正常胎儿脊柱骨骺发育与血运关系的研究

本文对9-34周胎儿124例，经胸主动脉注入10%福尔马林炭素墨汁，做胸腰椎段连续切片观察，结果胎生9周时脊柱体节已分化完全；11周时骨骺形成，出现软骨管；13周时血管经软骨管进入骨骺滋养椎体，骨骺澡各层软骨细胞呈柱状放射状均匀圆形排列，离心性生长；14周时横突、椎板的骨骺也以软骨内化骨形式化骨，脊柱的血管由椎体后路的椎管，椎管前路及椎体表面进入骨骺内，即在骨骺内出现基质小泡，其内含有微小羟磷灰石结晶，基质小泡有浓缩钙的能力。具有促进骨化作用。     

MR检查在儿童肘关节骺(板)软骨损伤中的作用

儿童肘关节结构复杂，肱骨远端有滑车、小头、内上髁和外上髁骨骺，及桡骨头和尺骨鹰嘴骨骺等。骺（板）是软骨结构，平片不能直接显示；有些骨骺出现时间晚，如肱骨滑车骨骺多数在9～11岁时出现，这些都增加了儿童肘关节损伤X线平片诊断的困难。有时仅依据平片不能准确判断损伤情况，尤其是X线平片对骺（板）软骨受累、关节软骨是否中断及移位等情况不能清楚显示而影响治疗方法的确定，即如果损伤累及关节面并有移位时，需手术治疗，否则可保守治疗。     

原位空心钉固定治疗股骨头骨骺滑脱的临床观察

目的探讨原位空心钉固定治疗股骨头骨骺滑脱的临床疗效。方法自2002年起采用C型臂引导下原位空心钉固定技术治疗股骨头骨骺滑脱3例，并定期随访。结果原位空心钉固定后1周即可以床上活动，4-6周可以下床活动，术后近期尚未发现股骨头坏死和软骨溶解等并发症。结论原位空心钉固定治疗股骨头骨骺滑脱，操作方法简便，有利于患儿早期活动，值得推广。     

新生儿化脓性关节炎九例临床分析

新生儿不同于年长儿，在生理方面，免疫功能的不成熟，抗感染能力弱，局部及全身对炎症反应也较儿童弱，局部体征轻微。解剖方面，新生儿股骨头骨骼尚未骨化，为软骨组织，其中有丰富的软骨管，并与全身血循环相通，一旦细菌人血，就容易停滞于骨骺中，发生骨骺骨髓炎，而骨骺的一部分相当于关节面，所以很容易引发化脓性关节炎，关节内脓液积聚和关节周围肌肉因炎症刺激发生挛缩，常导致关节病理性脱位，如治疗不及时或方法不当，常导致患儿残疾。为此，本研究将近几年在我科诊治的新生儿化脓性关节炎临床资料作一总结。     

新生儿化脓性关节炎九例临床分析

新生儿不同于年长儿,在生理方面,免疫功能的不成熟,抗感染能力弱,局部及全身对炎症反应也较儿童弱,局部体征轻微。解剖方面,新生儿股骨头骨骼尚未骨化,为软骨组织,其中有丰富的软骨管,并与全身血循环相通,一旦细菌入血,就容易停滞于骨骺中,发生骨骺骨髓炎,而骨骺的一部分相当于关节面,所以很容易引发化脓性关节炎,关节内脓液积聚和关节周围肌肉因炎症刺激发生挛缩,常导致关节病理性脱位,如治疗不及时或方法不当,常导致患儿残疾。为此,本研究将近几年在我科诊治的新生儿化脓性关节炎临床资料作一总结。临床资料病例选自2002年至2006年我院儿…     

骺板骨桥切除术治疗儿童骺板部分早闭

骺板是儿童骨骺与干骺端之间的生长活跃软骨区,具有纵向和横向生长的功能,骨折、感染、肿瘤、辐射均可导致骺板损伤。骺板损伤后可能在骨骺与干骺端之间的软骨区形成骨性连接即骨桥,使骺板全部或部分提前闭合,导致肢体短缩和（或）成角畸形。传统的治疗方法是针对临床表现的短缩和（或）成角畸形,采取诸如截骨矫形、骨骼延长或健侧骺板阻滞术等方法进行治疗。     

甲状腺机能减退症合并股骨头骨骺滑脱症保守治疗一例

股骨头骨骺滑脱常见于青春期儿童。外伤、佝偻病、软骨发育不全、内分泌异常以及多发性骨骺发育异常可引起骨骺滑脱。股骨上端骨骺可在没有任何异常的情况下发生自然滑脱。常见的畸形系股骨颈自股骨头的骺板向上向前移位，而股骨头向后下滑脱。内分泌异常合并股骨头骨骺滑脱症的治疗有其特殊性。本文报告1例原发性甲状腙机能减退症合并单侧股骨头骨骺滑脱症保守治疗的情况，     

骺板损伤的诊断与治疗的新进展

骨骺软骨板是儿童期骨骺与干骺端之间的软骨组织,有骨骼生长的功能,随着骨骼的发育成熟而与原始骨化中心融合,骨骼长度的增长是骺软骨板增殖发育的结果。骨折、感染等损伤可以导致儿童长管状骨骨骺与干骺端之间形成骨性连接即骨桥,使骺板全部或部分提前闭合,造成肢体短缩和/或成角畸形,相应关节功能受损,且随着儿童的生长发育,畸形会逐渐加重。16岁以下的儿童中骨骺损伤占长骨骨折的6%～30%,骨骺损伤好发年龄:男孩为9～12岁,女孩为8～11岁。儿童骨骺损伤各部位的发生率犤1犦:桡骨远端(28.0%)、指骨(25.8%)、胫骨远端(9.4%)、趾骨(7.1%)、肱…     

骨骺发育障碍与生长

正常的骨骼对维系人体正常体型及活动非常重要,任何骨骼疾病都会危及健康。骨骼生长发育是一个复杂的过程,受诸多通路的调控及因素影响。骨骺软骨承载的生长板是骨生长的重要部位,其发育障碍直接影响骨骼生长。该文就骨骺的正常生长发育及其障碍所引起的代表性骨病--脊柱骨骺发育不良及软骨发育不全综合征进行阐述。     

骺板中生长因子的表达与调控

人体骨骼的骺板(epiphyseal plate),即软骨生长板(growth plate)是位于长骨骺与干骺端之间,以及椎间盘与椎体间的一层具有纵向生长能力的透明软骨,人体发育过程中长骨和椎体的生长均需通过骺板的软骨内骨化来完成.骺板从骨骺端到骨干可依次分为四个区:静止区、增殖区、肥大区和成骨区.其中静止区中软骨细胞进入增殖区,这里的细胞形态扁平,分裂活跃,以纵向分裂为主,形成典型的柱状排列.     

The blood supply of early, late, and nonossifying cartilage: preliminary gray-scale and Doppler assessment and their implications

Background Comparative gray-scale Doppler US studies of various cartilages have not been reported before. Objective To study gray-scale US and perfusion patterns of different cartilages. Materials and methods Three groups of cartilages were studied in 42 normal neonates. Group A included the proximal femoral chondroepiphysis of 20 neonates as well as proximal humeral, distal femoral, and proximal tibial epiphyses of 8 others. Group B included the patellar cartilage of nine neonates and group C included the rib cartilage of five neonates. Results Early ossifying cartilages all had numerous echogenic columns on US. Late ossifying patellar cartilage was amorphous and hypoechoic at birth but contained echogenic columns near the ossification age. Rib cartilage was hypoechoic and amorphous at all ages. The blood supply was detectable in all cartilages except the ribs. Peak systolic velocities increased with age in the proximal femoral epiphysis. The patellar cartilage was less vascular than the distal femoral epiphysis at birth, but more vascular at 14–24 months of age. The rib cartilage did not have any discernable blood supply at any age. Conclusions Cartilage blood flow is detectable with current technology. Cartilage blood flow correlates with the timing of its ossification. Normal cartilage blood flow may prognosticate normality of its growth and development potential.     

儿童创伤性骺板及骨骺损伤的多排螺旋CT诊断分析

目的探讨儿童骺板及骨骺损伤的多排螺旋CT影像学表现。方法收集首都医科大学附属北京儿童医院2009年1月至2011年3月收治的X线平片或CT检查可疑骨骺损伤的33例患儿临床资料,年龄1d至14岁,中位年龄7岁,男14例,女19例,病史为1h至3个月。分别行x线平片及CT检查,分析其多排螺旋CT表现。结果33例患儿共29处骺板受累,其中2例为双骨干骺端骨折,6例经多排螺旋CT证实排除骺板骨折,9例X线平片未发现骨骺损伤而多排螺旋CT发现骺板骨折。骨折位于肱骨远端8例,肱骨近端1例,桡骨近端2例,桡骨远端3例,股骨远端2例,胫骨近端1例,胫骨远端8例,腓骨远端1例,指骨2例,趾骨1例。按Salter—Harris分型,Ⅰ型2例（6．9％）,Ⅱ型19例（65．5％）,Ⅲ型4例（13．8％）,Ⅳ型4例（13．8％）。结论多排螺旋CT可以了解骨骺受累情况,直观观察骨骺移位以及关节内情况,及时提示临床进行相应处理,对病变的预后起着重要的作用。     

缺血对骺板移植影响的实验研究

目的 研究不同缺血时间对移植骺板组织结构和生长的影响。方法 在３６只８周幼兔的右下肢,对胫骨下端骺根的血供分别阻断２、４和８小时,在左侧胫骨相同部位埋置金属标志作为对照,利用Ｘ线测量术后第３个月的生长长度,并作切片观察骺板组织学改变。结果缺血２和４小时的骺根组织结构正常,生长速度与对照侧相同。缺血８小时可导致骺根中心散在变性、坏死,生长速度较对照侧慢。结论 ４小时以内的缺血对骺板的组织学和生长无     

MRI evaluation of the knee in children with infantile Blount disease: tibial and extra-tibial findings

Background

Infantile Blount disease is a developmental condition characterized by disorganized endochondral ossification in the medial aspect of the proximal tibial physis.

Objective

To describe the MR imaging abnormalities in the proximal tibia, distal femur, menisci and ligaments of children with infantile Blount disease.

Materials and methods

We retrospectively evaluated 11 children (18 total knee MR examinations) with infantile Blount disease and compared them with an age-matched control group with normal MR examinations. Morphological and morphometric measurements were performed.

Results

The medial menisci were enlarged with increased T2 signal intensity in all MR examinations. The medial femoral epiphyseal cartilage showed abnormal foci of increased signal intensity in nine (50%). The mid-coronal thickness of the medial tibial epiphyseal cartilage was decreased with concomitant increase in the mid-coronal joint space distance. Angular measurements of the proximal tibia demonstrated posteromedial down-sloping configuration.

Conclusions

Most severe abnormalities of infantile Blount disease occur in the medial compartment of the knee, especially at the medial tibial physis and epiphysis. However, other important structures of the knee and the lateral compartment are often affected. MR imaging helps to delineate the extent of multiple tibial and extra-tibial abnormalities, including meniscal abnormalities, perichondrial membrane changes and premature physeal closure.     

永生化骨骺软骨细胞的生物学性状研究

目的比较永生化骨骺软骨细胞与原代骨骺软骨细胞的生物学性状,为细胞替代疗法治疗小儿身材矮小提供理论依据。方法利用SV40LTag诱导骨骺软骨细胞永生化,经G418稳定筛选后,观察细胞形态,应用MTT、血清依赖性实验、软琼脂克隆形成试验、裸鼠致瘤试验分析其生物学性状。结果原代软骨细胞体外传代至第6代左右即出现衰老现象,而转化软骨细胞可连续传代,未出现衰老迹象。转化软骨细胞更趋向于长梭形。两者的生长曲线比较相似,但转化软骨细胞的饱和密度明显高于正常软骨细胞。两者都对血清有依赖性,都为二倍体核型,均不能在软琼脂上形成克隆。经8周观察两者都不能使裸鼠致瘤。结论永生化骨骺软骨细胞为良性转化,为转基因细胞移植治疗身材矮小等疾病的研究提供了安全的细胞来源。     

Humeral head and coracoid ossification in Nigerian newborn infants

The presence of the coracoid and proximal humeral head epiphysis in 201 Nigerian newborn infants was related to gestational age. The appearance of the humeral head of ossification centre was delayed, while the coracoid epiphysis appeared earlier than those of Caucasian newborn infants. There was no difference in the pattern of epiphyseal ossification between the sexes.     

Spondyloepiphyseal dysplasia with an accumulation of glycoproteins in chondrocytes

A case presenting a peculiar type of spondylo-epiphyseal dysplasia was studied. Clinically, the normal height was striking. The X-rays showed large epiphysis and wide metaphysis. Bilateral coxa valga with very large femoral necks was present. The height of the vertebral bodies was slightly reduced. The study of the upper tibial growth cartilage showed glycoprotein inclusions in the chondrocytes and large dilatations of the rough endoplasmic reticulum. The gel electrophoresis of the non collagenous proteins extracted from the growth cartilage had an abnormal densitometric tracing. The type of inheritance of this syndrome is unknown, the patient being an isolated case in a normal family.     

Safety profile of ciprofloxacin used for neonatal septicemia

We conducted a case matched control study to observe the adverse effects of ciprofloxacin used in neonatal septicemia We enrolled 30 neonates with multidrug-resistant septicemia who were treated with intravenous ciprofloxacin for 14 days. Thirty matched neonates with septicemia treated with other antibiotics were enrolled as controls There was no difference in the mean serum electrolytes, hepatic, renal and hematologic parameters of the two groups. Serial ultrasonographic measurements of the cartilage of the knee after 1 and 6 months showed no difference in the two groups. The femoral cartilage showed an increase of 78.8% in the mean longitudinal area after 6 months in the study group. In the control group, the femoral cartilage showed a 78.4% increase after 6 months. Similarly, the tibial cartilage showed no difference in the percentage increase in size of the study and control group at the end of 6 months. When controlled for birth weight and gestation, cartilage size was not affected by ciprofloxacin.     

Unilateral late-onset tibia vara associated with bilateral proximal femoral growth disturbance in monozygotic twins: case report.

Clinical and histopathological similarities and rare association of Blount's disease with various proximal femoral physeal affections (i.e. adolescent coxa vara and slipped capital femoral epiphysis) are well known. Association of tibia vara with another epiphyseal disease of the proximal femur has not been reported previously. In this paper, a monozygotic set of twins with concordant bilateral epiphyseal growth disturbance of the proximal femur and unilateral late-onset tibia vara is presented. Radiological characteristics of the affected knees revealed a wedging in the proximal tibial epiphysis, depression of the medial joint surface and varus deformity of the tibia. Proximal femurs of both cases showed aspheric congruity, coxa magna, shortness of the femoral neck, and subchondral cystic changes. The presented cases support the genetic etiology of tibia vara, and association of the two conditions is unique.     

Tuberculosis of the knee in a child

The diagnosis for skeletal tuberculosis is often overlooked. We report a 9-year-old patient with a history of 2 years of swollen joint, with a diagnosis of tuberculosis of the knee with involvement of the proximal tibial epiphysis, and treated surgically and with anti-tuberculosis drug therapy.