同种异体骨支撑架结合自体骨和DBM治疗股骨头坏死

目的探讨同种异体骨支撑架植入结合自体松质骨和脱钙骨基质（DBM）治疗成人股骨头坏死初步疗效。方法采用经大转子下通过股骨颈钻隧道至股骨头骨坏死区,将装有自体松质骨和DBM的同种异体骨支撑架经隧道置入骨坏死区直至软骨下骨约5mm处,隧道远端用自体髂骨填塞。结果经临床应用23例24个髋关节,随访12～27个月,并按成人股骨头缺血性坏死疗效百分评价法进行评价,优良率为95.8％。结论同种异体骨支撑架植入结合自体松质骨和DBM治疗成人股骨头坏死具有以下优点：①手术操作简单,不破坏患者股骨头本身的血液供应,创伤小,且不增加日后行人工关节置换的困难;②将具有骨诱导活性的DBM直接放入骨坏死区,成骨作用强;③增加股骨头负重区软骨下骨的机械支撑,降低局部应力,有利于股骨头坏死的修复及重建。     

两种强化股骨头力学结构治疗股骨头坏死临床疗效比较

[目的]比较同种异体骨支撑架/自体松质骨/脱钙骨基质（DBM）与钛合金支撑架/自体松质骨/脱钙骨基质（DBM）分别植入行髓芯减压后的股骨头,强化其力学结构,治疗股骨头坏死的疗效。[方法]2001年1月～2004年8月治疗成人股骨头坏死（FicatⅠ～Ⅲ期）63例（68髋）,在股骨头坏死行髓芯减压后分别植入同种异体骨支撑架/自体松质骨/DBM（A组）和钛合金支撑架/自体松质骨/DBM（B组）,A组32例（34髋）,B组31例（34髋）,分别观察2组病例的手术时间、术中出血量、Harris髋关节评分、X线影像学进展情况及并发症的发生率。[结果]两组所有患者均获得随访,平均随访47个月（24～67个月）,以最后1次随访资料作为最终评价依据。两组在手术时间、术中出血量、Harris评分变化、X线影像学进展情况及并发症的发生率方面均无显著性差异,但两组术后的Harris评分均较术前明显提高,差异有显著性。[结论]同种异体骨支撑架结合自体松质骨和DBM植入治疗成人股骨头坏死,和钛合金支撑架一样能增加股骨头负重区软骨下骨的机械支撑,有利于股骨头坏死的修复与重建。能用同种异体骨支撑架代替钛合金支撑架以加强股骨头软骨下骨的机械强度治疗股骨头坏死。     

同种异体骨支撑架微创治疗股骨头坏死的临床研究

目的应用改良髓芯减压术结合同种异体骨支撑架加自体骨和脱钙骨基质（decalcified bone matrix，DBM）治疗早期股骨头坏死，探索早期股骨头坏死的微创治疗方法。方法2004年1月～2005年4月，23例24个髋关节采用经大转子下通过股骨颈钻隧道至股骨头骨坏死区，将装有自体松质骨和DBM的同种异体骨支撑架经隧道拧入骨坏死区直至软骨下骨约5mm处，隧道远端用自体髂骨填塞。观察手术前后Harris评分变化、x线影像学表现及是否需进一步治疗。结果本组所有患者均获得随访，平均随访19（12—27）个月，以最后一次随访资料作为最终评价依据。Harris评分，术前优良率为43．5％（10／23）。术后优良率为91．3％（21／23）。22侧髋关节影像学表现保持稳定，无明显并发症发生。结论同种异体骨支撑架植入结合自体松质骨和DBM治疗成人股骨头坏死，增加了股骨头负重区软骨下骨的机械支撑，成骨作用强，有利于股骨头坏死的修复与重建，同时，不破坏患者股骨头本身的血液供应，创伤小，操作简单，值得临床推广使用。     

病灶清除结合自体骨植入支撑治疗股骨头早中期坏死

目的 探讨病灶清除结合自体骨植入支撑治疗成人股骨头坏死初步疗效.方法 42例57髋经大粗隆下通过股骨颈钻隧道至股骨头骨坏死区,将自体腓骨经隧道植入骨坏死区达软骨下骨约5 mm处.结果 随访14～36个月,按Haaris评分标准评价疗效,优良率为84.2%.结论 病灶清除结合自体骨植人支撑治疗成人股骨头坏死具有以下优点:①手术操作简单,不破坏患者股骨头的血液供应,创伤小,且不增加日后行人工关节置换的难度;②自体骨移植避免排异反应,愈合能力强;③隧道的建立缓解了关节囊内压力,同时腓骨瓣植入增加股骨头负重区软骨下骨的机械支撑,降低局部应力,有利于股骨头坏死的修复及重建.     

空心钛支撑架结合自体骨移植治疗股骨头坏死

目的探讨应用空心钛支撑架结合自体骨移植治疗股骨头坏死近期疗效。方法11例12个股骨头采用从转子下经转子至股骨头坏死区域钻相应隧道,清除坏死骨,取自体髂骨松质骨装入空心钛支架内后植入股骨头坏死区域隧道内,隧道远端采取生物材料填充。结果患者均获得1~3年随访,7例疼痛消失,2例疼痛明显减轻,2例症状改善。结论采用空心钛支撑架结合自体骨移植治疗FicatⅠ~Ⅱ期的股骨头坏死,效果满意。     

同种异体骨支撑架结合自体骨和DBM治疗股骨头坏死的生物力学研究

[目的]研究同种异体骨支撑架结合自体骨和脱钙骨基质（decalcified bone matrix，DBM）植入治疗股骨头坏死生物力学变化。[方法]建立羊双侧股骨头坏死模型，4周后分为4组：单纯行髓芯减压组（A组）、髓芯减压后植入自体松质骨和OSTEOSET^2 DBM组（B组）、髓芯减压后植入同种异体骨支撑架／自体松质骨OSTEOSE^2 DBM组（C组）和正常对照组。术后分别于5、10、20周对股骨头行影像学、组织学观察和生物力学测定。[结果]影像学和组织学检查结果显示C组在髓芯减压区骨缺损修复及成骨方面较B组略高，B、C两组都较同时期的A组明显增强。生物力学测试结果表明，术后5、10、20周时C组力学强度较A、B两组明显增高．差异有统计学意义（P〈0．05），在10、20周时C组股骨头生物力学强度和正常股骨头己无明显差异。[结论]应用同种异体骨支撑架结合自体骨和脱钙骨基质治疗股骨头坏死，能有效加强股骨头的力学结构，促进坏死骨的修复，防止股骨头关节面的塌陷。     

强化力学结构治疗股骨头坏死的实验研究

目的探讨髓芯减压术后利用同种异体骨支撑架结合自体骨和脱钙骨基质（DBM）植入治疗股骨头坏死的可行性。方法取大尾羊22只，其中2只作为正常对照组，其余20只建立双侧股骨头坏死模型，4周后随机挑选2只检测股骨头坏死情况，确定造模成功后，将其余18只（36侧）随机分为A、B、C三组，每组6只（12侧），A组单纯行髓芯减压，B组在行髓芯减压后植入自体松质骨和DBM，C组在行髓芯减压后植入同种异体骨支撑架、自体松质骨和DBM。分别于术后5、10和20周对股骨头行影像学检查、生物力学测试和组织学观察。结果影像学检查和组织学观察结果显示C组在髓芯减压区骨缺损修复及成骨方面较B组略高，但差异无统计学意义（P〉0．05）；B、C两组都较同时期的A组明显增强，差异有统计学意义（P〈0．05）。生物力学测试结果表明，术后5、10、20周时C组力学强度较A、B两组明显增高，差异有统计学意义（P〈0．05），在10、20周时C组股骨头生物力学强度和正常股骨头无明显差异。结论应用同种异体骨支撑架结合自体骨和DBM治疗股骨头坏死，能有效加强股骨头的力学结构、促进坏死骨的修复及防止股骨头关节面的塌陷。     

网球支架置入治疗成人股骨头缺血性坏死

目的 观察网球支架置入治疗青壮年中晚期股骨头缺血性坏死的疗效。方法 采用记忆金属网球支架置入４５例患者（５４髋）坏死塌陷的股骨头内,取同侧髂骨松质骨植入网球内顶起已塌陷的股骨头,并以带旋髂深动脉及静脉的髂骨骨块封闭股骨头、颈交界处窗口。结果：扫成人股骨头缺血性坏死的疗效百分评价法对４５例５４髋随访１２～３６个月,优良率达８８．９％。结论 应用网球支架置入治疗成人股头缺血性坏死具有以下优点：（１）彻     

股骨头内支撑器/rhBMP-2/自体松质骨修复股骨头坏死骨缺损及防止塌陷的实验研究

目的 探索应用新材料、新方法治疗股骨头坏死防止股骨头塌陷的一种新的治疗方法。方法 活门法(Trap-door)建立犬股骨头坏死骨缺损模型。通过活门A组植入股骨头内支撑器／rhBMP-2／自体松质骨;B组植入rhBMP-2／自体松质骨;C组植入自体松质骨。通过组织学、影像学、生物力学观察评价对股骨头坏死骨缺损的修复以及防止股骨头塌陷的效果。结果 各组均未出现关节脱位、关节间隙正常。A组缺损区修复,无关节软骨塌陷;B组骨缺损区修复,但骨密度低于周围骨组织;C组仅缺损区周围少量低密度骨形成。A组组织学无软骨塌陷,内支撑器周围新生骨组织包绕,与周围骨组织融合;B组2例软骨塌陷(1.2 mm、1.5 mm),活门区软骨色泽近与正常;C组活门区软骨塌陷(1.8~5.2 mm),色泽苍白,质软易碎。力学测试A组修复区抗压强度明显强于B、C组(P<0.05)。结论应用股骨头内支撑器／rhBMP-2／自体松质骨修复股骨头坏死骨缺损可以加快修复速度,并且恢复股骨头力学强度防止股骨头塌陷。     

镍-钛记忆合金网球治疗成人股骨头缺血性坏死初步报告

探讨记忆金属网球植入治疗成人股骨头缺血性坏死的手术方法及初步疗效。方法,设计采用记忆多球植入坏死塌陷的股骨头内,取向侧髂骨松质骨植入网内并顶起已塌陷的股骨头,并以带旋髂深动脉及静脉的髂骨骨块植入治疗成人股骨头缺血性坏死。结果经临床应用２２例２８个髋关节,初步随访６－２０个月,并按人股头缺血性坏死疗效百分评价法进行评价,优良率为９０．９％结论记忆金属网主治疗成人股骨 头缺血性坏死具有以下优点：（１）     

跖骨感染骨外露的显微外科治疗

[目的]回顾总结跖骨骨感染骨外露的显微外科治疗方法。[方法]自1995年～2005年采用显微外科技术治疗214例跖骨骨外露骨感染患者。[结果]全部病例获得随访1～10年，平均随访3年，14例游离植皮术后皮肤成活良好，199例术后皮瓣全部成活，1例腓肠神经营养血管皮瓣移位修复术出现远端部分皮肤坏死，后经换药处理后，伤口自然愈合。皮瓣移植术后质地良好，无溃疡复发。患足均可负重走路。[结论]应用显微外科技术治疗跖骨骨感染骨外露可获得较好的疗效。     

Genetic regulation of bone mass: from bone density to bone strength

Osteoporosis is a common disease characterized in adults by diminished bone density. Bone is an organ that evolves and grows throughout life, and establishing optimal bone density in childhood and adolescence serves to buffer bone loss later in life. Bone density, a measurable entity, is the clinical substitute for bone strength, or the ability to defend against fracture. Chronic diseases may adversely affect optimal peak bone density. Bone density is under genetic control, as revealed by three lines of investigations. These include (1) the finding of quantitative trait loci for bone density, (2) the finding that specific mutations in genes that are important in the development of osteoblast or osteoclast lineages alter bone density, and (3) the linkeage of known polymorphisms for genes involved in mineral homeostasis to bone density and/or fracture. Future therapeutics for improving peak bone density or delaying bone loss later in life may take advantage of the genetic nature of bone density development.This work was presented in part at the IPNA Seventh Symposium on Growth and Development in Children with Chronic Kidney Disease: The Molecular Basis of Skeletal Growth, 1–3 April 2004, Heidelberg, Germany     

重组合异种骨植骨修复骨囊肿所致骨缺损

2001年10月～2003年9月,笔者共收治28例骨囊肿患者,均采用病灶刮除,瘤腔灭活和重组合异种骨植骨治疗,获得满意疗效,体会如下。     

Aneurysmal bone cyst of the frontal bone

Aneurysmal bone cyst rarely affects the skull. We report two cases of aneurysmal bone cyst of the frontal bone. One of the cases is associated with pregnancy. The association of pregnancy with aneurysmal bone cyst and enlargement of the aneurysmal bone cyst during the pregnancy have been discussed.     

Assessment of bone density and bone loss

Osteoporosis International - Dual-energy X-ray absorptiometry has become the standard for the evaluation of osteoporosis. It is useful both for identifying those people who are going to be at risk...     

Aneurysmal bone cyst of the occipital bone

A 13 years boy presented with a painless hard and fixed swelling in occipital region for the last three months. Plain X-ray, CT scan and MRI showed an expansile multi loculated cystic lesion in occipital bone. Histopathological examination revealed it to be an aneurysmal bone cyst. Treatment of choice is surgery. However, radiotherapy may be helpful in incompletely excised lesions.     

Aneurysmal bone cysts of the occipital bone

Two cases of aneurysmal bone cysts are reported. Each patient presented with a palpable mass in the occipital region and signs of compression of structures in the posterior fossa. One of the cases is unique, in that the aneurysmal bone cyst was associated with an epidural hematoma in the posterior fossa. The pertinent literature is reviewed.     

Development of bone canaliculi during bone repair

We recently found that silver impregnation staining with protargol (silver protein), that is, a modified Bodian method, is useful for histologically identifying the details of bone canaliculi structure, using thin sections of decalcified bone tissues. With this staining method, we conducted the present study to assess the development of bone canaliculi during the process of intramembranous ossification using a fracture-like stimulation model of the rat femur. After making a drill-hole in the cortex of the rat femur, decalcified thin sections were obtained after 3, 5, 7, and 14 days by the standard paraffin-embedding procedure. Silver staining for bone canaliculi was performed using our previously reported technique. The results showed that woven bone covered the fracture surface of the cortex after 5 days, then immature lamellar bone attached to the woven bone after 7 days, and finally the lamellar bone matured and became thick with appositional growth after 14 days. The osteocytes in the woven bone appeared at an early stage of bone repair and developed a few canaliculi that were short and irregularly distributed in the osteoid matrix, while the osteocytes in the lamellar bone at a late stage formed many bone canaliculi that were long and regularly distributed in mature bone matrix. Therefore, we concluded that woven bone osteocytes may be necessary for induction of the lamellar bone osteocytes followed by active appositional growth of the lamellar bone at the early stage of bone repair, and also that both bone tissues could be clearly distinguished from one another based on the pattern of development of bone canaliculi by the osteocytes, as seen with the use of our sensitive staining method.