骨形态发生蛋白4、脱钙骨基质和切断跟腱诱导的异位骨化动物模型的研究

目的:建立骨形态发生蛋白4(bone morphogenetic protein 4,BMP4)、脱钙骨基质和切断跟腱诱导的异位骨化动物模型,并初步探讨其形成机制,为异位骨化的研究奠定实验基础。方法:制备动物模型:(1)构建BMP4重组腺病毒,实验组裸鼠的一侧腓肠肌内注入50μl1×107pfu BMP4重组腺病毒液,对照组腓肠肌内注入50μl1×107pfu空病毒液。4周后行X线和组织学检查。(2)无菌条件下,股后外侧入路,将50mg脱钙骨基质植入裸鼠股后肌群内,4周后行X线和组织学检查。(3)20只小鼠于跟腱中点行跟腱切断术,10周后行X线和组织学检查。结果:X线和组织学检查显示4周后,注射BMP4重组腺病毒的动物均出现异位骨,注射空病毒组未见异位骨形成。4周后,植入脱钙骨基质的动物均出现异位骨。10周后,行跟腱切断术的动物均在跟腱部位出现异位骨。结论:BMP4、脱钙骨基质和切断跟腱可有效诱导异位骨化,结果稳定可靠。     

siRNA抑制Smad4或Runx2基因表达治疗大鼠异位骨化效果比较

目的:研究siRNA抑制Smad4基因表达治疗异位骨化大鼠模型的效果,并与抑制Runx2的疗效进行比较。方法:1、设计6条分别针对大鼠Smad4和Runx2的mRNA模板,用体外转录合成法分别合成6条siRNA,采用RT-PCR从mRNA水平在培养的原代成骨前体细胞中筛选有明显抑制作用的siRNA。2、设计合成针对Smad4基因和Runx2基因编码的发卡样siRNA的双链DNA,与腺病毒的穿梭质粒连接后,取其启动子和终止子连接于非病毒载体上。在培养的大鼠原代成骨细胞中,采用RT-PCR和western blot测定Smad4特异性siRNA非病毒对Smad4的抑制作用和Runx2特异性siRNA非病毒对Runx2的抑制作用。3、采用体内实验测定Smad4或Runx2特异性siRNA非病毒载体对切断大鼠跟腱诱导异位骨化动物模型的影响:实验组行跟腱切断术和植入100μg的Smad4-siRNA或Runx2-siRNA重组非病毒载体,对照组行跟腱切断术和植入100μg的pcDNA4/HisA非病毒载体。10周后,行CT三位重建检测形成的异位骨大小,HE染色观察其组织形态。结果:1、在合成的3条Smad4-siRNA中,siRNA139-159对Smad4的抑制效果最明显,在合成的3条Runx2-siRNA中,siRNA1057-1077对Runx2的抑制效果最明显。2、成功构建重组非病毒载体,转染原代成骨细胞可明显抑制Smad4和Runx2的表达。3、CT三位重建显示,Smad4-siRNA实验组形成的异位骨体积较对照组减小92%,Runx2-siRNA实验组形成的异位骨体积较对照组减小93%,差异均有统计学意义(P<0.05)。组织学观察显示非病毒载体介导的特异性Smad4-siRNA和Runx2-siRNA在体内可以抑制异位骨形成,两者之间的抑制效果差异无统计学意义(P>0.05)。结论:Smad4和Runx2两种信号通路的特异性siRNA可以明显抑制切断跟腱诱导的异位骨化,但两种不同siRNA的抑制效果无差别。     

髋周骨肿瘤及肿瘤样病变影像学诊断

目的评价髋周骨肿瘤及肿瘤样病变的影像学表现。资料与方法回顾性分析82例经穿刺活检或手术病理证实的髋周骨肿瘤及肿瘤样病变的影像学表现。全部病例均行X线平片检查,42例行CT检查,24例行MRI检查。结果骨囊肿13例,动脉瘤样骨囊肿16例,骨巨细胞瘤6例,软骨母细胞瘤2例(合并动脉瘤样骨囊肿1例),骨母细胞瘤1例,骨样骨瘤3例,骨化性纤维瘤2例,非骨化性纤维瘤3例,骨纤维异常增殖症6例,嗜酸性肉芽肿3例,骨肉瘤4例,软骨肉瘤3例,恶性骨母细胞瘤1例,淋巴瘤2例,转移瘤17例。良性骨肿瘤17例(占20.7%),肿瘤样病变38例(占46.4%),原发恶性骨肿瘤10例(占12.2%),转移瘤17例(占20.7%)。结论髋周是良性骨肿瘤及肿瘤样病变的好发部位,X线平片+CT或X线平片+MRI是较好的综合检查手段。     

跟腱创伤伴随颅脑损伤后跟腱异位骨化机制研究

目的 探讨跟腱创伤伴随颅脑损伤后跟腱异位骨化发生的机制。方法 选取42只雄性SD大鼠,采用随机数字表法将其随机分为3组,其中,空白对照组6只,跟腱创伤组(HO组)18只,跟腱创伤伴随颅脑损伤组(TBI组)18只。在造模后1、2、4周,通过micro-CT比较HO组、TBI组大鼠跟腱局部开始出现异位骨化的时间、异位骨化的骨密度(BMD)及骨体积占比(BV/TV);通过苏木素伊红染色比较异位骨化的骨小梁厚度(Tb.Th);通过免疫组化检测跟腱创伤局部的焦亡相关蛋白的表达水平;通过透射电镜(TEM)检测HO组、TBI组大鼠跟腱局部早期的病理性矿化。结果 TBI组大鼠出现异位骨化的时间早于HO组,且造模4周后,TBI组的BMD及BV/TV均大于HO组,差异有统计学意义(P<0.05);同时,TBI组大鼠异位骨化的Tb.Th也大于HO组,差异有统计学意义(P<0.05)。在造模1周后,TBI组损伤跟腱组织中的NLRP3⁺、CASPASE-1⁺、GSDMD⁺的细胞均高于HO组,差异均有统计学意义(P<0.05)。同...     

股骨近端良性骨病的影像特征研究

目的:分析股骨近端良性骨肿瘤与肿瘤样病变的影像学特征表现,探讨其临床意义。方法:回顾性分析56例经手术病理证实的股骨近端良性骨肿瘤和肿瘤样病变的影像学特征表现。全部病例均行X线检查,其中30例同时行CT检查,25例行MRI检查。结果:骨囊肿15例,骨纤维结构不良11例,骨软骨瘤6例,动脉瘤样骨囊肿5例,骨巨细胞瘤5例,软骨母细胞瘤和骨母细胞瘤各3例,骨化性纤维瘤2例,非骨化性纤维瘤1例,纤维组织细胞瘤1例,内生软骨瘤1例,韧带样纤维瘤1例,软骨粘液样纤维瘤1例,骨样骨瘤1例。所有病例在病变部位、数目、大小、边界、内部结构、软组织改变及病理性骨折方面具有一些共性及特性。结论:股骨近端良性骨病种类繁多,以骨纤维结构不良和骨囊肿为好发病种,多种影像学方法的联合使用在诊断和鉴别诊断中具有重要作用,有利于临床选择治疗方式及评判预后。     

软骨肉瘤的影像诊断

目的 探讨软骨肉瘤的影像诊断,旨在提高其影像诊断水平.方法 回顾性分析14例经病理证实的软骨肉瘤的X线、CT和MRI表现.14例均行X线平片检查,其中8例同时行CT检查,10例行MRI检查.结果 14例软骨肉瘤中,发生在骨盆6例,管状骨7例,椎体1例.11例表现为斑片状、虫蚀样的溶骨性骨质破坏,12例可见钙化或骨化,1例可见针状骨膜反应,8例可见明显软组织肿块.结论 对于软骨肉瘤,X线平片及CT能清晰地显示钙化、骨化,磁共振能准确地显示病变范围,X线平片结合CT及/或磁共振能明显提高其诊断准确性.     

椎板再生的实验研究

目的:探讨大鼠椎板切除后的再生机制和后果.方法:以SD大鼠为模型行L5全椎板切除,与对照组一同进行运动和感觉功能检查、影像学及病理学检查,计算机分析结果数据.结果:病理学检查见椎板缺损处首先形成纤维组织,继而椎板边缘松质骨以软骨内成骨的方式向对侧再生形成椎板,椎板皮质骨则以膜内成骨的方式再生,此外纤维组织中出现软骨岛并骨化成椎板.术后16周L5椎管截面积测量结果显示,椎板再生引起实验组椎管狭窄15.6%(P＜0.05),同时实验组出现了明显间歇性跛行(P＜0.05).体感诱发电位(SEP)结果还显示实验组出现了下肢感觉障碍--潜伏期延长(P＜0.05),波幅下降(P＜0.05).结论:椎板再生包括纤维组织软骨内成骨和椎板切缘的骨再生,再生造成椎管狭窄.     

儿童脊柱正常MRI与胎儿脊柱骨发育

目的 :探讨胎儿椎体和椎间盘的组织学结构以及儿童脊柱的正常X线和MRI表现。方法 :44周胎儿X线平片 1例 ;儿童脊柱正常椎体MRI 13例 ;胎儿脊柱标本 2 6例 ,全部标本经固定、水冲洗、分批脱水、火棉胶包埋后制成脊柱标本整体切片 ,HE染色。结果 :44周胎儿脊柱每个椎体前面X线表现均有“V”字形凹陷。 13例儿童脊柱正常椎体MRI ,共分析了110个椎体的信号变化 ,其T1WI和T2 WI表现 :44 %的椎体前面“V”形凹陷呈高信号 ,63 %的椎体后面“V”形凹陷 ;16.4%的椎体前后面均凹陷 ;47%的椎体中心有雪花样高信号 ;13例中有 9例各椎体内均有双层低信号生长线。 2 6例胎儿脊柱椎体的组织学结构 :① 12周和 15周胎儿 ,椎体软骨内血管数量较多 ;②胎儿椎体前、后面中部凹陷 ,以膜内成骨形成“V”字形骨皮 ,不同病例椎体前面或后面均可见凹陷 ,出现率 9.6%～ 2 7.1% ,有 2例在椎体前面“V”字骨皮内形成松质骨小梁 ,并有骨髓形成 ;③椎体骨化中心有红髓和血管 :椎体后面“V”字骨皮内的大静脉窦与骨化中心静脉窦相通 ;④椎间盘 :只见于 12周的胎儿椎间盘内有血管 ,2例紧贴椎间盘的软骨椎体内见无细胞区 ,且部分髓核物突入椎体软骨内。结论 :4～ 11岁儿童脊柱正常椎体MRI表现仍然相应的保持着胎儿脊柱骨发育的组织学特点     

骨髓基质成骨细胞-松质骨基质复合人工骨肌袋移植的成骨作用

成年新西兰兔骨髓细胞体外培养、诱导后 ,经混匀、接种、固化形成骨髓基质成骨细胞 藻酸盐 松质骨基质复合人工骨 ,并植回取材兔肌袋内 ,对照组分别植入藻酸盐 松质骨基质复合物和松质骨基质。植入 4、8周取材 ,行X线摄片、组织学检查 ,观察骨形成情况。结果显示 ,骨髓基质成骨细胞 松质骨基质复合人工骨肌袋内成骨效果明显优于藻酸盐 松质骨基质复合物组和松质骨基质组。复合人工骨标本兼有膜内成骨和软骨成骨 ,以膜内成骨为主 ;对照组仅见少量软骨成骨。提示 ,采用组织工程方法形成的复合人工骨肌袋内成骨作用明显 ,用该方法所形成的组织工程骨展现出良好的应用前景。     

髓髓基质成骨细胞—松质骨基质复合人工骨肌袋移植的成骨作用

成年新西兰兔骨髓细胞体外培养、诱导后，经混匀、 接种、固化形成 骨髓基质成骨细胞－藻酸盐－松质骨基质复合人工骨，并植回取材兔肌袋内，对照组分别植入藻酸盐－松质骨基质复合物和松质骨基质。植入4、8周取材，行X线摄 片、组织学检查，观察骨形成情况。结果显示，骨髓基质成骨细胞－松质骨基质复合人工骨肌袋内成骨效果明显优于藻酸盐－松质骨基质复合物组和松质骨基质组。复合人工骨标本兼有膜内成骨和软骨成骨，以膜内成骨为主；对照组仅见少量软骨成骨。提示，采用组织工程方法形成的复合人工肌袋内成骨作用明显，用该方法所形成的组织工程骨展现出良好的应用前景。     

Heterotopic bone formation in patients with DISH following total hip replacement

Radiographs of 236 patients who underwent total hip replacement (THR) were evaluated for heterotopic bone formation. There was no significant difference in the presence and degree of ossification in patients with and without diffuse idiopathic skeletal hyperostosis (DISH). The authors conclude that DISH is not a significant risk factor in the development of heterotopic bone formation following THR.     

Syndesmosis sprains of the ankle. The influence of heterotopic ossification.

A retrospective study of 50 syndesmosis sprains in 44 football players was performed. Five patients (6 ankles) were lost to follow-up, allowing review of 44 injuries. Average follow-up was 47 months. The patients were evaluated for recurrent injury, overall ankle function, and for persistent ankle symptoms, including stiffness, pain, limping, and swelling. Follow-up radiographs of the injured ankle were obtained in 22 patients. The average return time to full activity was 31 days. Pain with pushing-off was a major factor preventing return to activity. At final followup, 36% of the patients complained of persistent mild to moderate stiffness of the ankle. Twenty-three percent had mild to moderate pain, usually with activity. One patient had a mild limp with activity, and 18% of the ankles had persistent mild to moderate swelling. Ankle function was rated as good to excellent in 86%. All patients with fair results had recurrent ankle sprains. There were no poor results. Eleven of the 22 patients with follow-up radiographs developed heterotopic ossification within the interosseous membrane, but no patient developed a frank synostosis. The patients with heterotopic ossification required an average of 11 days more recovery time than those without ossification. There was no significant difference between the 2 groups' ultimate ratings of ankle function or ankle symptoms, but the ankles with heterotopic ossification were associated with more recurrent lateral ankle sprains. We conclude that syndesmosis sprains require a longer recovery period than other types of ankle sprains. Most of these injuries showed good to excellent ankle function after recovery, unless there was a recurrent ankle sprain.2+ formation of heterotopic ossification.     

Technetium-99m MDP demonstration of heterotopic ossification in fibrodysplasia ossificans progressiva

The extensive heterotopic bone formation in patients with fibrodysplasia ossificans progressiva (FOP) has been documented previously with radiographs. A case in which a Tc-99m MDP bone scan showed increased uptake at sites well before ossification could be documented radiographically is described. This finding suggests that bone scans would likely be useful to monitor the extent of involvement with FOP and to detect areas of new activity.     

Heterotopic mesenteric ossification

We report a case of heterotopic bone formation in the mesentery. A 64-year-old man presented with abdominal pain and stiffness two months after undergoing several surgical interventions for hemorrhagic colitis. The diagnosis was heterotopic mesenteric ossification. We describe the imaging findings and review the literature.     

转染骨形态发生蛋白-2基因的人骨髓间质干细胞复合异种骨支架异位成骨的效果

目的 观察骨形态发生蛋白-2(BMP-2)罐因转染的人骨髓间质干细胞复合异种骨支架异位成骨效果。方法 分组：(1)BMP-2基因转染细胞 异种骨支架[去抗原牛松质骨(BCB)]；(2)对照基因转染细胞 BCB；(3)未转染细胞 重组BMP-2 BCB；(4)未转染细胞 BCB；(5)BCB。分别将各组人工骨植入裸鼠皮下，于术后4，8周行组织学观察．结果 体内植入后3d，细胞持续表达外源基因BMP-2基因转染组8周时完全由新形成的编织骨构成，血管丰富。结论 BMP-2基因转染后细胞复合BCB支架，可以在异位形成骨组织并诱导毛细血管长入。     

MR imaging of early fibrodysplasia ossificans progressiva

Fibrodysplasia ossificans progressiva is a rare disorder characterized by progressive heterotopic bone formation in connective tissue and muscle in association with congenital skeletal anomalies. The disease usually leads to extensive immobility and eventual disability. We report the magnetic resonance findings in a boy prior to ossification of his soft tissue masses.     

Periarticular heterotopic ossification secondary to central neurogenic dysfunction

A case of a 48 year old woman with a medical background of tetraparesis related to a right lobectomy and periarticular ossification development (that included both knee joints) is presented. Bone scintigraphy was performed to evaluate the metabolism of the bone lesions. The scintigraphic pattern showed an important involvement of the medial and lateral left knee and medial right knee compartments, initially attributed to degenerative osteoarthritis. We believe that the presentation of this case report is interesting for two reasons: 1) the rareness of knee involvement in periarticular heterotopic ossification related to cerebral dysfunction, and 2) the possibility of a false positive diagnosis: osteoarthritic involvement versus juxta-articular ossification. This paper reviews the role of diagnostic imaging methods in the assessment of periarticular heterotopic ossification and the differential scintigraphic diagnosis regarding to osteoarticular disorders (more frequent among the general population).     

True heterotopic bone in the paralyzed patient

In past years the clinical and radiologic presentation of true heterotopic bone in the paralyzed patient has been confused with osteomyelitis, neoplasm, trauma, and thrombophlebitis. We reviewed 376 paralyzed patients' roentgenographic files and found 78 patients with soft tissue ossification unassociated with infection, neoplasm, or underlying fractures, which we called true heterotopic bone. From this population the usual spectrum of radiologic findings is described, so that the radiologist may separate roentgenographically a group of patients from other types of ectopic ossification.     

Observations on para-articular uptake of radiophosphate after hip replacement

A correlation was made between the incidence and intensity of 99mTc-methylene diphosphonate (MDP) concentration and the radiographic incidence and volume of heterotopic calcium deposition in 44 patients with hip arthroplasties, as well as with the duration of the hip implants. The incidence of soft tissue para-articular MDP concentration was 95% compared to a 68% incidence of radiographically visible heterotopic calcium, bone or both. The concentration of MDP did not decrease on average with the age of the implant, which ranged from 6 months to 15 years, even though radiographs showed evidence of mature ossification in many of them. The cause of these sustained high uptakes is open to speculation, but the findings indicate that radiophosphate imaging is not a reliable means of assessing maturation of heterotopic bone associated with hip arthroplasty.     

Bone in the belly: traumatic heterotopic mesenteric ossification

Heterotopic mesenteric ossification is an unusual but important complication in patients who sustain blunt and penetrating abdominal trauma. In this condition, bone formation occurs in the mesenteric and omental fat in response to injury and may result in serious complications such as bowel obstruction and fistula formation. Although a few case reports exist, the radiology literature on this topic is scant. Based on our experience, this entity is under-recognized on imaging studies and often results in diagnostic confusion due to its resemblance to other pathologies such as barium leak and extraskeletal bone-forming neoplasms. This review highlights the imaging features of heterotopic mesenteric ossification with an emphasis on computed tomographic findings. Radiologist awareness of this condition is crucial to avoid misdiagnosis as well as to direct appropriate and timely management.