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.     

同种异体骨复合人工关节治疗股骨肿瘤的研究

目的探讨应用同种异体骨复合人工关节对股骨肿瘤切除后骨缺损的治疗.方法自1996年12月至2004年12月,采用同种异体骨复合人工关节治疗股骨肿瘤20 例,其中复合股骨上端的全髋关节置换8 例,复合股骨下端全膝关节置换12 例.按Enneking分期,广泛边缘性切除肿瘤,选用长柄人工关节和形态合适的同种异体骨与宿主骨经骨水泥髓内固定,假体柄插入宿主骨髓内长度与异体骨轴心长度比应为0.8以上.术后均未使用免疫抑制剂.结果 20 例中随访18 例,平均36个月.2 例骨肉瘤患者术后15个月内死亡,其余患者均无瘤生存.所有患者均无关节脱位、假体松动和断裂.16 例异体骨和宿主骨形成骨性融合,融合时间为6～12个月,平均8个月.8 例股骨上端的全髋关节置换者,髋关节的主动活动度为70°～120°,平均83°;10 例复合股骨下端全膝关节置换者,膝关节的主动活动度为67°～130°,平均90°.按ISOLS骨肿瘤术后功能重建评分为21～29分,平均27.5分.结论异体骨与宿主骨间的生物连接增加了人工关节的固定臂,从而降低了假体松动、下沉或断裂的发生率.同种异体骨移植复合人工关节置换具有异体骨和人工关节两者的优点,更适合良性和生存时间较长的恶性肿瘤的保肢治疗.     

The Formation of Stress by Acrylic Bone Cements During Fixation of the Acetabular Prosthesis

The forces developed by acrylic cement during the final phase of polymerization under conditions that simulate the cementing of the acetabular prosthesis are evaluated. Calculations show that forces of 500–1100 N may be reached in a three-point fixational system. the importance of the dimensions of the plastic and the bone and the relevance of the E-moduli are discussed.     

多发性骨与关节损伤的及时诊断与早期救治

本文通过对141例多发性骨与关节损伤治疗结果分析,认为对主要骨干骨折早期手术内固定可减少并发症的发生.文中对141例多发性骨与关节损伤的临床特点、诊断及其救治问题做了讨论,并强调了骨折早期手术内固定及术后早期康复的重要性.     

The Relaxation of Some Acrylic Bone Cements

The creep and relaxation of acrylic cements during conditions simulating the conditions in the acetabulum have been examined. CMW and Simplex were found to reach stresses of about 10 N/cm² after 1 year whereas Palacos had lost most of its stress after 6 weeks.     

病灶切刮骨水泥植入术治疗胫骨上端骨巨细胞瘤（附15例报告）

目的：探讨病灶切刮骨水泥植入术治疗胫骨上端骨巨细胞瘤的手术方法和疗效。方法：采用病灶扩大切除后行骨水泥植入或植骨加骨水泥植入术，8年内共治疗胫骨上端骨巨细胞瘤15例。结果：平均随访4年6个月，未见局部复发病例。按照Enneking标准功能评分，平均得分29（27－30）点。结论：除外骨质破坏严重，病灶切刮骨水泥植入术对于此类胫骨近端各期骨巨细胞瘤应作为首选的治疗方法。     

骨肿瘤病段切除并骨缺损修复

目的 修复切除骨肿瘤后的骨缺损肢体,恢复其功能。方法 采用特制人工金属假体,带血管蒂游离骨、异体关节、自体骨、骨水泥等修复骨缺损。结果 26例中应用带血管蒂游离骨或自体骨植骨术愈合最佳并且无复发;异体骨移植有一定的排异反应;骨水泥堵塞只适用于特殊部位骨缺损的修复;人工假体修复,功能恢复良好。结论 对某些良性骨肿瘤及低度恶性的骨肿瘤作病段切除后,选择适当的替代物修复缺损行之有效。     

Penetration of Acrylic Bone Cements into Cancellous Bone

The depth of penetration of five commercial acrylic bone cements into cancellous bone was measured in vitro. Under standard, idealized conditions, cement penetration was found to vary significantly with different cements. Penetration was critically influenced by the coarseness of the cancellous bone and increased directly with the effective volume of the “cells” within the osseous matrix. An inverse correlation was determined between the mean cement viscosity during flow into the bone and final penetration depth. The dough time, set time and working time of each acrylic formulation was found to have no significant effect upon the depth of cement penetration.

It is suggested that in addition to the techniques adopted for introduction of cement to the bone, the selection of the bone cement itself may critically influence the incidence of late loosening following total joint replacement.     

Penetration of Acrylic Bone Cements into Cancellous Bone

The depth of penetration of five commercial acrylic bone cements into cancellous bone was measured in vitro. Under standard, idealized conditions, cement penetration was found to vary significantly with different cements. Penetration was critically influenced by the coarseness of the cancellous bone and increased directly with the effective volume of the “cells” within the osseous matrix. An inverse correlation was determined between the mean cement viscosity during flow into the bone and final penetration depth. The dough time, set time and working time of each acrylic formulation was found to have no significant effect upon the depth of cement penetration.

It is suggested that in addition to the techniques adopted for introduction of cement to the bone, the selection of the bone cement itself may critically influence the incidence of late loosening following total joint replacement.     

骨基质明胶颗粒/骨水泥复合材料固定人工关节假体的实验研究

[目的]探讨骨基质明胶颗粒(BMG)复合骨水泥(PMMA)用于人工关节假体固定的可行性.[方法]制备成年新西兰白兔股骨中上段15 mm骨缺损,于髓腔内置入直径3 mm的钛棒并以骨水泥或BMG/PMMA复合材料固定,模拟人工股骨头置换术之动物模型,分别进行术后步态、X线检查、生物力学、组织学检查观察.[结果]术后第2d～12周两组动物均可正常行走;术后24h力学检测示两种固定方法无显著性差异;随着时间的延长,骨缺损无短缩;X线及组织学检查示复合材料组钛棒周围有成骨现象,扫描电镜见复合材料内有骨长入.[结论]BMG颗粒/PMMA复合材料固定假体时显示出可靠的力学性能及诱导成骨能力,将可能使其成为一种新的假体固定方法.     

全膝置换术后预防假体松动研究

目的 :探讨双膦酸盐类 (阿仑膦酸钠 )对早期预防全膝置换术后假体松动的意义。 方法 :36个人工膝关节置换首次膝关节骨密度采集为手术后的 2周。骨密度采集后开始口服阿仑膦酸钠 10mg/d ,连续服用 3个月后复查膝关节骨密度变化。 结果 :用药前、后各区骨矿化含量统计学分析结果显示用药前、后各区骨矿化含量具有明显差异 (P <0 0 0 5 ) ,用药前、后各区骨矿化含量差量进行统计学交叉分析 ,各区差量统计学分析显示R1与R2、R1与R3、R1与R4、R2与R3及R3与R6组间无统计学差异 (P >0 5 )。 结论 :阿仑膦酸钠对预防全膝置换术后假体早期松动具有明显的临床意义。     

两种不同方法治疗早期股骨头坏死临床疗效比较

目的用多孔钽金属棒植入和带血管蒂的大转子骨瓣移植两种不同方法治疗早期股骨头坏死,比较其临床疗效差异。方法2007年2月至2008年5月治疗成人早期股骨头坏死（FicatⅠ-Ⅱ期）43例（48髋）,A组：在股骨头坏死行髓芯减压后植入多孔钽金属棒;B组：用带血管蒂的大转子骨瓣移植修复股骨头坏死。A组24例（29髋）,B组19例（19髋）,分别观察两组病例的手术时间、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,随访18-32个月,平均随访26个月,以最后一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、输血量、X线影像学进展情况方面均有显著性差异（P〈0.05）,两组术后的Harris评分均较术前明显提高,差异有显著性。结论钽棒微创植入治疗早期股骨头坏死,相比带血管蒂的大转子骨瓣移植创伤小、出血少、手术时间短、并发症少,早期临床效果优良,对预防股骨头进一步塌陷具有更好的效果,值得推广使用。     

The Bone and Joint Decade 2000-2010: An update

Background?Fracture and low bone mineral density both have strong predictive value for future fractures. The risk of future fractures can be reduced by medi-cal treatment if patients with osteoporosis are identified, for example by screening fracture patients for low bone mineral density. We suggest that these screening rou-tines be organized at orthopedics departments and we report our experience with such a screening system.

Patients and methods?We screened all patients between 50–75 years of age with a wrist, vertebral, prox-imal humerus, or hip fracture visiting our orthopedics department by measuring bone mineral density (BMD) using DEXA scans. After diagnosis, the patients were referred to their primary care physician for treatment.

Results?Between November 1, 2002, and October 31, 2003, 239 patients were investigated and only 13% had normal BMD values. 45% of the patients were diagnosed with osteopenia and 42% with osteoporosis.

Interpretation?Screening of fracture patients who visit an orthopedics department appears to be an effec-tive way of identifying individuals with low bone min-eral density. The screening routines can be organized as an osteoporosis team consisting of a doctor, a nurse and a secretary at each department. Today, these patients are largely undetected and untreated—at least in our region. In our series, only 13 patients had been DEXA-scanned and were treated by antiresorptive drugs at the time of fracture.??     

Injuries to the Articular Cartilage

Abstract Injuries to articular cartilage are commonly encountered in orthopedic sports medicine. These lesions can lead to sport invalidity and premature osteoarthritis. The management of chondral and osteochondral lesions represents a challenge to clinicians and scientists. The aim of the therapy has to be the recurrence to former sport levels and the prevention of early osteoarthritis. Today there are different concepts of treatment. One therapy principle is the recruitment of mesenchymal stem cells. These procedures lead at best to fibrocartilaginous repair tissue that is functionally inferior to normal hyaline cartilage. Another group of procedures is the transplantation of autologous osteochondral grafts, which provide repair with a hyaline cartilage matrix and show good clinical medium-term results. But osteochondral grafts are limited and there is a potential donor-site morbidity. Finally, the transplantation of autologous chondrocytes is used. However, this kind of transplantation repairs the chondral injury only by fibrocartilaginous repair tissue, too. Therefore, new techniques for the treatment of articular cartilage injuries have to be established. The most promising field today is the combination of tissue-engineering and gene therapeutic methods for the treatment of the chondral and osteochondral lesions.     

Long-Term Results after Early Treatment of Knee Injuries

A total of 175 patients were reviewed 1 to 8 years (average 42 months) after treatment of knee ligament injury in the acute stage. Two-thirds were treated operatively because of total ligament tears and the remainder, with minor injuries, were treated non-operatively. In two-thirds of the patients with total substance tear of the anterior cruciate early repair was successful. Repair of the posterior cruciate was generally successful. Functional loss was correlated to the presence of a pivot shift sign and with abduction or adduction instability in extension. An important reason for a poor result was either medial meniscectomy or some component of the injury being missed in the primary diagnosis. Diagnosis based on arthroscopic and clinical findings was more reliable when selecting patients for operative or non-operative treatment than was diagnosis based on clinical examination alone. There was no difference in the results of non-operative treatment between patients immobilized in plaster and those treated with early mobilization without weight-bearing.