应用复合脱蛋白骨移植治疗新鲜长骨骨折——一种前瞻性临床 …

比较观察复合脱蛋白牛松质骨和自体松质骨移植治疗长骨鹇骨折的疗效。采用前瞻性临床实验,按随机数字表分为实验组和对照组,实验组接受脱蛋白牛松质骨复合自体骨髓治疗,对照组接受自体松质骨溶愈合率及各种并发症均无显著性差异（Ｐ〉０．０５）,但自体骨移植组手术时间明显长于牛松质骨组（Ｐ〈０．０５）,且供骨部有３０％出现疼痛并有２例感染。认为对于需骨移植的长骨鹇性骨折应用脱蛋白牛松质骨复合自体红骨髓移植治疗,其     

脱蛋白牛松质复合骨在脊柱后外侧融合术中的应用

目的 比较观察脱蛋折牛松质复合骨和自体髂骨移植融合脊柱后外侧疗效。方法 随机分治疗组60例和对照组59例,治疗组接受脱蛋白牛松质量复合自体红骨髓治疗,对照组接受自体松质治疗。结果 随访20个月,两组脊柱后外侧部的融合率及各种并发症均无显著性差异（P＜0.05）,对照组手术时间明显长于治疗组（P＜0.05）,且供骨部有30％左右出现疼痛并有1例感染。结论 应用脱蛋白牛松质骨复合自体红骨髓移植融合脊柱后外侧部,其疗效、安全性和自体骨移植相同,且能减少手术时间和取髂骨后所产生的并发症。     

新鲜胎儿骨移植临床应用观察

自 1994年 7月至 1996年 10月 ,我科使用新鲜胎儿骨移植治疗骨缺损、骨不连 11例 ,随诊 6月～ 2年 ,效果满意 ,报道如下。1　临床资料　　男 8例 ,女 3例 ;经病理活检证实 ,肱骨内生软骨瘤 2例 ,胫骨上段纤维结构不良 1例 ,股骨下段骨巨细胞瘤 1例 ,肱骨骨不连 3例 ,股骨骨不连 1例 ,胫骨骨不连 3例 ;最大病灶范围 10 5ｃｍ×7 2ｃｍ× 5 3ｃｍ ,为右股骨下段骨巨细胞瘤。2　治疗方法2 1　胎儿骨的制备　健康母体大月份死胎儿 ,娩出 8小时内。无菌操作取四肢长骨及髂骨 ,去除软骨和骨膜 ,0 6Ｎ稀盐酸浸泡 1小时 ,部分脱钙 ,大量无菌生理…     

可吸收螺钉内固定+自体骨移植治疗新鲜舟状骨腰部骨折

1997年6月~2004年10月,我院采用可吸收螺钉内固定 自体骨移植治疗新鲜舟状骨腰部骨折18例,疗效满意。1材料与方法1.1病例资料本组18例,男15例,女3例,年龄15~41岁。左手6例,右手12例。致伤原因:各类训练伤3例,摔伤9例,车祸伤6例。骨折根据Coon-ey分型:稳定型10例,非稳定型(移位型)8例。受伤至手术时间3~19 d,平均5·1 d。1.2手术方法以桡骨茎突顶为中心,经鼻烟壶作5 cm纵形切口,保护头静脉和桡神经浅支,切除部分桡骨茎突。以腕关节桡偏时不再与腕舟骨骨折线相抵触为准,不可过分切除,否则会引起腕关节不稳定。切除的桡骨茎突可用于骨折断端间…     

不同方法治疗踝部骨折伴随的距骨骨软骨骨折临床效果对比研究

目的 对比研究自体骨软骨移植术和骨软骨折块摘除钻孔术治疗踝部骨折伴随的急性Ⅲ、Ⅳ型距骨骨软骨骨折的临床效果.方法 2002年5月至2007年8月,38例踝部骨折伴随的急性Ⅲ、Ⅳ型距骨骨软骨骨折,术中明确距骨骨软骨骨折的部位以及范围.20例折块摘除后,自同侧膝关节非负重区钻取骨软骨柱,采取打压固定技术将骨软骨柱植入受区的孔中,为移植组;18例骨软骨折块摘除后行钻孔术为钻孔组.对比观察研究两组患者踝关节的功能、X线以及MRI表现.结果 移植组随访1.5～4.0年,平均(2.92±0.65)年,钻孔组随访2.5～5.0年,平均(3.02±0.83)年.7例行多柱移植,13例行单柱移植.根据Baird和Jackson踝关节评分系统进行功能评分:移植组平均(89.85±4.83)分,钻孔组平均(84.28±5.65)分,两组比较差异有统计学意义(t=3.277.P=0.002);X线片示移植组3例踝关节发生创伤性关节炎,发生率为15.0%(3/20),钻孔组8例踝关节发生创伤性关节炎,发生率为44.4%(8/18),两组比较差异有统计学意义(χ2=31.7,P<0.05);MRI显示移植组3例骨软骨柱松动吸收,发生距骨剥脱性骨软骨炎,占15.0%(3/20),其余修复的关节面平滑,骨软骨柱与周围组织结合良好;钻孔组6例发生距骨剥脱性骨软骨炎,发生率为33.3%(6/18),两组比较差异有统计学意义(χ2=39.6,P<0.05);两组膝关节均无远期供区并发症.结论 自体骨软骨移植治疗踝部骨折伴随的急性Ⅲ、Ⅳ型距骨骨软骨骨折是一种有效的手术方法 ,降低了踝关节创伤性关节炎和距骨剥脱性骨软骨炎的发生率,提高了踝关节的功能.     

带血管骨移植治疗骨折萎缩性不愈合

[目的]骨折断端缺乏血运可造成骨折萎缩性不愈合，通过吻合血管的腓骨、髂骨移植使骨折断端获得血运，从而达到骨性愈合。[方法]将骨不愈合端的萎缩骨、硬化骨切除，钻通髓腔，根据骨缺损的长短，切取相应带腓血管的腓骨，带旋髂深血管的髂骨移植到骨缺损处，采用钢板或单纯螺丝钉固定骨折，然后将带骨的血管蒂与受区血管吻合，恢复腓骨和髂骨的血运，术后辅以石膏外固定。[结果]25例骨折萎缩性不愈合随访8个月-3a，全部骨折愈合。其中19例3个月，5例4个月，1例6个月达骨性愈合。[结论]吻合血管的骨移植可使骨断端重新获得血运，将陈旧性骨折变成类似新鲜的骨折，骨折愈合过程不经过“爬行替代”，是治疗骨折萎缩性不愈合的理想选择。     

自体外周血干细胞与脱钙骨复合移植治疗兔桡骨缺损的实验研究

目的：观察自体外周血干细胞／脱钙骨（APBSC／DB）复合移植治疗骨损损的疗效,方法：24只家兔双侧桡骨做成长度1cm的骨缺损,随机分为APBSC／DB组和DB组,每组12只,分别进行X线,生物力学以及组织学的对比研究,结果：术后第2,4,8,14周,X线观察,改进的Gay评分及光镜观察结果显示,APBSC／DB组优于DB组,术后第14周,APBSC／DB组整骨破坏载荷和骨缺损修复形态学评分均明显优于DB组。结论：APBSC在DB的骨形态蛋白诱导下具有明显的成骨作用,因此APBSC／DB复合移植治疗骨缺损的疗效优于单纯DB移植。     

牛脱蛋白松质骨、胶原、BMP、RBM复合物修复骨缺损的实验研究

目的 探讨牛脱蛋白松质骨，胶原，骨形态发生蛋白（BMP），自体红骨髓（RBM）复合物修复骨缺损的能力及其作用自体骨移植替代材料的合理性，可行性。方法 在42只家兔双侧桡骨中段制备骨缺损模型，分为4组：牛脱蛋白松质骨，胶原，BMP，RBM复合物植入组（A1组：20侧），单纯牛脱蛋白松质骨植入组（A2组，20例），自体骨植入组（B1组：20侧），空白对照（B2组：20侧）。在2，4，8，12周分别进行大体标本观察，X线检查，病理组织学检查及生物力学测试。结果 12周时，A1组，B1组骨缺损均已完全修复，而A2组，B2组骨缺损未修复；生物力学测试术后4周A1组的最大扭矩和抗扭刚度均高于B1组，而术后8周后则无显著性差异。结论 牛脱蛋白松质骨，胶原，BMP，RBM复合物具有较强的成骨能力，可修复骨缺损，并能作为自体骨移植的一种替代材料。     

Osteoperiosteal Decortication and Autogenous Cancellous Bone Graft Combined with Bridge Plating for Non-hypertrophic Diaphyseal Nonunion

BackgroudThe aim of this study was to evaluate results of osteoperiosteal decortication and autogenous cancellous bone graft combined with a bridge plating technique in atrophic and oligotrophic femoral and tibial diaphyseal nonunion.MethodsWe retrospectively reviewed 31 patients with atrophic or oligotrophic femoral and tibial diaphyseal nonunion treated with osteoperiosteal decortication and autogenous cancellous bone graft between January 2008 and December 2018. Patients with hypertrophic nonunion, infected nonunion, and nonunion treated with autogenous cancellous bone graft alone were excluded. The nonunion site was exposed by using the Judet technique of osteoperiosteal decortication. Nonunion with a lack of stability was stabilized with a new plate using a bridge plating technique or augmented by supplemental fixation with a plate. Nonunion with malalignment was stabilized with a new plate after deformity correction. Autogenous cancellous bone graft was harvested from the posterior iliac crest and placed within the area of decortication. A basic demographic survey was conducted, and the type of existing implants, mechanical stability of the implants, the type of implants used for stabilization, the operation time, the time to bone union, and postoperative complications were investigated.ResultsThe average follow-up period was 33.3 months (range, 8–108 months). The operation time was 207 minutes (range, 100–351 minutes). All but 1 nonunion (96.7%) were healed at an average of 4.2 months (range, 3–8 months). In 1 patient, bone union failed due to implant loosening with absorbed bone graft, and solid union was achieved by an additional surgery for stable fixation with a new plate, osteoperiosteal decortication, and autogenous cancellous bone graft. There were no other major complications such as neurovascular injuries, infection, loss of fixation, and malunion.ConclusionsOsteoperiosteal decortication and autogenous cancellous bone graft combined with stable fixation by bridge plating showed reliable outcomes in atrophic and oligotrophic diaphyseal nonunion. This treatment modality can be effective for treating atrophic and oligotrophic diaphyseal nonunion because it is very helpful stimulating bone union.     

Tensile Fracture of Cancellous Bone

Excised specimens of cancellous bone from human femora were subjected to compressive or tensile testing, and the resulting force-displacement curves were recorded. the relationships between bone strength and apparent density were similar for specimens tested in these two loading modes. the modulus of elasticity was also comparable for the tensile and compressive specimens. Specimens loaded in compression absorbed considerable energy after the initial fracture because of progressive impaction of the trabecular in the specimens loaded in tension, the fractured bone fragments separated and therefore absorbed little additional energy after the initial failure. the energy absorption capacity was thus significantly lower for the tensile specimens.

The results of this study show that the primary difference in mechanical properties of cancellous bone tested in tension and compression is the energy absorption capacity. This finding suggests that tensile and avulsion fractures of cancellous bone observed clinically are associated with minimal energy absorption and therefore may be precipitated by relatively minor trauma.     

自身骨泥在长管状骨骨折中的应用与实验研究

探讨长管状骨钢板内固定产生的自身骨泥有无骨诱导活性,能否作为植骨材料及其临床应用。采用22只兔桡骨钻孔采集的骨泥股部肌肉内植入,在二周时五只兔做ECT检测,在一、二、三周取材,做组织形态学观察和碱性磷酸酶(ALP)检测。另5只兔桡骨中段骨折模型一侧自身骨泥植骨、对侧对照,二周做ECT检测。研究结果显示:自身骨泥植入兔肌袋内一周软骨生长,三周网织骨形成;ALP二周水平最高;二周ECF检查肌肉植入区出现放射性浓集,放射性计数明显高于对侧正常肌肉(P<0.05)。骨折模型植骨ECT计数比值明显高于对侧(P<0.05)。52例56处长管状骨钢板内固定自身骨泥植骨取得了良好效果,无一侧骨延迟愈合或骨不连。结果表明长管状骨内固定产生的自身骨泥具有诱导成骨活性,可做为植骨材料,应用于长管状骨骨折钢板内固定一期植骨,可望促进骨折愈合。     

髌骨骨折空心拉力螺钉组合张力带固定的生物力学

目的：比较空心拉力螺钉组合张力带与常用AO,改良张力带及松质骨螺钉固定髓骨骨折的生物力学强度。方法：取20具膝关节标本,随机分为4组,制成骨折模型,用四种方法固定,用WD－10E电子力学实验机测定四种内固定的抗张强度,骨折端分离1．0mm为固定失效,结果：四种固定方法均能满足420N股四头肌收缩力,但与其它三种内固定方法相比,空心拉力螺钉抗张强度最大（P＜0．05）,AO张力带抗张强度最小,松质骨加压螺丝钉固定欠可靠,结论：治疗髌骨骨折应首选空心拉力螺钉加张力带钢丝固定。     

同侧下肢长骨骨折并急性膝关节不稳定的治疗

自1985年至1993年我院收治同侧下肢长骨骨折并急性膝关节不稳定病人24例,采用早期手术内固定治疗长骨骨折,短期内二次手术处理膝关节不稳定及次要骨折部位。经6个月至9年的随访,优良率达75％。本文强调对长骨骨折行坚强内固定术后,对膝关节不稳定明确诊断,尽早处理,全面修复。     

Tubular Remodeling of Massive Cancellous Bone Graft in the Treatment of Long Bone Defects

Abstract Background: This case report describes the clinical and radiological result at the 4.5-year follow-up after an extensive reconstruction of the femoral diaphysis using autologous cancellous bone graft. The radiological study including axial tomography demonstrates secondary remodelling to form tubular diaphyseal bone. Methods: A patient with an existing hip fusion, who sustained a fracture of the proximal femur 12 years later, was treated by open internal fixation using a plate and screws. Infection followed which became chronic, causing bone resorption and necrosis and producing a septic non-union. Reconstruction in two stages was performed: open radical debridement which ended with a 14.5 cm diaphyseal defect of the femur, temporary alloplastic spacer interposition and secondary de-arthrodesis of the hip with massive autologous cancellous grafts into the induced foreign body membrane left by the spacer. Fixation was provided by a plate and screws. Results: The femur was free of infectious recurrence at 4.5 years. The patient walks without crutches with a shortened lower limb using a leg length compensation shoe and a painfree sine-sine hip arthroplasty. The former bone defect is fully remodelled into new cortical bone. X-ray and CT-scan demonstrate the tubular form of the reconstructed bone. Conclusion: This clinical case demonstrates the restoration of a medullar cavity after massive cancellous bone grafting of a diaphyseal defect of the femur. The question remains open as to whether the foreign body membrane has only a simple passive protective function against extraosseous bone resorbing factors or whether it functions actively by producing growth factors or other beneficial bone inducing factors.     

富血小板血浆重组脱蛋白异种骨修复兔桡骨骨缺损的放射学评估

目的从放射学方面来评价富血小板血浆重组脱蛋白异种骨修复节段性骨缺损的疗效。方法新西兰大白兔28只,采用二次离心法制成PRP,将PRP与激活剂按5：1比例制成PRP凝胶。在右桡骨中下段造一长1 cm的骨缺损,随机分空白组、实验组、对照组。术后第2、4、8、12周分别对3组家兔行尺桡骨X线检查,根据Lane骨移植X线片评分了解两侧桡骨骨缺损区修复情况。结果术后伤口愈合良好,实验侧Lane骨移植X线片评分明显高于对照侧。结论复PRP异种脱蛋白骨可用于节段性骨缺损的修复,动物卖验证明PRP在骨缺损的修复中具有促进作用。     

骨形态发生蛋白复合同种松质骨载体修复节段性骨缺损的实验研究

目的　本实验将探讨同种松质骨作为 BMP的载体修复节段性骨缺损。方法　将 rh BMP- 2复合同种松质骨载体 (其中含 rh BMP- 2 0 .4 mg)植入兔桡骨 15 m m人工缺损处 ,以新鲜自体松质骨植入 ,单纯同种松质骨植入作为对照 ,通过放射学骨缺损修复 L ane评分 ,Nilsson骨愈合组织学评分 ,扫描电镜观察 ,比较术后 4、8、12周各组修复骨缺损的效果。结果　 rh BMP- 2复合同种骨载体组术后 4、8、12周各项评分与同期自体骨组之间无显著性差异 (P>0 .0 5 ) ,明显优于单纯同种骨组 (P<0 .0 5 )。结论　 rh BMP- 2具有高效的骨诱导能力。同种骨是一种较理想的 BMP载体 ,rh BMP- 2复合同种松质骨载体的骨修复效果与自体骨基本一致     

复合组织移植治疗创伤性慢性跟骨骨髓炎

目的 探讨复合组织移植治疗慢性创伤性跟骨骨髓炎.方法 1987年8月～2005年8月,应用复合组织瓣修复慢性跟骨骨髓炎或皮肤软组织缺损患者47例,男31例,女16例,年龄24岁～58岁.结果 一期消灭死腔,改善局部血运,效果满意.结论 取得良好疗效主要关键是彻底清创,合适肌皮瓣的应用和术后早期冲洗创口.