椎间盘移植实验—组织形态学研究

观察了６只猴自体腰椎间盘移植术后不同时期间盘组织形态学变化。结果表明：移植椎间盘高度术后１～３月呈下降趋势，４～６月呈恢复上升趋势。大体形态观察，移植间盘髓核的反光性减弱，呈较粘稠状。光镜下纤维环和终板软骨结构无明显改变，髓核中有部分细胞退变，同时亦有软骨样纤维细胞再生，表明间盘组织对损伤有一定的自体修复能力。组织形态学研究结果表明，猴自体椎间盘移植是可以接受的。     

同种异体椎间盘移植的实验研究

本研究是在自体椎间盘移植实验研究的基础上进一步通过Ｘ线、组织病理、生物学活性、生物化学和生物力学探索异体椎间盘移植是否可存活、功能及其归宿。１２只猴随机分为４组，移植术后３、６、９和１２个月分别处死检测。结果表明移植间盘高度术后下降，但１２个月时仍保持正常高度的６１．４％。光镜下未见明显排斥反应，终板和纤维环结构无明显改变，术后早期可见移植间盘终板软骨增生现象，髓核基质密度增大，成软骨样纤维细胞增生明显。３Ｈ－ｐｒｏｌｉｎｅ掺入较对照组明显增加。术后移植间盘的蛋白多糖和水含量降低，而胶原含量增加。生物力学动态变化表明术后早期移植间盘有失稳趋势，晚期则稳定性恢复。上述结果显示同种异体移植间盘可存活，生化代谢虽有变化但有一定的自限性，形态结构无明显改变，生物力学满足功能需要。     

椎间盘移植实验—生物化学研究

恒河猴１２只，于Ｌ＿（３￣４）行自体间盘移植手术。对术后不同时间移植间盘进行生化分析，测定了间盘组织的水、胶原和蛋白多糖含量变化，结果显示：术后２月蛋白多糖及水含量降低，胶原含量升高，髓核较纤维环变化明显。术后４月蛋白多糖及水含量进一步降低，胶原含量回升，与对照组已无统计学差异，水份和胶原含量较，４月无明显变化。提示：椎间盘移植后虽然在早朝有退变倾向，但在后期这种退变部分恢复。     

猴自体椎间盘移植的组织学研究

本实验观察了猴自体椎间盘移植术的不同时期间盘组织学变化。结果表明大体形态移植间盘髓核的含水景减少，呈较粘稠胶状，光镜下纤维环和终板软骨结构无明显变化，髓核中有部分细胞退变，同时亦有成软骨样纤维细胞再生。透射电镜发现间盘髓核中仍有脊索细胞存在，移植后不同时间组髓与纤维环中均可见部分细胞变性坏死。本实验成功地建立了椎间盘移植动物模型，为进上步深入研究提供了依据。     

冷冻保存异体椎间盘移植的实验研究

目的 观察猴冷冻保存异体椎间盘移植后的Ｘ线、组织形态学、分子生物学、生物化学少生物力学的变化,探讨移植椎间盘的长期归宿及临床应用的可能性。方法 １７只猴中的１２只随机分为０．５、１、１．５、２、６和２４个月组。移植椎间盘梯度降温至－１９６℃保存,术前复温后手术植入。结果 Ｘ线显示无脱位,２４个月极能维持正常高度的６４．９％。术后２周权在移植椎间盘终板下骨与宿主椎体骨界面区有轻度免疫排斥反应,４周时     

影响椎间盘退变生物化学改变的因素

椎间盘退卞的生物化学改变表现为 :蛋白多糖含量减少 ,硫酸角质素与硫酸软骨素的比例增加 ,Ⅰ型型胶原增多 ,Ⅱ型胶原减少 ,水分减少等 ,这一变化严重影响了椎间盘的生物力学特性 ,由此构成了椎间盘突出的病理基础。近年来 ,随着分子生物学、分子免疫学等医学基础学科的迅速发展 ,椎间盘退变生物化学改变及其影响因素等方面的研究取得了一些进展 ,现在综述如下 :1　应力对椎间盘退变的生物化学影响椎间盘由四周的纤维环、中心的髓核及上下软骨终板组成。正常椎间盘髓核呈流体静压状态 ,椎间盘内压为轴间压载荷的 1.3～ 1.5倍 ,当外载荷达 2 …     

椎间盘移植实验──生物力学研究

本实验在６只猴体上制备自体椎间盘移植模型，观察术后不同时期生理载荷下屈伸活动时移植椎间盘的刚度（ｓｔｉｆｆｎｅｓｓ）变化。结果表明：术后２月，移植的Ｌ３～４椎间盘在整个屈伸活动中较上、下正常对照椎间盘的变形增大；术后４月，移植椎间盘变形接近正常对照椎间盘；术后６月，移植椎间盘刚度明显恢复。实验结果提示术后早期有腰椎节段性不稳倾向，中晚期稳定性恢复，移植椎间盘可满足生理活动功能需要。     

在连续被动活动作用下自体骨膜游离移植修复髋、膝关节软骨大面积缺损的临床应用

关节软骨损伤修复是临床骨科难题之一。在动物实验研究基础上，从１９８７年１月起，采用自体游离骨膜移植修复４３例关节软骨大面积缺损的病人，在连续被动活动作用下，促进修复后的关节功能恢复。并对３５例病人进行随诊观察，包括先天性髋关节脱位１８例、创伤性髋关节炎７例、股骨头低毒性感染１例、类风湿性髋关节炎１例、膝关节内骨折６例和创伤感染后膝关节僵直２例。术中，切除病变的软骨组织达出血的骨组织，从胫骨前内侧切取稍大于软骨缺损的骨膜缝合固定在缺损表面，移植骨膜和关节间放置硅膜。术后立即进行ＣＰＭ练习，逐渐增加活动范围，活动时间为４～６周，术后６个月取出硅膜。随访的３５例病人中男１６例，女１９例，年龄１２～２９岁，平均随访时间为３５个月（６～６０个月）。评价结果：髋和膝关节功能优良率分别为７６．９％和８８．９％。     

颈椎间盘退行性疾病

颈椎间盘退行性疾病是以颈椎间盘退变为主所引起的一组疾病。因颈椎间盘退变程度不同可分为 :颈椎间盘膨隆、突出、脱出症。表现为颈椎神经、脊髓、血管等受压的症状、体征。1　颈椎间盘解剖与组织成份颈椎间盘位于Ｃ2 ～Ｔ1的两个椎体间。主要由纤维环和髓核两部分组成 ,软骨终板是否属于椎间盘的构成部分 ,各作者认识有分歧。纤维环呈同心圆行层状结构 ,前侧及两侧较厚 ,后侧较薄 ,各层纤维方向不同 ,彼此呈 3 0°～ 60°交角。纤维环的外层和中层为胶原纤维 ,通过夏贝氏纤维附于椎体骺环 ,内层为纤维软骨 ,附于软骨终板上。髓核位于椎间…     

退变椎体周边关节软骨产生碱性磷酸酶与骨赘形成的关系

目的：研究椎体骨赘形成的机理。方法：通过切除免颈棘上韧带及棘间和分离颈椎后旁两侧肌肉引起动物颈椎力学上的失衡,经３个月的时间的发展而造成免颈椎间盘退变模型。用生物化学方法分别测定每个动物颈椎间盘纤维环和髓核、椎体关系软骨、周边关节软碱性磷酸酶性结果：颈椎间盘退变动物椎体周边关节软骨中碱性磷酸酶活性明显升高。结论：研究结果在生物化学上支持椎体骨赘来自于周边关节软骨增殖、化生、钙化和骨化的组织学观察。     

Bisphosphonates are effective prophylactic of early bone loss after renal transplantation

INTRODUCTION: Rapid bone loss and fractures occur early after solid organ transplantation. We examined the preliminary results of a prospective study evaluating the efficacy of prophylactic use of bisphosphonates in renal allograft recipients. METHODS: Bone mineral density (BMD) was measured at the lumbar spine and the hip by dual energy X-ray absorptiometry at 1, 6, 12 months. Alendronian or risedronian were initiated for patients with osteopenia or osteoporosis at 1 month who had no contraindications to bisphosphonates. The treatment lasted at least 6 months. Sixty-six patients were included in the study; 39 were treated with bisphosphonates (A), and 27 were drug-free (B). Presently, 24 group A and 13 group B patients have completed the 12-month observation period. RESULTS: In group A 53.8% (21) subjects had osteoporosis and 46.2% (18), osteopenia. Mean T-score L(2)-L(4) in group A at 1, 6, and 12 months were: (-)2.22 +/- 1.06; (-)2.07 +/- 1.25; (-)1.89 +/- 1.07, respectively. The T-score increase between 6 and 12 months was significant (P = 0.0014). The relative rise in BMD L(2)-L(4) between 1 and 12 months was 2.26%. In group B mean T-score L(2)-L(4) at 1, 6, and 12 months were: (-)0.26 +/- 1.34; (-)0.80 +/- 1.19; (-)1.2 +/- 1.59, respectively. The T-score decrease between 1 and 12 months in group B was significant (P = .0082). The 12-month relative decrease in femoral neck and trochanter BMD in group B was (-)2.1% and (-)2.75%, respectively. CONCLUSION: Bisphosphonates are effective for prophylaxis of rapid bone loss early after renal transplantation.     

腹腔镜超低位直肠癌经括约肌间切除术后肛门控便机制变化的研究

目的探讨腹腔镜超低位直肠癌经括约肌间切除（ISR）术后肛门控便机制变化的规律。 方法选择2014年6月至2016年6月间29例腹腔镜超低位直肠癌ISR术患者为治疗组,分别于术后1、3、6、12个月时进行肛门失禁Wexner评分,与肛管测压、代直肠静息容量测定相结合以评估患者的排便功能,同时设立健康成人对照组,进行统计学分析。 结果肛门失禁Wexner评分显示,治疗组术后1、3、6、12个月均与对照组差异有统计学意义（P<0.01）,治疗组内术后3、6、12个月均与上一个检测时间点差异有统计学意义（F=182.4,P<0.001）。患者肛管压力测定显示,治疗组术后1、3、6个月的最大静息压、最大收缩压均明显低于对照组（P<0.05）,治疗组内术后3、6、12个月的最大静息压均与上一个检测时间点差异有统计学意义（F=25.029,P<0.05）。代直肠静息容量测定显示,治疗组所有检测时间点的静息向量容积、收缩向量容积均明显低于对照组（均P<0.001）,治疗组内术后3、6、12个月均与上一个检测时间点差异有统计学意义（F=4 640.715、3 421.403,均P<0.001）。 结论低位直肠癌经括约肌间切除术的患者肛门控便功能是一个逐渐恢复的过程,术后12个月左右达到或接近正常水平。     

ANKYLOS种植体修复术后骨生长情况研究

目的观察ANKYLOS种植体修复牙列缺损后骨生长情况,为其进一步临床应用提供参考依据。方法 2008年2月-2009年8月,对170例牙列缺损患者采用318枚ANKYLOS种植体植入修复。男74例,共植入133枚种植体;女96例,共植入185枚种植体。年龄23～68岁,平均43.8岁。术后随访摄根尖X线片,了解种植体颈部周围骨结合、颈部牙槽骨吸收以及种植体留存等情况。结果术后患者均获6、12、24个月定期随访。318枚种植体中不留存9枚,种植体总留存率为97.17%(309/318);其中术后6个月内脱落3枚,6～12个月脱落4枚,12～24个月脱落2枚,各时间点种植体留存率比较差异无统计学意义(χ2=0.470 3,P=0.492 8)。术后部分患者(6个月4例,12个月31例)种植体颈部周围有新骨形成,术后6、12、24个月骨组织增长量分别为(0.392 7±0.217 4)、(0.633 5±0.202 1)、(0.709 0±0.199 1)mm,各时间点间比较差异均有统计学意义(P<0.05)。其余患者术后6、12、24个月种植体颈部周围骨组织丧失量分别为(0.392 7±0.217 4)、(0.716 7±0.220 3)和(0.723 2±0.215 4)mm,各时间点间比较差异均有统计学意义(P<0.05)。结论 ANKYLOS种植体修复牙列缺损后近期周围骨生长情况稳定,临床疗效较好,具有较高的临床成功率,远期疗效有待进一步观察。     

自体骨髓复合人工骨联合髂骨骨膜移植治疗四肢难治性骨不连

目的评价自体骨髓复合人工骨联合髂骨骨膜移植治疗四肢难治性骨不连的初步临床疗效。方法2004年1月-2006年7月，收治难治性四肢长骨骨不连12例13肢，取自体骨髓复合人工骨联合髂骨骨膜移植治疗。其中男8例，女4例；年龄17～58岁。骨不连部位：胫骨中、下段7肢，股骨中、下段3肢，尺桡骨1肢，肱骨中段2肢。曾接受治疗骨不连手术次数1～4次，平均2．5次。骨折至本次治疗时间13个月～9年，平均47．6个月。术前摄X线片示骨不连骨断端距离6～30mm，平均15mm。采用内固定11肢，其中交锁髓内钉10肢，限制性接触．动力加压钢板1肢；支架外固定2肢。术后第1天及1、3、6、9、12个月摄x线片，观察骨折愈合情况。结果术后供受区愈合良好。患者均获随访，随访时间12～26个月，平均17，5个月。骨折愈合时间4～7个月，平均6个月。x线片示13肢均骨折愈合，无旋转、成角及短缩畸形。6肢因关节僵硬、瘢痕挛缩等，骨折愈合后遗留功能障碍。结论自体骨髓复合人工骨联合髂骨骨膜移植治疗四肢难治性骨不连效果满意。     

Renal Ultrasound Changes After Pyeloplasty in Children With Ureteropelvic Junction Obstruction: Long-term Outcome in 47 Renal Units

Purpose

We evaluated the use of renal ultrasound for monitoring pyelocaliectasis after pyeloplasty in children.

Materials and Methods

Changes in pyelocaliceal dilatation following pyeloplasty were assessed by serial ultrasound. Of 104 children 0 to 12 years old who underwent pyeloplasty between 1982 and 1992, 44 (47 renal units) were monitored with serial ultrasound for at least 2 years (range 2 to 9, mean 3.8). Patient ages at pyeloplasty were 0 to 3 months (17), 4 to 12 months (8), 1 to 6 years (13) and 7 to 12 years (6). Preoperative and postoperative ultrasound was reviewed by a single pediatric radiologist blinded to the date of surgery. The degree of pyelocaliectasis was graded as 0 to 4 according to the classification of the Society for Fetal Urology.

Results

Preoperative ultrasound revealed grade 4 pyelocaliectasis in 26 kidneys (55 percent) and grade 3 disease in 21 (45 percent). Grade was the same or worse 1 month after pyeloplasty in the majority of kidneys (92 percent) studied at this interval. Of the 47 renal units assessed 43 (91 percent) showed improvement in pyelocaliectasis during postoperative followup. Only 38 percent of the kidneys improved during the first 6 months of followup, while 81 percent were improved 2 years postoperatively. Improvement to grade 0 or 1 dilatation occurred in only 9 kidneys (19 percent). The rate of resolution of pyelocaliectasis was not related to preoperative grade or patient age at pyeloplasty.

Conclusions

Improvement on renal ultrasound after pyeloplasty appears to be gradual. Less than half of the patients had improvement in the initial 6 months after pyeloplasty and pyelocaliectasis rarely resolved completely. While renal ultrasound can provide an accurate and cost-effective means of monitoring children on a long-term basis after pyeloplasty, sonographic evaluation in the early postoperative period commonly shows increased or unchanged pyelocaliectasis.     

A preliminary study of the efficacy of Beta Tricalcium Phosphate as a bone expander for instrumented posterolateral lumbar fusions

The associated morbidity of allograft(s) as bone graft expanders in spinal surgery has prompted the search for alternatives. The efficacy of Vitoss/Beta Tricalcium Phosphate (B-TCP: OrthoVita, Malvern PA, USA), an artificial bone substitute, combined with lamina autograft (50:50 mix) in 40 prospective posterolateral fusions utilizing pedicle/screw instrumentation was analyzed. Multilevel lumbar laminectomies (average 3.7 levels) were accompanied by 1 (27 patients) and 2 level (13 patients) fusions. Two neuroradiologists independently assessed fusion progression on dynamic x-rays and 2D-CT studies performed at 3, 6, and up to 12 months postoperatively. Outcomes were quantified utilizing Odom Criteria and Short-Form 36 (SF-36) questionnaires (preoperatively; and 3, 6, and 12 months postoperatively). By the sixth postoperative month, fusion was neuroradiologically confirmed on both dynamic x-rays and CT studies for 26 of 27 single level fusions (1 pseudarthrosis), and 11 of 13 two level fusions (L4-S1). Odom Criteria 3, 6, and 12 months postoperatively revealed continued improvement for all patients. SF-36 outcomes, however, revealed deterioration on 2 Health Scales (Role Physical, Role Emotional) 3 and 6 months post-operatively, and minimal to marked improvement on 6 Health Scales (PF, V, PF, V, SF, BP). Twelve months postoperatively improvement occurred on all 8 Health Scales, exceeding pre-operative baselines; minimal (RP, GH), mild (MH), moderate (PF, BP, V, SF), and marked improvement (RE). Although Vitoss/B-TCP and laminar autograft resulted in pseudarthrosis for 1 of 27 single level and 2 of 13 two level posterolateral instrumented lumbar fusions, only 1 of the latter patients required a secondary fusion.     

Alemtuzumab induction with tacrolimus monotherapy in de novo renal transplantation

OBJECTIVES: Alemtuzumab is increasingly being used as induction therapy for kidney transplantation, allowing immunosuppression minimization. This study examined the efficacy of alemtuzumab induction followed by low-dose tacrolimus monotherapy in standard risk primary kidney transplant patients. METHODS: This retrospective cohort of primary standard risk renal transplant recipients were given alemtuzumab induction and low-dose tacrolimus maintenance immunosuppression (target trough 7 to 10 ng/mL for the first 6 months and 5 to 7 ng/mL thereafter). Serum creatinine values, acute rejection episodes, and graft survival were noted at week 1 as well as months 3, 6, 12, and 18. RESULTS: At the time of analysis, 47 patients were at 6 months, 28 at 12 months, and 6 patients at 18 months from transplant. Mean follow-up was 12.53 months (range, 6 to 23). Mean serum creatinine was 1.47 +/- 0.65 mg/dL at 3 months, 1.56 +/- 0.84 at 6 months, 1.45 +/- 0.37 at 12 months, and 1.74 +/- 0.35 at 18 months. The 1-year clinical acute rejection rate was 21% (6/28), occurring at 0 to 3 months in 2 (33%), 4 to 6 months in 1 (17%), and >6 months in 3 patients (50%). Biopsy-proven acute rejection was 14% (4/28). The episodes were classified as borderline in one, Banff 2A in two, and Banff 3 in one patients. One patient had both acute cellular and acute humoral rejection; half responded to steroid pulse therapy. The 1-year patient survival rate was 90%. The 1-year death-censored graft survival rate was 98%. CONCLUSION: Alemtuzumab induction with tacrolimus monotherapy is an acceptable option in standard risk patients. BPAR was 14%, but renal function remained satisfactory at 18 months posttransplant.     

Prospective psychosocial monitoring of living kidney donors using the Short Form-36 health survey: results at 12 months

BACKGROUND: Lack of prospective psychosocial outcome studies on living kidney donors impedes identification of risk factors for poor outcome. METHODS: Psychiatric assessment of living kidney donors was performed preoperatively and at 4 and 12 months postoperatively using a semistructured interview, the Short Form (SF)-36 Health Survey, and Patient Health Questionnaire psychiatric assessment. A total of 48 of 51 consecutive donors (94%) over a 5-year period were available for follow-up and completed all assessments. RESULTS: At preoperative assessment, only 1 of the 48 donors (2%) had a Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Axis I psychiatric disorder, but 15 (31%) developed a disorder during the 12 months, a 29% incidence. Disorders were depressive (12%), anxiety (6%), and adjustment (13%). Seven donors (15%) demonstrated a disorder at 12 months (depressive 10%, anxiety 2%, adjustment 2%). There was a corresponding decline in psychosocial function as measured by the SF-36 Mental Component Summary score; it decreased at both 4 and 12 months (P<0.01, P<0.05); for 19% of donors, this was a larger decrease than would be expected for the cohort (>2 standard error of measurement units). Scores for SF-36 scales of General Health and Vitality decreased significantly (P<0.05), as did those of Bodily Pain, indicating greater impairment from pain. Psychiatric disorder at 12 months was associated with donor psychosocial function (Mental Component Summary) and psychiatric disorder at 4 months (P<0.01), physical function (SF-36 Physical Component Summary score) at 4 and 12 months (P<0.01), and recipient psychiatric disorder at 12 months (P<0.05). CONCLUSIONS: Donors should be alerted to possible psychosocial impairment, assessed for risk factors, and monitored for at least 12 months. Treatment should be available.     

Long-term effects on bone mineral density and bone metabolism of 6 months’ treatment with gonadotropin-releasing hormone analogues in Japanese women: comparison of buserelin acetate with leuprolide acetate

Our objective was to assess the effects of 6 months’ treatment with two types of gonadotropin-releasing hormone (GnRH) analogues on lumbar bone mineral density (BMD) and bone metabolism. We studied 27 women who had been given a diagnosis of endometriosis or uterine myoma. The subjects received drug therapy for 6 months and were subsequently followed up for 1 year. The BMD of the lumbar spine (L2, L3, L4) was measured by dual energy X-ray absorptiometry four times: at baseline, after 6 months, after 12 months, and after 18 months. The serum concentrations of sex steroids and bone metabolic markers were measured at the same times as BMD. Compared with the baseline value, the mean decrease in the buserelin group L2–4 BMD was 3.7% at 6 months, 1.7% at 12 months, and 0.4% at 18 months. In the leuprolide group, L2–4 BMD decreased respectively by 5.1%, 6.2%, and 4.3%. Serum concentrations of calcium increased significantly after 6 months of treatment (P < 0.05) and returned to the baseline level at 12 months in both groups. In the leuprolide group, the intact osteocalcin concentration after 6 months was significantly higher than the baseline value, and after 12 months, it decreased to the baseline level. Our results indicate that the effect on BMD of 6 months’ treatment with GnRH analogues virtually resolves by 1 year after treatment, provided that drugs affecting bone metabolism are not given during this period.     

Effects of discontinuation as well as intervention of cyclic therapy with etidronate on bone remodeling after cementless total hip arthroplasty

We previously reported the effects of cyclic therapy with etidronate (CTE) on periprosthetic bone mineral density (BMD) after cementless total hip arthroplasty (THA). This study aimed to evaluate the effects of withdrawal and intervention of CTE after cementless THA. The control group consisted of 24 patients without osteoactive drugs. Sixteen patients continued on CTE (i.e., 400 mg/day oral etidronate for 2 weeks followed by 12 weeks of 500 mg/day calcium lactate, repeated every 14 weeks) for the first 12 months followed by no treatment for 18 months (early-etidronate group). Fifteen patients received no treatment for the first 18 months followed by CTE for 12 months (late-etidronate group). Periprosthetic BMD in seven regions of interest based on the zones of Gruen et al. was measured with dual energy X-ray absorptiometry at 3 weeks, 6, 12, 18, 24, and 30 months postoperatively. At 12 months after operation (off therapy point in the early-etidronate group), postoperative decreases of BMD in the early-etidronate group were significantly smaller than those in the control group in zones 1, 2, 5, 6, and 7 and those in the late-etidronate group in zones 1, 5, 6, and 7 (P < 0.05 for each). In the early-etidronate group, significant decreases in BMD were found during months 12-30 (off therapy period) after withdrawal of CTE in zones 1 and 7 (P < 0.05 for each). In the late-etidronate group, BMD increased significantly in zones 4 and 6 (P < 0.05 for each) during months 18-30 (on therapy period) after intervention trial, while in the controls, BMD decreased significantly in zone 3 (P < 0.05) over this period. At the final follow-up (30 months), BMD loss in zone 7 was significantly less in the early-etidronate group than in the other groups (P < 0.05). BMD changes in the early-etidronate group and late-etidronate group were associated with changes in biochemical bone markers.