扭矩在动物骨移植中的应用

报道在同一狗体上同时进行带和不带血管蒂二种类型的骨移植术,手术后2、3、4、5、6月时测定双侧移植骨部的扭矩及扭转角,并作分析比较,得出以下结论:(1)在同一动物体中,测定双侧移植骨连接部的扭矩和扭转角,以判断二种手术后骨愈合的过程和程度,是一个较为客观可靠的方法。(2)决定移植骨连接部力学强度的主要因素是骨的愈合程度,术后2月时的部分,3月后的全部,移植骨连接部的力学强度实际上都大于稍细完整骨部的力学强度。(3)双侧扭矩均有随时间而逐渐加强的趋势,移植骨愈合早期,骨表现为橡皮样性质——低扭矩、低坚强度和较大的角形变:中晚期表现为硬组织样性质—高扭矩、高坚强度和较小的角形变,(4)带血管蒂骨移植侧力学强度明显优于不带血管侧。     

狗下颌骨缺损带与不带血管的骨块游离移植

用犬进行带血管与不带血管的游离骨瓣移植修复下颁骨缺损,观察其骨愈合过程的差异,经99mTC扫描,X线摄片及血管造影,病理组织学等检查,结果表明:移植骨在3cm长的情况下,带与不带血管移植愈合过程基本相似,供骨与受骨均有成骨作用,与骨折后通过骨痂愈合过程相类似。     

旋髂深血管蒂髂骨瓣游离移植即刻修复下颌骨缺损(附15例报告)

本文报告了用旋髂深血管蒂髂骨瓣游离移植即刻修复下颌骨缺损共15例。对Taylor 的手术方法作了采些改进。带血管蒂的髂骨瓣移植成话后对感染具有极强的抵抗力。特别适用于受区已有明显感染而需立即植骨的病例。     

带真皮下血管网游离植皮修复指端缺损

目的介绍带真皮下血管网游离植皮修复指端缺损的手术方法．手术适应征及临床疗效。方法上臂内侧取与创面大小相符的带真皮下血管网皮片,指端缺损创面经过清创,如有指骨及肌腱外露,经过软组织转移覆盖或咬去部份骨皮质后可一期植皮修复创面。 １９９７年至 １９９８年临床应用２５例,创面最大面积为 ３．０ ｃｍ~（２）,最小为 １．０ ｃｍ~（２）。结果　皮片全部成活,残端外形满意。经随访４个月至 １年,皮片的质量,质地感觉和伤指的使用情况均满意。结论该手术方式适应征广,尤其适用于缺损面积较大的指端缺损。手术方法简单,残端功能评价优良。     

Reconstruction of large limb bone defects with a double-barrel free vascularized fibular graft

Background The use of a free, vascularized fibular graft is an important technique for the reconstruction of large defects in long bones. The technique has many advantages in strong, tubular bones; a more reliable vascular anatomy with a large vascular diameter and long pedicle is used, minimizing donor-site morbidity. Due to limitations in both fibular anatomy and mechanics, they cannot effectively be used to treat large limb bone defects due to their volume and strength.
Methods From 1990 to 2001, 16 clinical cases of large bone defects were treated using vascularized double-barrel fibular grafts. Patients were evaluated for an average of 10 months after surgery.
Results All the patients achieved bony union; the average bone union took 10 months post surgery, and no stress fractures occurred. Compared with single fibular grafts, the vascularized double-barrel fibular grafts greatly facilitate bony union and are associated with fewer complications, suggesting that the vascularized double-barrel fibular graft is a valuable procedure for the correction of large bone defects in large, long bones in addition to enhancing bone intensity.
Conclusions The vascularized double-barrel fibular graft is superior to the single fibular graft in stimulating osteogenous activity and biological mechanics for the correction of very large bone defects in large, long bones. Free vascutarized folded double-barrel fibular grafts can not only fill up large bone defects, but also improve the intensity margin. Therefore, this study also widens its application and enlarges the treatment targets. However, in the case of bone deformability, special attention should be paid to bone fixation and protection of donor and recipient sites.     

FREE VASCULARIZED BONE GRAFT

Taylor reported clinical use of vascularized bone grafts first in 1975. 212 dried human fi- bulae for total length, circumference and nu- trient artery were studied. Angiographies were then done on fresh limb specimens after 6 amputations to locate the branches of posterior tibial vascularization, find out the peroneal ar- tery diameter, etc, locating the favorable spot for anastomosis. Bone deficiencies after osteomyelitis, tumor or trauma in 7 patients in which free vascularized bone grafts were used, the length of isolated fibula varying from 10-20 cm are reported and postoperative 113M In-EDTMP examination showed that blood supply to the grafts were adequate and bone healing and limb functional restoration satisfactory. The vascular supply of living bone and heterogenous living fibula grafts for limb tubu- lar bone loss as the procedure of choice are discussed.     

带血管与不带血管神经移植再生组织的形态学对比观察

研究目的探讨带血管与不带血管神经移植术，神经纤维再生的组织学差异。研究背景Taylor首次以带血管的神经移植获得成功。但对于不带血管神经移植的实质缺乏系统对比资料。方法SD雄性大鼠50只，随机分组，6只为正常对照组，其余等分为A组（带血管的神经移植组）和B组（不带血管的神经移植组），两组在移植后不同时间取材，进行光镜、电镜对比观察。结果在移植后的前4周，A、B两组组织学形态变化基本相似。从第6周起，A组较B组结缔组织少，神经纤维再生好。B组神经束内有结缔组织包括几条神经纤维的小束，再生而又退变的神经纤维多。结论带血管的比不带血管的神经移植，神经纤维再生好，因前者血供好，结缔组织再生少，有利于再生神经纤维的生长。     

吻合血管腓骨皮瓣组合异体骨移植修复下肢软组织伴大段骨缺损

目的：探讨在下肢软组织伴大段骨缺损患者中应用吻合血管腓骨皮瓣组合异体骨移植的临床疗效。方法：选取2005年5月~2009年5月于我院住院治疗的12例下肢软组织伴大段骨缺损患者为观察组,采用吻合血管腓骨皮瓣组合异体骨移植治疗进行修复。选取2000~2004年行腓骨皮瓣治疗的16例患者为对照组。结果：所有患者随访12~40个月,所有皮瓣全部成活,术后3~8个月后异体骨与腓骨愈合。观察组Enneking评分显著优于对照组,两组肢体功能恢复（91.7%vs 80.7%）,差异有高度统计学意义（P〈0.01）;两组关节优良率分别为91.7%（11/12）、81.3%（13/16）,差异有统计学意义（P〈0.05）。结论：应用吻合血管腓骨皮瓣组合异体骨移植治疗下肢软组织伴大段骨缺损,自体骨与异体骨愈合良好,可改善患肢功能并减少伤残率。     

吻合血管的兔下颔部复合组织自体原位移植

本文报告10例吻合血管的兔下颌部复合组织自体原位移植。这一复合组织的营养血管颌外动脉和面前静脉,采用标准显微外科技术进行吻合;其通畅率均达到100％。术后移植物皮肤伤口愈合良好,平均9.2d皮肤被毛开始生长,3～4周时,被毛已完全覆盖移植物,移植区外观形同正常。本实验表明,应用复合组织原位移植修复颌面部缺损,具有良好的修复作用,能够获得满意的美学效果。     

放射性核素铟用于动物骨移植的观察

本文介绍在同一狗体上,同时做右侧胫骨带血管蒂、左侧胫骨不带血管蒂的原位游离骨移植术。术后分别于第1、2天,1、2、3、4、5、6月,用113m铟-潘替磷酸对植骨部作骨扫描观察,共15例。实验发现,术后第10天开始作放射性核素测定较能反映植骨部的真实情况:术后4月内,左侧骨修复持续活跃,而右侧渐趋向稳定和下降;术后6月时,骨修复仍然左侧强于右侧:双侧后肢负重右侧比左侧早0.5～1月。