异种骨和人工骨修复骨肿瘤性骨缺损

背景:自体植骨是修复骨肿瘤刮除后骨缺损最理想的材料和方法,但存在增加手术创伤,取骨部位的后遗症如感染和疼痛及自体骨的取量有限等缺点。目的:分析硫酸钙人工骨和异种骨修复良性骨肿瘤刮除后骨缺损的临床疗效。方法:选择26例良性骨肿瘤患者,其中骨巨细胞瘤8例,内生软骨瘤5例,纤维组织细胞瘤4例,骨纤维异样增殖症3例,非骨化性纤维瘤2例,骨囊肿2例,动脉瘤样骨囊肿和软骨母细胞瘤各1例。12例采用单一硫酸钙骨粒填充肿瘤切除后的骨缺损,6例采用单一异种骨条填充肿瘤切除后的骨缺损,8例采用硫酸钙骨粒+异种骨条填充肿瘤切除后的骨缺损。治疗后1周内、3个月、1年拍X射线片检查,了解植骨愈合情况。结果与结论:治疗后随访36-72个月,发现硫酸钙骨粒的降解发生较早,一般治疗后1个月就开始出现骨粒降解,3个月大部分已降解完毕并有骨替代发生,1年骨修复塑型良好;异种骨条3个月后降解并有骨替代发生,植骨充填物边缘模糊,6个月后骨缺损及充填物之间边界变模糊,有融合现象,1年骨缺损内密度均匀,骨小梁形成明显,骨修复良好;骨粒+骨条混合植骨者介于单纯硫酸钙骨粒和单纯异种骨条之间,出现骨粒部分先降解先修复、骨条部分后降解后修复,一般术后1年达到骨性愈合。说明硫酸钙人工骨和异种骨在骨肿瘤性骨缺损修复应用中的效果良好,在良性骨肿瘤刮除后植骨可以替代自体骨植骨。     

重组合异种骨修复良性骨肿瘤及瘤样病变骨缺损

目的研究重组合异种骨(RBX)修复良性骨肿瘤及瘤样病变刮除术后遗留的骨缺损的临床应用价值。方法应用 RBX 修复64例良性骨肿瘤及瘤样病变刮除术后遗留的83处骨缺损。患者平均年龄26.5 岁,肿瘤类型依次为骨囊肿、骨纤维结构不良、内生软骨瘤、骨样骨瘤、动脉瘤样骨囊肿、非骨化性纤维瘤等,观察患者术后全身及切口局部反应,相关免疫学检测,X 线片检查,平均随访时间14个月。结果全部患者未见明显全身反应,相关免疫学检测无明显异常,随访见所有患者术后3～6个月均有 RBX 降解和骨替代现象发生。结论良性骨肿瘤及瘤样病变刮除后利用 RBX 填充修复骨缺损,无明显不良反应,并发症少,经骨替代后可真正完成骨修复。     

硫酸钙人工骨和异种骨修复良性骨肿瘤刮除后骨缺损的机制及近、远期疗效分析

目的探讨硫酸钙人工骨和异种骨修复良性骨肿瘤刮除后骨缺损的机制及近、远期临床疗效。方法选取我院骨科2010年6月~2013年6月收治的良性骨肿瘤患者82例,随机分为实验组和对照组,每组各41例。实验组患者植入医用硫酸钙人工骨颗粒,对照组患者植入重组合异种异体骨,观察患者术后1个月、3个月、6个月、1年时植入骨的降解、吸收、及愈合生长情况。结果实验组患者在术后4w即开始出现硫酸钙骨粒的降解,术后3个月时植入的硫酸钙骨粒已大部分降解完毕并有大量新骨生成,与周围组织无法区分,术后6个月时硫酸钙颗粒已完全吸收并被新骨替代,术后1年骨修复塑形良好;而对照组患者在术后3个月可看到植入骨的降解和新骨的生成,术后6个月时填充物与骨缺损边界模糊,有融合现象,术后1年可看到骨缺损内骨密度均匀,骨小梁明显形成,骨修复良好。结论硫酸钙人工骨颗粒降解速度快,适合非负重部位骨肿瘤刮除后骨缺损的填充,重组合异种骨降解速度慢,适合负重部位骨肿瘤刮除后骨缺损的填充,二者均排异反应小、后期塑形效果显著,可在良性骨肿瘤刮除后骨缺损修复中替代自体骨植骨。     

含BMP的骨填充材料在骨肿瘤与瘤样病变手术中的应用

目的 探讨含骨形态发生蛋白(BMP)的骨填充材料在骨肿瘤及瘤样病变手术中的临床应用价值。方法本组骨肿瘤及瘤样病变患者34例，男20例，女14例。骨填充材料(金骨威、金世植骨灵)应用方法：病灶刮除术骨缺损填充：灭活术后骨缺损填充；病灶切除后在骨干一假体结合部或骨干一同种异体1／4关节结合部植入骨填充材料。肿瘤及瘤样病变类型包括骨纤维结构不良、骨巨细胞瘤、骨肉瘤、骨囊肿、动脉瘤样骨囊肿、内生软骨瘤、软骨粘液样纤维瘤、非骨化性纤维瘤、骨母细胞瘤。观察患者术后全身及局部反应和影像学变化。结果平均随访时间13．5个月。全部患者均无全身不良反应，除1例创口二期愈合外，余病例未见明显局部反应。X线片显示术后3～6个月即有填充材料降解和骨替代现象发生。结论在骨肿瘤与瘤样病变手术中应用含BMP的骨填充材料代替自体或异体骨移植，不增加创伤，并发症少，术后基本无不良反应，且骨缺损修复效果满意，是理想的骨缺损填充材料。     

陶瓷人工骨修复32例成人良性骨肿瘤和瘤样病变刮除后骨缺损

目的评估陶瓷人工骨填充成人良性骨肿瘤和瘤样病变刮除后骨缺损的疗效及潜在并发症。方法回顾性分析2013年1月至2017年6月在本院行病灶刮除植骨的良性骨肿瘤和瘤样病变患者资料。共纳入32例,男17例,女15例,平均年龄34.2(18～57)岁。平均病变体积25.0(0.1～169.6)cm3。平均植入人工骨4.0 g(0.2～10 g)根据X线片表现以改良Neer法评估骨愈合、材料吸收和病变复发情况。Goslings和Gouma法评估术后并发症。结果平均随访1.8(0.5～6)年,Neer分级6例Ⅰ级,26例Ⅱ级。2年以上随访11例,7例骨皮质增厚,3例材料完全吸收。1例手部内生软骨瘤术后发生骨折,并发症分级为Ⅰ级。随访期间未发现病变复发。所有患者均恢复肢体正常功能。结论该人工骨填充成人良性骨肿瘤和瘤样病变刮除后骨缺损效果可靠,并发症少,但材料吸收较慢。     

瘤段截骨加热70℃蒸馏水中15min:灭活回植治疗腓骨近端骨肿瘤

背景:骨肿瘤治疗的目标不仅仅是完整切除肿瘤组织,而且应最大限度的修复组织缺损并恢复受损功能,自体灭活骨是具有实用价值的移植和重建材料。目的:探讨改良Malawer法结合瘤段截骨灭活回植治疗腓骨近端骨肿瘤的效果。方法:内蒙古医科大学附属医院骨科2007年以来收治5例6侧腓骨近端肿瘤患者,分别采用股骨下段截肢、瘤腔内刮除植骨、腓骨上段截骨肿瘤切除+瘤段截骨加热(70℃蒸馏水中加热15 min)灭活回植内固定治疗,随访观察治疗效果。结果与结论:1例截肢患者随访4年未见肿瘤复发和全身转移;1例瘤腔内刮除植骨患者术后1年复发;3例腓骨上段截骨肿瘤切除加热灭活回植内固定患者随访5个月,行走功能接近正常,膝关节外侧结构愈合好,拍片显示灭活骨截骨部尚未愈合,骨痂形成不明显,局部未见肿瘤复发,内固定无松动,灭活骨无骨折和吸收迹象。结果证实截肢和肿瘤刮除都有较明显的局限性;在Malawer术式基础上将瘤段截取骨灭活后回植能更好地保证小腿骨骼结构的完整性,原位重建膝关节外侧的股二头肌腱和侧副韧带止点,但灭活骨血运重建和愈合会随着灭活温度的提高而变得困难和缓慢,因而患者术后支具保护的时间应予以相对延长,允许剧烈运动的时间需要延迟,避免出现骨折等并发症。     

硫酸钙人工骨在良性骨肿瘤刮除术后骨缺损填充中的愈合情况及其重建作用研究

目的观察硫酸钙人工骨在良性骨肿瘤刮除术后骨缺损填充中的愈合情况,探讨其在骨肿瘤患者中的重建作用。方法回顾性分析在2010年1月~2013年9月期间,我院骨外科收治的临床随访资料完整的良性骨肿瘤患者,根据植骨材料的不同,分别采用硫酸钙人工骨、同种异体骨以及自体骨修复肿瘤刮除术后骨缺损。每组各选择随机样本40例。根据术后随访的X线结果和相关临床资料。评估不同移植骨在良性骨肿瘤缺损填充中的降解、吸收和愈合情况。结果 120例患者获得3~48个月随访,平均随访时间14.7个月。随访期自体骨组、硫酸钙人工骨组和同种异体骨组均未发生深部感染、植骨不愈合、伤口不愈合、植骨部位骨折及肿瘤复发等相应的并发症,临床获益率达100%。三组病例在骨愈合时间无统计学意义,愈合率也无显著性差异(0.05)。结论用硫酸钙人工骨材料填充良性骨肿瘤刮除后的骨缺损,愈合效果与自体骨和同种异体骨相近。且硫酸钙人工骨生物相容性好,并发症少,值得在临床上推广。     

髋部骨肿瘤患者行定制人工髋关节置换的体会

目的探讨定制人工髋关节假体在髋部骨肿瘤保肢术中的应用疗效。方法收集我院自1999年3月~2010年10月因髋部骨肿瘤行定制人工假体置换术病例,按照Enneking标准评价术后肢体功能,并分析术后并发症。结果本组病例中,38例获得良好随访,随访时间为14个月~8年﹙平均55个月﹚,其中髋臼9例,股骨近端29例;肿瘤类型:骨巨细胞瘤12例,软骨肉瘤4例,良性纤维组织瘤10例,骨肉瘤8例,复发性软骨瘤2例,动脉瘤性骨囊肿2例,本组病例;术后肢体功能:优﹙≥23分﹚11例,良﹙15~22分﹚19例,差﹙<15分﹚8例,平均19.8分,优良率为78.95%;1例术后出现假体脱位,成功手法复位。结论定制人工髋关节假体置换术后患者肢体功能恢复较快,是髋部骨肿瘤较为满意的一种保肢治疗方法。     

人工假体置换与骨肿瘤保肢后的骨缺损修复②

<正>6人工髋关节假体在股骨近端转移性肿瘤中应用13例施林军(重庆医科大学附属第一医院骨科,重庆市400016)推荐理由:文章回顾性分析股骨近端转移性骨肿瘤患者13例。全部病例均经病理证实为转移性骨肿瘤,并采用病灶刮除+人工髋置换治     

人工全髋关节置换治疗股骨近端骨肿瘤:疗效及安全性分析

背景:随着医疗水平的提高,肢体恶性肿瘤保肢手术的价值日益提高,目前已替代截肢,成为当今肢体肿瘤外科治疗的主流与发展方向。但目前为止,对股骨近端肿瘤还没有统一的手术适应证,仍存在争议。目的:观察人工全髋关节置换联合瘤段扩大切除治疗股骨近端骨肿瘤的效果。方法:选取中南大学湘雅二医院收治的股骨近端骨肿瘤患者并随机分为对照组和观察组,每组30例。对照组患者根据病情选择病灶刮除,瘤体壁灭活,自体和(或)异体骨、人工骨混合植骨后行植入物内固定治疗。观察组患者接受瘤段扩大切除加人工全髋关节置换治疗。比较两组患者手术时间、术中术后出血量、住院时间及关节功能情况。2年后对患者进行回访,比较两组患者的转移复发率、死亡率以及生活质量。结果与结论:两组患者手术时间及术中出血量间无显著性差异(P0.05),但观察组患者住院时间短于对照组,关节功能恢复优良率(83%)高于对照组(53%),术后2年内转移复发率(7%)和死亡率(3%)均低于对照组(30%,23%)。观察组患者生活质量各项指标均优于对照组,差异有显著性意义(P0.05)。提示人工全髋关节置换治疗股骨近端骨肿瘤安全有效。     

Modes of reinforcement and gender and culture of experimenter and subject: effects of "alien" and external reinforcement for Japanese and American men and women

In this study, we examined external and "alien" reinforcement (ER and AR. respectively) as a factor in social learning, and studied the combined effects of culture and reinforcement mode. A female (Experiment 1) and a male (Experiment 2) experimenters conducted experimental sessions. Both men and women, who grew up in the same culture as the experimenter, participated and performed the experimental task. A three-way interaction effect of experimenter gender, culture, and reinforcement mode was found on task performance. And the effect was more pronounced for a Japanese experimenter. A female and a male experimenters conducted Experiments 3 and 4, respectively; however participants this time were men and women who grew up in different cultures than the experimenter. Results indicated that the pattern of the subject gender and reinforcement mode interaction effect, when the experimenter was Japanese with American subjects, was exactly opposite to that when the experimenter was American. These experiments showed that AR was as effective for social learning as ER, and that the cultural backgrounds of experimenter and subject influenced AR and ER effectiveness.     

Rates of oxygen consumption and of anaerobic glycolysis in renal cortex and medulla of adult and new-born rats and guinea-pigs

1. Rates of oxygen uptake and of anaerobic glycolysis were estimated in slices from the renal cortex and medulla (a) of adult rats and guinea-pigs, (b) of new-born (1-, 5- and 21-day-old) rats and of guinea-pigs of 1, 12, 21, 24 and 120 hr age.2. In the adult rat, Q(O2) values for the cortex were 12.55 +/- 0.20 (22) and for the medulla: 8.56 +/- 0.17 (22) mul./hr.mg dry weight, while in the new-born rat (24 hr old) they were 10.99 +/- 0.46 (12) and 9.33 +/- 0.18 (9) mul./hr.mg dry weight respectively.3. Values for Q(CO2) (N2) (anaerobic glycolysis) in the 14 hr old new-born rat were in the renal cortex 9.65 +/- 0.35 (5) and in the medulla 7.39 +/- 0.43 (5) mul./hr.mg dry weight; while in the adult they were 2.25 +/- 0.08 (16) and 5.76 +/- 0.14 (16) mul./hr.mg dry weight, respectively.4. In the adult guinea-pig values for Q(CO2) (N2) were of the same order as in the adult rat, though the rate of O(2) uptake was for the cortex 8.12 +/- 0.22 (12) and for the medulla 5.02 +/- 0.23 (11) mul./hr.mg dry weight.5. Though the Q(O2) values in the renal cortex and medulla were smaller in the 1 hr old new-born guinea-pig, they were already increasing in the 12 hr old neonate.6. The results are discussed in the light of enzyme changes occurring during the process of maturation of the nephron as indicated by histochemical observations.     

Timing and intensity of early fevers and the development of allergies and asthma

BACKGROUND: Early childhood fevers appear to protect against later allergies and asthma. What is not known is the time in which fevers exert this effect and whether the degree of temperature increase is important. OBJECTIVE: We sought to examine the relationship between the time and degree of early fevers and later allergies and asthma. METHODS: Eight hundred thirty-five children from southeast Michigan were enrolled at birth. Clinic records from their first 2 years were abstracted for episodes of fever. At age 6 to 7 years, children underwent allergy testing. We examined fevers occurring within 6-month intervals in the first 2 years of life and outcomes at age 6 to 7 years. The primary outcome measures were allergic sensitization, asthma, asthma with allergic sensitization, and asthma without allergic sensitization. RESULTS: In the unadjusted analysis each episode of fever between 7 and 12 months of age was associated with a lower odds of allergic sensitization (odds ratio [OR], 0.71; 95% CI, 0.54-0.93) and asthma with allergic sensitization (OR, 0.43; 95% CI, 0.21-0.90) at age 6 to 7 years. Likewise, every 1 degrees C increase in the maximum temperature between 7 and 12 months was associated with a lower odds of allergic sensitization (OR, 0.77; 95% CI, 0.61-0.96) and asthma with allergic sensitization (OR, 0.62; 95% CI, 0.40-0.94). After adjusting for potential confounders, each episode of fever between 7 and 12 months was associated with a lower likelihood of asthma with allergic sensitization (adjusted OR, 0.33; 95% CI, 0.11-0.94) at age 6 to 7 years. CONCLUSIONS: Both the timing and intensity of childhood fevers appear to be important factors in the development of allergies and asthma.     

纳米水平分子成像与诊疗一体化研究进展与挑战

分子成像能以非侵入性的方式重现活体细胞的生理功能和生物学过程,提高疾病的早期和特异性诊断水平。纳米颗粒/材料具有物理性质可控性高、易于表面修饰、血液循环时间长和可功能化等优点,在疾病诊断与治疗中显示出巨大潜力。但如何阐明纳米材料多功能间的内在联系、解决其代谢及安全性等关键机制难题、实现纳米颗粒/材料多功能性到临床多功能...