B型超声直方图检测骨折愈合的临床价值

作者应用Ｂ超直方图连续观测３６例骨折愈合过程，着重分析１５例以外固定架治疗的胫腓骨新鲜骨折愈合过程的动态变化。发现Ｂ超能观察骨折愈合的早期变化，直方图灰阶参数可作为骨愈合程度的定量指标之一。初步研究表明，骨折间隙灰阶值为对照的５０－６０％时可去除外固定架；超过７５％便基本达到临床愈合。由于它具有方便、无创、量化的特点，对骨折临床诊断、治疗的决策均有重要的辅助作用。     

骨折愈合、延迟愈合和骨不连

骨折愈合分为四个阶段：血肿炎症期、肉芽形成期、骨化期和重塑期。四阶段的病理变化连续而重叠，诸多炎性介质和生长因子起了非常重要的作用。最终骨折根据稳定性程度达到直接愈合或骨痂愈合。骨折是否发生延迟愈合和骨不连可以从治疗时间、临床表现、放射学表现和生物力学几方面进行评价，重点对骨不连的两种基本形式进行了解释，并对造成延迟愈合和骨不连的主要原因进行了分析，并从生物性、全身性、机械性和生物物理治疗四方面概括了促进骨折愈合的多种手段。     

骨生长因子与骨愈合的研究和展望

骨生长因子与骨愈合的研究和展望胡蕴玉骨代谢与骨愈合是一个极其复杂的过程，受多种因素的影响．就内在因素而言，有两种机制：激素调节钙＿磷代谢的系统作用和骨生长因子的局部调节作用．这些作用通过自分泌和旁分泌系统促进成骨细胞增殖和骨基质的生物合成．现已从骨基...     

骨连接素在骨愈合中作用的探讨

目的：骨连接素（ｏｓｔｅｏｎｅｃｔｉｎ，ＯＮ）是骨基质中含量较多的非胶原性基质蛋白，在启动矿化过程中和促使矿物质在交原成分上沉积有重要的作用，了解ＯＮ在骨折愈合过程中的作用是认识骨折愈合机理的一部分。方法：实验动物模型选用ＳＤ雄性大鼠２４只，于胫骨上段造成骨缺损，应用原位杂交技术检测缺损区骨愈合过程中ＯＮ ｍＲＮＡ的变化情况。结果：术后在第４天近髓腔侧开始出现少量编织骨，其中成骨细胞和骨细胞对ＯＮ     

金属内植物腐蚀与骨愈合

随着生物材料研究的进步及手术技巧的提高,各种金属材料的内植物广泛应用于临床,降低了病残率、取得了满意的效果.但是植入体内的人工关节、内固定装置等内植物可因生物学、生物力学及电化学方面的原因而腐蚀,表现为内植物结构完整性的破坏或释放降解产物[1～4].内植物降解产物与机体组织间的相互反应,以及腐蚀产物对骨折愈合过程的干扰,目前国内报道尚少见,本文将有关文献作一综述,以期引起重视. 1 金属内植物腐蚀的机制     

不同植骨法治疗股骨干骨折不愈合及延迟愈合

1995年 6月～ 2 0 0 0年 10月 ,我院收治股骨干骨折不愈合或延迟愈合 2 2例 ,本院 5例 ,外院 17例。全部使用单侧多功能外固定架的同时进行自体骨移植 ,将其分为颗粒状和细棒状植骨两组进行比较。现将结果报告如下 :临床资料一、一般资料　本组 2 2例 ,男性 16例 ,女性 6例 ;平均年龄 32岁。左右侧各 11例 ;有假关节形成 8例 ;根据骨折不愈合的标准 ,均在 6个月以上。骨折部位 :股骨上段 3例 ,中段 14例 ,下段 5例。 2 1例行内固定 :普通钢板 4例 ,加压钢板7例 ,梅花针 5例 ,V型针 2例 ,带锁髓内针 2例 ,捆扎钢丝 1例 ,外固定架外固定 1例…     

植骨量对骨缺损愈合因素的前瞻性研究

目的为既利于骨折愈合,又不浪费骨量,以避免供骨区骨取出过多及降低供骨区并发症的发生率,探讨合适的植(取)骨量。方法选择自体髂骨植骨术的45例尺桡骨干骨折患者为观察对象。术中测量骨缺损和游离碎骨块的体积。根据植(取)骨量和骨缺损量的比例将患者分为1.0倍组、1.5倍组和2.0倍组3组,每组15例。植(取)骨量分别为骨缺损量的1.0倍、1.5倍和2.0倍。随访12个月,观察3组骨折愈合情况。结果 1.0倍组骨折愈合率为86.67%(13/15)。显著低于1.5倍组(100%)和2.0倍组(100%)。差异具有统计学意义(P0.05)。但1.5倍组和2.0倍组差异无统计学意义(P0.05)。结论为减少骨量浪费和提高愈合率,选择1.5倍植骨量较适宜。     

体外高能震波治疗骨不连和骨延迟愈合的初步结果

目的观察Ossatron高能体外震波仪治疗骨不连和骨延迟愈合的效果。方法2004年10月～2005年10月采用体外震波治疗18例四肢骨折术后骨不连和4例骨延迟愈合患者,C型臂X线机透视定位,根据不同骨折部位选择合适的震波能量、频率和冲击次数。内固定不稳定者震波治疗后以石膏或支具固定6～8周。术后6、12周及以后每个月随访复查X线片,直至骨折愈合。结果所有患者获3～12个月(平均6．7个月)随访。10例患者震波后出现局部瘀斑或肿胀,术后1～3 d缓解；无其它并发症发生。22例患者中,13例(59．1%)获骨性愈合,骨折愈合时间平均为4．3个月(6周～6个月)。18例内固定稳定的患者中12例骨折获愈合,其愈合率为66．7%。9例患者(40．9%)骨折未愈合。结论震波治疗对骨折断端稳定的骨不连和延迟愈合具有一定疗效,其突出特点是安全、无创。     

延迟分离对延长区骨愈合影响的实验研究

目的：探讨延迟分离适宜时间及其保进延长区骨愈合机制,方法：对68只兔左胫骨干髓端截骨,按开始延长时间不同分为4组,采用微血管铸型,力学强度等方法进行动态观察和比较,结果：截骨术后第4天,截骨断端髓腔血管开始吻合沟通,延长过程中,延长区血管网丰富,仅早期术后立即延长组血管网略显稀疏,结论：恰当的延迟分离延长有利于延长区的骨形成和改建,延迟分离时间的过长,并不能进一步加速延长区骨愈合和改建,同时存在严重并发症的潜在风险,延迟分离可能的机制是有利于截骨断端血循环的重建,适宜的延迟分离时间应根据截骨断端血循环重建所需时间而定。     

Experimental study of effect of stress-relaxation bone plate on fracture healing

ＩＤｅｐａｒｔｍｅｎｔｏｆＯｒｔｈｏｐａｅｄｉｃｓ ,ＳｉｘｔｈＰｅｏｐｌｅ ｓＨｏｓｐｉｔａｌ,Ｓｈａｎｇｈａｉ 2 0 0 2 33 ,Ｃｈｉｎａ (ＺｈａｎｇＸＬａｎｄＺｈａｎｇＷ)ＤｅｐａｒｔｍｅｎｔｏｆＯｒｔｈｏｐａｅｄｉｃｓ ,ＳｈａｎｇｈａｉＮｉｎｔｈＰｅｏｐｌｅ ｓＨｏｓｐｉｔａｌ,ＳｈａｎｇｈａｉＳｅｃｏｎｄＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｓｈａｎｇｈａｉ2 0 0 0 11,Ｃｈｉｎａ (ＤａｉＫＲ)ＴｈｉｓｓｔｕｄｙｗａｓｓｕｐｐｏｒｔｅｄｂｙｔｈｅｇｒａｎｔｓｆｒｏｍｔｈｅＮａｔｉｏｎａｌＮａｔｕｒａｌＳ…     

BMP促进去神经后废用性骨质疏松骨折愈合的实验研究

为了观察ＢＭＰ对去神经后废用性骨质疏松性骨折愈合的作用，作考选用６月龄健康标准大鼠，严格配对分组，切除双侧坐骨神经后３周证实有明显骨质疏松。然后在腔骨人工骨折骨缺损处分别植入酸解胶状鼠尾胶原（对照）及ＢＭＰ与胶原混和物（实验组）。通过血清钙浓度、碱性磷酸酶活性及骨组织形态计量学多项参数的观察，显示ＢＭＰ对去神经后废用性骨质疏松骨折愈合有明显促进作用（Ｐ＜０．０５～０．０１）     

The biology of fracture healing

The biology of fracture healing is a complex biological process that follows specific regenerative patterns and involves changes in the expression of several thousand genes. Although there is still much to be learned to fully comprehend the pathways of bone regeneration, the over-all pathways of both the anatomical and biochemical events have been thoroughly investigated. These efforts have provided a general understanding of how fracture healing occurs. Following the initial trauma, bone heals by either direct intramembranous or indirect fracture healing, which consists of both intramembranous and endochondral bone formation. The most common pathway is indirect healing, since direct bone healing requires an anatomical reduction and rigidly stable conditions, commonly only obtained by open reduction and internal fixation. However, when such conditions are achieved, the direct healing cascade allows the bone structure to immediately regenerate anatomical lamellar bone and the Haversian systems without any remodelling steps necessary. In all other non-stable conditions, bone healing follows a specific biological pathway. It involves an acute inflammatory response including the production and release of several important molecules, and the recruitment of mesenchymal stem cells in order to generate a primary cartilaginous callus. This primary callus later undergoes revascularisation and calcification, and is finally remodelled to fully restore a normal bone structure. In this article we summarise the basic biology of fracture healing.     

体外冲击波在促进骨愈合中的应用

目的:观察体外冲击波促进骨折愈合、治疗骨不连的疗效。方法:选取22例外伤性骨折愈合延迟、骨不连患者进行体外冲击波冲击治疗,治疗后每4～6周进行X线片复查,观察骨折愈合情况。首次冲击波治疗12周后如骨折处无明显骨痂形成,则进行第2次冲击波治疗。冲击波能量为0.4mJ/mm2,每次脉冲总数为1600～2400次。结果:22例下肢外伤性骨折愈合延迟及骨不连经体外冲击波治疗后,骨性骨痂形成的时间为4～12周,20例有明显骨痂形成,其中17例在治疗后3～6个月内骨折完全愈合。2例胫骨下段骨折冲击波治疗无效。结论:体外冲击波在治疗骨不连,促进骨折愈合方面效果满意,有广阔的应用前景。     

Early period of fracture healing in ovariectomized rats

Objective. To evaluate the effect of osteoporosis on fracture healing through observing the hlstomorphological changes, bone mineral density of callus and expression and distribution of transforming growth factor beta 1 (TGF-β1 ), basic fibroblast growth factor (bFGF)and bone morphogenetic protein.2 (BMP-2) in ovariectomized rats. Methods. Sixty female Sprague-Dawley rats ( aged 12 weeks and weighing 235 g on average ) were randomly divided into an ovariectomized (OVX) group (n =30) anda sham-operated (SO) group ( n = 30). Ovariectomy was performed in the OVX rats and same incision was made in the SO rats. Three months later, fracture of femoral shaft was made on all the rats. Then they were killed at different time points. Callus formation was observed with histological and imethods. Results: A reduction in callus and bone mineral density in the healing femur and a decrease of osteoblasts expressing TGF-β1 near the bone trabecula were observed in the OVX rats 3-4 weeks after fracture.Histomorphological analysis revealed a higher content of soft callus in the OVX rats than that in the SO rats.Immunohistochemistry results showed that no remarkable difference in expression and distribution of BMP-2 and bFGF between the OVX and SO groups was found. Conclusions: Osteoporosis influences the quantity and quality of callus during the early period of fracture healing. The effect of osteoporosis on fracture healing has no relationship with the expression of BMP-2 or bFGF. The decreased expression of TGF-I31 in osteoblasts may cause a decrease in quality of facture healing after osteoporosis.     

Vascular reorganization and return of rigidity in fracture healing

The present study addresses the relationship between vascular reorganization and the biomechanical changes occurring during canine long bone fracture healing. A middiaphyseal osteotomy of the radius was performed, and angiographic studies were carried out using India ink injections from 2 to 12 weeks postosteotomy. The radii were harvested, subjected to nondestructive four-point bend testing on an Instron, and then sectioned and cleared according to the Spaltholtz technique. The observed microangiographic patterns were correlated with the calculated rigidity values. Quantitative bone blood flow measurements around the osteotomy were performed on a different group of animals, using the radiotracer microsphere technique, at 3, 6, and 9 weeks postosteotomy to correlate with our qualitative microangiographic results. We demonstrated a direct and predictable relationship between the phase of vascular reorganization and the rigidity. This correlation was present even in our delayed union specimens.     

周围神经系统对骨折愈合影响的实验研究

目的研究周围神经系统在骨折愈合早、中期所起的作用。方法将大鼠一侧下肢制成失神经胫骨骨折模型,对侧制成正常神经支配骨折模型。骨折后15d、30d处死大鼠,取双侧胫骨,拍X线片、测定生物力学强度,制备不脱钙切片,进行骨计量学观察。结果X线片显示失神经组骨痂形成量明显增多(P<0.01),但抗弯强度降低(P<0.05)。骨计量学显示,失神经组矿化骨小梁宽度明显减小(P<0.05),类骨质宽度增加,破骨细胞指数及骨吸收表面明显增大(P<0.05),成骨细胞指数及骨形成表面两组无差别。动态参数显示失神经组矿化沉积率明显变小(P<0.05),类骨质成熟时间延长(P<0.05)。结论周围神经在骨折愈合早、中期起重要的调节作用,完整神经支配是骨折愈合所必需的。     

去势对骨折早期愈合过程的影响

目的 通过对去势大鼠股骨骨折模型愈合早期骨痂的组织学、骨密度以及转化生长因子β1(Transforming growth factor beta 1.TGF-β1)、碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF）、骨形态发生蛋白-2(bone morphogenetic proteins-2，BMP-2)合成变化的观察．探讨骨质疏松骨折早期愈合过程的变化。方法 将60只雌性SD大鼠分为去势组和对照组，3个月后制成股骨干骨折模型．伤后不同阶段处死．分别进行组织学、骨密度以及TGF-β1,bFGF,BMP-2免疫组化染色方法观察。结果 大鼠去势后3个月全身骨密度检查证实去势组骨质疏松形成。骨折后第3d两组均开始形成原始骨痂；第4～6周，去势组骨痂比对照组少，且软骨痂比例较高．骨密度较低，免疫组化染色显示，在两组间bFGF、BMP-2的表达与分布、高峰出现与持续时间差异无显著性．去势组骨小梁附近表达TGF-β1的成骨细胞数目减少，结论 骨质疏松使大鼠骨折早期骨痂的数量与质量降低，自软骨性骨痂至骨性骨痂演变过程减缓．对骨折愈合过程的影响与BMP-2、bFGF的表达无明显关联。TGF-β1在成骨细胞中的表达减少可能是引起骨质疏松骨折愈合质量下降的因素之一．     

The effects of cryopreserved human amniotic membrane on fracture healing: Animal study

ObjectiveThe aim of this study was to investigate the effects of human amniotic membrane (HAM) on fracture healing in an animal model.MethodsStandard tibial diaphysial fractures were created in twenty-eight Wistar-Albino rats and treated with intramedullary Kirschner wire (K-wire) and HAM (HAM (+) group) or K-wire only (HAM (–) group). Fracture healing was evaluated by histological analysis, radiologic X-ray views and callus diameter measurements at 3rd and 6th weeks postoperatively.ResultsFracture healing was histologically better in the HAM (+) group and the difference was statistically significant at both 3rd and 6th weeks postoperatively (p < 0.05). The highest histologic scores and entire woven bone formation (Huo Stage 8–9) were obtained at 6th weeks postoperatively in the HAM (+) group. Histological examination also revealed predominant fibrous tissue and partial cartilage formation (Huo Stage 2) at the postoperative 3rd week in the HAM (-) group. Equal amounts of woven bone and cartilage formation (Huo Stage 6–7) were observed at 3rd weeks postoperatively in the HAM (+) group and at 6th weeks postoperatively in the HAM (-) group. The callus diameters were greater in the HAM (+) group and the difference was statistically significant (p < 0.05) at 3rd and 6th weeks postoperatively. Although there was only a statistically significant difference (p < 0.05) at the postoperative 3rd week, radiological scores tended to be higher in the HAM (+) group at both the 3rd and 6th weeks postoperatively.ConclusionHAM is a cheap and easily accessible alternative biological material. HAM may be used to support surgical treatment of fractures, particularly where bone healing is expected to last longer.     

骨折愈合的应力适应性研究

设计了生物适应性很强的力学控制装置──滑动机械加载控制器,对骨折断端没有应力遮挡,把肌肉动力与肢体负重力作为执行力学加载的源动力,通过压力传感器、多导传感放大器动态记录生理活动状态下断端受力情况及愈合过程中断端的应力状态。结果表明,同一时期内骨折断端压力随肌肉收缩及步态发生变化,不同愈合时间断端压力均值随时间的增加而逐渐增加,而滑动机械加载控制器上承载由术后当日平均2.4kg逐渐变小至术后五周平均0.78kg.同时,通过解剖显微镜进行断端骨痂显微观察,显示断端完全由外骨痂包绕,从而认为骨折断端压力变化是肢体功能恢复,断端骨痂承受载荷的表现,提示临床骨折固定后应适时地进行功能锻炼,肌肉收缩、患肢负重可为断端提供最好的力学环境──生理应力状态。