长期不懈地努力,使儿麻后遗髋部畸形矫治工作有了飞速的进展,在许多问题认识趋向■致,治疗方法逐渐规范化。在实践中,创出了不少新技术,涌现出许多高水平的成果,积累了丰富的经验,为儿麻后遗症的矫治作出了萱大贡献。当然,仍有些问题需进一步探讨,改进方法,提高疗效。1儿麻髋部畸形的成因 过去对髋部畸形的矫正常用“头痛医头,脚痛医脚”的方法,效果较差。为提高效果,经深入研究,一致认为髋部畸形的原因主要来自:①动力性不平衡:髋关节是连接躯干和下肢的多轴杵臼关节,周围的肌肉分为屈伸、收展和旋转三对拮抗肌群,任何一个肌群肌力减弱或消失,拮抗组的肌力相对增加;②静力性不平衡:由于无正常的肌力平衡,克服重力影响以维持肢体姿势,处于异常状态;     

利用腰大肌腱悬吊股骨头治疗麻痹性髋脱位

作者用腰大肌腱悬吊股骨头的术式,主要适用于麻痹性髋脱位。临床应用6例,同期施行了臀肌重建4例,SaHer氏截骨术3例,股骨上端内翻截骨2例,经3.5年以上随访,效果满意。本法的主要优点是增加了髋关节稳定性,改善了功能,对儿童不会损伤股骨头骨骺。