带蒂豆状骨移位治疗半月骨无菌性坏死(附3例报告)

半月骨无菌性坏死是腕关节疼痛的常见原因之一。自１９９８０５以来，在应用解剖学研究的基础上，采用带筋膜血管蒂和尺侧腕屈肌腱的豆状骨移位，为３例半月骨无菌性坏死的患者进行了手术治疗。现报告如下。１ 病例资料例１，女性，４８岁，缝纫工。右腕扭伤１年，活动痛，近３个月腕部疼痛加重伴僵直，肿胀，腕关节活动受限，以背伸为著。腕背侧半月骨部位有压痛，可向前臂放射。Ｘ线片示半月骨在斑点状囊性改变，边缘密集增高，整个半月骨变扁，塌陷。术后４个月腕背肿胀及叩压痛征象消失，屈腕活动比术前增加２０°，背伸增加１０°。…     

富血小板血浆结合自体松质骨移植治疗陈旧性腕舟骨骨不连的临床研究

目的 观察富血小板血浆结合自体松质骨移植治疗陈旧性腕舟骨骨不连的临床效果.方法 随机选择19例陈旧性腕舟骨骨折骨不连患者,采用富血小板血浆结合自体松质骨移植的手术治疗方法,术后4周开始,每两周拍摄腕关节X线片1次,至骨折愈合,并记录骨折愈合时间.术后随访观察并评估腕关节功能活动及握力改善情况.结果 术后随访3个月~2年,19例陈旧性腕舟骨全部愈合,骨折愈合时间10~20周,平均13.9周.腕关节功能根据改良Mayo评分评估:优11例,良5例,可3例,优良率84.2%.手术后腕关节活动度(背伸掌屈度数及尺桡偏度数)以及握力恢复情况较术前明显增强,差异有统计学意义(P<0.05).结论 富血小板血浆结合自体松质骨移植是临床治疗陈旧性腕舟骨骨不连的一种有效治疗方法,其操作简单,值得临床推广应用.     

自体骨膜包绕肌腱与BMP复合体替代月骨的研究

目的：探讨自体骨膜包绕肌腱与骨形态发生蛋白（BMP）形成复合体替代月骨治疗Kienbock‘s病的可能性。方法：42只日本大耳白兔，随机分为2组：骨膜包绕肌腱与BMP组（A组），骨膜包绕肌腱组（B组，对照组），将复合体置入兔膝关节髌上囊，术后1、2、4、8、12、16、24周取标本进行放射学、光镜及电镜检查。结果：复合体4周即有新生骨出现，12周形成表面光滑，外周为完整骨包壳，中心为骨髓细胞的类圆形骨性团块，24周复合体无退变吸收。结论：复合体成骨完全，并兼有良好的可塑性和成骨时间早等优点，为月骨良好的替代物。     

桡骨远端楔形截骨术治疗腕舟状骨不愈合和月骨坏死的效果探究

目的研究桡骨远端楔形截骨术治疗腕舟状骨不愈合和月骨坏死的临床效果。方法选取我院于2000年1月至2011年4月收治的50例腕舟状骨不愈合和36例月骨坏死患者的资料进行研究。结果手术后患者静息时与负重时的腕关节疼痛VAS评分、腕关节活动度以及握力情况与手术前相比P〈0.05,具有统计学意义;手术后患者患侧腕关节活动度以及握力情况与健侧相比差异性不大,无统计学意义。结论桡骨远端楔形截骨术治疗腕舟状骨不愈合和月骨坏死效果理想。     

第4、5伸肌鞘管动脉桡骨瓣转移联合外固定架治疗月骨无菌性坏死的临床效果观察

目的评价以第4、5伸肌鞘管动脉为蒂的桡骨远端骨瓣转移联合外固定架治疗月骨无菌性坏死的临床效果。方法对2006年6月~2013年6月诊断为月骨无菌性坏死的15例住院患者为研究对象,X线片显示月骨不同程度囊性变、密度增高或边缘硬化。采用第4、5伸肌鞘管动脉桡骨瓣联合外固定架治疗,术后10周拆除外固定架后行功能锻炼。腕关节疼痛程度采用视觉模拟评分(VAS)法评定,并对活动度进行评价,腕关节功能按Krimmer评分。结果术后随访10~18个月,平均12个月。术后腕部疼痛、无力症状较术前明显好转,术后6个月随访X线片显示月骨形态正常,坏死区消失9例,明显缩小4例,部分缩小2例,桡腕关节间隙正常。腕关节疼痛程度、活动度较术前改善,腕关节功能按Krimmer评分:优8例,良5例,可2例,优良率达86.7%。结论第4、5伸肌鞘管动脉桡骨瓣转移联合外固定架治疗月骨无菌性坏死效果确切,术后腕关节功能良好,是一种较好的治疗方法。     

桡骨远端骨膜瓣移位结合Herbert螺钉内固定治疗腕舟骨骨不连

目的：探讨应用桡骨远端骨膜瓣逆行带蒂转移结合Herbert螺钉内固定治疗腕舟骨骨不连的疗效。方法回顾性分析2007年3月至2013年4月对21例腕舟骨骨不连患者采用桡骨远端骨膜瓣逆行带蒂转移结合Herbert螺钉内固定进行治疗。 X-线片显示腕舟骨腰部骨折骨不连16例,腕舟骨近端骨不连5例,切取桡骨骨膜瓣1.2cm＆#215;4.2cm。术后定期复查X-线片,随访骨折愈合时间、腕关节疼痛、腕关节活动度等情况。结果术后21例患者均获得随访,时间为8-20个月,平均10个月。骨折均达到骨性愈合,时间为3-8个月,平均为4个月,腕关节疼痛基本消失,腕关节功能参照Krimmer腕关节评分系统评定结果：优17例,良3例,可1例。结论应用带蒂桡骨远端骨膜瓣移位结合Herbert螺钉内固定治疗腕舟骨骨不连具有重建舟骨血运,促进骨折端再血管化及成骨,同时提供坚强有效内固定,提高该类骨折愈合率。     

月骨无菌坏死术后的康复治疗

目的：报道头状骨移位与桡骨瓣植入联合治疗月骨无菌坏死术后的康复治疗。方法：对46例患者行坏死骨摘除头状骨带蒂移位后以血管蒂骨瓣植入填塞头状骨空隙。术后分为A、B两组，A组46例，B组44例，A组按本课题方法进行系统的康复治疗，B组采用传统的康复治疗方法。结果：术后随访16－48个月，平均21．5个月，康复治疗各随访期资料表明，联合术式与康复治疗的有机结合使康复进程和疗效明显提高。结论：两种术式的联合应用结合系统的康复治疗措施对LichtmanⅢ、Ⅳ期月骨无菌坏死疗效显著。     

头状骨移位替代术治疗晚期Kienbock病

目的评估带血管蒂头状骨移位替代术治疗晚期kienbock病的手术疗效。方法A组：13例晚期（Licht-manⅢ、Ⅳ期）kienbock病患者,入院后均行腕部X线检查、头状骨移位替代术。B组：11例行月骨假体植入术。结果以术后12个月随访结果为准。A组除差1例,12例腕痛基本消失、平均握力恢复至健侧的76%,腕关节活动范围为健侧的51%。结论头状骨移位替代术治疗晚期kienbock病,能缓解疼痛、改善握力及腕关节活动度。     

晚期月骨无菌性坏死的一种新疗法（附5例报告）

月骨无菌性坏死又称Kienbock氏病，系因慢性损伤而致月骨的缺血坏死，临床病例较少见，治疗也较困难。我们利用腕背侧动脉网，成功地用带血管筋膜蒂头状骨移位治疗晚期月骨无菌性坏死3例，术后随访一年，手术效果较满意，现报告如下。     

可吸收棒内固定并注入aFGF治疗陈旧性腕舟骨骨折

目的:评价掌侧可吸收棒内固定并注入酸性成纤维细胞生长因子(aFGF)治疗陈旧性腕舟骨骨折及骨不连的临床价值.方法:23例陈旧性腕舟骨腰部骨折及骨不连患者,采用掌侧小切口可吸收棒内固定治疗,术中骨折处注入aFGF透明质酸凝胶.结果:23例获随访,随访时间平均10.5个月.23例骨折全部愈合,愈合时间平均为术后11周.19例伤腕没有疼痛,4例轻微疼痛,23例握力良好.2例腕关节活动轻度受限,患侧腕关节活动度与健侧相比无明显差别.按Krimmer腕关节功能评分表调查21例优,1例良,1例满意.优良率95.7%.结论:可吸收棒内固定并注入酸性成纤维细胞生长因子(aFGF)治疗陈旧性腕舟骨骨折及骨不连具有微创、骨折治愈率高、内固定牢靠、手腕功能恢复好、内固定无需取出等优点.术中加用aFGF透明质酸凝胶对骨折愈合有促进作用.     

骨髓腔游离植骨治疗骨缺损和骨不连的探讨

目的 探讨骨髓腔游离植骨治疗骨缺损和骨不连的临床效果。方法 对四肢长骨因创伤及感染造成骨缺损和骨不连,切取同骨或另骨的皮质骨植入骨的两段骨髓腔,并用内外固定。结果 本组骨缺损和骨不连２３例,经此法治疗,随访１８个月,全部治愈。结论 此法本组病例验证,是治愈骨缺损和骨不连的有效方法,其手术操作简单,无南非     

Genistein prevents bone resorption diseases by inhibiting bone resorption and stimulating bone formation

Genistein, a soybean-derived isoflavone, has been shown to suppress osteoclastic bone resorption. To clarify the mechanisms underlying this action, we investigated the effects of genistein on the differentiation, cytoskeleton and function in mice osteoclasts in vitro and bone metabolism in ovariectomized rats. Study design: Primary OCs were isolated from 3 week-old mice and induced by 1,25(OH)(2)D(3). Then OCs were exposed to genistein at various concentration of 0 M, 10(-9) M, 10(-8) M, 10(-7) M, 10(-6) M, and 10(-5) M. The number of TRAP+ cells were counted as well as the surface area of bone resorption on bone slice. F-actin change was observed by Confocal. In vivo, forty 12 week-old female SD rats were randomly assigned to four groups: (1) sham operated (Sham); (2) (OVX); (3) ovariectomized and treated with estradiol (OVX-E); (4) ovariectomized and received genistein (OVX-G). After 12 weeks, BMD, body weight, serum level of alkaline phosphatase (ALP), acid phosphatase (ACP), osteocalcin (OC), IL-1beta, TNFalpha, IL-6 and calcitonin (CT) were evaluated. Femur were sectioned. In addition, the serum estradiol, the weight of uteri and histological behavior were also examined to indicate the side effect of genistein to the uteri. Results: In vitro, the number of TRAP+ cells decreased depending on the concentration of genistein as well as the area of bone resorption. F-actin became disorder under Confocal. In vivo, after treated with genistein, BMD and the serum level of ALP, ACP, osteocalcin increased significantly, while the serum level of IL-1beta and TNFalpha decreased. Especially, the increase of ALP and osteocalcin of OVX-G was higher than that of OVX-E. Histologically, the pachy-trabecula were observed as well as the more mineral deposition lines. Additionally, the uterus weight index and the serum estradiol in OVX-G rats were lower significantly than those of OVX-E. The epithelia of uteri gland in OVX-G appeared cubic while those of OVX-E became squamous. Conclusions: Genistein can prevent bone resorption diseases by the promotion of bone formation and the prevention of bone resorption with slight side effect.     

一期自体骨钻孔骨屑植骨在预防四肢长骨骨折骨不连中的应用

随着现代交通、工业、农业的发展,四肢创伤骨折的发生率明显增多。切开复位钢板内固定是临床治疗四肢骨折的常用方法。但在临床治疗过程中骨不连或骨延迟愈合时有发生。植骨是临床上预防,治疗骨不连或骨延迟愈合的有效方法之一,依植骨的有效性及病人的自身考虑,1989年1月～2003     

带血管蒂骨膜瓣对异体骨移植血管化的影响

目的研究带血供骨膜瓣对异体骨移植血管化的影响,修复骨缺损过程中对微血管生成的作用。方法将兔的股骨经去抗原化后作为供体,制作带血供骨膜瓣包裹同种异体骨修复兔大段骨缺损的模型,实验设置对照组,即未用血管化骨膜瓣包裹移植物。分别在术后4、8、16周分别对移植物及周围软组织、骨组织进行组织学观察,观察内皮细胞生长因子（VEGF）的表达。对Ⅷ因子相关抗原特异性标记,比较不同时间微血管密度（MVD）的变化。结果实验组骨组织哈佛氏管内较早出现微血管;在相同阶段,实验组VEGF的表达强于对照组,MVD高于对照组。结论带血供骨膜瓣对异体骨移植的血管化过程有明显的促进作用。     

Demineralized bone matrix in bone repair: History and use

Demineralized bone matrix (DBM) is an osteoconductive and osteoinductive commercial biomaterial and approved medical device used in bone defects with a long track record of clinical use in diverse forms. True to its name and as an acid-extracted organic matrix from human bone sources, DBM retains much of the proteinaceous components native to bone, with small amounts of calcium-based solids, inorganic phosphates and some trace cell debris. Many of DBM's proteinaceous components (e.g., growth factors) are known to be potent osteogenic agents. Commercially sourced as putty, paste, sheets and flexible pieces, DBM provides a degradable matrix facilitating endogenous release of these compounds to the bone wound sites where it is surgically placed to fill bone defects, inducing new bone formation and accelerating healing. Given DBM's long clinical track record and commercial accessibility in standard forms and sources, opportunities to further develop and validate DBM as a versatile bone biomaterial in orthopedic repair and regenerative medicine contexts are attractive.     

Receptor tyrosine kinase inhibition causes simultaneous bone loss and excess bone formation within growing bone in rats

During postnatal skeletal growth, adaptation to mechanical loading leads to cellular activities at the growth plate. It has recently become evident that bone forming and bone resorbing cells are affected by the receptor tyrosine kinase (RTK) inhibitor imatinib mesylate (STI571, Gleevec®). Imatinib targets PDGF, ABL-related gene, c-Abl, c-Kit and c-Fms receptors, many of which have multiple functions in the bone microenvironment. We therefore studied the effects of imatinib in growing bone. Young rats were exposed to imatinib (150 mg/kg on postnatal days 5-7, or 100 mg/kg on postnatal days 5-13), and the effects of RTK inhibition on bone physiology were studied after 8 and 70 days (3-day treatment), or after 14 days (9-day treatment). X-ray imaging, computer tomography, histomorphometry, RNA analysis and immunohistochemistry were used to evaluate bone modeling and remodeling in vivo. Imatinib treatment eliminated osteoclasts from the metaphyseal osteochondral junction at 8 and 14 days. This led to a resorption arrest at the growth plate, but also increased bone apposition by osteoblasts, thus resulting in local osteopetrosis at the osteochondral junction. The impaired bone remodelation observed on day 8 remained significant until adulthood. Within the same bone, increased osteoclast activity, leading to bone loss, was observed at distal bone trabeculae on days 8 and 14. Peripheral quantitative computer tomography (pQCT) and micro-CT analysis confirmed that, at the osteochondral junction, imatinib shifted the balance from bone resorption towards bone formation, thereby altering bone modeling. At distal trabecular bone, in turn, the balance was turned towards bone resorption, leading to bone loss.     

Short- to mid-term effects of ovariectomy on bone turnover, bone mass and bone strength in rats

To determine the short- to mid-term effects of ovariectomy on bone turnover, bone mass and bone strength in rats. SD rats aged 12 weeks were randomly divided into No-treatment, Sham and OVX groups. The rats were sacrificed for sample collection at week 0, week 4 and week 18 after surgical operation. Chemistries in serum and urine were measured by standard colorimetric methods and bone turnover markers were measured by ELISA kits. Bone mass and bone strength were determined using pQCT system and three-point bending tests, respectively. At week 4, OVX rats showed drastic increase in the level of urine Ca, P and DPD. At week 18, in OVX rats the levels of serum ALP, urine DPD and Ca were much higher and the level of serum Ca was much lower when comparing with Sham rats. Ovariectomy produced significant reduction in cancellous BMD, total BMD and SSI of proximal tibial metaphysis rapidly at week 4 and continuously at week 18 after surgical operation. However, no marked changes of bone mass and bone strength were found in the diaphysis of tibia and femur, respectively. The current study concluded that ovariectomy induced the uncoupling of bone turnover, and the proximal metaphysis of long bone was the sensitive site for the short- to mid-term effect of ovariectomy, demonstrated as the markers of bone mass and stress strain index.     

单纯自体骨联合Bio-oss骨粉修复牙周牙槽骨缺失患者的临床对比研究

目的研究单纯自体骨同Bio-OSS骨粉联合修复牙周牙槽骨缺失患者的临床效果,评价其临床价值。方法选择本院2009年5月-2011年11月门诊接受治疗的牙槽骨缺失患者35例作为研究对象,将所有患者随机分为单纯自体骨组和Bio-OSS联合联合组。其中,单纯自体骨组中18例患者18颗牙槽骨缺失;Bio-OSS联合组17例患者18颗牙槽骨缺失。自体骨组患者中使用合适的钻针并使用自体骨碎屑注入牙槽骨缺失部位。Bio-OSS联合组患者在植入螺纹种植体后,并联合Bio-OSS人工骨,将二者混合植入牙槽骨缺失区域。对比两组患者在手术后种植体周围骨组织的相对高度,并比较患者的疼痛程度。结果两组患者实行植入手术后均随访3-12个月,所有患者缺失牙槽骨均生长良好,但Bio-OSS联合组的新生骨量较单纯植入骨组多,患者进行二次手术的比例显著低于单纯自体骨组。两组患者的疼痛程度无明显差异。结论在牙种植手术制备过程中收集到的自体骨碎屑可以作为填充牙周骨缺失部位的有用材料,减少了二次手术的概率,提高了手术一次成功性,避免自体骨再次使用。自体骨联合Bio-OSS混合植入具有较好的效果,值得于临床广泛使用。