Are Bone Turnover Markers Capable of Predicting Callus Consolidation During Bone Healing?

The aim of this study was to determine the ability of the following bone turnover markers to monitor the course of callus consolidation during bone healing: Carboxy-terminal propeptide of procollagen type I (PICP), skeletal alkaline phosphatase (sALP), and amino-terminal propeptide of type III procollagen (PIlINP). Since interfragmentary movements have been proven to possess the ability to document the progression of bone healing in experimental studies, correlations between bone turnover markers and interfragmentary movements in vivo were investigated. Therefore, two different types of osteosyntheses representing different mechanical situations at the fracture site were compared in an ovine osteotomy model. Blood samples were taken preoperatively and postoperatively in weekly intervals over a nine-week healing period. At the same intervals, interfragmentary movements were measured in all sheep. After nine weeks, animals were sacrificed and the tibiae were evaluated both mechanically and histologically. Wide interindividual ranges were observed for all bone turnover markers. The systemic PICP level did not increase with callus consolidation. The bone-healing model seemed to influence the systemic level of PIIINP and sALP but no general correlation between bone turnover markers and interfragmentary movements could be detected. No differences between the different types of osteosyntheses and thus the different mechanical situations were observed. All analyzed markers failed as general predictors for the course of callus consolidation during bone healing.     

骨重建中的骨代谢指标

骨重建是破骨细胞和成骨细胞共同完成的旧骨退化,等量新骨取代的骨组织更新过程,在骨重建过程中,许多激素和细胞、体液因子以及细胞代谢产物影响骨的重建.目前国内外通过生物化学检测技术获得的骨代谢指标分为骨代谢调节激素、细胞与体液因子、骨吸收、骨形成标志物.笔者将影响骨重建生物化学指标的生理作用、临床意义进行综述.骨代谢指标虽不能作为骨质疏松诊断的金标准,但已广泛应用于临床,评价骨代谢状态、骨质疏松诊断分型、预测骨折风险、观察药物治疗的疗效,以及代谢性骨病的鉴别诊断.并且在抗骨质疏松药物的研究及流行病学研究方面具有重要应用价值.     

异体松质骨移植治疗骨肿瘤切除后骨缺损

目的：探讨应用异体松质骨移植治疗肿瘤切除后骨缺损的生物材料填充方法。方法：总结应用深低温冷冻保存异体松质骨移植治疗骨肿瘤切除后骨缺损57例。年龄6－56岁,平均年龄17．4岁。结果：除1例因感染异体骨取出外,其余56例均取得满意的骨愈合,愈合时间平均为4．5个月。依骨腔大小或植骨量的不同愈合时间 亦有所不同。单纯异体松质骨移植与异体松质骨加自体松质骨混合移植相比,愈合时间没有明显不同。植骨量越大,骨愈合时间越长。此组患者中未见明显排异反应及并发感染者。肿瘤复发率为7％。结论：同其他骨缺损填充方法和大块异体骨的使用相比,此种方法可行性较好,安全性较高。在骨愈合率,骨愈合时间上及复发以外并发症的发生上同自体松质骨植骨无明显差异。     

在下肢大段骨缺损治疗中Ilizarov技术的选择

[目的]总结应用Ilizarov技术治疗下肢大段骨缺损的临床体会，探讨不同病例的术式选择。[方法]14例下肢大段骨缺损，平均8．5cm，其中股骨2例；胫骨12例；创伤11例，均伴有不同程度的骨感染和（或）软组织缺损，骨肿瘤切除3例？分别采用肢体短缩加骨段截骨延长，或加骨段输送延长，或单纯骨段截骨输送治疗。[结果]全部病例均获得1a以上随访，骨缺损治愈，骨感染消失，皮肤创面消灭，肿瘤无复发，无附加神经血管损伤症状：[结论]Ilizarov技术是治疗骨大段缺损的简单而有效方法，根据不同病例，选择不同术式可简化治疗过程．缩短治愈时间。     

活骨移植治疗四肢骨肿瘤切除后长段骨与关节缺损

目的:探讨四肢骨肿瘤的广泛或边缘切除后,长段骨关节缺损的修复方法及其疗效。方法:四肢骨肿瘤切除术后骨缺损14例,男10例,女4例;年龄4~37岁。骨巨细胞瘤4例,骨化性纤维瘤1例,非骨化性纤维瘤2例,韧带样纤维瘤1例,骨纤维结构不良3例,侵袭性骨母细胞瘤1例,软骨母细胞瘤1例,瘤样病损致骨溶解1例。14例四肢侵袭性良性骨肿瘤行肿瘤广泛或边缘切除,应用吻合血管的腓骨、带腓骨头腓骨近端和带旋髂深血管的髂骨瓣移植修复骨缺损、重建桡腕关节和重建肩关节。移植体行简单内固定加外固定。术后定期复查X线片、多普勒血管超声,其中3例行ECT核素骨扫描,并作关节功能评定。结果:随访3个月~5年,13例均于手术后3个月后达Ⅰ期愈合,其中1例因内固定松动再次手术而愈合。1例肿瘤局部复发,再次行肿瘤切刮与植骨术后愈合;2例畸形愈合行截骨矫形后愈合。关节功能评定:优9例,良3例,差2例。结论:骨肿瘤切除后行骨移植修复骨缺损、重建关节,手术切除彻底,复发率低,植骨愈合可靠,重建后的关节功能良好。     

Bone substitutes

Summary Biocompatible calcium phosphate ceramics has been used for several years in orthopeadic surgery. We have been using two new synthetic biphasic calcium phosphate ceramics (BCP) since September 1996 for bone defect filling in any orthopaedic or trauma operation where autograft use was not possible or even wanted. The first, Eurocer 400® has 300 to 500 micron wide macropores with a totally interconnected porosity. This salt seed like product can be used in bone defect filling, when solidity is not a major concern. The second, Eurocer 200® has not totally interconnected 200 micron large pores. Its main characteristic is a mechanical resistance up to 30 Mpa. We use it in any case of weight-bearing surgery. Different sizes and presentation forms are available and will be chosen according to the recipient site shape. We report one hundred and fifty cases with a six to thirty month follow-up. In one third of the patients hip revision surgery was addressed. Another third concerned recent trauma or sequelae cases,.whereas the last third involved cold orthopaedic procedures. General principles are the need of a living and non-infected site after thorough debridement if necessary. Osteocompatibility of calcium phosphate ceramic is confirmed by our results. We report no mechanical failure. In all cases X-rays show a progressive integration, with new bone formation. Our substitutes have been histologically studied in nine cases, four to fifteen months after implantation. New bone formation around and in the substitute is impressive. Indeed, their good mechanical properties without loss of biological quality is the most relevant feature of these BCPs, leading to a wider indication field; therefore we have now abandoned the use of any bony auto, allo or xenograft.Paper presented at the 1998 meeting of GECO (Arc 1800, Bourg-Saint-Maurice, France)     

表面脱钙骨基质明胶修复长骨骨缺损9例报告

采用表面脱钙骨基质明胶（ＳＤＢＭＧ）移植治疗长骨大块骨缺损９例，结果，除１例因适应证选择不当而失败外，其它８例均得到治愈，患健肢等长。说明ＳＤＢＭＧ具有良好的成骨作用和可靠的生物力学性能，是修复长骨大块骨缺损的理想移植材料，可作为自体骨合适的替代材料推广使用，但对急性感染性骨缺损应慎用     

骨基质明胶复合自体红骨髓及同种异体骨修复骨缺损

目的:评价骨基质明胶复合自体红骨髓及同种异体骨联合移植修复骨缺损的疗效。方法:76例良性骨肿瘤和瘤样病损患者,彻底刮除病灶或作肿瘤骨段切除,并对瘤壁作灭活处理,以同种异体骨作支架,周围填充骨基质明胶和自体红骨髓复合物,术后观察机体反应及骨缺损修复情况。结果:术后机体无明显免疫排斥反应,无1例发生感染,所有病例随访时间为5～16个月,X线显示新骨形成时间为术后1.5～4月,完全骨化的时间为术后5～9月,骨缺损骨性愈合74例,并获得较好的关节功能,肿瘤复发2例。结论:骨基质明胶、自体红骨髓、同种异体骨复合物能有效修复骨缺损,有广泛的临床应用前景。     

深度冷冻大段同种骨的制备及应用

目的：建立现代骨组织库，观察深度冷冻大段同种骨移植的临床效果。方法：采用深度冷冻、物理脱脂、真空包装和辐照灭菌等现代技术处理人类大段骨组织，临床应用24例，包括创伤性肢体骨重建、半侧骨盆重建、半侧骶骨移植、四肢大段骨或骨关节移植等，观察近期临床结果。结果：骨移植材料的无菌检测合格，生物力学强度无明显下降，可远程运输和短期保存．全部病例无明显的免疫排斥反应，成功率为100％.结论：深度冷冻大段同种骨临床使用安全可靠，保存和运输方便.     

The comparative effects of dichloromethylene diphosphonate (Cl2MDP) and ethane-1-hydroxy-1,1-diphosphonate (EHDP) on growth and modeling of the rat tibia

Summary Male rats weighing 100 g were assigned to groups and injected daily for 10 days with vehicle (control), 0.4, 2.0, 4.0, 10.0, or 20.0 mg/kg/day of ethane-1-hydroxy-1,1-diphosphonate (EHDP) or dichloromethylene diphosphonate (Cl₂MDP). The proximal tibial metaphysis and epiphysis were assayed for changes in percentage of hard tissue and bone formation parameters. From the data, information about hard tissue resorption was deduced.All doses of Cl₂MDP and doses of 2.0 mg EHDP/kg/day and greater caused significant increases in percentage of hard tissues with Cl₂MDP being more effective than similar doses of EHDP in decreasing bone resorption.Osteoclast population parameters were increased with all doses of both Cl₂MDP and EHDP with Cl₂MDP having a greater effect than similar doses of EHDP. Decreases in the proliferation of the osteoprogenitor pool parallel the decreases in osteoblasts and bone formation parameters. These decreases in osteoprogenitor pool proliferation do not account for the increases with diphosphonates in osteoclast population parameters.     

同种异体骨关节移植修复长段骨关节缺损

目的 评价同种异体骨关节移植修复长段骨关节缺损后的临床效果。方法 １９９１年９月￣１９９７年１１月对侵袭性或恶性骨肿瘤瘤段切除后长段骨关节或骨干缺损３６例,创伤性长段骨缺损２例,采用低温冷冻或冻干同种异体骨关节或骨干移植物修复。结果 术后早期３８例均未发生明显的免疫排异反应。随访１年５个月￣７年５个月,平均４．２年,存活３１例,优良率达７４．１９％。结论 低温冷冻或冻干的同种异体骨或骨关节移植物抗     

一种新型生物活性人工骨的制备及成骨活性的研究

目的：研制CPC/BMP复合人工骨,检测其成骨活性。方法：制备CPC/BMP及CPC骨块,扫描电子显微镜观察表面结构。用小鼠肌袋植入实验观察材料的成骨活性。结果：BMP在CPC中呈微球状均匀分布。CPC植入小鼠肌袋内不能诱导,CPC/BMP植入后1周有软骨细胞出现,2周有编织骨,4周以后小梁骨生成,16周出现成熟的板层骨。同时材料出现降解迹象。有机质含量、碱性磷酸酶浓度在CPC/BMP组出现升高,扫描电镜结果同样证实有新骨形成。结论：CPC/BMP生物活性人工骨可异位诱导成骨,可望成为新型的骨缺损修复材料。     

冷冻干燥同种骨临床应用的初步报告

目的：建立现代骨组织库，观察系列冷冻干燥同种骨移植的临床效果。方法：采用深度冷冻、真空冷冻干燥和辐照灭菌等现代技术处理人类骨组织，临床应用系列冻干骨94例，包括骨缺损填充、骨不连植骨、脊柱和关节融合、人工关节翻修、髋臼造盖等，观察近期临床结果。结果：冻干同种骨的理化性能、无菌检测和生物性能完全符合体内植入物的相关国家标准，常温下可保存2年。94例中的90例无明显的免疫排斥反应，优良率为95．76％，成功率为97．87％。结论：冷冻干燥同种骨使用安全，保存和运输方便，可替代临床自体骨移植。     

D-半乳糖对不同月龄雌性小鼠骨代谢的影响

目的比较D-半乳糖对1月龄及3月龄雌性小鼠骨干重、骨羟脯氨酸、骨钙及微量元素的影响.方法 1月龄及3月龄昆明种雌性小鼠每日颈背部皮下注射D-半乳糖1O00mg·mg·d-1,连续42d,取右侧股骨测定骨干重、骨羟脯氨酸、骨钙、骨微量元素.结果 D-半乳糖对1月龄小鼠骨干重、骨羟脯氨酸、骨钙和微量元素无明显影响;可使3月龄小鼠骨干重、骨羟脯氨酸和骨钙减少,骨干重与体重比值,骨镁与骨干重比值降低.结论 D-半乳糖不能导致1月龄小鼠骨质丢失,但可导致3月龄小鼠骨质丢失,提示D-半乳糖对处于骨生长期及已进入骨维持期的雌性小鼠具有不同的骨药理作用.D-半乳糖导致3月龄小鼠骨质丢失可能与骨镁减少有关.     

应用显微外科技术修复骨肿瘤骨缺损

目的：介绍骨肿瘤骨缺损的显微外科治疗及临床疗效。方法：回顾性的总结15例骨肿瘤巨大骨缺损的显微外科手术治疗资料。病灶处理：切刮12例，段截3例。作带血管蒂的的骨块转位移植12例，吻合血管的游离腓骨移植3例。结果：全部病例获长期随访，平均随访3年。所有病例在术后3～4月达骨愈合，无一例复发。结论：应用显微外科技术修复骨肿瘤巨大骨缺损，能缩短骨愈合时间，复发少，患功能恢复好。     

骨基质明胶复合红骨髓及同种骨修复节段性骨缺损的实验研究

目的 探讨骨质基明胶 (BMG)复合自体红骨髓移植及其与同种库存骨联合移植修复骨缺损的效果,为其应用于临床提供实验依据。方法 将 BMG与自体红骨髓复合,制成 BM;并采用兔桡骨干 1.5 cm缺损的动物模型。通过观察大体形态及进行 X线检查、组织学检查等,比较 BM移植、 BM与同种库存骨联合移植 (简称 BMA移植 )及自体骨移植修复节段性骨缺损的疗效。结果 (1)BMA移植,术后 16周全部骨愈合 (5/5),修复效果优于自体骨和 BM移植 (P 0.05); (3)BMA、 BM、自体骨移植明显优于对照组 (P     

Bone quality: A determinant for certain risk factors for bone fragility

Low bone quantity alone is insufficient cause for fragility fractures. This paper examines the role of bone quality in the fracture risk associated with age, sex, and race. Aspects of bone quality to be considered are bone architecture, matrix, mineralization, and fatigue damage. The trabecular network becomes progressively disconnected and weaker with age. Death of old osteocytes leads to hypermineralization and brittleness of bone. The stability of bone collagen declines with age, and unremodeled bone accumulates fatigue damage. The lower bone fragility rates in males than in females may be due to a combination of the larger male skeleton, greater cortical bone density after age 60 years, and greater bone turnover which would replace fatigue damaged bone. Fragility fracture rates in American and African blacks are lower than in whites, bone mineral density (BMD) is greater in American but not in African blacks (except for hip BMD), and American blacks have lower and African blacks higher bone turnover compared to whites. In South African blacks, trabeculae are thicker and better connected and trabecular bone undergoes less destructive age changes than in whites. To reconcile the disparate findings in American and African blacks we suggest that both groups have a genetic tendency to greater BMD than whites; American blacks realize this potential and African blacks do not, possibly because of calcium deficiency. Consequent high turnover removes fatigue damage and so improves bone quality. Weight-bearing activity in African blacks may be responsible for good hip bone density and thick trabeculae. American and African blacks have lower fragility fracture rates than whites for different reasons: American blacks because of higher BMD, and African blacks because of higher bone turnover, better hip BMD, and sturdier trabeculae.Presented at the NIA Workshop on Aging and Bone Quality, September 3–4, 1992, Bethesda, Maryland     

自体游离骨膜包裹多孔块状HAP修复掌指骨骨缺损的初步临床应用

为研究修复骨缺损的新材料，我们于１９９０年起，应用游离移植骨膜包裹多孔块状羟基磷灰石，修复５例掌指骨骨缺损的患者，手术时应保护好骨膜生发层，ＨＡＰ大小适宜，固定要牢固，经８￣１２个月的随访，均达到骨性愈合，我们认为ＨＡＰ是修复骨缺损的一种新材料，但仍需作进一步研究。     

Trabecular bone turnover, bone marrow cell development, and gene expression of bone matrix proteins after low calcium feeding in rats

Low-calcium-fed animals have been accepted as one of the experimental models showing a reduction in bone mass. However, the effects of short-term low-calcium feeding on bone turnover, the development of osteoprogenitor cells, and gene expression of bone matrix proteins have not been reported. In this study, we examined the effect of a low-calcium diet on rat tibia and analyzed the changes in the bone by histomorphometry, bone marrow cell culture, and in situ and Northern hybridization of the bone matrix proteins. Rats were fed either a low-calcium diet (0.05% Ca) or a normal calcium diet (0.5% Ca) using the pair feeding technique. They were killed at day 0, 12 h, and days 1, 2, and 3. In the low-calcium group, the serum parathyroid hormone (PTH) level was temporarily increased in 12 h after feeding the low-calcium diet. Bone mineral density in the trabecular bone was significantly decreased from 1 day after the low-calcium feeding, but cortical bone did not show any changes during the experimental period. The bone volume per tissue volume in the proximal tibia also decreased from day 1 in the low-calcium group. The number of osteoclasts and osteoblasts on the trabecular bone surface was increased in the low-calcium group compared with the normal-calcium group. An ex vivo study showed that the number of progenitors of osteoclasts and osteoblasts in bone marrow was also increased in the low-calcium group of rats. The localization of type I collagen mRNA was observed in osteoblasts in the low-calcium group. The Northern hybridization study showed that the gene expression of type I collagen, osteopontin, and osteocalcin was increased at day 3 in the low-calcium group. These results indicated that the trabecular bone surface quickly responded to the low-calcium feeding and that bone remodeling activity was activated probably by PTH. The changes in bone marrow cell populations and the gene expression of bone matrix proteins are closely associated with increased bone turnover induced by the low-calcium diet, resulting in rapid bone loss of the trabecular bone.     

Bridging large bone defects with a xenograft composited with autologous bone marrow

Summary We have investigated the role of defatted, decalcified xenogenic bone implants composited by impregnation with fresh autologous marrow in bridging large cortical defects. Diaphyseal cortical implants were obtained from orthopaedic operations on humans and from guinea pigs and prepared by treatment with acetone, 0.6 M HCl and ethanol. The composited graft was used to bridge a 3 cm defect in the diaphysis of the ulna of rabbits. Periodic investigations were made clinically, radiographically and histologically and by tetracycline, fluorescence studies up to 20 weeks. Abundant new bone formation was observed in 85.7% of composited human xeno-autografts and in 83.3% of composited guinea pig xeno-autografts. New bone formation was seen in 13.3% of noncomposited xeno-implants. No appreciable antigenicity was observed either clinically or histologically in the grafts. The high degree of success obtained justifies further studies on implants composited by fresh autologous marrow and offers hope for the enhancement of new bone formation clinically, particularly in reconstructive operations for significant skeletal defects. We feel that the osteo-inductive potential of autologous marrow was responsible for the healing of the defects aided by the better internal milieu provided by defatted decalcified xeno implant.

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Résumé Les auteurs ont étudié le rôle, dans le remplacement de pertes de substance corticales étendues, d'implants osseux hétérogènes, dégraissés et décalcifiés, et rendus composites par imprégnation à l'aide de moelle autogène fraîche. Les greffons corticaux diaphysaires ont été obtenus au cours d'interventions orthopédiques chez l'homme et sur des cobayes. Ils sont ensuite lavés successivement à l'acétone, à l'acide chlorhydrique et à l'alcool éthylique. La greffe composite est alors utilisée pour ponter une perte de substance de 3 cm, au niveau de la diaphyse cubitale du lapin. Des examens périodiques, cliniques, radiographiques et histologiques, ont été pratiqués jusqu'à la 20 semaine, ainsi que l'étude de la fluorescence par la tétracycline. Une abondante formation d'os nouveau a été observée dans 85,7% des greffes composites d'origine humaine et dans 83,3% des greffes composites de cobaye. Une néoformation osseuse n'a été constatée que dans 13,3% des greffes hétérogènes non composites. Ni cliniquement ni histologiquement, il n'est apparu de réaction antigénique au niveau des greffons. Le nombre élevé de succès obtenus justifie des études complémentaires et perment d'espérer l'accroissement de la néoformation osseuse, notamment dans les opérations reconstructrices pour pertes de substance étendues. Les auteurs estiment que le potentiel inducteur de la moelle est l'agent de la consolidation du matériau idéal que constitue la greffe hétérogène, dégraissée et décalcifiée.