骨形态发生蛋白与骨肿瘤

骨形态发生蛋白与多种骨疾患有着直接或间接的关系 ,如骨发育异常、某些骨肿瘤和异位骨化等 ,明确他们之间的关系 ,有助于进一步了解此类疾病的发生、发展和预后 ,为选择合适的治疗方案提供指导。就骨形态发生蛋白与骨肿瘤的关系做一综述     

同种异体骨与自体骨混合移植治疗良性骨肿瘤疗效观察

目的 探讨同种异体骨与自体骨混合移植治疗良性骨肿瘤的临床疗效.方法 采用同种异体骨与自体骨混合移植的方式治疗良性骨肿瘤患者32例,并进行疗效评价.结果 全组患者患肢功能良好恢复,未发生肿瘤复发、骨缺损及骨不连接等并发症,优良率达到了87.5%.结论 同种异体骨与自体骨混合移植治疗良性骨肿瘤疗效较好.     

Bone Marrow Immunoscintigraphy Compared with Conventional Bone Scintigraphy for the Detection of Bone Metastases

Immunoscintigraphy of haematopoetic bone marrow was compared to conventional bone scanning in 141 patients with malignant disease. Forty patients had breast cancer, 25 prostatic carcinoma, 14 kidney or bladder cancer, 13 bronchial carcinoma, 39 malignant lymphoma and 10 multiple myeloma. A total of 18 800 skeletal regions were evaluated. Marrow scans showed more metastatic lesions than bone scanning in all patient subgroups. Computerized tomography was concordant with bone marrow scintigraphy in 83.3% of 323 skeletal sites. Bone marrow scans in 30 control patients with fever of unknown origin were abnormal only in 3 patients and in only 7 out of 2 135 skeletal regions examined. In patients with malignant lymphoma, bone marrow histology or aspiration cytology was concordantly positive in 14 and concordantly negative in 17 patients. We conclude that immunoscintigraphy of haematopoetic bone marrow provides a reliable, sensitive and safe novel approach for non-invasive detection of metastatic spread to the skeleton.     

胎骨移植治疗骨肿瘤缺损：附10例报告

近3年来，用制备的胎骨充填良性骨肿瘤及病样病变术后骨缺损，经观察10例效果良好。胎骨因其自身组织学和生理学特点，具有抗原性小、诱导成骨活性高，利于“爬行各代”等优点。而且来源丰富、采制简单、储存容易、费用低度，是一种良好的植骨材料，特别适于儿童及年老体弱患者自身取骨困难的骨缺损植骨需要。但其为异体骨，有一定免疫原性，抗支撑强度略差，应注意严格无菌操作、消除免疫原性、配合使用内、外固定等措施。     

全身骨闪烁显像探测恶性肿瘤骨转移：附110例分析

本文对110例原发肿瘤全身骨闪烁显像图形进行了分析。骨转移检测阳性率为77％(85/110),图形特点是多数病例呈现多发性局灶性放射性核素浓度增加区域(82/85);多数转移灶累及中轴骨(68/85)。我们认为全身骨闪烁显像为探测骨转移及其分布范围,提供了高敏感及高特异性的方法。     

Metastatic Bone Disease

The cancer patient with skeletal metastases now has a much improved range of treatment options with major advances in bone-specific drug therapy as well as radiotherapy and radiopharmaceuticals, orthopaedic surgery, and systemic anticancer therapy with cytotoxic and endocrine agents. Recent advances in the understanding of bone remodeling mechanisms and the interdependence of cancer cells and bone have been closely associated with development of the bisphosphonate drugs and newer agents such as osteoprotegerin (OPG). The bisphosphonates are potent inhibitors of osteoclast mediated bone resorption and appear to function either by induction of apoptosis in mature osteoclasts or by inhibition of formation of osteoclasts from progenitor cells. Bisphosphonates are the treatment of choice in tumor-induced hypercalcemia. Bisphosphonates have a clear role in reducing bone pain and skeletal complications, such as pathological fracture and are being evaluated in the prevention of bone metastases. Until recently, intravenous (IV) pamidronate has been the drug most commonly prescribed for oncological indications and oral clodronate has also been widely used in some countries outside the US. However, newer and more potent drugs, such as zoledronate, are increasingly having a major impact on routine therapy. Three of the largest ever bisphosphonate trials, using zoledronate in metastatic bone disease have recently been completed. In a breast and multiple myeloma trial in 1648 patients, zoledronate (4mg IV) was shown to be equivalent to pamidronate (90mg IV) in reducing skeletal events and was more convenient to administer. In trials in prostate cancer and a wide range of other solid tumor types affecting bone, both the number of patients with skeletal-related events and the rate of bone complications were reduced. The indications for bisphosphonates are, therefore, no longer constrained by tumor type. The assessment of response to therapy is a vital part of management of metastatic bone disease. Plain radiographs and the isotope bone scan remain widely used but have many limitations. Newer imaging techniques such as computerized tomography, magnetic resonance imaging, and positron emission tomography may be useful in selected situations. Recent research suggests that measurement of tumor markers and bone-specific markers will play an increasingly important role in assessment of response. In particular, bone resorption markers measuring collagen breakdown have potential as rapid, convenient, and inexpensive measures of response, with suppression of bone resorption into the normal range being an important aim of bone-specific treatments.     

锁定接骨板联合同种异体骨治疗四肢长骨良性骨肿瘤伴病理性骨折的60例疗效分析

目的 探讨锁定接骨板联合同种异体骨治疗四肢长骨良性骨肿瘤伴病理性骨折的的疗效.方法 选取了60例良性骨肿瘤患者,按住院单双号随机分为两组,研究组(31例)行锁定接骨板联合同种异体骨,对照组(29例)行锁定接骨板.观察并记录患者术后12个月的患肢功能,血清骨折愈合相关因子,VAS评分,2年内的排斥反应率,病灶复发率和骨折愈合时间,以评价两种手术方式的疗效.结果 术后12个月,研究组优良率明显高于对照组(P<0.05),随访2年期间,研究组排斥反应率、骨折愈合时间、病灶复发率均少于或低于对照组(P<0.05);术后12个月,两组骨钙素(BGP)、骨保护素(OPG)、碱性磷酸酶(ALP)、神经生长因子(NGF)水平均明显升高(P<0.05),且研究组上述指标明显高于对照组(P<0.05);术后6,12个月,两组痛觉感受评分均明显降低(P<0.05),但组间比较差异无统计学意义(P>0.05).结论 锁定接骨板联合同种异体骨对四肢长骨良性骨肿瘤伴病理性骨折具有较好的治疗效果,术后提高患肢功能,减轻疼痛,促进骨折愈合,降低肿瘤复发率,值得临床推广使用.     

Bone markers in multiple myeloma

Bone disease, a hallmark of multiple myeloma occurs in the majority of the patients, is associated with bone pain, fractures, hypercalcemia and has major impacts on quality of life. Myeloma is characterized by a unique form of bone disease with osteolytic bone destruction that is not followed by reactive bone formation, resulting in extensive lytic lesions. This review will focus on the pathophysiology of osteoclast activation and osteoblast inhibition in multiple myeloma and on biochemical markers of bone turnover. Since osteolytic lesions do not rapidly heal in myeloma, X-rays cannot reflect the activity of bone disease during antimyeloma treatment. Activity in bone turnover does not parallel changes in monoclonal protein levels. Thus, there is a need for biochemical markers reflecting disease activity in bone. The utility, prognostic implications and limitations of classical and novel markers of bone remodeling (e.g. ICTP, NTx, TRACP-5b, osteoprotegerin, sRANKL) will be discussed in this overview.     

博宁对骨转移患者骨吸收标志的影响

目的：探讨博宁对骨转移患者骨吸收标志的影响。方法：临床确诊为骨转移患者２４例,一次性接受博宁９０ｇｍ静点,观察治疗前及后７天骨吸收标志的变化。结果：治疗前尿钙、尿吡啶酚和脱氧吡啶酚较正常值分别为２５％,７１％和１００％患者升高。治疗后第７水钙、尿吡啶酚和脱氧吡啶较治疗前均明显下降,三项指标较治疗前分别下降了５９％,６２％和６０％,血钙治疗后也有明显下降,而血磷治疗前后无明显变化。     

Bone metastases in breast cancer

Opinion statement Patients with advanced breast cancer who develop bone metastases suffer from longterm skeletal morbidity. Complications of bone metastases include pain, pathologic fractures, and spinal cord compression, which have a significant impact on the quality of life of patients. Treatment options for patients with bone metastases include surgery, radiation, and analgesics to reduce bone pain and to prevent or repair fractures. Intravenous bisphosphonates can delay the onset of bone metastasis and reduce the percentage of patients who experience skeletal complications of bone metastasis, thus reducing skeletal morbidity. For the past 6 years, pamidronate disodium (90 mg administered by 2-hour intravenous infusion) has been the treatment of choice for the prevention of skeletal complications of bone metastases in patients with breast cancer. However, a more potent bisphosphonate, zoledronic acid (4 mg administered by 15-minute intravenous infusion), was approved for use and has improved efficacy in patients with bone metastases. Because of the increased efficacy and more convenient infusion time, zoledronic acid may become the new standard of care for the treatment and prevention of skeletal complications secondary to bone metastases in patients with breast cancer. Phase III clinical trials have shown that patients with an existing skeletal complication are more likely to develop subsequent complications compared with patients who have not experienced a complication. Therefore, zoledronic acid therapy should be initiated when the patient is diagnosed with bone metastasis.     

Bone changes in tuberous sclerosis mimicking metastases

Sclerotic and lytic bone changes of tuberous sclerosis (TS) can mimic bone metastases. We report a case of bone metastases from bronchogenic carcinoma in a patient with TS bone changes. Bone scintigraphy and magnetic resonance imaging are useful in distinguishing the TS bone lesions from bone metastases.     

骨膦治疗恶性肿瘤溶骨性转移骨痛47例临床报告

目的评价骨膦对恶性肿瘤溶骨性转移骨痛的疗效。方法骨膦３００ｍｇ加入生理盐水５００ｍｌ４～５小时静点连用５天,从第６天起骨膦１２００ｍｇ每日二次空腹服１６天。结果４７例骨痛患者,完全缓解１１例,部分缓解２７例,有效率８０．８％。结论骨膦治疗肿瘤溶骨性转移骨痛效果明显、平稳、持续时间长,副作用小。     

Bone and soft-tissue tumors

There have been great advances in recent years in the treatment of malignant bone and soft-tissue tumors thanks to advanced diagnostic techniques, improved chemotherapy and improved surgery involving extensive resection of the area involved, with bone and joint replacement. Here, we present details of the pathological findings, treatment and prognosis of cases of malignant bone and soft-tissue tumors, such as osteosarcoma, bone MFH, soft-tissue MFH, rhabdomyosarcoma and synovial sarcoma.     

肺癌病人放射性核素骨显像

本文利用放射性核素骨显像研究56例肺癌的骨转移情况。其阳性率为62％,肺癌病人骨显像阳性发现早,常在术前及术后8个月以内,且常为多发灶。骨显像被认为是一高灵敏而非特异的检查骨转移的方法,故需仔细判断骨显像中所示阳性区域病灶。可使其假阳性降低为零。骨显像所示骨转移尤其是“隐匿性骨转移”似应与传统骨转移灶相区分,并对其性质、预后及治疗方法进行深入研究,从而使肺癌病人的骨转移得到早期、合理的治疗。     

负瘤骨截除后煮沸灭活再植治疗恶性骨肿瘤的临床研究（附16例报告）

用煮沸灭活的方法治疗恶性骨肿瘤１６例，即将截除的瘤段煮沸灭活，然后再植回原位达到保肢的目的。随访１年至４年４个月，健在８例。煮沸灭活之骨都已成活并和主骨愈合。局部感染２例，骨折３例，复发３例，保留后的肢体功能较好。同其它保肢方法如假体、异体骨置换，酒精灭活等比较，此方法具有经济、安全、简单易行等优点，值得推广。     

骨代谢生化指标和恶性肿瘤骨转移不同临床表现的关系

目的探讨骨代谢生化指标尿吡啶酚(uPYD)、尿脱氧吡啶酚(uDPD)、血清骨特异性碱性磷酸酶(sBAP)、血清骨钙蛋白(sBGP)和恶性肿瘤骨转移临床表现的关系。方法采用ELISA方法对99例进展期骨转移阳性肿瘤进行uPYD、uDPD、sBAP、sBGP的浓度水平检测。结果uPYD和uDPD、sBAP和sALP之间显著相关,肿瘤骨转移重度疼痛、无痛和轻度疼痛之间uPYD、uDPD、sALP水平有显著性差异(P<0.05),uDPD、sBAP和sALP水平在不同的骨转移程度有显著性差异(P<0.05),sBAP和sALP水平在不同的骨转移数目有显著性差异(P<0.05)。结论骨转移时uPYD和uDPD、sBAP和sALP之间显著相关,uPYD、uDPD、sBAP水平和骨痛明显相关,uDPD、sBAP水平和肿瘤骨转移程度、骨转移数目明显相关。骨代谢生化指标uPYD、uDPD、sBAP和骨转移临床表现的关系对肿瘤骨转移的病情判断有一定临床意义。     

胰腺癌骨转移

目的探讨胰腺癌骨转移的诊断与治疗。方法回顾性分析1999年至2003年间胰腺癌骨转移病例2例。结果经X线、B超、CT、ECT,淋巴细胞rDNA分析,肿瘤细胞学检查、肿瘤标记物检测等方法确诊。1例女性胰腺低分化腺癌,术后2年胸椎及右骶髂骨转移,接受放疗后半年后死亡;1例男性胰腺癌伴胸腰椎骨转移,在行梗阻性黄疸内引流术后1个月因肺部感染,呼吸衰竭死亡,尚未能接受对骨转移灶的治疗。结论影像学检查是发现骨转移瘤的主要方法。胰腺癌骨转移,预后差,除对原发肿瘤治疗外,应积极治疗骨转移灶以延长此类晚期患者的生存期及提高生活质量。     

Specimen Radiography of Bone Tumours

Radiographs obtained with a transportable roentgen apparatus and a shielded cabinet on fine grain films of whole specimens and/or slabs of transsected bone in primary bone tumours and soft tissue tumours with skeletal invasion or ossification were compared with clinical roent-genograms and related to gross and microscopic pathology as demonstrated in selected cases. Specimen radiography is found to be a valuable adjunct to standard morphologic examination and forms a link to clinical radiology in the study of bone tumours and related diseases.     

带血管骨移植在四肢骨肿瘤治疗中的临床应用价值

目的 探讨带血管骨移植在四肢骨肿瘤治疗中的临床应用价值.方法 选取90例四肢骨肿瘤患者,按住院单双号分为2组,对照组(44例)给予瘤段切除后无血管骨移植,观察组(46例)给予瘤段切除后带血管骨移植.通过观察并记录患者术后肢体功能情况、骨愈合情况及随访期间并发症发生率,评价带血管骨移植在四肢骨肿瘤治疗中的临床应用价值.结果 术后12个月,观察组肢体功能总的优良率明显高于对照组(P＜0.05),但2组骨愈合率差异无统计学意义(P＞0.05).观察组患者平均骨愈合时间明显短于对照组(P＜0.05).随访期间,观察组并发症发生率4.3％,对照组并发症发生率25.0％,观察组术后并发症发生率明显低于对照组(P＜0.05);2组均未发生伤口感染、下肢深静脉血栓、内固定物松动等并发症.结论 带血管骨移植可以明显提高四肢骨肿瘤的治疗效果,骨愈合时间短,术后并发症较少,值得临床推广使用.     

Bone metastasis of intracranial meningeal hemangiopericytoma

The authors investigated the clinical and radiological features and the treatment strategy for bone metastasis from a rare tumor, intracranial meningeal hemangiopericytoma. The clinical presentations and characteristic imagings were retrospectively reviewed in 15 bony metastatic lesions of four patients with this tumor. All four cases were initially diagnosed as atypical meningioma, and all of the bone metastases developed more than 10 years after the initial intracranial surgery. The common symptom induced by the metastatic lesions was pain. On plain roentgen films and computed tomography (CT), the involved bones showed thinning and expansion. On bone scintigraphy, a “cold-in-hot” appearance was typically observed. The clinical and radiological findings were diagnosed as bone metastasis from intracranial meningeal hemangiopericytoma. The prognosis after bone metastasis was relatively short compared to the long duration before bone metastases, because of the coexistence of other, visceral, metastasis. Combined with effective radiation therapy, surgical intervention for bone metastasis of this tumor should be carefully considered.