三枚中空螺纹加压钉+髂骨块植骨治疗股骨颈骨折的生物力学研究与临床应用

目的：对作者设计的三枚中空螺纹加压钉＋髂骨块植骨（ＨＳＩ）治疗股骨颈（头下型）骨折,进行生物力学分析。为临床应用提供科学依据。方法：利用新鲜尸股骨标本进行实验应力分析。比较三枚中空螺纹加压钉＋髂骨块植骨与单纯应用三枚中空螺纹加压钉固定（ＨＳ）比较,观察两者在内固定上的生物力学性能指标变化。结果;实验结果表明采用螺纹钉＋髂骨植骨固定（ＨＳＩ）与单纯采用螺纹钉固定（ＨＳ）治疗股骨颈（头下型）骨折,其生物力学性能无显著性差异。临床１３例实践证明。采用螺纹钉＋髂骨植骨术式符合生物力学模型。是治疗股骨颈（头下型）骨折一种有效的新方法。     

过氧乙酸-乙醇联合辐照灭菌对脱钙骨基质成骨诱导活性的影响

目的探讨过氧乙酸-乙醇(PES)联合辐照灭菌对脱钙骨基质(DBM)成骨诱导活性的影响。方法取SD大鼠长管骨制作成骨粉装入胶囊后分为两组进行消毒灭活处理:PES+20k Gy的钴-60射线消毒组(实验组)和20k Gy钴-60射线消毒组(对照组)。将DBM骨胶囊植入40只SD大鼠体内,分别在2、4、6、8周处死SD大鼠,将之前植入的DBM骨胶囊取出,对DBM的骨诱导活性进行检测。结果从大体观察看,实验组所植DBM骨块呈散在颗粒状、形态不完整,对照组所植DBM骨块呈卵圆形、质地较硬、形态完整;从新生微血管数(MVQ)看,实验组MVQ值少于对照组,差异有统计学意义(0.0001);从新生骨生长速率看,对照组的生长速率为1.59 m/d,而实验组生长速率过低,无法测量;从钙、磷、碱性磷酸酶含量看,实验组钙含量小于对照组,差异有统计学意义(0.05),实验组磷含量小于对照组,差异有统计学意义(0.001),实验组碱性磷酸酶含量小于对照组,差异有统计学意义(0.05)。结论使用PES联合辐照灭菌以后会降低DBM的成骨诱导活性。     

椎骨骨质增生的形态与组织学观察

目的：观察椎骨骨质增生与组织结构。方法：在３９０条干燥成人脊柱９７５０块椎骨标本，随机锯３０块增生骨唇经脱钙组织切片或骨磨片，光镜观察。结果：脊柱有骨质增生者２５８付占６６．１％，无骨质增生者１３２付占３３．９％。每块椎骨均可发生骨质增生。镜下观察，Ⅰ度和部分Ⅱ度较短增生骨唇只有骨密质。Ⅲ、Ⅳ和部分Ⅱ度较长的增生骨唇由上、下层骨密质和中层的骨松质三层结构组成，骨密质的骨板排列整齐，骨小梁排列不整齐，网眼大小不一。结论：椎体增生唇可累及其周围的血管神经，椎体增生骨唇可因载荷过重或椎间盘退行性变，椎间关节骨质增生可因椎关节不对称等因素。     

microCT重建距骨骨内微小动脉三维结构的临床解剖学研究

目的获得距骨内微小动脉三维结构模型,对临床上不同分型的距骨骨折的预后做出更精确的解释和预测。方法对12例新鲜尸体下肢行股动脉插管并灌注铅造影剂。距骨取材,进行microCT扫描并且重建高精度模型,图像最终分辨率为52.30μm。最终获得距骨周围与距骨内血管在各个切面的图像,观察距骨表面动脉与骨内分支的走行和分布,并计数动脉的骨内分支数。结果距骨骨外血管集中分布于表面的韧带和关节囊内。距骨表面主要有4大血管分布区域,分别为跗骨管-跗骨窦区、距骨颈上表面、距骨体内侧面和后结节区。距骨颈周围血管环由跗骨管-跗骨窦区和距骨颈上表面的骨外血管连接而成(骨内分支数分别为5.1±1.3和5.6±1.9),是距骨的主要血供来源,分支分布于距骨头、距骨颈和大部分距骨体,并有丰富的吻合。此外,距骨体还接受距骨体内侧面(骨内分支3.2±1.4)和后结节区(骨内分支0.7±0.5)的骨内分支的血供。结论血管环是距骨的主要血供来源,骨内分支有丰富吻合。距骨颈骨折的坏死风险取决于该分型对血管环骨内分支和吻合的破坏程度。距骨体矢状面骨折和粉碎骨折对血管环的骨内分支的破坏较大,缺血坏死风险相对高。距骨头血供丰富,骨折时缺血坏死的可能小。     

自体块状皮质骨修复种植区颌骨缺损

文题释义：自体块状皮质骨：自体块状皮质骨具有刚性的板层状结构,毛细血管的含量较低,因此移植后很难维持具有活性的成骨细胞或骨祖细胞,致密的矿化基质导致血管重建和长入的速度相对缓慢,但其空间维持能力强,生物相容性好,其中含有的成骨细胞和生长因子对骨再生起促进作用,是骨移植材料的“金标准”。 Onlay植骨：于两侧下颌外斜线处取长方形皮质骨块,在上颌左侧骨缺损区植入皮质骨块,右侧骨缺损区植骨同期植入种植体。 背景：自体骨有骨传导、骨诱导及骨生成的特性,同时具有良好的生物相容性,移植后无排斥反应。但关于自体骨块移植后的骨块是完全被吸收替代？还是能保留细胞活性长期存留？仍存在争议。 目的：观察皮质骨移植后改建再生过程中的组织学变化。 方法：6只健康比格犬麻醉后拔除两侧上颌前磨牙,并去除颊侧宽约10 mm、长约15 mm、厚度约2 mm的骨板,建立上颌骨缺损模型,在双侧下颌骨体颊侧切取相应大小的块状皮质骨并修整边缘。在上颌骨缺损区移植皮质骨块,一侧为单纯块状皮质骨移植,另一侧在块状皮质骨移植同期植入种植体。分别于骨移植后3,6个月取材,进行大体观测和组织学观察,分析移植骨块的吸收率、移植骨中的细胞存活率。实验方案经大连医科大学动物实验伦理委员会批准。 结果与结论：①大体观察可见移植骨块体积逐渐缩小,边缘圆钝,与基骨结合稳固;②6个月时全部种植体脱落;硬组织磨片可见移植骨块与基骨间存在新生骨连接;6个月时移植骨骨陷窝孔隙率明显低于3个月,移植骨吸收率显著高于3个月(均P < 0.05);③结果说明,块状皮质骨移植后,能够与受植区基骨发生骨结合,其内部的骨细胞部分保持活力,随着愈合期延长,新生骨细胞的比例增加,移植骨块的体积逐渐变小。皮质骨移植同期种植后移植物吸收明显,种植体骨结合不良。 ORCID: 0000-0001-5201-9377(王宁) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

两种方法治疗股骨干骨折合并较大游离骨块的效果比较

目的　比较两种方法治疗股骨干骨折合并较大游离骨块的效果差异。 方法　选择66例股骨干骨折合并较大游离骨块行切开复位内固定治疗患者。按游离骨块处理方法不同分为对照组（35例,仅复位固定,未行钻孔和植骨）和试验组（35例,行钻孔、松质骨孔内插秧式植骨和周围植骨,以及复位固定）。比较两组的手术时间、手术出血量、骨折愈合时间、并发症发生情况和末次随访时临近关节功能恢复（HSS法）。 结果　两组患者一般资料比较差异无统计学意义（P>0.05）。对照组的手术出血(847.58±147.53) ml和手术时间(138.43±12.10) min优于试验组（分别752.18±143.78 ml和115.27±11.31 min）,而试验组的骨折愈合时间（4.79±1.00 月）、骨延迟愈合（1/35）、骨不连（0）和内固定断裂（0）的发生率以及功能恢复（26/5/0/0）均优于对照组（分别为9.49±2.59 月,11/35,8/35,4/35和15/13/7/0）,差异均有统计学意义（P<0.05）。 结论　对于股骨干骨折合并较大游离骨块,仅复位固定的效果较差,而采用钻孔、松质骨植骨可以加快爬行替代愈合速度和改善骨折端的力学性能,骨折治疗效果明显优于前者。     

股骨近端Stro-1+细胞与骨形态发生蛋白及其受体的相关性

背景：髋关节置换后假体的融合率与假体周围的骨重建密切相关,这个过程中骨髓间充质干细胞的募集、向成骨细胞分化的途径受骨形态发生蛋白调控。 目的：分析股骨近端Stro-1⁺细胞与骨形态发生蛋白7、骨形态发生蛋白受体的相关性。 方法：32例患者初次进行髋关节置换,取术中股骨矩开槽时骨块,体外细胞培养14 d后检测骨髓间充质干细胞数量,Stro-1⁺标记干细胞的总量,骨形态发生蛋白7、骨形态发生蛋白受体1a、骨形态发生蛋白受体2的表达。 结果与结论：Stro-1⁺、骨形态发生蛋白7、骨形态发生蛋白受体1a、骨形态发生蛋白受体2的表达在不同年龄组有轻微差异,但差异无显著性意义,在不同性别组差异也无显著性意义;股骨近端Stro-1⁺细胞数量(即代表具有向成骨细胞分化功能的细胞)与骨形态发生蛋白7表达呈负相关关系,与骨形态发生蛋白受体1a表达呈正相关关系,其可以影响髋关节假体的骨融合与生存率。     

藏酋猴椎体骨质的解剖学观察

目的通过对藏酋猴各段椎体骨质的解剖学观察,比较不同节段椎体骨松质与骨密质的分布、排列规律及异同,为藏酋猴脊柱的应用研究提供形态学依据。方法对6具成年健康藏酋猴各段椎体标本进行正中冠状切、矢状切和水平切,并进行测量和观察。结果藏酋猴骨密质从颈部至腰部逐渐变薄;骨松质总体上在正中水平面和正中冠状面上排列紧密,在正中矢状面上排列较为稀疏。颈椎、胸椎和腰椎间骨密质除水平面上差异无统计学意义(P0.05)外,在冠状面、矢状面上差异均有统计学意义(P0.05或P0.01);骨松质在各切面的差异也均有统计学意义(P0.05或P0.01)。结论藏酋猴椎体骨密质和骨松质在颈、胸和腰椎的分布有显著的差异性,适用于对椎骨形态与功能及其病变的相关研究。     

不同填充块对内侧开放楔形胫骨高位截骨应力分布的影响

目的 分析填充块材料和尺寸对胫骨截骨模型应力分布的影响。方法 建立3种不同材料(髂骨、松质骨和聚醚醚酮)、5种不同尺寸填充块,分别植入胫骨截骨模型,对模型进行力学加载,分析模型的应力分布和边缘位移。结果 就3种材料而言,植入髂骨材料的填充块模型在胫骨近端、钢板的应力和边缘位移低于松质骨和聚醚醚酮材料,但髂骨材料的填充块应力最高;在不同尺寸填充块植入截骨间隙时,胫骨截骨各部分应力分布和边缘位移存在差异,特别是填充块宽度从30 mm减小到10 mm,胫骨近端、钢板和填充块应力峰值平均分别增加了49.3%、92.7%、54.4%。结论 不同的填充块参数会影响胫骨截骨不同部位的应力分布。研究结果为临床胫骨截骨填充块参数的选择提供理论依据。     

AgNOR在骨巨细胞瘤分级及预后判定中的价值

对４２例骨巨细胞瘤（ＧＣＴ）患者进行ＡｇＮＯＲ计数，其中Ｉ级１８例，Ⅱ级１４例，Ⅲ级１０例，结果发现ＡｇＮＯＲ在Ｉ级与Ⅱ级瘤间差异无显著性（Ｐ〉０．０５）而在Ⅱ级与Ⅲ级瘤间差异有高度显著性（Ｐ〈０．０１）。提示ＡｇＮＯＲ的表达与Ｊａｆｆｅ分级不太一致，因而，我们倾向于将骨ＧＣＴ只分为良，恶性两肿，而且ＡｇＮＯＲ的高低与骨ＧＣＴ的预后有关。     

How many bones? Every bone in my body

Textbooks frequently report that there are 206 human bones, or 200 bones and 6 auditory ossicles. The human bone counts in history and within adulthood were reviewed. Tallies of 197 to 307 bones have been reported over the past several centuries. The relatively low modern reckoning of 206 was due to exclusion of teeth and sesamoid ossicles, and to reassessments of the hyoid, sacrum, coccyx, and sternum as unitary bones. An audit of bone counts during adulthood failed to confirm a rational justification for the total of 206. The number is higher in young adults and lower in the elderly. Difficulties in establishing a definitive bone count include individual differences and the inconsistency of viewing the adult cranium as a collection of 21 bones. Clin. Anat. 33:187–191, 2020. © 2019 Wiley Periodicals, Inc.     

Craniofacial skeleton of MEXICAN tetra (Astyanax mexicanus): As a bone disease model

A small fresh water fish, the Mexican tetra (Astyanax mexicanus) is a novel animal model in evolutionary developmental biology. The existence of morphologically distinct surface and cave morphs of this species allows simultaneous comparative analysis of phenotypic changes at different life stages. The cavefish harbors many favorable constructive traits (i.e., large jaws with an increased number of teeth, neuromast cells, enlarged olfactory pits and excess storage of adipose tissues) and regressive traits (i.e., reduced eye structures and pigmentation) which are essential for cave adaptation. A wide spectrum of natural craniofacial morphologies can be observed among the different cave populations. Recently, the Mexican tetra has been identified as a human disease model. The fully sequenced genome along with modern genome editing tools has allowed researchers to generate transgenic and targeted gene knockouts with phenotypes that resemble human pathological conditions. This review will discuss the anatomy of the craniofacial skeleton of A. mexicanus with a focus on morphologically variable facial bones, jaws that house continuously replacing teeth and pharyngeal skeleton. Furthermore, the possible applications of this model animal in identifying human congenital and metabolic skeletal disorders is addressed. Developmental Dynamics 248:153-161, 2019. © 2018 Wiley Periodicals, Inc.     

Bone microstructure and bone mineral density are not systemically different in Antarctic icefishes and related Antarctic notothenioids

Ancestors of the Antarctic icefishes (family Channichthyidae) were benthic and had no swim bladder, making it energetically expensive to rise from the ocean floor. To exploit the water column, benthopelagic icefishes were hypothesized to have evolved a skeleton with “reduced bone,” which gross anatomical data supported. Here, we tested the hypothesis that changes to icefish bones also occurred below the level of gross anatomy. Histology and micro-CT imaging of representative craniofacial bones (i.e., ceratohyal, frontal, dentary, and articular) of extant Antarctic fish species specifically evaluated two features that might cause the appearance of “reduced bone”: bone microstructure (e.g., bone volume fraction and structure linear density) and bone mineral density (BMD, or mass of mineral per volume of bone). Measures of bone microstructure were not consistently different in bones from the icefishes Chaenocephalus aceratus and Champsocephalus gunnari, compared to the related benthic notothenioids Notothenia coriiceps and Gobionotothen gibberifrons. Some quantitative measures, such as bone volume fraction and structure linear density, were significantly increased in some icefish bones compared to homologous bones of non-icefish. However, such differences were rare, and no microstructural measures were consistently different in icefishes across all bones and species analyzed. Furthermore, BMD was similar among homologous bones of icefish and non-icefish Antarctic notothenioids. In summary, “reduced bone” in icefishes was not due to systemic changes in bone microstructure or BMD, raising the prospect that “reduced bone” in icefish occurs only at the gross anatomic level (i.e., smaller or fewer bones). Given that icefishes exhibit delayed skeletal development compared to non-icefish Antarctic fishes, combining these phenotypic data with genomic data might clarify genetic changes driving skeletal heterochrony.     

Cetacean Skull Telescoping Brings Evolution of Cranial Sutures into Focus

Many modifications to the mammalian bauplan associated with the obligate aquatic lives of cetaceans—fusiform bodies, flukes, flippers, and blowholes—are evident at a glance. But among the most strikingly unusual and divergent features of modern cetacean anatomy are the arrangements of their cranial bones: (1) bones that are situated at opposite ends of the skull in other mammals are positioned close together, their proximity resulting from (2) these bones extensively overlapping the bones that ordinarily would separate them. The term “telescoping” is commonly used to describe the odd anatomy of modern cetacean skulls, yet its usage and the particular skull features to which it refers vary widely. Placing the term in historical and biological context, this review offers an explicit definition of telescoping that includes the two criteria enumerated above. Defining telescoping in this way draws attention to many specific biological questions that are raised by the unusual anatomy of cetacean skulls; highlights the central role of sutures as the locus for changes in the sizes, shapes, mechanical properties, and connectivity of cranial bones; and emphasizes the importance of sutures in skull development and evolution. The unusual arrangements of cranial bones and sutures referred to as telescoping are not easily explained by what is known about cranial development in more conventional mammals. Discovering the evolutionary-developmental processes that produce the extensive overlap characteristic of cetacean telescoping will give insights into both cetacean evolution and the “rules” that more generally govern mammalian skull function, development, and evolution. Anat Rec, 302:1055–1073, 2019. © 2019 Wiley Periodicals, Inc.     

Attitudes of professional anatomists to curricular change

Throughout the world, recent developments in medical curricula have led to marked changes in the teaching of gross anatomy. This change has involved decreasing curricular student contact time and the use of new methods for anatomical teaching. Some "modern" anatomists have welcomed the arrival of these novel methods while other, more "traditional," anatomists have fought to maintain the use of cadaveric dissection. Consequently, controversy over teaching methods has developed to the point that "modernist" and "traditionalist" views within the community of professional anatomists seem to have diverged such that the importance of gross anatomy in the medical curriculum is disputed and that cadaveric dissection by students is no longer the preferred method of teaching. This study tests this hypothesis using Thurstone and Chave attitude analyses to assess attitudes to educational change and the importance of anatomy in medicine and a matrix questionnaire that required professional anatomists to relate course aims to different teaching methods. In total, 112 completed questionnaires were received from anatomists who are employed at higher education institutions that use various teaching methods and who span the academic hierarchy. The results suggest that over 90% of anatomists favor educational change and approximately 98% of professional anatomists believe that gross anatomy has an important role to play in clinical medicine. A clear majority of the anatomists (69%) favored the use of human cadaveric dissection over other teaching methods (this method seeming to achieve a range of different course aims/objectives) (P < 0.001; Kruskal-Wallis). Using Kruskal-Wallis statistical tests, the order-of-preference for teaching methods was found to be as follows: 1. Practical lessons using cadaveric dissection by students. 2. Practical lessons using prosection. 3. Tuition based upon living and radiological anatomy. 4. Electronic tuition using computer aided learning (CAL). 5. Didactic teaching alone (e.g. lectures/class room-based tuition). 6. Use of models. The preference for the use of human cadaveric dissection was evident in all groups of anatomists, whether "traditionalist" or "modernist" (P = 0.002, Chi-squared). These findings are therefore not consistent with our initial hypothesis.     

Variation in mineral properties in normal and mutant bones and teeth

Hydroxyapatite mineral is deposited in an organized fashion in the matrices of bones and teeth. The amount of mineral present, the composition of the mineral, and the size of the mineral crystals varies with both tissue and animal age, diet, health status, and the tissue being examined. Here, we review methods for measuring these differences in mineral properties and provide some illustrations from bones and teeth of animals in which the small leucine-rich proteoglycans (biglycan and decorin) were ablated. Differences in mineral properties between biglycan-deficient bones and teeth are related to the functions of this small proteoglycan in these tissues.     

掌骨长度,前后径,横径和重量的测定

用甘肃出土的１７７副、（男１２７副、女５０例）３５４侧、１７７０根汉族成人掌骨的长度，前后径、横径和重量进行了测量，测量数据作了统计学处理，并作了男女、同侧、左右两侧的对比。结果表明：除第１、４掌骨少数项目具有性别和侧别差异外，多数无统计学差异。     

Ectodermal dysplasias: Classification and organization by phenotype,genotype and molecular pathway

An international advisory group met at the National Institutes of Health in Bethesda, Maryland in 2017, to discuss a new classification system for the ectodermal dysplasias (EDs) that would integrate both clinical and molecular information. We propose the following, a working definition of the EDs building on previous classification systems and incorporating current approaches to diagnosis: EDs are genetic conditions affecting the development and/or homeostasis of two or more ectodermal derivatives, including hair, teeth, nails, and certain glands. Genetic variations in genes known to be associated with EDs that affect only one derivative of the ectoderm (attenuated phenotype) will be grouped as non‐syndromic traits of the causative gene (e.g., non‐syndromic hypodontia or missing teeth associated with pathogenic variants of EDA “ectodysplasin”). Information for categorization and cataloging includes the phenotypic features, Online Mendelian Inheritance in Man number, mode of inheritance, genetic alteration, major developmental pathways involved (e.g., EDA, WNT “wingless‐type,” TP63 “tumor protein p63”) or the components of complex molecular structures (e.g., connexins, keratins, cadherins).     

西藏现代藏族人颅的颅型及其特点

测量７０个西藏现代藏族人颅４０项指标；计算指数１６项；根据指数确定颅型，额型，颌型，眶型，鼻型与腭型；进行数理统计；观察性别差异，发现男发性间各测量值差显著，     

The genitourinary and reproductive systems: Interpretation of Avicenna's (980–1037 AD) treatise in the Canon of Medicine

Avicenna (also known as Ibn Sina 980–1037 AD) was the most influential Persian physician and scholar in the medieval times (9–12^th century AD). Avicenna contributed to various fields of medicine, astronomy and metaphysics during his time. In the field of basic medical sciences, Avicenna systematically described the anatomy and pathology of various organs of the human body and devised surgical interventions towards the treatment of disorders associated with them. Avicenna compiled his famous book the Canon of Medicine which went on to become a reference textbook of medicine in the region and the West. Although neither formal human cadaveric dissection nor surgical training was recorded during his time, the anatomical and surgical information presented in the Canon of Medicine is comparable to modern literature. In the current vignette, we present an analysis of the basic structural anatomy and functional aspects of the genitourinary and reproductive systems and some reproductive concepts presented in the Canon of Medicine textbook and compare their relevance in modern medical literature. We found Avicenna's information on these systems to be congruent to modern anatomy and physiology literature. The only differences are attributed to the differences in the experimental approaches with Avicenna's information being derived in an era with less technological advances especially on the histology of organs. However, Avicenna's information in this treaty can be regarded as pioneering in the fields of urology and gynaecology.