新型人工骨修复材料在骨缺损修复中的临床研究

目的 探讨新型人工骨修复材料和羟基磷灰石生物陶瓷在骨缺损修复中的临床效果,并评估新型人工骨修复材料的有效性和安全性.方法 选取2019年12月至2021年4月中国人民解放军联勤保障部队第九二○医院收治的50例骨缺损并接受骨缺损重建修复术患者,采用随机单盲法,分为新型人工骨修复材料组(实验组)和羟基磷灰石生物陶瓷组(对照...     

Primary alveolar soft part sarcoma of bone

AIMS: Alveolar soft part sarcoma is a distinct, rare soft tissue tumour occurring primarily within the skeletal muscles or musculofascial planes in young adults. Primary involvement of bone is extremely rare. We report on six patients with alveolar soft part sarcoma occurring primarily in bone. METHODS AND RESULTS: Thorough clinical and radiographic examinations were done to rule out any other primary site. The patients were four women and two men aged 17-35 years (mean, 24.5 years). The primary site of the tumour was the femur in three patients, the ilium in one and the fibula in two. In one of the patients with fibular involvement, the tibia was also involved by direct extension. Of the long bone lesions, three were centred in the metaphysis and one in the diaphysis. Radiographically, all of the lesions demonstrated an osteolytic pattern of bone destruction with ill-defined margins and a wide zone of transition between the lesion and adjacent normal bone. Microscopically, all tumours showed the typical histological pattern of alveolar soft part sarcoma. Diastase-resistant, periodic acid-Schiff-positive crystalline structures were identified within the cytoplasm and confirmed ultrastructurally. Immunohistochemically, a keratin stain was negative in all cases; there was positive staining for MyoD1 in the cytoplasm but not the nuclei. Distant metastasis developed in four patients; one died. CONCLUSION: Alveolar soft part sarcoma arising in bone is extraordinarily rare but should be considered in the differential diagnosis of metastatic hypernephroma in a young patient.     

Resorbability of rigid beta-tricalcium phosphate wedges in open-wedge high tibial osteotomy: a retrospective radiological study

The open-wedge high tibial osteotomy (OWHTO) is a well accepted treatment modality for patients with osteoarthritis of the medial compartment associated with genu varum. To fill in the osteotomy gap 30% macroporosity rigid beta-tricalcium phosphate (β-TCP) is frequently used as a stable resorbable bone substitute. However, the resorbability of these β-TCP wedges is not known. The aim of this study was to investigate this.

Twenty-one OWHTO procedures in seventeen patients were performed with the use of 30% macroporosity rigid β-TCP wedges. The osteotomies were fixed using an angle-stable locking plate. Conventional AP and lateral radiographs were examined in order to assess the resorbability of the 30% macroporosity rigid β-TCP wedges as a function of time. A radiological classification system consisting of five phases was used to monitor the resorption of the 30% macroporosity rigid β-TCP wedges. The mean duration of follow-up was 62 months (± 23 range of 28–99).

In all 21 cases, remnants of the 30% macroporosity rigid β-TCP wedges were still present at maximum follow-up. Although the boundaries between 30% macroporosity rigid β-TCP wedges and bone remained slightly visible, all osteotomies were completely consolidated and full osseointegration took place. In 16 out of 21 knees the fixation system was removed after a mean duration of 32 months (± 19 range of 6–62). In six out of 21 knees a conversion to a knee arthroplasty was performed after a mean duration of 56 months (± 18 range of 37–82). The OWHTO did not interfere with the placement of knee prostheses.

Complete resorption of 30% macroporosity rigid β-TCP wedges did not take place up to 8 years after operation.     

成人非创伤性股骨头坏死不同部位骨密度结合骨转换标志物特点研究

目的研究成人非创伤性股骨头坏死(ONFH)不同部位的骨密度以及骨转换标志物特点。 方法收集2017年9月至2019年3月在广州中医药大学第一附属医院三骨科住院诊断为非创伤性ONFH的患者共150例278髋(坏死组),男92例、女58例,平均年龄为(40.9±9.5)岁,其中酒精性ONFH 43例,特发性ONFH 23例,激素性ONFH 84例,国际骨循环研究会(ARCO)分期Ⅱ期84例,Ⅲ期ARCO 66例。收集同期在广州中医药大学第一附属医院行骨密度检查的健康人群共101例(对照组),男61例、女40例,平均年龄为(41.9±10.7)岁。采用双能X线骨密度测量仪测量2组股骨颈、腰椎(L1～L4)、髋关节的骨密度值,抽血检测2组血清Ⅰ型胶原氨基端延长肽(P1NP)、Ⅰ型胶原降解产物(β-CTx)及碱性磷酸酶(ALP)等骨转换标志物的水平。数据比较采用独立样本t检验与单因素方差分析。 结果(1)坏死组的股骨颈骨密度值[(0.97±0.15) g/cm²]高于对照组股骨颈骨密度值[(0.91±0.14) g/cm²],差异有统计学意义(t＝3.148,P＝0.002),坏死组髋关节骨密度值[(0.94±0.12) g/cm²]、腰椎骨密度值[(1.11±0.14) g/cm²]与对照组髋关节骨密度值[(0.96±0.14) g/cm²]、腰椎骨密度值[(1.12±0.15) g/cm²]相比,差异均无统计学意义(t＝－0.548、－1.461,P＝0.584、0.145);坏死组患者血清P1NP[(65.44±28.64) ng/mL]、ALP[(68.89±19.15) U/L]水平均高于对照组血清P1NP[(56.82±23.49) ng/mL]、ALP[(59.64±23.72) U/L],而血清β-CTx[(0.54±0.27) ng/mL]水平低于对照组[(0.62±0.29) ng/mL],差异均有统计学意义(t＝2.608、3.404、－2.095, P＝0.010、0.001、0.037)。(2)坏死组中酒精性ONFH股骨颈骨密度值[(1.02±0.15) g/cm²]高于激素性ONFH[(0.96±0.14) g/cm²]与特发性ONFH[(0.93±0.14) g/cm²],差异有统计学意义(F＝3.954,P＝0.021);3种坏死类型间腰椎与髋关节的骨密度值、血清P1NP 、β-CTx水平比较,差异均无统计学意义(P值均大于0.05),酒精性ONFH血清ALP[(76.09±18.36) U/L]水平高于激素性ONFH[(65.49±18.82) U/L],差异有统计学意义(P<0.05)。(3)坏死组中ARCO Ⅱ期患者股骨颈骨密度[(0.95±0.15 )g/cm²]低于ARCO Ⅲ期[(1.00±0.14) g/cm²],差异有统计学意义(t＝－2.346,P＝0.020),腰椎与髋关节骨密度值差异均无统计学意义(P值均大于0.05);ARCO Ⅱ期患者血清P1NP[(70.24±32.11) ng/mL]、血清β-CTx水平[(0.60±0.27) ng/mL]均高于ARCO Ⅲ期[(59.33±22.26) ng/mL、(0.47±0.25) ng/mL]患者,差异均有统计学意义(t＝2.454、2.985,P＝0.015、0.003),两期患者血清ALP水平比较,差异无统计学意义(P>0.05)。 结论成人非创伤ONFH的坏死周围区域骨密度可能会升高,且随着病情的进展,坏死部位的修复,坏死周围区域的骨密度呈上升趋势。而在不同坏死类型中,酒精性ONFH周围区域骨密度增高最明显。     

羟基磷灰石／胶原人工骨在创伤后骨缺损修复中的初步研究

目的评估羟基磷灰石，胶原（hydroxyapatite/collagen，HAC）人工骨在创伤后骨缺损修复中的临床效果。方法48例创伤后四肢骨骨折患者，无其他病史，分为2组。试验组25例，其中男性15例，女性10例，年龄22～82岁，平均年龄45.3岁。对照组患者23例，其中男性13例，女性10例，年龄21～81岁，平均年龄46岁。对所有患者进行骨折切开复位，选择合适的内固定。试验组于固定后，在骨缺损处、骨髓腔、骨折线周围直接植骨，羟基磷灰石，胶原人工骨修复材料植入量0.4～4.0g不等。对照组不植入羟基磷灰石，胶原人工骨。结果两组46例病例获随访。试验组中2例失随访，余23例患者无局部或全身不良反应，骨折均达临床愈合。X线片显示,术后1～3个月材料植入区与缺损周围的骨组织间界限模糊，有新骨形成，3～6个月材料植入区内有明显的新骨长入，人工骨与骨组织融合，骨缺损基本修复。对照组3例延迟愈合和1例骨折不愈合患者在功能上恢复较差；试验组与对照组比较具有统计学意义，P〈0．05。结论胶原，羟基磷灰石人工骨具有良好的材料，细胞界面，使材料本身更具备与骨键合的能力。其三维多孔结构便于骨组织的长入，生物降解性有利于骨组织的改建和塑形，具有良好的临床应用前景。     

网状植骨治疗股骨中下段大段骨缺损的临床研究*

目的研究网状植骨结合钢板或外固定支架治疗股骨中下段骨折并大段骨缺损的临床效果,为基层医院治疗类似病例提供临床经验。方法我院自2008年8月-2011年3月共收治31例股中下段骨折并骨缺损患者,其中男性27例,女性4例,年龄16-43岁,平均21.7岁。术中采用残存自体骨或取髂骨,在残存大骨片及取髂骨周边钻孔,以可吸收缝线编织成网状,分别固定在近远端,网状腔中间填塞松质骨。固定方式采用普通钢板、锁定钢板、LISS钢板以及外固定支架固定。结果 31例骨折患者取得较好效果,其中22例均顺利愈合,6例出现钢板断裂,另3例发生感染及骨不连并发症,9例均在术后5-18月二次手术,效果良好。结论网状植骨结合钢板或外固定支架治疗股骨下段骨缺损效果良好,是治疗股骨中下段骨骨折并骨缺损的方法之一。内固定的材料、股骨髁间骨折、内侧植骨的可靠程度与远期钢板断裂及下肢内翻等并发症有一定关系。     

Establishment and effects of allograft and synthetic bone graft substitute treatment of a critical size metaphyseal bone defect model in the sheep femur

Assessment of bone graft material efficacy is difficult in humans, since invasive methods like staged CT scans or biopsies are ethically unjustifiable. Therefore, we developed a novel large animal model for the verification of a potential transformation of synthetic bone graft substitutes into vital bone. The model combines multiple imaging methods with corresponding histology in standardized critical sized cancellous bone defect. Cylindrical bone voids (10 ml) were created in the medial femoral condyles of both hind legs (first surgery at right hind leg, second surgery 3 months later at left hind leg) in three merino‐wool sheep and either (i) left empty, filled with (ii) cancellous allograft bone or (iii) a synthetic, gentamicin eluting bone graft substitute. All samples were analysed with radiographs, MRI, μCT, DEXA and histology after sacrifice at 6 months. Unfilled defects only showed ingrowth of fibrous tissue, whereas good integration of the cancellous graft was seen in the allograft group. The bone graft substitute showed centripetal biodegradation and new trabecular bone formation in the periphery of the void as early as 3 months. μCT gave excellent insight into the structural changes within the defects, particularly progressive allograft incorporation and the bone graft substitute biodegradation process. MRI completed the picture by clearly visualizing soft tissue ingrowth into unfilled bone voids and presence of fluid collections. Histology was essential for verification of trabecular bone and osteoid formation. Conventional radiographs and DEXA could not differentiate details of the ongoing transformation process. This model appears well suited for detailed in vivo and ex vivo evaluation of bone graft substitute behaviour within large bone defects.     

Epithelioid haemangioendothelioma of the bone tissue

Summary An epithelioid haemangioendothelioma arising in a 43-year-old Japanese woman is presented. The patient first complained of severe back pain and neurogenic disturbances due to compression fracture of the spinal bone. Radiographically the tumour masses showed osteolytic lesions without reactive new bone formation. Similar lesions were noted in other bones. Biopsy and surgical specimens showed the features of epithelioid haemangioendothelioma. A lymphocyte associated antigen, HLA-DR which has been regarded as a B lymphocyte marker was detected in the tumour cells. The importance of this finding was emphasized with respect to the identification or classification of vascular tumours.     

Correlation of estrogen receptor beta gene polymorphisms with spinal bone mineral density in peri- and post-menopausal Greek women

Estrogens play a significant role in bone physiology. Their action is mainly exerted through their receptors. Estrogen receptor alpha (ER) plays a major role in bone homeostasis and there is evidence suggesting that estrogen receptor beta (ERβ) has also an effect on BMD.

We investigated the possible effect of two ERβ gene polymorphisms on spinal bone mineral density (BMD) and metabolic bone markers in Greek women.

Spine BMD as well as biochemical bone markers were measured in 147 healthy peri- and post-menopausal women [mean age (S.D.) 54 (7.9) years]. Genotyping was performed for two restriction fragment length polymorphisms (RFLPs) of ERβ gene, RsaI in exon 5 and AluI in exon 8. For each polymorphism studied the cohort was divided into two groups: the “wild-type” group (RR and AA, respectively) and the “carrier” group including subjects with at least one allele with the restriction site (Rr&rr and Aa&aa, respectively).

The distribution of RsaI genotypes was RR: 91.2% (n = 134), Rr: 8.2% (n = 12), and rr: 0.6% (n = 1) and of AluI genotypes AA: 36.7% (n = 54), Aa: 57.2% (n = 84), and aa: 6.1% (n = 9). No linkage disequilibrium was found between the two polymorphic sites studied. Spine BMD did not differ significantly in the two groups of either polymorphism, after adjusting for age, weight, height, and years since menopause [mean BMD (S.D.) for RR 0.841 (0.17) g/cm² versus Rr&rr 0.798 (0.13) g/cm², p = 0.25, and mean BMD (S.D.) for AA 0.828 (0.16) g/cm² versus Aa&aa 0.848 (0.17) g/cm², p = 0.32]. No significant differences were noted in metabolic bone markers except for a marginal difference of RR versus Rr/rr in urinary hydroxyproline/creatinine ratio [median (IQR) 3.88 (6.04) μmol/mmol in RR versus 8.2 (4.32) μmol/mmol in Rr/rr, p = 0.05]. Furthermore, no interaction between the two polymorphisms on BMD was found.

In conclusion, in a Greek female post-menopausal population, the two ERβ gene polymorphisms were not associated with BMD, or metabolic bone markers.     

开放性楔形胫骨高位截骨术中植骨与未植骨的Meta分析

目的 通过Meta分析系统评价开放性楔形胫骨高位截骨术（OWHTO）治疗术中植骨与未植骨的疗效。方法 通过计算机检索建库至2021年4月PubMed、Cochrane Library、Embase、中国知网、万方数据库，查找所有比较开放性楔形胫骨高位截骨术中植骨与未植骨的临床对照研究，根据纳入标准及排除标准进行文献筛选、质量评价和数据提取后，应用Revman 5.4软件对各项评价指标进行Meta分析。结果 共纳入10篇文献，共581例膝关节病例，其中279 例植骨，302 例未植骨。Meta 分析结果显示：植骨与未植骨相比，骨性愈合时间［MD=-0.2，95%CI（-0.26，-0.14），P＜0.001］、术后FTA［MD=0.7，95%CI（0.23，1.17），P=0.004］比较，差异有统计学意义（P＜0.05）；但术后3个月骨性愈合率、术后矫正丢失角度、术后KSS膝关节评分、术后KSS功能评分、术后膝关节Lysholm评分、术后IKDC评分、术后并发症比较，差异均无统计学意义。结论 两组患者均获得良好的术后功能及疗效，开放性楔形胫骨高位截骨术植骨组的骨性愈合较快，但术后3个月的骨性愈合率无差异，所以对于术中截骨后撑开高度较小时，可以考虑不植骨。     

Decrease of bone mineral density during estrogen substitution therapy

A decrease in bone mineral density (BMD) in patients treated with hormone replacement therapy (HRT) is sometimes observed in clinical practice. In order to assess the frequency and the characteristics of these cases, we reviewed the data of 102 women treated with HRT for more than 2 years, and who had undergone at least 3 lumbar BMD measurements during that period. For each patient, a linear function was fitted to the BMD data in relation to time. The slope was calculated. There was an overall gain in BMD during treatment, mean (± S.E.M.) values of slope 0.007 g/cm²/year (± 0.002). Fifty-three patients had a slope higher than 0.005, 28 a slope close to 0 (between 0.005 and −0.005) and 21 a slope lower than −0.005. By dividing the patients in tertiles of slopes (tertile l: slope < 0; tertile II: 0 < slope < 0.011; tertile III: slope > 0.011), significant differences were observed between the three groups of slope for the initial BMD (P < 0.001), hydroxyproline/creatinine ratio (P < 0.01), weight, DHEAS and alkaline phosphatase (P < 0.05). Only 1 of the 15 patients with a low bone mass (lower than mean ± I S.D.) had a negative slope, while 9 of the 16 with a high-bone mass (higher than mean ± I S.D.), had a negative slope. Under HRT, about 21% of postmenopausal women have a slight decrease in BMD as assessed by DPA. Because of the DPA coefficient of variation, however, the exact number of bone losers cannot be determined. Nevertheless, the present study suggests that patients with low bone mass are likely to respond better than patients with high bone mass.     

The chronological change of vertebral bone loss following oophorectomy using dual energy X-ray absorptiometry: the correlation with specific markers of bone metabolism

The changes of vertebral bone mineral density (BMD; g/cm²) following oophorectomy were studied, using dual energy X-ray absorptiometry (DEXA) in 38 premenopausal and 244 oophorectomized women. Two biochemical indices of bone remodeling, urinary deoxypyridinoline (DPyr) for bone resorption and serum intact human osteocalcin (hOC) for bone formation, were also measured at the same time. The rate of bone loss in the first year after oophorectomy was 10.7%, while that in the second year was 5.7% (rapid phase), followed by a slow phase at the rate of 1.1%. The bone mass finally reached an osteoporotic level (BMD < 0.767 g/cm²) at 12 years after oophorectomy. The DPyr increased to reach a peak level in the first year, whereas the hOC increased and reached its peak level in the second year after surgery. The maximal bone loss in the first year is considered to be caused by the remarkable increase of bone resorption and the biological delay of the maximal increase in bone formation.     

Distinct histological features characterize primary angiosarcoma of bone

Verbeke S L J, Bertoni F, Bacchini P, Sciot R, Fletcher C D M, Kroon H M, Hogendoorn P C W & Bovée J V M G
(2011) Histopathology  58, 254–264
Distinct histological features characterize primary angiosarcoma of bone Aims: To define the histological criteria of primary angiosarcoma of bone. Methods and results: Forty‐two angiosarcomas of bone in 23 males and 15 females were studied. Histological criteria were related to patients’ outcome. Eleven patients had multifocal lesions. Lesions were located in the long and short tubular bones followed by the pelvis, spine and trunk. Tumour cells were positive for CD31 in 38 of 40, von Willebrand Factor in 21 of 35, CD34 in 15 of 38, smooth muscle actin in 22 of 36, D2–40 in 11 of 35 and keratinAE1AE3 in 27 of 39. Thirty‐nine tumours showed an epithelioid phenotype. One‐ and 5‐year survival rates were 55% and 33%, respectively. Survival analysis showed that a macronucleolus, three or more mitoses per 10 high‐power field (HPF) and fewer than five eosinophilic granulocytes per 10 HPF within a tumour was associated with an even worse survival compared to the overall group. Conclusions: Because keratin positivity is seen in the majority of cases, pathologists should avoid misinterpretation as metastatic carcinoma. A macronucleolus, three or more mitoses per 10 HPF and fewer than five eosinophilic granulocytes per 10 HPF can be used to further define angiosarcoma of bone.     

Bone resorption increases tumour growth in a mouse model of osteosclerotic breast cancer metastasis

Osteosclerotic metastases account for 20% of breast cancer metastases with the remainder osteolytic or mixed. In mouse models, osteolytic metastases are dependent on bone resorption for their growth. However, whether the growth of osteosclerotic bone metastases depends on osteoclast or osteoblast actions is uncertain. In this study, we investigate the effects of high and low bone resorption on tumour growth in a mouse model of osteosclerotic metastasis. We implanted human breast cancer, MCF-7, cells into the tibiae of mice. Low and high levels of bone resorption were induced by osteoprotegerin (OPG) treatment or calcium deficient diet respectively. We demonstrate that OPG treatment significantly reduces tumour area compared to vehicle (0.42 +/- 0.06 vs. 1.27 +/- 0.16 mm2, P < 0.01) in association with complete inhibition of osteoclast differentiation. In contrast, low calcium diet increases tumour area compared to normal diet (0.90 +/- 0.30 vs. 0.58 +/- 0.20 mm2, P < 0.05) in association with increased osteoclast numbers (84.44 +/- 5.18 vs. 71.11 +/- 3.56 per mm2 bone lesion area, P < 0.05). Osteoblast surfaces and new woven bone formation were similarly increased within the tumour boundaries in all treatment groups. Tumour growth in this model of osteosclerotic metastasis is dependent on ongoing bone resorption, as has been observed in osteolytic models. Bone resorption, rather than bone formation, apparently mediates this effect as osteoblast surfaces in the tumour mass were unchanged by treatments. Treatment of breast cancer patients through correction of calcium deficiency and/or with anti-resorptive agents such as OPG, may improve patient outcomes in the adjuvant as well as palliative settings.     

Autogenous bone marrow concurrent with static magnetic field effects on bone-defect healing: radiological and histological study

To stimulate the process of bone healing, several methods have been used previously. These methods include use of ultrasound, electrical stimulation, exposure to electromagnetic field, bone graft, interporous hydroxyapatite (as a bone graft substitute). The aim of this study was evaluation of bone-defect healing with autogenous bone marrow concurrent with static magnetic field. Twenty adolescents, 2-kg-weighing, white New Zealand male rabbits were used in this study. In the control group (n = 10) mid-radii bone defect was created and filled with harvested bone marrow. In the experimental group (n = 10) the procedure was similar to control group with static magnetic application over the bone-defect area. Radiological, histopathological and evaluations were performed blindly and results scored and analyzed statistically. The results show those experimental groups were superior to control group in radiological and histological evaluation.     

No deterioration of kinematics and cruciate function 10 years after medial unicompartmental arthroplasty

The mechanisms of failure for unicompartmental arthroplasty are poorly understood. There is some suggestion that long term ligament degeneration, particularly of the anterior cruciate ligament (ACL), may affect long term survivorship. This study evaluated whether the cruciate mechanism remained functional in the long term (10 years) following UKA.

Two separate cohorts of patients who had undergone St Georg Sled medial compartmental arthroplasty had knee kinematics assessed using an established fluoroscopic technique. One group (early) was assessed at a mean of 46 months (3.8 years) since surgery, whilst the other (late) was assessed at a mean of 125 months (10.4) following surgery. No significant difference was found in the sagittal plane kinematics between the two groups or in comparison to the control normal knee.

The results suggest that after fixed bearing UKA the cruciate mechanism remains intact over time and the ligaments continue to function similarly to those of the normal knee.     

Calcifying solitary bone cyst: morphological aspects and differential diagnosis of sclerotic bone tumours

Fourteen solitary bone cysts (SBC) with large areas of calcification (7 in the femur, 4 in the humerus, and 1 each in the pelvis, the tibia and the scapula) and 402 SBC from the Hamburg Bone Tumour Registry were reviewed in a retrospective study. The analysis was done with emphasis on the clinical, radiological and histological appearances. SBC are well known lesions, but calcifying SBC (CSBC) or extensive extragnathic cement-like bone productions are rare. The clinical and radiological differential diagnosis includes fibrous dysplasia, chondroma, low-grade chondrosarcoma and osteosarcoma. Bits of this cement-like matrix are detectable within the wall of approximately 70% (278 of 402) of SBC from the registry. CSBC are changed SBC. The intraoperative confirmation of the diagnosis on a frozen section by the bone pathologist leads to curettage which is currently the most common therapy in this benign lesion.     

Fractures of the tibial spine: epidemiology and outcome

We documented functional outcome in 83 knees with tibial spine fractures. The mean age at injury was 35 years. There was a medial collateral ligament sprain in 17 knees and posterolateral corner injury in three knees. Twenty patients with displaced tibial spine fractures were treated with fixation of the tibial spine and 63 patients with undisplaced or minimally displaced fractures were treated non-operatively.

Fourteen (22%) non-operatively treated knees developed symptomatic instability, three of which underwent ACL reconstruction. Tibial spine fixation restored stability in 18 of 20 knees, but knee stiffness was more common in this group when compared to non-operatively treated knees (60% vs 19%, p < 0.0005). Patients with postoperative knee stiffness had a mean age of 28 years compared to 18 in patients with no knee stiffness (p < 0.05).

We concluded that tibial spine fracture in skeletally mature patients is associated with a significant risk of knee stiffness and instability.     

Total knee arthroplasty in a patellectomised posterior cruciate ligament-deficient knee: a new technique of patellar tendon bone grafting

Total knee arthroplasty in patients with previous patellectomy are less successful because of anteroposterior instability, residual pain and the loss of the mechanical advantage of the patella. To restore the moment arm of the quadriceps, the senior author (C.W.) described the technique of bone grafting the patellar tendon in a patient using the tibial plateau obtained from the routine tibial cut during total knee arthroplasty. The tibial eminence was used as the interfacetal ridge of the ‘created’ patella. At follow-up, the results were excellent with a postoperative knee society score of 90 and a postoperative patient functional score of 92. Radiological investigations showed a well-incorporated graft in the patellar tendon.     

数字化载银羟基磷灰石人工骨抗菌性及生物相容性

背景：载银珊瑚羟基磷灰石作为一种新型抗菌植骨材料,受到越来越多的关注,作为植入物需与人体具有良好的生物相容性。 目的：观察数字化载银珊瑚羟基磷灰石人工骨材料的抗菌性及生物相容性。 方法：将珊瑚羟基磷灰石粉末浸泡于不同浓度的硝酸银溶液,制备出不同含银量的载银羟基磷灰石,再将其与聚乳酸混合,并通过选择性激光烧结快速成形制备出具有特殊形状的数字化载银抗菌人工骨材料。 结果与结论：连续光源原子吸收光谱仪测定珊瑚羟基磷灰石浸泡于10^-2,10^-3,10^-4,10^-5 mol/L AgNO₃中制备的载银人工骨中Ag+的含量分别为2.31×10^-1%,3.18×10^-2%,6.75×10^-3%,6.05×10^-4%。体外抑菌圈实验表明浸泡10^-2 mol/L AgNO₃中制备的载银人工骨材料对金黄色葡萄球菌和大肠杆菌的抑菌圈直径分别为(13.00±1.52)mm 及(12.30±1.65)mm;浸泡10^-3 mol/L AgNO₃中制备的载银人工骨材料分别为(11.50±0.73) mm及(11.00±0.46) mm。浸泡10^-4,10^-5 mol/L AgNO₃载银人工骨材料对两种细菌均无抑菌圈产生。细胞毒性试验结果表明100%浸泡10^-2,10^-3,10^-4,10^-5 mol/L AgNO₃的载银珊瑚羟基磷灰石人工骨材料的细胞毒性分别为3级、1级、0级、0级。急性全身毒性试验表明浸泡10^-3 mol/L AgNO₃中的人工骨浸提液对小鼠无明显的急性毒性反应,具有良好的安全性。结果表明浸泡10^-3 mol/L AgNO₃中的载银珊瑚羟基磷灰石人工骨在体外对金黄色葡萄球菌及大肠杆菌有明显抗菌作用,且具有良好的生物相容性及安全性。