纳米人工骨混合自体骨治疗骨肿瘤及骨病43例

背景：纳米人工骨是一种新型的骨移植材料,具有良好生物相容性等优势,但其治疗骨肿瘤及骨病的临床效果尚有待进一步研究。 目的：回顾性分析纳米人工骨混合自体骨治疗骨肿瘤及骨病的临床效果。 方法：对43例骨肿瘤及骨病患者病灶进行彻底刮除,选用大小不一的纳米人工骨条或颗粒混合人工骨充填,并用尽量将腔隙填满压实。病理性骨折的4例患者行内固定,其余患者未行内固定,依病情选择适当的支具。观察植骨后患者全身状态及植骨局部情况,术后不同时间X射线片观察植骨局部情况。 结果与结论：43例患者均获随访,最短为6个月,最长为24个月。1例患者切口延迟愈合。余患者全身状态及切口愈合均良好。术后1~3个月纳米人工骨混合人工骨植入区与缺损周围的骨组织之间界限模糊,但局部仍可见密度高影。约12个月植入骨区与周围骨组织密度相似。结果证实应用纳米人工骨混合人工骨治疗骨肿瘤及骨病效果满意,且并发症较少,其为一种比较理想的移植骨替代物,且具有良好应用前景。 关键词：纳米人工骨;自体骨;骨肿瘤;骨病;骨组织工程 doi:10.3969/j.issn.1673-8225.2010.25.027     

70001VIP/人工植骨材料的生物学特性与临床应用

摘要 目的：总结近年有关人工植骨材料的生物学特性与临床应用现状。 方法：由作者应用计算机检索维普数据库,检索时限为1998-01/2010-10。检索关键词：骨充填材料,骨缺损,骨肿瘤,骨病,骨组织工程。纳入与各种人工植骨材料的生物学特性与临床应用有关的文献,对资料进行初审,并查看每篇文献后的引文。共15篇文献符合标准纳入结果分析。 结果：人工植骨材料包括无机材料、有机材料和复合材料,复合材料组合了前两者的优势,具备较好的生物安全性、生物相容性、生物活性及生物力学性能。在四肢骨折内固定或骨肿瘤刮除后于骨缺损处植入人工骨,明显加速骨骼愈合过程．降低延迟愈合或不愈合的发生率,有较大临床应用价值。 结论：人工植骨材料在促进骨愈合、椎体融合效果接近自体骨,无排异反应,具有良好的生物相容性。 关键词：骨充填材料;骨缺损;骨肿瘤;骨病;骨组织工程 doi:10.3969/j.issn.1673-8225.2011.12.033     

硫酸钙人工骨材料应用于跟骨骨折12例

背景：目前治疗跟骨骨折的观点是手术复位后植骨修复骨缺损,但在骨缺损的填充物选择方面仍有不同的意见。 目的：观察硫酸钙人工骨结合内固定置入物治疗跟骨骨折骨缺损的临床疗效。 方法：自2007-10/2008-12采用硫酸钙人工骨植骨及接骨板置入内固定治疗SandersⅡ、Ⅲ型跟骨骨折12例。所有患者均采用跟骨外侧“L”形手术切口,将骨折复位后选取粉状或颗粒状硫酸钙人工骨植入,植骨后于跟骨外侧放置预弯好的树形接骨板置入内固定。术后每月门诊复查平片,8周起按照X射线片显示的骨折愈合情况指导患者部分负重锻炼,骨折愈合后患肢完全负重行走。手术前后采用Maryland评分评价患足功能。 结果与结论：所有患者经7~18个月(平均11.2个月)随访,骨折平均愈合时间12周,根据Maryland足部评分系统,总优良率92%,所有患者无排斥反应、过敏反应及毒性反应。提示硫酸钙人工骨植骨结合切开复位内固定可有效治疗跟骨骨折;硫酸钙人工骨是一种良好的骨移植替代物。     

应用多孔磷酸三钙植骨治疗胫骨平台骨折的组织学特性

目的：观察胫骨平台粉碎性骨折内固定治疗中采用磷酸三钙多孔生物陶瓷植骨后的组织学变化。 方法：自2004-01/2007-01于上海交通大学瑞金医院集团闵行医院骨科收治胫骨平台粉碎性骨折患者34例，其中男19例，女15例；年龄24~65岁；骨折类型按Schatzker分型：Ⅱ型7例，Ⅲ型12例，Ⅳ型6例，Ⅴ型6例，Ⅵ型3例。进行切开撬拨复位、磷酸三钙多孔生物陶瓷植骨、接骨板内固定治疗。 结果：34例患者随访12~28个月，平台塌陷部分均解剖复位，其下所植磷酸三钙多孔生物陶瓷材料3~6个月后逐渐与自体相邻骨密度接近，显示逐渐被自体骨替代，无再塌陷发生，无排异渗出、感染等发生。取内固定的同时，植骨区骨组织组织学观察可见材料部分溶解，成骨细胞分泌大量骨基质包埋其中，形成骨陷窝，出现大量新生骨小梁，骨小梁之间形成骨髓腔。 结论：磷酸三钙多孔生物陶瓷具有良好的生物相容性和骨传导作用，影像学观察、组织学观察均显示其生物降解效应与骨组织的改建塑性基本同步。     

自体髂骨嵌入式植骨和桥接钢板置入固定治疗尺骨远端缺损性萎缩性骨不连21例

背景：坚强的固定和骨折部位充足的血供是治疗骨不连的基本保证。 目的：观察自体髂骨植骨和桥接钢板置入固定治疗尺骨远端缺损性骨不连的疗效。 设计、时间及地点：自身对照观察，于2002-08/2006-05在上海交通大学附属第六人民医院骨科完成。 对象：入选尺骨远端缺损性骨不连21例，其中尺桡骨双骨折引起的骨不连13例，单纯尺骨骨折引起的骨不连8例。首次发病开放性骨折15例，闭合性骨折6例。骨缺损1.5~5.0 cm，平均3.1 cm。 方法：应用嵌入式髂骨植骨，填充骨缺损处。同时控制尺骨的长度和轴线，用5~8孔1/3管形钢板、重建钢板或锁定钢板桥接固定，最远端至少固定2枚螺钉，近端3枚或4枚螺钉。固定后每个月随访1次，观察临床表现和X射线片。 主要观察指标：骨折愈合情况，测量其腕关节背伸和掌屈活动度，前臂旋前和旋后活动度。 结果：21例患者平均随访14.7个月。所有患者均获骨性愈合，愈合时间3~7个月，平均4.6个月。19例对位对线良好，1例冠状面成角< 10°，另1例矢状面成角15°，优良率90.5%。 结论：自体髂骨嵌入式植骨和钢板桥接固定治疗尺骨远端缺损性骨不连，能够重建尺骨长度，矫正畸形，取得良好的骨愈合和功能恢复。     

自体骨、异种骨及人工骨微创植入治疗骨不连、骨缺损11例

回顾性分析上海市交通大学医学院附属仁济医院骨科2004-01/2007-12收治的骨折术后骨折延迟愈合、骨不连、骨缺损进行微创植骨的患者11例，局部麻醉或连续硬膜外麻醉下，在电视透视引导下定位，做5~8 mm的切口。通过植骨器撑开软组织，切割、钳夹、取出纤维瘢痕组织，并打通硬化封闭的髓腔，形成新鲜植骨床。通过套筒将自体骨、异种骨或人工骨植入。植骨后每2周复查X射线片，观察植骨块吸收、骨再生以及骨折的愈合情况。10例患者植骨后一般情况好，无发热，伤口无明显肿胀、渗出等炎症反应，均为一期愈合。骨折延迟愈合或骨不连均在植骨后2~4个月(平均2.9个月)达到临床愈合，恢复正常负重。1例胫骨中下1/3开放性骨折骨不连患者3周内出现炎症反应，植骨后8个月仍未愈合。提示微创植骨术操作简便，创伤小，愈合较快，疗效较好。     

纳米人工骨在颈椎前路植骨融合术中的应用

目的：评估颈前路植骨融合中应用纳米人工骨后临床症状的改善和影像学变化。 方法：2005-06/2006-06辽宁医学院附属第一医院骨科收治脊髓型颈椎病26例,混合型颈椎病5例,颈椎创伤脱位29例,均采用纳米人工骨替代自体髂骨进行60例颈椎前路椎体次全切减压植骨融合钛板内固定。植入前根据临床症状行神经功能JOA评分,并予颈椎X射线、CT、MRI等检查。植入后1周、3个月、6个月、1年、1年半随访情况定期复查,行神经功能JOA评分,X射线检查分析椎体高度,颈椎生理曲度等,并将植入前后情况比较分析。 结果：60例患者随访≥3个月,植入后均未见过敏及毒性反应,切口愈合均良好。植入后定期拍片复查,可见颈椎骨折者伤椎高度恢复,颈椎病患者未发现伤椎高度丢失,颈椎椎间角和颈前屈基本正常,内固定位置良好,未发现内固定松动、移位等现象。植入前X射线片及磁共振可见C4~5椎体脱位,脊髓受压;植入后3个月X射线可见骨折复位良好,内固定可靠。植入后神经功能JOA评分有明显提高,随访3个月者JOA评分由植入前(9.78±3.15)分增加到(15.25±2.79)分。 结论：纳米人工骨在颈椎前路植骨融合术中效果良好,可以替代自体骨应用于颈椎前路植骨融合。     

髂骨瓣钢板内植骨有限内固定置入结合外固定支架治疗肱骨术后骨不连13例

背景：对于肱骨骨折术后骨不连至今尚无十分有效完善的方法。髂骨钢板的应用不仅可以保持骨折端与植骨块的紧密接触,促进骨折的愈合;还可以为骨折愈合提供良好的稳定性,提供更加坚强的固定。 目的：观察应用髂骨钢板植骨有限内固定置入结合外固定支架治疗肱骨骨折术后骨不连的临床效果。 方法：选择解放军济南军区总医院骨创伤外科收治的肱骨骨折术后骨不连患者13例,男11例,女2例;年龄20~51岁,平均年龄35.5岁;全部患者采用髂骨钢板植骨有限内固定结合外固定支架治疗。X射线平片观察骨愈合情况;肩关节功能采用Neer评分进行评定,及有无并发症发生。 结果与结论：13例患者均获得随访,随访时间7~64个月,平均随访38个月。全部患者原骨不连处均在6~10个月(平均8.1个月)内完全愈合;所有患者肩肘关节活动功能正常,术后半年Neer评分71~96分,平均87分。无感染及患肢疼痛等并发症,无再发骨折及骨不连发生,肩肘关节功能均得到恢复。提示髂骨钢板植骨有限内固定结合外固定支架固定治疗肱骨骨折术后骨不连是一种十分合理、安全、可靠和有效的方法。     

Osteoset人工骨加自体骨移植治疗胸腰椎脊柱结核：与自体骨移植的比较

目的：分析病灶彻底清除后Osteoset人工骨加自体骨移植联合内固定治疗脊柱结核的安全性、可行性和治疗效果，并与单纯使用自体骨植骨比较。 方法：①实验对象：2003-01/2005-11在四川大学华西医院骨科手术治疗的脊柱结核患者124例，随机选择40例胸腰椎脊柱结核患者进行分析，对治疗和实验均知情同意。②实验材料：Osteoset-T人工替代骨: 由美国瑞特（Wright）医疗技术公司生产的骨移植替代材料。③实验方法：实验组20例，病灶彻底清除后带妥布霉素的Osteoset人工骨加自体骨植骨内固定；对照组20例，病灶彻底清除后单纯自体骨植骨内固定。④实验评估：根据术前、术后、术后3个月、术后6个月、术后12个月患者脊柱X射线正侧位片及CT扫描对两组患者的骨融合和畸形矫正情况进行评定和分析。 结果：①患者平均住院19.5 d（12～27 d）。所有患者术后伤口均一期愈合，无全身并发症状，术后1周平均白细胞计数8.2×109。②随访12～48个月，平均26个月。影像学资料提示钢板位置良好，内固定无松动；结核病灶均无复发，脊柱后凸畸形平均矫正Cobb角15°，畸形矫正角度没有丢失。③Osteoset人工骨加自体骨植骨术后3个月融合率为40%（8/20）；术后6个月融合率为85%（17/20）,单纯自体骨植骨术后3个月融合率为10%（2/20例），术后6个月达55%（11/20）。术后1年两组的融合率均为100%。 结论：Osteoset人工骨在胸腰椎脊柱结核骨融合术中可以补充植骨量,与单纯使用自体骨植骨相比达到骨性愈合的时间较短。     

股骨干骨折髓内置钉治疗骨折不愈合20例：附加钢板结合植骨的有效性★

背景：前交锁髓内钉是大部分股骨干骨折的首选治疗方法，纵观目前对于股骨干骨折髓内钉治疗后骨折不愈合的治疗方法，主要集中在更换原有髓内钉和改用钢板固定并植骨治疗方面，手术创伤大，费用高，术后不能早期功能锻炼，患者不易接受。 目的：随访观察不更换原有髄内钉，直接附加钢板结合植骨治疗股骨干骨折髓内钉固定后骨折不愈合的效果。 方法：回顾分析保定市第一医院骨外科2006-02/2008-12收治的20例股骨干骨折交锁髓内钉固定后不愈合患者，采用不更换原有髄内钉直接附加钢板并结合植骨的方法治疗。手术采用外侧切口，骨折端周围骨膜及骨痂给予保留，清理骨折端的纤维组织及硬化骨，术中检查骨折端稳定性差，于股骨前外或后外侧给予用7~9孔窄有限接触钢板固定，固定钢板处不剥离骨膜，骨折远近端各用3枚螺钉固定，固定后骨折端稳定，取自体髂骨植于骨折端，植骨后不负重或部分负重功能锻炼，骨折愈合后完全负重。 结果与结论：20例患者均得到随访，随访时间8~12个月，骨折全部愈合，愈合时间3~10个月，平均5个月，术后肢体活动良好。附加钢板结合植骨治疗股骨干骨折髓内钉固定后骨折不愈合，手术操作创伤小，可以综合交锁髓内钉和钢板内固定的优点，克服这两种内固定的不足，提高骨折固定稳定性，使患者早期进行功能锻练，促进骨折愈合，是一种简单有效的治疗方法。 关键词：交锁髓内钉；钢板；股骨干骨折；植骨；骨折不愈合；硬组织植入物     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -