股骨头髓心减压自体骨髓细胞加松质骨移植治疗股骨头坏死

目的探讨股骨头髓心减压自体骨髓细胞松质骨移植治疗股骨头缺血坏死的临床疗效。方法对69例（90髋）成人股骨头坏死（ARGO分期Ⅰ-Ⅱ期）,采用髓心减压自体骨髓细胞自体松质骨移植,术后采用髋关节Harris评分及影像学评定疗效。结果髓心减压自体骨髓细胞松质骨移植具有手术时间短、出血少,损伤小的优点。术中术后无严重并发症。所有患者获平均34．5个月随访,优良率达86％（P〉005）。结论髓心减压自体骨髓细胞松质骨移植,治疗成人早期股骨头缺血坏死是一种微创安全,有效的治疗方法。     

髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位治疗股骨头缺血坏死的比较

目的 对比研究髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位两种方法治疗成人股骨头缺血性坏死的疗效.方法 对48例(60髋)成人股骨头缺血性坏死(ARCO分期:Ⅰc～Ⅱc期)分别采用带血管蒂骨瓣转位和髓芯减压自体骨髓细胞移植治疗.髓芯减压自体骨髓细胞移植治疗23例(30髋),带血管蒂骨瓣转位治疗25例(30髋).术后采用髋关节的Harris评分及影像学稳定情况评定疗效.结果 髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位两组的手术时间和出血量,分别为40.2±16.5 min、57.4±18.5 min(P＜0.05)和180.0±20.5 ml、260.6±19.5 ml(P＜0.05).术中、术后无严重并发症发生.所有患者获平均36.5个月随访,髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位两组的优良率为别为83.3%、90.0%(P＞0.05);两组影像检查学分别显示24髋、25髋保持稳定(P＞0.05).结论 髓芯减压自体骨髓细胞移植和带血管蒂骨瓣转位治疗成人早期股骨头缺血性坏死的优良率相近,但前者较后者出血少并且手术时间短,是一种安全、有效的治疗早期股骨头缺血坏死的微创治疗方法.     

髓芯减压自体骨髓细胞结合重组合异种骨移植治疗股骨内髁骨坏死

目的应用病灶清除髓芯减压自体骨髓细胞结合重组合异种骨移植的方法治疗股骨内髁缺血性坏死,探索股骨内髁骨坏死的微创治疗方法。方法采用上述术式治疗股骨内髁缺血性坏死11例,均为单侧发病。病因特发性7例,激素性4例;术后平均随访2～4年,根据手术前后膝关节评分、影像学表现进行随访观察。结果术前膝关节功能评分平均为63分,术后平均92分,优良率81．8％;影像学表现9例保持稳定。结论病灶清除自体骨髓细胞结合重组合异种骨移植治疗股骨内髁骨坏死,手术操作简单、减少了供区的并发症、疗效确切,是一种值得提倡的微创手术治疗方法。     

髓芯减压术与直接前入路病灶清除自体骨移植治疗早期股骨头缺血性坏死疗效比较

目的比较单纯髓芯减压术与直接前入路病灶清除联合自体骨移植治疗早期股骨头缺血性坏死的临床疗效。方法回顾性分析自2013-10—2018-12诊治的42例(52髋)ARCOⅠ、Ⅱ期股骨头缺血性坏死,其中观察组18例(23髋)行直接前入路病灶清除联合自体骨移植治疗,对照组24例(29髋)行单纯髓芯减压术治疗。比较两组手术时间、术中出血量、保头成功率,以及末次随访时髋关节功能Harris评分。结果观察组随访时间为(25.9±12.8)个月,对照组随访时间为(26.8±13.1)个月。观察组手术时间较对照组长,术中出血量较对照组多,差异有统计学意义(P0.05)。观察组末次随访时ARCOⅠ期、ARCOⅡ期患者保头成功率、髋关节功能Harris评分均高于对照组,差异有统计学意义(P0.05)。结论直接前入路病灶清除联合自体骨移植治疗早期股骨头缺血性坏死较单纯髓芯减压术可取得更好的临床疗效,能有效缓解患者髋部疼痛症状,改善髋关节功能,延缓股骨头坏死进展。     

动脉灌注髓芯减压干细胞移植治疗股骨头坏死

目的评价动脉灌注加股骨头髓芯减压后注射干细胞治疗成人股骨头缺血性坏死的疗效。方法对30例成人股骨头缺血性坏死（ARCO分期ⅠA～ⅢA期）分别采用单纯动脉灌注、动脉灌注加股骨头髓芯减压、动脉灌注加股骨头髓芯减压后行干细胞移植三种方法治疗。术后采用髋关节Harris评分及影像学（主要为MRI）情况评定疗效。结果动脉灌注加股骨头髓芯减压后注射干细胞较另外两组在MRI表现上有明显差异（P〈0．05）。结论通过对早期股骨头缺血性坏死进行血管灌注、股骨头髓芯减压及自体骨髓干细胞注射的治疗,可以延缓或阻止股骨头缺血坏死、塌陷、变形的病理过程。     

计算机导航辅助髓芯减压自体骨髓移植治疗早期股骨头坏死

目的探讨计算机导航辅助多孔髓芯减压自体骨髓移植治疗早期(ARCOⅠ、Ⅱ期)股骨头坏死的临床疗效。方法计算机导航辅助多孔髓芯减压自体骨髓移植治疗18例ARCOⅠ、Ⅱ期股骨头坏死(21髋)。末次随访时采用Harris评分标准对手术疗效进行评价。结果患者均获得24个月随访。末次随访时采用Harris评分评价疗效:优16髋,良4髋,可1髋。结论计算机导航辅助多孔髓芯减压自体骨髓移植治疗早期股骨头坏死具有改善功能、延缓病程的作用。     

病灶清除自体骨髓细胞结合重组合异种骨移植治疗距骨缺血性坏死

目的应用病灶清除自体骨髓细胞结合重组合异种骨移植的方法治疗距骨缺血性坏死,探索距骨骨坏死的微创治疗方法。方法自2000年6月～2002年9月采用上述术式治疗距骨缺血性坏死17例,均为单侧发病。根据Ficat及Arlet分期标准Ⅱ期14例,Ⅲ期3例,术后随访24～51个月,平均37个月,根据手术前后美国足踝关节外科协会踝关节功能评分标准(AO—FAS)进行随访观察。结果术后17例踝关节功能均有不同程度的改善,AOFAS评分较术前平均提高29．9分,1例于术后25个月改行踝关节融合术。结论病灶清除自体骨髓细胞结合重组合异种骨移植治疗距骨骨坏死,手术操作简便、手术创伤小、疗效确切,是一种值得提倡的微创手术治疗方法。     

关节镜下自体干细胞体外培养回植治疗早期股骨头坏死的临床研究

目的 探讨关节镜监视下髓芯减压自体骨髓间充质干细胞体外培养自体回植治疗早期股骨头缺血性坏死的方法及疗效.方法 根据ARCO分期,选取早期股骨头缺血性坏死病例13例,其中ⅠC期2例,ⅡA期4例,ⅡB期5例,ⅡC期2例.在实施髓芯减压术的同时植入体外分离培养获得的骨髓间充质干细胞.结果 经1.5年随访及磁共振检查,股骨头坏死体积由32.5%降至5.7%,Harris评分显著提高.结论 关节镜监视下髓芯减压并自体骨髓间充质干细胞体外培养回植安全、有效,对早期股骨头缺血性坏死患者为一种有效的治疗选择.     

髓芯减压植骨自体骨髓间充质干细胞移植治疗早期股骨头缺血性坏死

目的 探讨应用髓芯减压植骨自体骨髓间充质干细胞(BMSCs)移植治疗早期股骨头缺血性坏死(ANFH)的疗效.方法 对26例早期ANFH采用髓芯减压植骨自体BMSCs移植治疗.结果 随访6～30个月,患者疼痛明显缓解,采用Harris髋关节功能评分,术前平均(51.6±4.86)分,术后为(93.8±7.36)分,比较差...     

关节镜下微创综合治疗早期股骨头缺血性坏死

目的通过与单纯闭合髓芯减压术比较,探讨关节镜下髓芯减压结合自体松质骨复合BMP植骨治疗早期股骨头缺血性坏死的疗效。方法回顾分析2007年1月-2010年3月收治的28例33髋早期股骨头缺血性坏死患者临床资料,其中采用关节镜下髓芯减压结合自体松质骨复合BMP植骨治疗18例21髋(试验组);单纯闭合髓芯减压术治疗10例12髋(对照组)。两组患者性别、年龄、病程、病因及骨坏死分期等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果术后两组切口均Ⅰ期愈合,无感染等并发症发生。两组患者均获随访,随访时间1～3年,平均2.5年。术后患者疼痛均明显缓解,髋关节功能改善。末次随访时,试验组Harris评分为(85.67±4.78)分,对照组为(81.33±7.03)分,差异有统计学意义(t=—2.10,P=0.04)。试验组FicatⅡ期1髋,对照组FicatⅠ期2髋、Ⅱ期2髋发生股骨头塌陷,行人工髋关节置换术;两组手术总有效率分别为95.24%及66.67%,比较差异有统计学意义(χ2=4.85,P=0.03)。结论与单纯闭合髓芯减压术比较,关节镜下髓芯减压结合自体松质骨复合BMP植骨治疗早期股骨头缺血性坏死具有定位准确、清除坏死骨彻底,能有效缓解疼痛,改善关节功能,延缓股骨头坏死进程的优点。     

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.     

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.     

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。     

Building better bone: The weaving of biologic and engineering strategies for managing bone loss

Segmental bone loss remains a challenging clinical problem for orthopaedic trauma surgeons. In addition to the missing bone itself, the local tissues (soft tissue, vascular) are often highly traumatized as well, resulting in a less than ideal environment for bone regeneration. As a result, attempts at limb salvage become a highly expensive endeavor, often requiring multiple operations and necessitating the use of every available strategy (autograft, allograft, bone graft substitution, Masquelet, bone transport, etc.) to achieve bony union. A cost‐sensitive, functionally appropriate, and volumetrically adequate engineered substitute would be practice‐changing for orthopaedic trauma surgeons and these patients with difficult clinical problems. In tissue engineering and bone regeneration fields, numerous research efforts continue to make progress toward new therapeutic interventions for segmental bone loss, including novel biomaterial development as well as cell‐based strategies. Despite an ever‐evolving literature base of these new therapeutic and engineered options, there remains a disconnect with the clinical practice, with very few translating into clinical use. A symposium entitled “Building better bone: The weaving of biologic and engineering strategies for managing bone loss,” was presented at the 2016 Orthopaedic Research Society Conference to further explore this engineering‐clinical disconnect, by surveying basic, translational, and clinical researchers along with orthopaedic surgeons and proposing ideas for pushing the bar forward in the field of segmental bone loss. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1855–1864, 2017.

     

The Penetration of Lincomycin into Normal Human Bone: Determinations of Penetration into Compact Bone, Spongy Bone and Bone Marrow

The penetration of lincomycin into normal bone was studied in 10 patients with fracture of the neck of the femur, a separate determination being made of the lincomycin concentration in serum, bone marrow, spongy bone and compact bone. The concentration of lincomycin in bone marrow was found to be at the same level as that in the serum. The concentration in spongy bone amounted in most cases to 50 to 75 per cent of the concentration in the serum, whereas the concentration in compact bone varied from 0 to 15 per cent of that in the serum.     

No adverse effects of early weight bearing after uncemented total hip arthroplastyA randomized study of 20 patients

Experimental fibular defects in 16 rats were filled with an acid decalcified homogenous bone matrix (bone inductive material). Autogenous bone grafts in corresponding defects in the other legs of the same rats served as controls. After 3 months, 11 of the 16 defects filled with bone inductive material healed with bony union, but only 4 of the 16 defects treated with autogenous bone grafts had healed. The results suggest that bone inductive material can repair bone defects which are too large to be healed by autogenous bone grafts.     

Repair of Bone Defects by Bone Inductive Material

Experimental fibular defects in 16 rats were filled with an acid decalcified homogenous bone matrix (bone inductive material). Autogenous bone grafts in corresponding defects in the other legs of the same rats served as controls. After 3 months, 11 of the 16 defects filled with bone inductive material healed with bony union, but only 4 of the 16 defects treated with autogenous bone grafts had healed. The results suggest that bone inductive material can repair bone defects which are too large to be healed by autogenous bone grafts.     

The benefit of bone marrow concentrate in addition to a glass‐reinforced hydroxyapatite for bone regeneration: An in vivo ovine study

This study evaluates the ability of a Glass Reinforced Hydroxyapatite Composite (GRHC), in a new microporous pellet formulation with autologous bone marrow concentrate (BMC), to enhance bone regeneration and new bone formation. Ninety non‐critical sized bone defects were created in the femurs of nine Merino breed sheep and randomly left unfilled (group A), filled with GRHC pellets alone (group B) or filled with GRHC pellets combined with BMC (group C). The sheep were sacrificed at 3 weeks (three sheep), 6 weeks (three sheep) and 12 weeks (three sheep) and histological analysis (Light Microscopy‐LM), scanning electron microscopy (SEM) and histomorphometric analysis (HM) were performed. At 3, 6, and 12 weeks, HM revealed an average percentage of new bone of 48, 72, 83%; 25, 73, 80%, and 16, 38, 78% for Groups C, B and A respectively (significantly different only at 3 weeks p < 0.05). LM and SEM evaluation revealed earlier formation of well‐organized mature lamellar bone in Group C. This study demonstrates that the addition of a bone marrow concentrate to a glass reinforced hydroxyapatite composite in a pellet formulation promotes early bone healing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1176–1182, 2017.