头状骨移位替代坏死月骨的解剖研究及其临床应用

目的　介绍一种治疗晚期月骨无菌性坏死的新术式。方法　对 5 0侧上肢标本进行显微解剖并观测腕部的血管结构。对 10 0侧腕骨标本中头状骨与月骨进行对比观测 ,并做相关性分析。设计以骨间前动脉背侧支为蒂的头状骨移位术 ,替代坏死碎裂的月骨。临床应用 2 0例 ,术后随访 1～ 13年。结果　头状骨与月骨的几何形状、外径和关节面的弧高、弧长极其相似 ,相关性显著。移位的头状骨有可靠的血运。 2 0例头状骨移位替代坏死月骨者术后腕痛消失 ,保持了腕高、腕骨间的稳定和腕关节的功能。结论　该术式符合腕关节的功能解剖和力学传导 ,是治疗晚期月骨无菌性坏死的较好方法。     

桡骨远端骨瓣转移治疗晚期月骨无菌性坏死

目的 报告以桡动脉腕背分支为蒂的桡骨远端骨瓣转移治疗晚期月骨无菌性坏死的手术方法及初步疗效.方法 对2例晚期(Ⅳ期)月骨无菌性坏死患者,采用桡动脉腕背分支为蒂的桡骨远端骨瓣转移治疗.术后随访患者症状、腕关节活动度和腕关节影像学的改变,并用Krimmer 评分表和DASH评分表进行功能评定.结果 2例患者随访时间分别为3年和6个月,静息时疼痛均已消失,活动时疼痛程度减低.影像学表现:例1患者X线片月骨可见高密度坏死骨质已吸收,有新骨质形成;例2患者MRI显示坏死骨和腕骨塌陷无进一步进展.2例腕关节功能按Krimmer评分、DASH评分均较术前有明显的改善.结论 桡动脉腕背分支为蒂的桡骨远端骨瓣转移术治疗晚期月骨无菌性坏死.初步疗效良好.     

自体骨膜联合带蒂骨瓣移植替代月骨

目的 探讨治疗晚期月骨无菌性坏死、月骨陈旧性脱位的新术式。方法 对2例晚期月骨无菌性坏死及1例陈旧性月骨脱位行月骨摘除后,自体骨膜联合带血管筋膜蒂骨瓣移植替代月骨术。结果 随访8～36月,2例腕痛消失,1例腕痛缓解,保持了腕高、腕骨间的稳定和腕关节功能。X线照片示替代月骨骨瓣的位置及密度基本正常。结论 应用自体骨膜联合带蒂骨瓣移植作为月骨的替代物,对晚期月骨无菌性坏死及陈旧性脱位的治疗,操作简便、创伤小、临床效果好。     

头状骨移位治疗月骨无菌性坏死

目的 介绍以骨间前动脉背侧支为蒂的头状骨移位治疗晚期月骨无菌性坏死。方法 对18例Lichtman分Ⅲ、Ⅳ期月骨无菌性坏死患者采用坏死月骨摘除，以骨间前动脉背侧支为蒂的头状骨移位替代坏死月骨。结果 术后随访1～5年，平均32个月，移位头状骨有可靠血运，16例腕痛消失，2例仍有轻度腕痛，优良率100％。结论 应用该法替代月骨支撑腕关节，符合腕关节功能解剖，是治疗Ⅲ、Ⅳ期月骨无菌性坏死的有效方法。     

头状骨移位治疗月骨无菌性坏死

目的　介绍以骨间前动脉背侧支为蒂的头状骨移位治疗晚期月骨无菌性坏死。方法　对 18例Lichtman分Ⅲ、Ⅳ期月骨无菌性坏死患者采用坏死月骨摘除 ,以骨间前动脉背侧支为蒂的头状骨移位替代坏死月骨。结果　术后随访 1～ 5年 ,平均 32个月 ,移位头状骨有可靠血运 ,16例腕痛消失 ,2例仍有轻度腕痛 ,优良率 10 0 %。结论　应用该法替代月骨支撑腕关节 ,符合腕关节功能解剖 ,是治疗Ⅲ、Ⅳ期月骨无菌性坏死的有效方法     

腕月骨无菌性坏死病的临床诊治和进展

腕月骨无菌性坏死又称Kien-boeck病，是腕关节痛的主要病因之一，近年来发病率有所上升。该病多发于青壮年男性体力劳动者，以月骨的缺血坏死为基础，表现为月骨内的骨折，密度、形状发生改变，继发腕关节滑膜炎，腕骨排列紊乱和腕关节不稳征。晚期多造成手的握力低下、腕关节剧痛和功能完全丧失，致残率较高。虽经近90年的临床研究，在病因学、诊断和治疗上有了较大的进步，但迄今为止最突出的问题仍是病因不清，伴之而来的是缺乏针对病因的确切有效的治疗方法^[1]。     

镍钛记忆合金舟大小融合器治疗舟骨旋转性半脱位和月骨无菌性坏死的应用研究

目的评价镍钛记忆合金舟大小融合器（NT-STTAC）治疗舟骨旋转性半脱位和月骨无菌性坏死的临床效果。方法对7例舟骨旋转性半脱位和3例月骨无菌性坏死患者入院后均使用镍钛记忆合金舟大小融合器行舟骨、大小多角骨局限性腕骨融合术（scapho—trapezio—trapezoeid arthrodesis,STT融合术）。术后平均随访12个月,随访内容包括术后患手握力、腕关节活动范围、腕关节疼痛程度、腕关节X线检查。采用疼痛视觉模拟评分（visual analogue scales．VAS）评估腕关节疼痛程度;采用Krimmer腕关节评分表对腕关节总体功能进行评价。结果术后平均握力为（32．49±6．21）Kg,恢复至健侧的80．8％：术后腕关节活动范围达到健侧的53％以上：X线检查未见骨不连病例;无伤口感染病例。VAS评分腕关节疼痛值休息状态下：术前为（4．46±1．27）分、术后为（1．31±0．95）分;负重状态下：术前为（7．00±1．41）分、术后为（2．62±1．26）分,差异有统计学意义（P〈0．05）。Krimmer腕关节评分值为79分。术后优良率为84．6％．结论应用镍钛记忆合金舟大小融合器进行舟大小融合术能保存大部分腕关节功能,是治疗慢性、静态性舟骨旋转性半脱位和月骨无菌性坏死的一种有效方法。     

腕关节神经支切断与假体置换治疗月骨缺血性坏死

目的防止月骨缺血性坏死后腕骨排列进行性紊乱，缓解腕痛，增加握力，改善功能。方法１９９２年１月～１９９７年１月，采用腕关节神经支切断，月骨假体置换术治疗月骨缺血性坏死６例。结果术后随访最短１０个月，最长５４个月，平均随访时间３２个月，优良率８３．３％。结论骨间前、后神经腕关节支切断术联合月骨假体置换术治疗月骨缺血性坏死，术后能获得无痛的关节。腕关节神经支切断联合假体置换是治疗月骨缺血性坏死的一种效果较好的方法     

带蒂头状骨替代月骨

自1985年以来,在对50侧新鲜成人上肢标本解剖观察的基础上,设计了以骨间掌侧动脉背侧支为血管筋膜蒂的头状骨移位,替代晚期缺血坏死、关节面完全破坏的月骨,重建桡腕关节功能。临床应用6例,随访6个月～4年,手术效果满意。介绍了解剖依据,手术优缺点,适应证等。     

重视和提高腕月骨无菌性坏死的整体整诊治水平

月骨无菌性坏死是腕关节痛的主要病因之一,1843年由Peste所发现,1910年Kienbck详细报告了其临床症状和体征,故被称为Kienbck病。该病在临床上并不少见,多发于青壮年男性体力劳动者。近年来,其发病率亦有上升的趋势。该病以月骨的缺血坏死为开始,可继发腕关节滑膜炎,月骨的密度、形状发生改变而导致桡、月关节面磨损,关节炎,腕骨的排列紊乱和腕关节不稳征。晚期可造成患者手的握力低下、腕关节剧痛和功能完全丧失,致残率较高。在近90年的诊治过程中,从解剖学、病因学、影像学和治疗等方面,国内外的研究报告较多,但迄今其病因仍然不清楚。该…     

自体骨膜骨髓复合移植修复肿瘤性骨缺损

目的 介绍自体骨膜骨髓复合移植修复少儿委性骨肿瘤切除后骨缺损的方法。方法 抽取自体髂骨骨髓，自然形成凝块后植入骨缺损处，自体胫前骨膜切片１～２ｍｍ＾２邮票状，均匀植入骨髓凝块中。结果 随访４～１０个月，术后１个月新生骨形成，术后３～４个月１４例骨缺损处新生骨骨密度与周围组织一致，术后４个月恢复正常的关节功能和肢体负重功能。结论 自体游离骨膜骨髓复合移植，成骨能力强，方法简便，是治疗骨肿瘤切除后骨缺     

感染性骨缺损的治疗及研究进展

感染性骨缺损由于存在感染及骨缺损双重病变,治疗棘手,疗程长,且易出现肌肉萎缩、局部瘢痕而致肢体功能受到严重影响.近年来随着外固定技术、显微外科技术、生物材料技术及骨组织工程技术等的发展,感染性骨缺损的治疗取得明显进步,短缩了治疗时间,且效果显著,笔者对其研究进展综述如下.     

自体外周血及自体红骨髓干细胞与脱钙骨复合移植治疗骨缺损的比较研究

目的 对比观察自体外周血干细胞（APBSC）／脱钙骨（DB）复合移植与自体外红骨髓（ARBM）／DB复合移植治疗骨缺损的疗效。方法 36只家兔双侧桡骨造成1cm骨缺损,随机分为DB组、ARBM／DM级和APBSC／DB组,每组12只,分别进行X线片、生物力学和组织学检查,然后作对比分析。结果 术后第2、4、8、14周,APBSC／DB组和ARBM／DB组X线片、改进的GaryX线评分和光镜观察结果,以及术后第14周整骨破坏载荷和骨缺损修复形态学评分均明显优于DB组;但APBSC／DB组与ARBM／DB组间差异无显著性。结论 APBSC与ARBM都能在DB的骨形态蛋白诱导下促进成骨细胞的形成,复合移植疗效明显优于单纯DB移植。     

移植骨复合骨髓基质干细胞修复兔股骨缺损

目的观察同种异体骨复合骨髓基质干细胞对兔股骨大段缺损修复情况,探讨其修复骨缺损的可行性。方法将24只大耳兔随机分为2组,造成股骨大段缺损,对照组植入打孔同种异体骨,实验组植入打孔同种异体骨＋明胶海绵＋骨髓基质干细胞。术后2个月行X线片观察、病理组织学检查及骨密度测试。结果①放射学检查：对照组在异体骨结合部可见骨痂通过,实验组整个异体骨段均可见明显骨痂形成。②病理组织学检查：对照组可见少量内骨痂及外骨痂且被大量纤维结缔组织所分隔,实验组异体骨有坏死后弧形吸收窝,可见内外骨痂生长,髓腔内充满大量骨母细胞。③平均骨密度值测定：实验组高于对照组及正常股骨,差异有显著性（P〈0．05）。结论同种异体骨复合骨髓基质干细胞用于修复兔股骨大段缺损,较单纯异体骨成骨量大、迅速,能够对骨缺损进行有效的修复。     

Segmental Replacement of the Femur in Baboons with Fiber Metal Implants and Autologous Bone Grafts of Different Particle Size

A study was made of bone ingrowth into fiber metal composite prostheses used to replace large segments of the femur in baboons. Bone grafts of two different types were used to cover the segment: chips of bone with large particle size and ground bone with a smaller particle size. The prosthetic segment was bridged by bone at 3 and 6 months in all cases irrespective of the structure of the transplant. In animals sacrificed at 6 months bone ingrowth occurred, with a marked difference between specimens with the two different grafts. In the ground bone specimens ingrowth occurred over the total surface area, and bone penetrated deep into the composite. With the chip grafts ingrowth was more irregular occurring only in some areas and it was always superficial. The difference is believed to be due to the improved contact between the fiber metal surface and the transplant. The lesser bulk of the ground transplant is advantageous when the soft tissue cover of the bone is thin.     

移植的"肱骨头"吸收-缺损原因和治疗

目的 分析带或不带腓血管，含腓骨头的腓骨上段替代肱骨头后，骨吸收-缺损的原因。寻找缺损肱骨头的修复方法。方法 对4例因肱骨近端肿瘤行瘤段骨切除，含腓骨头腓骨上段移植患者术后不同时段的临床和X线片表现进行分析，其中1例应用带肱二头肌短头和喙肱骨蒂喙突转位治疗，随访时间56-91个月（平均5年7个月）。结果 无论带或不带腓血管，在软组织床基本相同的条件下，移植骨均出现骨缺损仅见2例，“肱骨头”与肩峰或肩胛盂的反复撞击。最终导致骨缺损，带肌蒂喙突移位植骨法近期效果良好。结论 虽然“肱骨头”的吸收不可避免，但可以用减少撞击来减轻缺损程度，带肌蒂喙突移位植骨法可修复较大的缺损。     

冷冻灭活皮质骨移植治疗股骨头颈部侵袭性肿瘤的疗效观察

目的 评估病灶刮除液氮冷冻灭活结合皮质骨支撑治疗股骨头颈部侵袭性骨肿瘤的疗效。方法 １１例患者在诊断明确后均采取病灶刮除加液氮注入法冷冻灭活,缺损处以自体（或异体）腓骨和自体髂骨填充修复,７例辅以内固定。结果 １１例随访３～１０年（平均６年６个月）。参照Ｅｎｎｅｋ－ｉｎｇ评定标准进行功能评估,优７例,良４例。结论 该疗法是治疗股骨头颈部侵袭性肿瘤的良好方法之一。     

Osteogenesis after Bone and Bone Marrow Transplantation: II. The Initial Cellular Events Following Transplantation of Decalcified Allografis of Cancellous Bone

An experimental study was done in rabbits to investigate the fate of allogeneic iliac cancellous bone, both non-decalcified and decalcified with hydrochloric acid, transplanted to a muscular site for up to 14 days. Some of the treated allografts were impregnated with autologous bone marrow cells, obtained from the femoral medulla by aspiration, and each was compared with allografts alone. Combined myelo-osseous grafts produced bone after 7 to 8 days implantation, as did marrow autografts alone. In addition non-decalcified implants stimulated the production of multinucleated giant cells. Three different types of wash solution were used but these did not influence the cell population seen, nor the new bone formation. It is concluded that the critical events in bone formation after transplantation occur less than 8 days after the transplantation and that marrow cells have osteogenic capacity. This has relevance to the clinical aspects of bone grafting.     

Bone cement with reduced proportion of monomer in total hip arthroplasty: Preclinical evaluation and randomized study of 47 cases with 5 years' follow-up

Bone cement with reduced amount of monomer and low curing temperature may improve implant fixation due to reduced toxicity. We analyzed the mechanical, chemical and thermal properties of such a cement (Cemex Rx) using Palacos R as control. The in vivo performance of the 2 cements was also evaluated in a prospective randomized study of 47 hips, where either of the cement types was used to fixate Lubinus SP2 prostheses with the stem made of titanium alloy. Cemex Rx had a reduced tensile strength, probably because this cement was manually mixed, as recommended by the manufacturer. A standardized laboratory test showed lower curing temperature for Cemex, but measurements at 37° and with prechilled Palacos R and Cemex Rx, as in clinical work, showed no difference. In the clinical study radiostereometric measurements of cup and stem migration showed similar values in the 2 groups up to 5 years after the operation. The cement mantle was stable in both groups, but the stems migrated similarly inside the cement mantle regardless of the type of cement used. Proximal wear was low (0.04-0.05 mm/year) and tended to be lower in the Cemex group (p = 0.02). Aluminum and vanadium levels in serum increased 5 years after the operation, but no difference was noted between the 2 groups. Collagen markers (PICP, ICTP) showed similar increases in bone turnover 6 weeks and 6 months after operation in both groups.     

On Injuries to the Acromio-Clavicular Joint: Treatment and Results

A study was made of bone ingrowth into fiber metal composite prostheses used to replace large segments of the femur in baboons. Bone grafts of two different types were used to cover the segment: chips of bone with large particle size and ground bone with a smaller particle size. The prosthetic segment was bridged by bone at 3 and 6 months in all cases irrespective of the structure of the transplant. In animals sacrificed at 6 months bone ingrowth occurred, with a marked difference between specimens with the two different grafts. In the ground bone specimens ingrowth occurred over the total surface area, and bone penetrated deep into the composite. With the chip grafts ingrowth was more irregular occurring only in some areas and it was always superficial. The difference is believed to be due to the improved contact between the fiber metal surface and the transplant. The lesser bulk of the ground transplant is advantageous when the soft tissue cover of the bone is thin.