个体化假体复合组织工程技术修复兔下颌骨缺损

目的研究快速成型（RP）技术辅助下制作的个体化假体复合珊瑚羟基磷灰石（CHA）、重组人骨形成蛋白2（rhBMP-2）修复兔下颌骨缺损的成骨效果。 方法以27只新西兰大白兔为实验对象，随机数字表法平均分成3组（每组9只），全部建立下颌骨连续性缺损模型，并在兔下颌骨缺损区分别植入个体化假体+自体骨（A组）、个体化假体+CHA（B组）、个体化假体+CHA+rhBMP-2（C组）。分别于术后4、12、24周3个时间点处死动物取材，进行大体标本观察，以及骨钙素（OC）、Ⅰ型胶原（COL-1）的免疫组化观察，分别比较各组修复骨缺损的能力，并对实验数据进行重复测量设计资料的单因素方差分析。 结果术后24周各组实验兔外形均对称，通过OC及COL-1的吸光度检测，骨缺损区均有大量新骨形成，A组（0.537 ± 0.010）、C组（0.530 ± 0.010）可见大量骨小梁及编织骨结构，缺损区的新骨OC、COL-1的免疫组化观察基本一致，差异无统计学意义（t = 0.007，P>0.05）；但A组强于B组（0.415 ± 0.009，t = 0.122，P<0.001）；C组也强于B组（t = 0.121，P<0.001），差异均有统计学意义。 结论在兔下颌骨缺损修复中，通过RP技术和组织工程技术相结合，CHA复合rhBMP-2后成骨能力明显增强，成骨效能肯定，为后期的临床应用提供可靠的实验基础。     

混旋聚乳酸-纳米羟基磷灰石复合板固定下颌骨骨折的实验研究

目的 探讨混旋聚乳酸—纳米羟基磷灰石(poly DL lactide—nano—hydroxyapatite，PDLLA—nano HA)复合板(简称复合板)作颌骨骨折内固定的可行性。方法 在兔两侧下颁骨体部造成实验骨折，分别采用复合板和纯PDLLA板固定。在不同时期行大体观察、组织学检查，测量骨痂横截面积。结果 各时期骨折固定良好；术后第2、3周，各有1只动物的PDLLA板侧出现炎性包块，形成瘘道；复合板侧均正常愈合。术后2、3、4周时复合板侧骨痂形成量与对侧差异有显著性。组织学检查发现，骨折愈合早期复合板侧成骨细胞和成纤维细胞及其分泌的细胞基质更为丰富。结论 复合板在体内降解速度适中，对骨折愈合过程无不良影响，比纯PDLIA板更适用于颌骨骨折。     

纯钛表面快速沉积羟基磷灰石涂层的实验研究

目的探讨在纯钛种植体表面快速沉积羟基磷灰石涂层的新方法。方法20片纯钛片均分为A、B两组。A组用H2SO54与HCI混合液酸蚀；B组用H2SO4与HCI混合液酸蚀，再用5mol／L NaOH溶液60℃处理24h后，600℃热处理1h。然后两组试件同时置于仿生液A液和B液中各1天。场发射扫描电子显微镜观察分析涂层的形貌。结果两组试件表面均可沉积致密的羟基磷灰石涂层，涂层由1—3μm的小球组成。X射线衍射分析证实其为碳酸化的羟基磷灰石。结论在纯钛表面可以快速沉积碳酸化的羟基磷灰石。     

不同氟化物对人工羟基磷灰石摄氟量的影响

目的：探讨复合氟化物制剂（Co-F)及其组成成分中的氟化锌对牙齿无机质的影响。方法：将羟基磷灰石浸入各种氟化物溶液中，经过1、10d作用后，测定羟基磷灰石摄取氟量。应用与Co-F溶液相同氟浓度的氟化钠溶液作为对照。结果：发现浸入氟化锌溶液的羟基磷灰石摄取氟量最高。X线衍射分析有磷酸锌及氟化钙生成。浸入对照组氟化钠溶液的羟基磷灰石摄取氟量明显低于浸入Co-F溶液的羟基磷灰石摄取氟量。浸入Co-F溶液的羟基磷灰石1d及10d期间摄取氟量与浸入氟化锌溶液的羟基磷灰石摄取氟量相比较，没有显著性差异。结论：在羟基磷灰石摄取氟方面，复合氟化物制剂中氟化锌组分有重要的作用。     

三种牙本质脱敏剂治疗（牙合）支托窝牙本质敏感效果分析

目的观察比较诺华敏（NovaMin）、格鲁玛脱敏剂（Gluma）和劲润牙本质保护膜（HybridCoat）3种脱敏剂对验支托窝牙本质敏感治疗的效果。方法选择175颗制备验支托窝的天然牙,随机使用NovaMin、Gluma和HybridCoat进行脱敏,NovaMin组56颗,Gluma组60颗,HybridCoat组59颗,使用视觉模拟评分法记录其敏感度,比较其在连续脱敏5d后即刻、1个月、2个月和3个月的脱敏效果。结果3组患者（牙合）支托窝连续脱敏治疗后,NovaMin组在1个月（P=0．027）、2个月（P=0．023）时的脱敏有效率均高于Gluma组,Gluma组（P=0．040）和HybridCoat组（P=0.012）的即刻脱敏有效率均高于各自3个月时的脱敏有效率,但3个月时组间脱敏有效率差异均无统计意义（P〈0．05）。连续脱敏治疗后,NovaMin组的即刻VAS值高于Gluma组和HybridCoat组（P〈0．05）,而在治疗后1个月和2个月,NovaMin组的VAS值均低于另外2组（P〈0．05）,到3个月时,3组的VAS值差异无统计学意义（P〉0．05）。结论NovaMin脱敏效果持久性好于Gluma和HybridCoat。     

超声评价纳米羟基磷灰石胃十二指肠动脉注射对兔肝VX2肿瘤的抑制作用

目的利用多普勒超声显像技术评价纳米羟基磷灰石胃十二指肠动脉化疗对兔肝VX2肿瘤的抑制作用。方法将VX2细胞接种于20只新西兰兔肝,建立兔肝VX2模型。随机分2组,每组10只,分别采用生理盐水及纳米羟基磷灰石胃十二指肠动脉介入治疗。治疗前后用超声仪观察肿瘤大小及血流变化情况。结果羟基磷灰石胃十二指肠动脉化疗后的兔肝VX2肿瘤的体积(2.34±0.05)cm3及生长率(13.7%)与对照组的体积(5.02±0.08)cm3及生长率(80.7%)相比差异有统计学意义(P<0.05)。治疗前,所有兔肝VX2肿瘤病灶利用能量及彩色多普勒均可检出瘤体内部及周边较丰富血流信号;经纳米羟基磷灰石治疗组瘤体内部及周边血流信号相对于对照组明显减少(P<0.05)。结论纳米羟基磷灰石可有效抑制兔VX2肿瘤。多普勒超声显像技术能及时检测血流动力学改变,有效地对纳米羟基磷灰石治疗肝肿瘤的疗效进行评价。     

纳米羟基磷灰石/壳聚糖复合支架修复兔股骨髁临界性骨缺损的实验研究

目的 探讨纳米羟基磷灰石(nHA)/壳聚糖(CS)复合支架修复兔股骨髁临界性骨缺损的能力. 方法 取44只健康成年新两兰大白兔,于兔左侧股骨外侧髁建立临界性骨缺损(直径为6mm、深为10 mm)模型,随机分为3组:实验组(n=20):骨缺损处植入nHA/CS复合材料;对照组(n＝20):骨缺损处植入单纯CS;空白组(n=4):骨缺损处旷置,不植入任何材料.术后8、12周取材行大体观察、X线摄片、显微CT扫描及组织学观察,比较各组骨缺损的修复能力. 结果 术后12周X线片显示实验组骨缺损修复良好,骨皮质连续;对照组缺损区明显缩小,两断端不连接;空白组缺损区无明显骨痂生成.实验组和对照组Lane-Sandhu X射线评分平均分别为(10.18±0.98)、(8.90±0.99)分,两组比较差异有统计学意义(t=6.858,P=0.000).显微CT扫描显示:实验组骨缺损基本完全修复,股骨髁外形恢复正常;对照组骨缺损空腔大部分为新生骨组织填充,缺损区仍留有缺损;空白组骨缺损基本无修复.实验组和对照组CT值平均分别为(256.1±26.8)、(169.2±25.4)Hu,两组比较差异有统计学意义(t=4.711,P=0.003).术后12周组织学观察显示:实验组可见大量新生骨小梁,新生骨质与周围骨床之间无明显分界线;对照组可见骨缺损为剩余材料与纤维组织充填;空白组骨缺损区均被少量纤维组织充填. 结论 nHA/CS复合材料较单纯CS能更好地促进兔股骨髁临界性骨缺损的修复,是一种很有应用前景的组织工程修复材料.     

Clinical trial of microcrystalline hydroxyapatite compound ('Ossopan') in the prevention of osteoporosis due to corticosteroid therapy

Summary

A controlled clinical trial was carried out in 40 patients at risk of osteoporosis because of long-term treatment with prednisolone (5 to 20?mg/day) to determine the efficacy and tolerance of microcrystalline hydroxyapatite compound (MCHC) when used to prevent the appearance or progression of osteoporosis: 32 patients were treated with 6 to 8?g MCHC for 12 months and 8 served as an untreated control group. The two groups were well matched as regards age, sex and underlying disease; 37 patients (29 MCHC, 8 control) successfully completed the trial. The majority (68%) of the patients had back pain prior to the trial, the severity of which was graded at 3-monthly intervals. In the MCHC-treated group, there was a dramatic and significant (p<0. 001) reduction in pain during the trial, almost to the point of its disappearance. Of 19 patients with initial back pain only 2 still reported any pain at all after 12-months' MCHC treatment. In the control group, back pain severity increased during the trial in 3 patients and was unchanged in the fourth. Neither MCHC-treated nor control group patients showed any significant change in standing or stem height during the 12-months' trial period. Both mean cortical thickness and mean metacarpal index figures showed small, insignificant decreases during 12-months' MCHC treatment but much more marked decreases in the control group which, despite the small number of patients, came close to being statistically significant. Fifteen (52%) of the MCHC-treated patients expressed dissatisfaction with the palatability of the powder formulation of MCHC and 9 (31%) were changed to an equivalent dose of tablets; all then completed the trial successfully. There were no reports of drug-related side-effects in the MCHC-treated putients. Laboratory tests of renal and hepatic function revealed no signs of toxicity during MCHC therapy. There was a significant (p<0.01) increase in plasma calcium levels associated with a similar increase in phosphate levels during MCHC treatment. Calcium × phosphate product therefore increased, producing the necessary biochemical environment for bone remineralization. The results indicate that, with MCHC therapy, dramatic reductions in symptoms (skeletal pain) in patients developing osteoporosis due to long-term corticosteroid treatment are associated with favourable biochemical and bone changes, which could probably be expected to progress further during longer-term MCHC therapy.     

两种椎体替代物在重建颈椎稳定性时的疗效比较

目的 比较钛网融合器与新型纳米羟基磷灰石/聚酰胺66(n-HA/PA66)复合生物活性人工椎体在重建颈椎稳定性时的临床疗效.方法 选取25例脊髓型颈椎病患者采用颈前路钛网植骨融合、钛板内固定术治疗(A组),12例各类颈椎疾病患者采用n-HA/PA66复合生物活性人工椎体植骨融合、钛板内固定术治疗(B组).比较两种椎体替代物重建颈椎稳定性时的疗效.观察患者椎间隙高度的变化和植骨融合情况,并采用日本矫形外科协会(JOA)评分评价神经功能的变化.结果 随访6～20(15.4±4.2)个月.两组患者末次随访时植骨均已融合.术前JOA评分:A组(8.40±0.96)分,B组(8.33±1.07)分,两组比较差异无统计学意义(P＞0.05);术后JOA评分:A组(14.36±0.86)分,B组(14.83±0.71)分,两组比较差异无统计学意义(P＞0.05),但两组各自术前、术后JOA评分比较差异有统计学意义(P＜0.05).两组优良率均为100%.A组有6例出现钛网下沉,B组有1例出现人工椎体下沉,但均无明显的临床症状.结论 钛网融合器与n-HA/PA66复合生物活性人工椎体均有下沉的可能,且钛网融合器下沉率较n-HA/PA66复合生物活性人工椎体高,但两种椎体替代物均能有效重建颈椎的稳定性,获得良好的融合率,改善脊髓功能.

Abstract：

Objective To compare the clinical outcomes of cervical vertebral reconstruction using titanium mesh and nano-hydroxyapatite and polyamide 66 (n-HA/PA66) mesh as two different kinds of artificial vertebrae. Methods From January 2008 to June 2009 had surgically treated 37 cases of cervical spondylosis with anterior corpectomy for decompression, and artificial vertebrae implanted combined platescrews fixation for cervical reconstruction and fusion. As a vertebral substitution, titanium mesh were implanted in 25 cases ( group A ), and the others (12 cases, group B) were implanted with n-HA/PA66 mesh. The height of fusion space immediately postoperatively and the implanted condition were observed. The fusion rate and the JOA score were recorded to compare the clinical outcomes. Results Two groups received 6-20 ( 15.4 ±4.2 )months follow-up. When follow-up to the end grafts were already fusion. The preoperative JOA score in group A,B [(8.40 ±0.96) scores vs. (8.33 ±1.07) scores(P ＞ 0.05)] were increased to (14.36 ±0.86)scores and (14.83 ±0.71) scores after postoperatively (P＞ 0.05),but there were statistically significant differences between preoperative and postoperative each group (P＜0.05). There were 6 cases artificial vertebrae in group A and 1 case in group B subsided asymptomaticly with 100% choiceness rate. Conclusion These two kinds of artificial vertebrae could show similar outcomes in cervical vertebral reconstruction, but the n-HA/PA66 mesh has a lower subsidence rate.     

羟基磷灰石/二氧化锆复合材料颗粒对骨髓间充质干细胞增殖及成骨分化的影响

目的 采用分子生物学方法评价羟基磷灰石/二氧化锆(HA/ZrO2)复合材料颗粒对兔骨髓间充质干细胞(MSCs)增殖及成骨分化的影响.方法 按不同比例将纳米HA粉体与纳米ZrO2粉体混合在高温下烧结制备HA/ZrO2复合材料颗粒,分离和培养兔MSCs.MTT法检测复合材料颗粒悬液对兔MSCs增殖促进作用,ALP法测定碱性磷酸酶活性,RT-PCR检测细胞Ⅰ型胶原(collagen Ⅰ),骨钙蛋白(osteocalcin),骨桥蛋白(osteopontin)mRNA表达.结果 HA和含有HA的复合材料颗粒均对细胞增殖有一定促进作用.Vonkossa染色显示复合材料和纯HA颗粒可使细胞阳染程度降低.细胞在HA和含有HA的复合材料颗粒的成骨诱导培养液中的ALP活性均显著高于常规培养基质及纯ZrO2组(P＜0.05).RT-PCR结果显示复合材料颗粒能够促进collagen Ⅰ和osteocalcin基因的表达.结论 HA/ZrO2复合材料颗粒可促进骨髓间充质干细胞增殖及成骨分化.

Abstract：

Objective To evaluate the effect of the HA/ZrO2 composite particle on proliferation and osteogenesis of rabbit mesenchymal stem cells (MSCs) by using molecular biology methods.Methods The HA/ZrO2 composite particles were sintered at high temperature using the powder of HA and ZrO2 with different proportions.MSCs were isolated from rabbits and cultured.The effect of the composite particles on promoting cell proliferation of rabbit MSCs was detected using MTT method.Alkaline phosphatase activities were measured with ALP method.RT-PCR method was applied to measure the expression of collagen Ⅰ , osteocalcin and osteopontin mRNA.Results Pure HA pauicles and composite particles which contain HA promoted MSCs proliferation.Vonkossa staining showed that both pure HA particks and composite particles decreased the degree of positive stain of MSCs.ALP test showed that cell activity in the culture medium that contained pure HA particles or composite particles was significantly higher than that in the conventional culture medium and that contained pure ZrO2 particles (P ＜ 0.05＝.RT-PCR results showed that composite particles promoted the expression of collagen Ⅰ and osteocalcin gene.Conclusion The HA/ZrO2 composite particles promote proliferation and osteogenesis of MSCs.