腱周组织及骨膜对骨-肌腱结合部位早期愈合质量的影响

背景：骨腱结合部组织结构复杂,损伤愈合过程相对缓慢,其愈合过程中的关键在于促进特征性结构纤维软骨移行带的修复。 目的：通过组织学方法对腱骨结合部愈合进行评估。 方法：18周龄新西兰大白兔随机分为两组。骨膜组将骨膜游离并植入兔髌骨部分切除模型中骨-肌腱结点中,对照组不植入骨膜。术后4,8,12周行组织学染色观察,对比Safranin’O染色阳性染色的积分吸光度值。 结果与结论：组织学检查显示骨膜组术后4,8周骨-肌腱结合部组织愈合明显,以从松质骨再生和骨-肌腱愈合接点纤维软骨带的再生为特征,较对照组迅速,提示早期骨膜组恢复较对照组迅速。说明骨膜可以促进骨-肌腱结合部位细胞增生,增加细胞基质合成,促进新生骨和纤维软骨移行带形成,促进其愈合。同时,组织学检测可以很好地判断腱骨结合部的愈合。     

兔髌骨-髌腱复合体中骨-骨愈合和骨-腱愈合的比较研究

目的　比较髌骨 -髌腱复合体中骨 -骨连接和骨 -腱连接愈合。方法　 6 0只雌性成年兔。在一侧后肢的髌骨远端 1/ 3处横行截骨 ,在骨 -骨连接组中 ,将两髌骨骨折块重新连接 ;在骨-腱连接组中 ,切除远端 1/ 3髌骨。将髌腱与髌骨断端连接。分别于术后 8、12和 2 4周取材进行生物力学和组织学对比研究。结果　两组的拉断载荷没有显着性差异。但骨 -骨连接组第 8周和第2 4周的极限拉应力明显大于骨 -腱连接组 (P <0 .0 5 )。组织学研究表明骨 -骨愈合可通过愈合界面的软骨内化骨 ;在骨 -腱连接组中 ,大量瘢痕组织形成桥接愈合界面 ,并逐渐塑型重建 ,但没有形成典型的骨腱接点中的纤维软骨层。结论　髌骨 -髌腱复合体手术修复时 ,解剖学重建应该是首要考虑的问题 ,应尽可能采用骨折 (骨 -骨 )固定 ,以达到较好的愈后效果     

膝关节固定后髌骨腱的生物力学改变

背景：骨关节固定常作为防止受伤组织被再次损伤的方法。 目的：膝关节固定对兔髌骨腱力学特性及超微形态的影响。 方法：将20只成年兔等分为固定组和对照组。固定组兔左后肢通过石膏和2个可调铝夹板,保持膝伸直,踝关节屈曲90°,固定6周后,取髌骨腱-骨复合物,观察两组髌骨腱的生物力学性能和超微结构变化。 结果与结论：膝关节固定6周拉伸强度和切线模量分别下降至对照组的64.44%和53.08%(P < 0.01),但两组伸长率和最大负荷差异没有显著性意义。两组材料常数及应力应变关系曲线完全不同。固定组髌骨腱的横截面积明显大于对照组(P < 0.01),小胶原纤维占有优势。说明固定不仅会导致髌骨腱生物力学的变化,而且对髌骨腱自身也产生影响。     

髌腱断裂伤1例

1　临床资料患者 ,男 ,15岁。在打蓝球迅速起跳投篮时 ,突感左膝无力、剧烈疼痛而急诊入院。查体 :左膝关节无明显肿胀 ,髌骨下缘触摸有空虚感且局部压痛 ,伸膝无力 ,髌骨较对侧上移 ,浮髌实验阴性。X线片示 :左髌骨上移约 2cm ,髌骨关节间隙增宽 ,胫骨结节撕脱性骨块直径约 1.5cm× 1.0cm。初步诊断为左胫骨结节撕脱性骨折。随后立即在连续硬膜外麻醉下手术 ,术中见髌腱在胫骨结节处撕脱且上移。将髌腱连同撕脱骨块复位 ,用螺丝钉内固定。术后左下肢长腿石膏外固定6周 ,之后进行膝关节功能锻炼。半年后取出内固定 ,左膝关节功能基本正常。…     

兔髌骨-髌腱结合部新骨形成与大小预测其愈合程度

目的探讨髌骨-髌腱结合部愈合中新骨形成量和力学指标之间的关系。方法15只雌性成年兔,在一侧后肢的髌骨远端1/3处横行截骨,切除远端1/3髌骨。将髌腱与髌骨断端连接。分别于术后第8和16周取材进行生物力学、组织学和新骨形成情况(X线摄片测量和骨密度测定)检测,进行对比研究。结果髌骨-髌腱结合部新骨面积、新骨长度及骨矿密度在第8和16周之间仍未达到显著性水平,但在第16周时的拉断载荷、极限拉应力和拉断能量均明显大于第8周;新骨面积与拉断载荷及极限拉应力呈显著性相关。结论新骨面积与拉断载荷及极限拉应力间显著相关,通过临床无创X线影像学对新骨面积的定量,可有效评估髌骨部分切除后髌骨-髌腱结合部愈合状况,为术后主动康复提供参考。     

自固化磷酸钙人工骨Ⅱ修复兔腱-骨损伤的生物力学变化

背景：磷酸钙人工骨与重组人骨形态发生蛋白2在实验中均有成骨诱导作用,有修复腱骨界面损伤的可能。 目的：评估自固化磷酸钙人工骨Ⅱ(含重组人骨形态发生蛋白2)修复兔肩袖腱-骨界面损伤后的生物力学变化。 方法：取27只成年健康家兔,其中3只直接取双侧肩关节腱-骨界面标本作为正常组,余下的24只家兔双侧肩关节接受兔肩袖急性断裂腱-骨止点重建手术,术中实验组12只填塞自固化磷酸钙人工骨Ⅱ,对照组12只不填塞任何药物。分别于术后2,4,8周采集标本行生物力学测试。 结果与结论：实验组各时间点肩袖腱-骨界面最大抗拉强度均高于对照组(P < 0.001),但低于正常组(P < 0.001);实验组术后8周肩袖腱-骨界面刚度高于对照组(P < 0.001),但低于正常组(P < 0.001)。表明自固化磷酸钙人工骨Ⅱ可以在术后早期提高兔腱-骨界面的最大抗拉强度和刚度,增强腱-骨界面结合力,促进腱骨界面愈合。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

带血管蒂髌腱移植物的力学性能

背景：临床上研究膝关节交叉韧带生物材料的力学性能具有重要意义,可为临床研制组织结构、生物力学及相容性好的材料提供理论依据。目的：分析带血管蒂髌腱移植物的力学性能。方法：切断42只新西兰大白兔左前腿前交叉韧带,随机分为2组,实验组植入自体带血管蒂髌腱移植物进行前交叉韧带修复,对照组植入自体不带血管蒂髌腱移植物进行前交叉韧带修复。移植后8,12,16周,检测两组移植标本的生物力学性能。结果与结论：两组不同时间点的断裂位置比较差异无显著性意义;实验组移植后12,16周的膝关节前后松弛度高于对照组(P < 0.05),两组移植后8周的膝关节前后松弛度比较差异无显著性意义;实验组移植后8,12,16周的最大载荷均高于对照组(P < 0.05),移植后8,12,16周的刚度均高于对照组(P < 0.05);两组移植后不同时间点的最大拉伸长度比较差异无显著性意义。表明带血管蒂髌腱移植物具有良好的力学性能。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

保留止点自体肌腱移植治疗陈旧性髌韧带断裂

背景：髌韧带在膝关节的运动中起着非常重要的的作用,因其断裂比较少见,临床上误诊率较高。目前重建髌韧带的方法较多,疗效报道不一,治疗不当容易出现髌骨位置不良,会严重影响膝关节的功能。 目的：探讨保留止点自体肌腱移植治疗陈旧性髌韧带断裂的临床疗效。 方法：对8例单侧陈旧性髌韧带断裂的患者行保留止点的半肌腱、股薄肌重建髌韧带,髌韧带重建后行半环形石膏后托固定屈膝15°1周,髌韧带重建后2周拆除切口缝线,3周去除石膏行股四头肌等长等张练习,6周时佩戴可调节膝关节护具进行膝关节活动度锻炼,3次/d,每周增加10°。髌韧带重建3个月后允许完全负重行走。 结果与结论：所有患者髌韧带重建后无并发症,X射线示髌骨恢复正常高度。膝关节功能恢复良好。所有患者髌韧带重建后24个月行走2 km以上膝关节无不适。与髌韧带重建前相比,髌韧带重建后24个月患者的Lysholm评分明显增加(P < 0.05),说明保留止点的半腱肌、股薄肌重建髌韧带可重建治疗陈旧性髌韧带断裂。     

咬合刺激调控胶原骨粉修复骨缺损过程中骨改建的形态学分析

背景：咬合刺激对于颌骨的功能及改建至关重要,但人们对其调节骨移植修复骨缺损过程中骨改建的作用尚缺少清楚的认识。 目的：应用形态学方法分析咬合刺激对胶原骨粉修复骨缺损中骨改建的可能调控作用。 方法：在成年SD大鼠左侧下颌骨及顶骨区分别建立标准骨缺损模型,随即植入胶原骨粉充填骨缺损区。术后12周,通过X射线、苏木精-伊红染色、Gomori染色、抗酒石酸酸性磷酸酶染色及骨形成蛋白2免疫组织化学染色观察两骨缺损区的差异。 结果与结论：下颌骨及顶骨骨缺损区均有新骨形成,顶骨骨缺损区的板层骨形成量明显多于下颌骨骨缺损区,新骨形成矿化度明显高于下颌骨骨缺损区,说明顶骨骨缺损区的骨改建优于下颌骨骨缺损区;顶骨骨缺损区抗酒石酸酸性磷酸酶及骨形成蛋白2积分吸光度值均低于下颌骨骨缺损区,说明顶骨骨缺损区的破骨细胞及成骨细胞活性低于下颌骨骨缺损区。表明咬合刺激可能通过影响骨的矿化及成熟而导致下颌骨骨缺损修复过程中骨改建的延迟。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

自固化磷酸钙人工骨Ⅱ型诱导成骨及修复腱骨界面损伤的生物力学分析

背景：自固化磷酸钙人工骨Ⅱ型与重组人骨形态发生蛋白均有一定的成骨诱导作用,存在修复腱骨界面损伤的可能。 目的：探讨自固化磷酸钙人工骨Ⅱ型的成骨诱导作用及修复腱骨界面损伤生物力学情况。 方法：35只成年健康的新西兰白兔,随机选取5只,处死后取双侧肩关节腱骨界面标本作为正常对照。剩余30只构建腱骨界面损伤模型后,随机等分为实验组和模型组,模型组不填塞任何药物,实验组填塞自固化磷酸钙人工骨Ⅱ型进行修复。 结果与结论：填塞自固化磷酸钙人工骨Ⅱ型后,兔损伤腱骨界面明显恢复,且随时间的延长,修复效果更佳,骨形态发生蛋白2表达水平也随之增加,损伤腱骨界面最大抗拉强度以及最大刚度明显增加。表明利用自固化磷酸钙人工骨Ⅱ型复合重组人骨形态发生蛋白对腱骨界面损伤进行修复具有良好的成骨诱导作用,可以促进损伤的修复。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

The Role of Transforming Growth Factor-β and Bone Morphogenetic Protein with Fibrin Glue in Healing of Bone-Tendon Junction Injury

Bone-tendon junction injuries have poor healing potential. This study evaluated the role of TGF-β and BMP-2 in a fibrin glue carrier in healing of injuries at bone-tendon junction. Seventy-two skeletally mature male rabbits were divided into 4 groups. The tendo-Achilles was surgically transected at its insertion and reattached with a pullout suture. Group 1 served as a control. In groups 2, 3, and 4, fibrin glue, a mixture of TGF-β and fibrin glue, and a mixture of BMP-2 and fibrin glue were injected into the bone-tendon junction. The animals were sacrificed at 2, 4 and 8 weeks after surgical procedure. The addition of TGF-β to fibrin glue did not significantly improve the biomechanical properties of repair tissue. BMP-2 in combination with fibrin glue accelerates healing in a bone-tendon injury and also improves the histological and biomechanical properties of the repair tissue so formed.     

三种不同固定方式治疗桡骨远端粉碎性骨折的骨愈合

背景：目前研究认为桡骨远端骨折保守治疗对腕关节功能恢复有明显的影响,临床上治疗多倾向于解剖复位桡骨远端关节面、恢复掌倾角及尺偏角,从而有益于腕关节功能恢复。 目的：评价3种不同方式固定桡骨远端粉碎性骨折后腕关节结构功能恢复差异及其优缺点。 方法：临床收治桡骨远端粉碎性骨折患者88例,其中闭合复位石膏外固定35例,闭合复位外固定架外固定28例,切开复位钢板内固定25例,分别对骨折愈合时间、腕关节骨性解剖结构及功能恢复程度进行评估。 结果与结论：所治患者均获骨愈合,愈合时间石膏组为(11.2±2.8)周,外固定架组为(11.8±3.0)周,钢板组为(10.8±2.6)周,外固定架组、钢板组与石膏组比较,差异无显著性意义(P > 0.05);术后6个月X射线评价钢板组桡骨远端掌倾角及尺偏角大于外固定架组、石膏组,差异有显著性意义(P < 0.05);固定后6个月腕关节功能按改良Gartland and Werley评分标准评价优良率,石膏组为54%,外固定架组为75%,钢板组为92%,外固定架组、石膏组与钢板组比较,差异有显著性意义(P < 0.05)。结果可见3种方式固定桡骨远端粉碎性骨折后骨愈合时间无明显差异,钢板内固定治疗能有效维持桡骨远端骨性解剖结构,对腕关节功能恢复优于外固定架及石膏外固定。     

The role of transforming growth factor-beta and bone morphogenetic protein with fibrin glue in healing of bone-tendon junction injury

Bone-tendon junction injuries have poor healing potential. This study evaluated the role of TGF-beta and BMP-2 in a fibrin glue carrier in healing of injuries at bone-tendon junction. Seventy-two skeletally mature male rabbits were divided into 4 groups. The tendo-Achilles was surgically transected at its insertion and reattached with a pullout suture. Group 1 served as a control. In groups 2, 3, and 4, fibrin glue, a mixture of TGF-beta and fibrin glue, and a mixture of BMP-2 and fibrin glue were injected into the bone-tendon junction. The animals were sacrificed at 2, 4 and 8 weeks after surgical procedure. The addition of TGF-beta to fibrin glue did not significantly improve the biomechanical properties of repair tissue. BMP-2 in combination with fibrin glue accelerates healing in a bone-tendon injury and also improves the histological and biomechanical properties of the repair tissue so formed.     

兔胫骨骨折模型的不同固定方法

背景：利用一种有效的固定方法维持骨折的稳定性是胫骨骨折动物模型成功制备的基础。 目的：观察4种不同的固定方法对兔胫骨骨折模型的固定效果。 方法：将日本大耳白兔截断胫骨骨干后随机分为4组,以4种方法分别固定：①直腿双托组：直腿双托石膏外固定。②塑形双托组：屈膝屈踝双托石膏外固定。③塑形管型组：屈膝屈踝管型石膏外固定。④内外固定组：克氏针内固定+屈膝屈踝双托石膏外固定。 结果与结论：相比其他3组,直腿双托组的外固定石膏脱落时间更早,损伤肢感染率更高(P < 0.05)。在骨折后第4周,内外固定组发生骨折断端移位的实验兔数量最少(P < 0.05)。证实只采用内固定+屈膝屈踝双托石膏外固定才能维持实验兔胫骨骨折的稳定性。     

可调式髌骨爪结合可吸收线与克氏针钢丝张力带修复粉碎性髌骨骨折的比较

背景：高能量下髌骨粉碎性骨折明显增多,单一的内固定已无法满足髌骨解剖复位、多点坚强固定及早期功能锻炼的要求。 目的：比较切开复位可调式髌骨爪+可吸收线与克氏针钢丝张力带修复粉碎性髌骨骨折的临床效果。 方法：纳入粉碎性髌骨骨折患者57例,随机分为2组,29例采用切开复位可调式髌骨爪+可吸收线固定,28例切开复位克氏针钢丝张力带固定。对比观察两组手术时间、切口长度、骨折愈合时间、治疗后并发症及膝关节功能美国特种外科医院评分,并进行统计学分析。 结果与结论：可调式髌骨爪+可吸收线固定组与克氏针钢丝张力带固定组切口长度、手术时间方面的差异无显著性意义;两组在骨折愈合时间、并发症发生率及治疗后膝关节功能方面的差异有显著性意义,可调式髌骨爪+可吸收线固定组优于克氏针钢丝张力带固定组(P < 0.05)。提示与克氏针钢丝张力带相比,可调式髌骨爪+可吸收线固定修复髌骨粉碎性骨折具有骨折愈合时间短、治疗后并发症少、膝关节功能恢复好等优点,固定符合生物力学内固定的原则,且操作简便,固定牢靠,具有良好的应用前景。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程      

应力条件下微小骨折块的愈合

背景：应力刺激可以促进四肢长骨干骨折愈合。 目的：观察应力因素对微小骨折块愈合的影响。 方法：制作兔双侧股骨大转子劈裂撕脱微小骨折模型,一侧采用克氏针固定(对照组),另一侧采用拉力螺钉置入固定(实验组)。 结果与结论：①X射线表现：实验组骨痂生长速度较对照组快,外骨痂量多,灰度高,骨痂塑型时间短。②CT表现：实验组内外骨痂生长速度比对照组要快,骨折处塑形较对照组好。③骨痂组织切片光镜观察发现,两组骨折愈合都表现为软骨内成骨方式,实验组血肿消失、机化较快,修复性纤维组织较早被软骨性骨痂取代,骨痂生长旺盛,断端骨痂愈合早且快,而且软骨性骨痂骨化、骨样小梁转化为编织骨均较对照组早,骨改建塑型亦较对照组好。④实验组和对照组骨折间隙内骨痂钙、磷元素的含量术后均逐渐升高至6周后开始下降,4周时实验组钙磷含量指标明显高于对照组(P < 0.01)。表明微小骨折块的愈合方式表现为软骨内成骨,适宜的加压固定较不加压固定骨折块周围组织水肿消退快,炎性反应小,骨痂中钙磷沉积早,含量大,骨折愈合时间短,骨痂质量好塑型快。     

微米中药功能衬材：活血及促进骨折愈合的作用

BACKGROUND: As a new self-synthetized medical orthopedic fixation material, micron traditional Chinese medicine functional lining material can promote the secretion of alkaline phosphatase and callus formation, decrease serum calcium level, as well as increase serum phosphorus level and calcium-phosphorus product. OBJECTIVE: To further verify the therapeutic effect of micron traditional Chinese medicine functional lining material on fracture healing. METHODS: Twenty-four New Zealand rabbits were selected to prepare models of right radial fracture, and then were randomly allocated into four groups: rabbits in micron group were treated with micron traditional Chinese medicine functional lining material (micron Panax notoginseng powder mixed with active ingredients of Davallia divaricata and Carthamus tinctoriousplus) plus plaster external fixation; those in traditional Chinese medicine control group treated with ordinary Chinese medicine functional material plus plaster external fixation; those in lining material control group treated with ordinary lining material (sterile degreasing cotton) plus plaster external fixation; those in model control group received no treatment. The whole blood viscosity at high/middle/low shear rates and plasma viscosity were detected at 2, 4 and 6 weeks before and after modeling. Additionally, rabbits in each group were killed at 6 weeks after modeling, and radial samples were removed for histological observation. RESULTS AND CONCLUSION: The whole blood viscosity at high/middle/low shear rates and plasma viscosity in the micron group were all lower than those in the other three groups in the same period, and had significant differences from those in the model control group at 4 and 6 weeks after modeling (P < 0.05 or 0.01). A large number of osteoblasts could be found, woven bone began to form and the bone marrow cavity was recanalized in the micron group; in the traditional Chinese medicine group, woven bone, chondrocytes and endochondral ossification coexisted and there was a connection between calluses inside and outside of the broken end, but the bone marrow cavity was not recanalized. In contrast, neither connection between calluses inside and outside of the broken end, nor recanalized bone marrow cavity appeared in the lining material and model control groups. In conclusion, micron traditional Chinese medicine functional lining material can promote fracture healing by improving microcirculation and accelerating osteoblast proliferation.     

可吸收内固定材料修复髌骨横断性骨折

BACKGROUND: In recent years, all kinds of absorbable internal fixation materials have been used in the clinical treatment of patellar transverse fractures. OBJECTIVE: To investigate the repairing effect of absorbable internal fixation materials on patellar transverse fractures. METHODS: Totally 102 cases of fresh patellar transverse fractures were included 62 males and 40 females cases, with a mean age of (41.85±11.15) years, and according to treatment methods, they were divided into two groups: observation group (n=52) using absorbable screws for reconstruction and control group (n=50) using Kirschner wire repair. At 12 months after repair, Lysholm knee function score were measured and evaluated, and the occurrence of adverse events was recorded. RESULTS AND CONCLUSION: The knee function score and excellent rate of the observation group were significantly higher than those of the control group (both P < 0.05). In the observation group, there were four cases of fracture displacement, but no skin irritation and other adverse events occurred; in the control group, there were two cases of nonunion and five cases of skin irritation or internal fixation loosening and slippage. Therefore, there was a higher incidence of adverse events in the control group compared with the observation group (P < 0.05). These experimental results show that the use of absorbable screws in the repair of patellar transverse fracture can promote the functional recovery of the knee joint, with good biocompatibility.      

A model for tissue engineering applications: femoral critical size defect in immunodeficient mice

Animal models for preclinical functionality assays lie midway between in vitro systems such as cell culture and actual clinical trials. We have developed a novel external fixation device for femoral critical size defect (CSD) in the femurs of immunodeficient mice as an experimental model for studying bone regeneration and bone tissue engineering. The external fixation device comprises four pointed rods and dental acrylic paste. A segmental bone defect (2 mm) was created in the midshaft of the mouse femur. The CSD in the femur of the mice were either left untreated or treated with a bone allograft, a cell-scaffold construct, or a scaffold-only construct. The repair and healing processes of the CSD were monitored by digital x-ray radiography, microcomputed tomography, and histology. Repair of the femoral CSD was achieved with the bone allografts, and partial repair of the femoral CSD was achieved with the cell scaffold and the scaffold-only constructs. No repair of the nongrafted femoral CSD was observed. Our results establish the feasibility of this new mouse femoral model for CSD repair of segmental bone using a simple stabilized external fixation device. The model should prove especially useful for in vivo preclinical proof-of-concept studies that involve cell therapy-based technologies for bone tissue engineering applications in humans.