Virtual temporal bone

Objective: To provide the virtual model of the temporal bone for improving 3-dimension (3D) vi-sualization of the inner ear. Methods：Plastination technique was used to make equidistant serial thin sections 1.0 mm in thickness. On SGI workstation, a Contours q-Marching Cubes algorithm was selected to recon-struct the temporal bone and intratemporal structures in 3D, then to view the middle ear, inner ear, and in-tratemporal structures which imitate the scenes observed by the traditional endoscopy. Results: The virtual model of the temporal bone was successfully constructed, with all reconstructed structures being represented individually or jointly and being rotated continuously in any plane. Virtual endoscopy improved 3D visualiza-tion of the middle ear, inner ear, and intratemporal structures. Conclusion. The reconstructed model can be used for the medical students to rehearse or review the surgeries on this part and for the surgeons to develop a new approach for operation. Virtual otoscopy stands as a promising new visualization technique for elucidat-ing the structure and relation of the middle ear, inner ear, and intratemporal structures.     

The use of allogeneic cancellous bone graft in bone cavity of jaw cyst

A new method for filling bone cavity with a graft of frozen-decalcified-defatted-driedallogeneic (FDDDA) cancellous bone was described.This method was used for the treatment of cavi-ties after the enucleation of jaw cysts in 10 patients from December 1985 to February 1990.Thewounds of 9 patients healed by first intension,but wound infection occurred in one case postopera-tively.The 9 patients,besides the patient who suffered from wound infection,were followed up for5 to 56 months,with an average of 41.1 months.Evidence of recurrence with jaw cyst.was not ob-served.     

Role of transforming growth factor P and bone morphogenetic protein composite on repair of bone defects

Bonerepairisacomplicatedprocess.Recentstudiesdemonstratedthatseveralgrowthfactorsplayanimportantroleinboneformation.Bonemorphogeneticproteins(BMPs)induceboneformationthroughstimulatingundifferentlatedmesenchymalproliferationanddifferentiationandinitiatingheterotopicboneformation.Transforminggrowthfactor5(TGF--0),mostabundantinquantityofthegrowthfactorsinthebody,stronglypromotestheembryogenesis,traumahealing,matrixsynthesis,osteoandosteochondralformationandboneremodeling.Ourpreviousexperimen…     

Structural bone allografts with intramedullary vascularized fibular autografts for the treatment of massive bone defects in extremities

Objective：To report the clinical outcome of repairing massive bone defects biologically in limbs by homeochronous using structural bone allografts with intramedullary vascularized fibular autografts. Methods： From January 2001 to December 2005, large bone defects in 19 patients （11 men and 8 women, aged 6 to 35 years） were repaired by structural bone allografts with intramedullary vascularized fibular autografts in the homeochronous period. The range of the length of bone defects was 11 to 25 cm （mean 17.6 cm）, length of vascularized free fibular was 15 to 29 cm （mean 19.2 cm）, length of massive bone allografts was 11 to 24 cm （mean 17.1 cm）. Location of massive bone defects was in humerus（n=1）, in femur（n=9） and in tibia（n=9）, respectively. Results： After 9 to 69 months （mean 38.2 months） follow-up, wounds of donor and recipient sites were healed inⅠstage, monitoring-flaps were alive, eject reaction of massive bone allografts were slight, no complications in donor limbs. Fifteen patients had the evidence of radiographic union 3 to 6 months after surgery, 3 cases united 8 months later, and the remained one case of malignant synovioma in distal femur recurred and amputated the leg 2.5 months, postoperatively. Five patients had been removed internal fixation, complete bone unions were found one year postoperatively. None of massive bone allografts were absorbed or collapsed at last follow-up. Conclusion： The homeochronous usage of structural bone allograft with an intramedullary vascularized fibular autograft can biologically obtain a structure with the immediate mechanical strength of the allograft, a potential result of revascularization through the vascularized fibula, and accelerate bone union not only between fibular autograft and the host but also between massive bone allograft and the host.     

Evaluation of transforming growth factor beta and bone morphogenetic protein composite on healing of bone defects.

OBJECTIVE To evaluate the effect of transforming growth factor-beta/bone morphogenetic protein (TGF-beta/BMP) composite on the healing of large segmental bone defects and to discuss the interaction between TGF-beta and BMP during bone repair.

METHODS A 1.5 cm segmental defect was made in the mid-upper part of the radial shaft of 48 adult rabbits. The defects were filled with implants of TGF-beta/carrier, BMP/carrier or TGF-beta/BMP/carrier separately. 120 micrograms of purified bovine TGF-beta and 12 mg of BMP were used in the composite. The defects were examined radiographically and histologically at 4, 8, 12 and 16 weeks post-operation.

RESULTS In the group filled with TGF-beta/BMP composite, the defect areas were bridged at 4 weeks, with callus of uniform radiodensity. Cortices of the cut ends were obscured by new bone. By 16 weeks post-operation, the defects were bridged by uniform new bone and the cut ends of the cortex could not be seen in all groups. In group of BMP/carrier, the defects were filled with more irregular woven bone callus than in other two groups. TGF-beta/BMP implanted defects in animals killed at 16 weeks showed histologically new lamella and woven bone that was formed in continuity with the cut ends of the cortex. Medullar canal was recanalized and contained marrow elements with normal appearance.

CONCLUSIONS These data demonstrate not only the synergistic action between TGF-beta and BMP in the process of bone healing, but also a better effect of TGF-beta/BMP composite than single TGF-beta or BMP on bone repair, especially in the early stage of bone repair process.

     

The destruction of bone by neutrophils.

Osteomyelitis is characterized by rapid bone degradation at the infection site. Although osteoclasts may be activated by prostaglandins elaborated by bacteria or by osteoclast and activating factor and interleukin-1 released by lymphocytes, they are rarely observed in the histology of acute osteomyelitis in which neutrophils predominate. We investigated the hypothesis that the rapid resorption of bone in acute osteomyelitis is mediated by neutrophils.     

Surgical management of metastatic disease of long bone

Objective To improve the life quality of cancer patients with metastasis to long bone and to long bone and to select suitable surgical treatment. Methods Fifty-two patients with metastasis 27 men and 25 women, were June 2003 Vol12 No2 treated from 1990 to 1999. Their average age was 56. 8 years (33 - 74). In 16 patients with multiple lesions, underwent surgery at bone shaft (29 patients) and bone epiphysis (26). Thirty patients were treated for pathologic fracture and the rest for impending fracture. Operations included limb-salvage (51 patients) and amputation (4) Limb salvage consisted of intralesional curettage (3 patients ), intramedullary nailing reconstruction (29 ), endoprosthesis ( 18 ), and temporary spacer ( 1 ). 21 patients accepted postoperative chemotherapy or radiotherapy. Results Follow-up of 52 patients for a mean of 28. 2 months (2 - 122 months) showed pain relief (41 patients), (75%) and full or part weight-bearing stability ( 36 ) 69 % . Local tumor recurrence occurred in 11 patients.     

Transsphenoidal approach to chordoma invading the sphenoid bone and clivuss

Objective To discuss the indication and methods on the surgical treatment of chordoma in volving the sphenoid bone and clivus how to improve the surgical outcome. Methods All patients were treated by transspenoidal approach surgery. Results Subtotal removal in 73.7% , and partial removal in 26.3% . No operative mortality the five-year survival rate was 58 % . Conclusion This aproach is less destructive, less time-concuming, less complications, easy to perform, and adapted to the majority of chordoma invading the sphenoid bone and clivus. Radical surgical removal and postoperative radiotherapy is an efficacious treatment and may prolong disease-free survival. 8 refs,4 figs.     

A case of aneurysmal bone cyst of maxillary sinus.

Aneurysmal bone cyst is a benign lesion characterized by bulging or ballooning of cortical bone due to associated underlying expanding fibrovascular mass. The condition is uncommon and found predominantly in the vertebral column and long bones, but scarcely in the facial bones. In the late 1950s. Bernier and Baskhar reported the first case of aneurysmal bone cyst in the jaw. Later on. some cases appeared subsequently in the literature. Now we report the first case of aneurysmal bone cyst of maxillary sinus in China. Its clinical features, radiological and histopathological characteristics, and treatment are discussed in detail.     

Relationship between osteocyte apoptosis and orbital bone development in rabbits

Orbitalboneactsasanimportantcomponentoforbit ,whichnotonlyprotectstheorbitalcontentsfrominjurybutalsomaintainscountenancenormal.Nowadaysthemechanismoforbitaldevel opmentisuncertain .Cellapoptosisisaselectionprocessofphysiologicalcellde letion .Itsexecutio…     

重组人骨形成蛋白－2与异种骨复合移植的扫描电镜观察

目的：明确含有重组人骨形成蛋白－２（ｒｈＢＭＰ－２）的新型复合异种骨的骨修复能力。方法：将ｒｈＢＭＰ－２与经综合化学处理的新生小羊骨松质（ＣＢ）结合，制备成复合异种骨．将复合异种骨植人兔下颌骨缺损，并以单纯松质骨移植、自体骨移植作为对照组，术后２、４、８、１２周分别取材做扫描电镜观察。结果：复合异种骨移植后，植骨区有大量新骨形成，新骨的量随移植时间延长而逐渐增多。自体骨移植组扫描电镜下表现与复合异种骨组基本相同。而单纯骨松质载体移植后，植入区多为纤维结缔组织，新骨形成少．结论：ｒｈＢＭＰ－２可显著促进复合异种骨内的新骨形成。这种新型复合异种骨可能是一种较理想的植骨材料，可望用于人体植骨     

去抗原牛松质骨块/bBMP复合材料修复兔长骨骨缺损

探讨大块异种骨的制备及其在修复节段性骨缺损中的作用。方法将大块的牛松质骨制备成消除抗原性的载体,与牛骨形态发性蛋白（ＢＭＰ）组合构成去抗原牛松质骨块／ｂＢＭＰ复合材料,采用兔桡骨１５ｍｍ节段性骨缺损模型,研究去抗原质骨块／ｂＢＭＰ复合材料在修复骨缺损中的作用。     

组织工程化骨组织诱导脊柱融合的实验研究

目的：在体外构建一种自体骨组织替代物,回植入体内,以期诱导兔脊柱融合。方法：体外培养兔的骨髓基质干细胞,基因重组工程生产出具有诱骨活性的重组人骨形态发生蛋白-4（recombinant human bone morphogenetic protein-4,rhBMP-4）,采用真空冷冻抽干技术将一定量的rhBMP-4和Ⅰ型胶原结合,构建出一种新的载体,并将一定量的骨髓基质干细胞吸附在载体上。建立兔脊柱关节突融合的动物模型,实验组植入复合rhBMP-4和骨髓基质干细胞的Ⅰ型胶原,对照组只采用Ⅰ型胶原和骨髓基质干细胞,植入兔脊柱的关节突之间来诱导脊柱融合。结果：应用rhBMP-4和Ⅰ型胶原组新骨形成良好,此侧的脊柱融合良好,而对侧无明显的骨组织形成。结论：应用含有骨生长因子、骨前体细胞和胶原载体的复合物是一种较为理想的自体骨组织替代物。     

Reconstruction of orbital defect in rabbits with composite of calcium phosphate cement and recombinant human bone morphogenetic protein-2

PURPOSE Calcium phosphate cement (CPC) is a biocompatible and osteoconductive bone substitute, and recombinant human bone morphogenetic protein-2 (rhBMP-2) has strong osteoinductibility, therefore we developed a composite bone substitute with CPC and rhBMP-2 and evaluate its reconstruction effect in rabbit orbital defect. METHODS Thirty-six rabbits were randomly divided into two groups and a 5mm×5mm×2mm bone defect in the infraorbital rim was induced by surgery in each orbit (72 orbits in all). The orbital defects were treated with pure CPC or composite of CPC and rhBMP-2. The osteogenesis ability of different bone substitute was evaluated by gross observation, histological examination, histomorphometrical evaluation, compressive load-to-failure testing, and scanning electron microscope (SEM). RESULTS Gross observation showed that both bone substitutes were safe and effective for reconstruction of orbital defect. However, histological examination, histomorphometrical evaluation and SEM showed that CPC/rhBMP-2 group had faster speed in new bone formation and degradation of substitute material than CPC group. Compressive load-to-failure testing showed that CPC/rhBMP-2 group had stronger compressive strength than CPC group at every stage with significant difference (P<0.05). CONCLUSIONS Composite of CPC/rhBMP-2 is an ideal bioactive material for repairing orbital defect, with good osteoconductibility and osteoinductibility.     

Reconstruction of orbital defect in rabbits with composite of calcium phosphate cement and recombinant human bone morphogenetic protein-2

Background Calcium phosphate cement （CPC） is a biocompatible and osteoconductive bone substitute, and recombinant human bone morphogenetic protein-2 （rhBMP-2） has strong osteoinductibility, therefore we developed a composite bone substitute with CPC and rhBMP-2 and evaluate its reconstruction effect in rabbit orbital defect.Methods Thirty-six rabbits were randomly divided into two groups and a 5 mmx5 mmx2 mm bone defect in the infraorbital rim was induced by surgery in each orbit （72 orbits in all）. The orbital defects were treated with pure CPC or composite of CPC and rhBMP-2. The osteogenesis ability of different bone substitute was evaluated by gross observation, histological examination, histomorphometrical evaluation, compressive load-to-failure testing, and scanning electron microscope （SEM）.Results Gross observation showed that both bone substitutes were safe and effective for reconstruction of orbital defect. However, histological examination, histomorphometrical evaluation and SEM showed that CPC/rhBMP-2 group had faster speed in new bone formation and degradation of substitute material than CPC group. Compressive load-to-failure testing showed that CPC/rhBMP-2 group had stronger compressive strength than CPC group at every stage with significant difference （P ＜0.05）.Conclusion Composite of CPC/rhBMP-2 is an ideal bioactive material for repairing orbital defect, with good osteoconductibility and osteoinductibility.     

Transfect bone marrow stromal cells with pcDNA3.1-VEGF to construct tissue engineered bone in defect repair

Background  We previously showed that nano-hydroxyapatite/carboxymethyl chitosan (n-Ha/CMCS) displayed excellent mechanical properties, good degradation rates and exceptional biocompatibility, with negligible toxicity. The aim of this study was to determine the effect of the same composite with vascular endothelial growth factor (VEGF)- transfected bone marrow stromal cells (BMSCs) in a rabbit radial defect model.

Methods  The nano-hydroxyapatite was produced through co-precipitation. The n-HA/CMCS scaffold was produced by particle filtration and lyophilization followed by genipin crosslinking. Total RNA from rabbit bone was reverse-transcribed to synthesize VEGF165-pcDNA3.1 that was transfected into the BMSCs. The composite was implanted into a rabbit radial defect model, and the osteogenic activity examined by gross morphology, X-ray examination and hematoxylin and eosin (HE) staining.

Results  The microstructure and mechanical property of the n-HA/CMCS scaffold resembled natural cancellous bone. Compared with glutaric dialdehyde crosslinked scaffolds, the genipin crosslinked scaffold was less toxic, and displayed a higher capacity to promote cell adhesion and proliferation. Spontaneous fluorescence of the composite permitted visualization of the composite-bone interface and the adhesion behavior of cells on the scaffold under laser scanning confocal microscopy. The scaffold with VEGF-transfected BMSCs bridged the bony defect and promoted healing, with most of the implanted material being replaced by natural bone over time with little residual implant. Using X-ray, we noted obvious callus formation and recanalization of the bone marrow cavity. Furthermore, HE stained sections showed new cortical bone formation.

Conclusions  The n-HA/CMCS scaffold composite with VEGF-trasnfected BMSCs is biocompatible, nontoxic, promotes the infiltration and formation of the microcirculation, and stimulates bone defect repair. Furthermore, the degradation rate of the composite matched that of growing bone. Overall, this composite material is potentially useful for bone defect repair.

     

无机骨骨髓复合物修复骨肿瘤术后骨缺损

目的:观察无机骨骨髓复合物修复骨肿瘤术后骨缺损的临床疗效.方法:采用无机骨(自制)复合自体骨髓作为移植材料修复骨肿瘤术后骨缺损13例(联合应用内或外固定),其中骨巨细胞瘤7例,骨纤维异样增殖症5例,骨肉瘤1例.结果:术后6个月随访,除1例肿瘤复发外,其余患者移植骨均与宿主骨融合.结论:无机骨骨髓复合物是一种较好的骨移植材料.     

异种骨复合自体骨髓基质干细胞修复节段性骨缺损

目的探讨异种骨复合骨髓基质干细胞(MSCs)修复节段性骨缺损的可行性。方法将MSCs与异种松质骨在体外联合培养,兔桡骨中上段制成1.5 cm的骨-骨膜缺损模型,实验组植入复合异种骨,对照组植入单纯异种骨,空白对照组不植入任何材料,分别于术后4、8、12周各时间点行标本的组织学观察、X线片观察、透射电镜观察及骨密度测试,比较其骨缺损区骨修复情况。结果术后第12周,实验组骨缺损区完全修复,骨密度接近正常;对照组骨缺损区修复缓慢,新骨形成量少;空白对照组骨缺损区未修复。结论异种骨复合MSCs修复节段性骨缺损能力强,在成骨速度和量上明显优于单纯异种骨。     

纤维蛋白胶复合BMP治疗兔股骨头缺血性坏死的实验研究

【目的】通过局部植入骨形态发生蛋白（BMP），探索股骨头缺血性坏死早期治疗的新方法。【方法】连续肌肉注射地塞米松制造股骨头缺血性坏死（ANFH）的动物模型，将实验动物分为A，B，C3组，于股骨头下钻孔，在A组和B组分别将BMP／FS或单纯的BMP植入孔道，C组作为空白对照。通过大体观察、MRI检查、钙含量测定和组织学观察，研究复合材料对ANFH的修复作用。【结果】MRI观察显示，植入BMP／FS8周后原骨缺损孔道消失，被新生骨所取代。单纯植入BMP可见少量新生骨，空白对照组内仍为纤维组织。A组钙含量显著高于另外两组。组织形态学观察可见A组术后8周原骨缺损区基本消失，有大量相对较成熟的骨小梁及板状骨并存。B组骨缺损区明显缩小，周边亦有少量骨小梁存在，新生毛细血管少见，缺损区有大量纤维组织填充。C组术后8周缺损区缩小，周边有少量新骨形成并逐渐形成骨壁，中心部仍为纤维组织，无骨组织充填。【结论】BMP在缺血坏死的股骨头内可诱导新骨形成，与FS复合后，BMP诱导新骨形成的质量和数量均明显提高，局部植入BMP／FS对ANFH具有良好的修复作用。     

pcDNA3.1-VEGF165转染BMSCs构建组织工程骨修复骨缺损的实验研究

目的：依据组织工程的原则,首先将pcDNA3.1-血管内皮生长因子（vascular endothelial growth factor, VEGF）165质粒转染至骨髓间充质干细胞（bone marrow stromal cells ,BMSCs）,然后将其与纳米羟基磷灰（nano-hydroxyapatite,n-HA) /羧甲基壳聚糖（carboxymethyl chitosan,CMCS）支架材料复合构建组织工程骨,观察该组织工程骨在兔桡骨骨缺损模型处的成骨能力及降解速度。 方法：采用化学共沉淀法制备纳米羟基磷灰石,以京尼平（Genipin）为交联剂,通过粒子沥滤结合冷冻干燥工艺制备纳米羟基磷灰石/羧甲基壳聚糖复合支架材料。采用扫描电镜观察其微观结构;三点弯曲法测试其力学性能;通过细胞形态分析测试其体外细胞毒性;激光共聚焦显微镜观察其荧光性能。根据设计的引物反转录合成VEGF165,pcDNA片段,构建pcDNA3.1-VEGF165质粒。骨髓间充质干细胞取自兔骨髓,培养、传代,采用电转法将 pcDNA3.1- VEGF165转至 BMSCs 然后与 n-HA/CMCS支架材料复合构建组织工程骨;建立动物模型将其植入兔桡侧,通过大体观察,X射线,HE染色及三点弯曲强度评价其成骨能力及降解速度。 结果：京尼平交联的n-HA/CMCS支架材料微观结构、力学性能与天然松质骨相似,可满足支架材料的要求;与戊二醛做交联剂所得支架相比,本研究所得支架生物毒性更小,更利于细胞的吸附与增殖,并且使用京尼平交联是支架材料具有自发荧光特征;成功构建出 pcDNA3．1-VEGFl65质粒,将其转至 BMSCs,并与n-HA/CMCS 复合构建组织工程骨。大体标本观察表明复合材料植入骨缺损处可见骨缺损处愈合良好,植入材料大部分已转化为自体骨组织仅少许未降解。X射线观察显示实验侧可见明显骨痂生成,骨髓腔形成,骨髓腔基本贯通。HE染色结果表明实验组骨缺损愈合,皮质骨形成,皮质主要由编织骨组成,部分由新生的骨单位构成,髓腔再通。 结论： pcDNA3.1-VEGF165转染BMSCs复合n-HA/CMCS支架材料具有生物相容性好、无毒副作用、促进局部微血管形成、加快骨缺损修复的作用,其降解速度与骨生长速度基本匹配;使用京尼平交联的支架不同于其他骨组织工程支架材料,其具有自发荧光特征。通过激光共聚焦显微镜可以清楚地观察到支架和细胞的界面,细胞的粘附特征,以及支架的微结构和降解时微结构特征变化。综上可知本研究所得复合骨是一种潜在的性能优良的骨修复材料。