膝关节腔内注射皮质类固醇对关节软骨损害的研究——病理组织…

３０只健康新西兰白兔，随机分为两组，每组１５只，Ａ组右膝关节腔内注射醋酸强的松龙，每次７．５ｍｇ／ｋｇ，每周１次，Ｂ组右膝关节内注射生理盐水，每次０．３７５ｍｌ／ｋｇ，每周１次，每组分别于第３，５，７，９，１１周的第１天，各取３只动物，在光镜下观察双侧膝关节和股骨头软骨标本有无病理组织学改变，并在第５，９，１１周加作超微结构观察，结果显示Ａ组用药２次后即双侧股骨头，膝关节软骨下区髓内脂肪细胞增多，     

膝关节腔内注射皮质类固醇对关节软骨损害的研究──病理组织学和超微结构观察

３０只健康新西兰白兔，随机分为两组，每组１５只。Ａ组右膝关节腔内注射醋酸强的松龙，每次７．５ｍｇ／ｋｇ，每周１次；Ｂ组右膝关节内注射生理盐水，每次０．３７５ｍｌ／ｋｇ，每周１次。每组分别于第３、５、７、９、１１周的第１天，各取３只动物，在光镜下观察双侧膝关节和股骨头软骨标本有无病理组织学改变，并在第５、９、１１周加作超微结构观察。结果显示，Ａ组用药２次后即见双侧股骨头、膝关节软骨下区髓腔内脂肪细胞增多，造血组织减少。用药６次后可见右侧膝关节软骨组织出现灶性溶解、坏死。电镜下可见软骨细胞核固缩明显，胞浆内脂滴增多、细胞器坏死、溶解，Ｂ组所有标本未见组织学和超微结构改变。结果提示，关节内注射皮质类固醇对关节软骨的损害是肯定的，且随给药次数的增加而加重。故而，临床疼痛治疗工作中，关节内注射皮质类固醇宜免用。     

神经根注射皮质类固醇治疗腰腿痛病例分析

目的　研究选择性神经根注射皮质类固醇治疗需要手术的腰腿痛病人的疗效。方法　5 8例腰腿痛病人经影像学 (CT或 MRI)示有神经根压迫征象 ,并证明有手术指针。他们被随机抽样分为两组 :治疗组选择性神经根注射利多卡因和康尼克通 ;对照组注射利多卡因。病人最多能选择三次神经根注射 ,最后如选择手术治疗 ,则神经根注射治疗宣告失败。结果　随诊 1— 3年 ,5 8例开始准备手术的病人有 30例经神经根注射药物后放弃手术治疗。治疗组 30例 ,2 1例放弃手术 ;对照组 2 8例 ,9例放弃手术。两组病人手术率具有显著差异性 (P <0 .0 0 5 )。结论　随诊 1— 3年 ,治疗组与对照组相比能更有效地减少腰腿痛病人的手术率。这一结果表明有 1— 2个节段神经根压迫症状的腰腿痛病人手术前应首先考虑选择性神经根注射皮质类固醇     

硬膜外腔注射类固醇激素复合药液后对血糖的影响

硬膜外腔注射类固醇激素复合药液后对血糖的影响刘义明，高云，刘晓娟，陈金典我院对患颈、腰椎间盘突出的５０例住院病人采用硬膜外腔注射小量类固醇激素等复合药物治疗疼痛和使其功能恢复，并对及治疗前后的空腹血糖进行了实验室的观察。报告如下：１临床资料本组５０例...     

硬膜外腔注射皮质类固醇不能防治硬膜外腔粘连

目的　观察动物长期硬膜外腔置管并注射皮质类固醇对硬膜外腔的影响。方法　绵羊2 0只 ,随机分成两组 ,每组 10只 ,A组为实验组 ,经留置硬膜外导管每周 1次注入地塞米松 4 m g及1%利多卡因 8ml,并在每次给药后观察麻醉起效时间、扩散范围和运动阻滞情况 ;B组为对照组 ,每周 1次注入 1%利多卡因 8ml。每组分别于第 3、5、7、9、11周的每 1天各取 2只动物进行硬膜外腔造影 ,随后处死取硬膜及硬膜外组织做组织学检查。结果　随着硬膜外腔置管时间延长 ,麻醉阻滞范围变窄 ,麻醉阻滞时间也明显缩短 ,两组之间没有明显区别 ;硬膜外腔造影显示 :造影剂在硬膜外腔扩散良好 ,无明显受阻 ;组织学检查显示 :置管时间长 ( 4周以上 )的动物 ,硬膜外组织炎细胞浸润、纤维组织增生、硬膜增厚 ,而且随置管时间延长 ,这种变化更加显著 ,但两组之间没有明显区别。结论　硬膜外腔注射皮质类固醇对硬膜外腔的粘连没有明显防治作用     

腔内注射骨肽针联合强筋健骨胶囊口服治疗膝关节骨性关节炎56例

目的讨论膝关节骨性关节炎的治疗方法和操作要点。方法对56例膝关节骨性关节炎患者,取髌骨外上缘穿刺点,膝关节腔内注射骨肽注射液,同时口服强筋健骨胶囊,观察治疗效果。结果经过每周1次、连续4次的注射及常规服药,本组患者痊愈6例,显效40例,改善5例,无效5例,总有效率(痊愈+显效+改善)91%。结论本疗法操作简单,对设备和技术要求不高,效果良好,尤其适于在基层医院开展。     

倍他米松病损内注射治疗瘢痕疙瘩疗效观察

目的：寻求简单有效的治疗瘢痕疙瘩的方法。方法：采用二丙酸倍他米松／倍他米松磷酸二钠病损内注射治疗瘢痕疙瘩６０例。结果：经１年随访,总有效率达８８．３３％。结论：通过讨论二丙酸倍他米松／倍他米松磷酸二钠作用机理、优点、不良反应等,作者认为该方法安全可靠、疗效显著。并发症少,尤其适合于中小面积瘢痕疙瘩的治疗。     

皮质类固醇激素治疗顽固性斑秃的疗效评价

目的 评价得宝松皮损内注射及甲基强的松龙静脉内冲击治疗顽固性多灶性斑秃的疗效。方法 对23例病程在13个月至6年的斑秃患者，于皮损内注射得宝松(0．1m1／cm^2)，治疗结束2个月后判定疗效，对得宝松治疗无效的病例，予甲基强的松龙冲击治疗，500mg／日，每月静滴3天，连续治疗3个月.结果 得宝松治疗组痊愈及显效病例为ll例(47．83％)，甲基强的松龙组痊愈及显效病例为4例(57．14％)。结论 皮损内注射得宝松及甲基强的松龙静脉内冲击治疗对病程至少是13个月的顽固性多灶性斑秃患者，有较好的疗效，对其他治疗手段抵抗的病例，只要掌握好适应证，皮质类固醇激素冲击治疗也是一种有效的治疗方法。     

膝关节骨内压测定髓腔减压术的临床应用

目的：探讨膝关节骨性关节炎发生的原因及治疗。方法：通过上胫骨上端骨内压的测定,依其结果行选择性髓腔钻孔减压。结果：58例86侧膝关节骨性关节炎患有42例63侧骨内压升高,占73．26％,对其施行减压后36例57侧临床症状缓解,占90．48％。结论：（1）膝关节骨性关节炎患胫骨上端骨内压多数偏高。（2）髓腔减压术对缓解膝关节骨性关节炎症状有较好疗效。（3）胫骨上端骨内压测定对膝关节骨性关节炎的早期诊断和治疗有一定作用。     

关节内注射皮质类固醇对肝功能及血脂的影响

目的:观察关节内注射皮质类固醇对肝功能和血脂的影响。方法:30只健康新西兰白兔随机分为2组,每组15只。A组动物右膝关节腔内注射醋酸强的松龙7.5mg/kg,每周1次。B组动物右膝关节腔内注射生理盐水0.375ml/kg,每周1次。所有动物每周称体重并检查皮下脂肪分布情况1次。于实验前及实验第3、5、7、9、11周的第1天,抽血3ml进行血清总胆固醇、甘油三酯、谷丙转氨酶及血钙含量测定。同时取肝组织在光镜下进行病理组织学检查。结果:A组动物在用药2次后,皮下脂肪减少,体重减轻,血清胆固醇、甘油三酯和谷丙转氮酶增高,血清钙含量下降,且随用药次数的增加而变化明显(P<0.01)。病理组织学检查发现用药4次后即出现肝脂变,且随用药次数的增加而加重。B组动物在整个的实验过程,体重增加,血脂、血钙含量正常,肝功能及肝组织无异常改变。结论:关节内注射皮质类固醇同全身用药一样,可造成脂肪代谢紊乱,血钙含量下降及肝功能损害。     

骨髓基质干细胞修复软骨缺损的实验研究

[目的]探寻体外诱导骨髓基质干细胞成软骨细胞的最佳细胞因子，寻求体内修复家兔软骨缺损的最为有效方案。[方法]rhFGF1、rhTGF-β1、rhIGF-1单独或联合应用对骨髓基质干细胞进行体外诱导培养，应用常规染色、MTT、免疫组织化学染色的方法筛选诱导骨髓基质干细胞成软骨细胞的最佳细胞因子，并将其与骨髓基质干细胞复合于纤维蛋白凝胶制成凝胶复合物，直接种植到兔膝关节实验性关节软骨缺损处，并与对照组相比较，观察软骨修复效果。[结果]常规形态学观察，rhTGF-β1和rhIGF-1联合应用诱导的细胞在形态上类似于软骨细胞，免疫组化染色提示诱导细胞具有软骨细胞表型。凝胶复合物直接种植在体内能诱导骨髓基质干细胞向软骨细胞分化，修复缺损的软骨，缺少细胞因子的对照组软骨缺损修复效果差。[结论]rhTGF-β1和rhIGF-1联合应用可作为诱导骨髓基质干细胞向软骨细胞分化的最佳组合，骨髓基质干细胞凝胶复合物能修复软骨缺损。     

能量CT定量测量骨密度和骨髓脂肪的研究现状

一直以来,骨质疏松症都是一个主要的公共卫生疾病,有着很高的致残率和死亡率,严重影响着患者的生命健康和生活质量,也导致国家医疗卫生系统承担着高昂的医疗保健费用。目前,骨密度是诊断骨质疏松症和预测骨折风险的主要指标。因此,精确测量骨密度对骨质疏松的早期预防至关重要,但是影响骨密度精确测量的因素有很多,骨髓脂肪便是现在关注的一个重点。目前,定量分析骨髓脂肪含量和骨密度的手段在不断革新,而能量CT作为一个新型技术备受研究者们的关注。因此,本综述旨在探讨能量CT定量分析骨密度和骨髓脂肪含量的研究进展,以期为后续相关研究提供一个新的可行性影像方法。     

Histochemical examination of ectopic bone formation induced in rat bone marrow

We examined the rapid formation and subsequent resorption of woven bone induced by partial ablation of rat bone marrow. On the 1st day after ablation, masses of clots occupied the region from which marrow was eliminated. On the 3rd day, alkaline phosphatase-(ALPase-) positive osteoblastic cells appeared in the vicinity of the marrow-eliminated region, forming woven bone. Other ectopic woven bone extended from the endosteal surface toward the bone marrow. Therefore, the newly formed bone originated in two different sites, the endosteal bone surface and the marrow tissues near the marrow-eliminated region. On the 7th day, numerous tartrate-resistant acid phosphatase- (TRAPase-) positive osteoclasts and ALPase-positive osteoblasts expressing the osteonectin gene indicated high activity in both formation and resorption of ectopic woven bone. On the 10th day, the ectopic bone had been markedly resorbed and replaced by bone marrow tissue as the ectopically formed woven bone had not been dynamically maintained, probably because of reduced bone formation activity. Immunoreactivity for basic fibroblast growth factor (bFGF) was indistinctly observed on osteoblastic and preosteoblastic cells on the 1st day after ablation. The fibroblastic cells in the marrow-eliminated region on the 3rd day, and both osteoblasts and preosteoblasts in the woven bone on the 7th day, showed strong immunoreactivity for bFGF. Unlike fractured cortical bone, no chondrogenesis was observed. This model appears to provide convenient material and an important clue for investigation of imbalanced bone formation and subsequent resorption.     

The Relationship Between Increasing Intraarticular Pressures and Intraosseous Pressures in the Juxtaarticular Bones: An Experimental Investigation in Dogs

The present experimental investigation of the relationship between intraarticular and intraosseous pressures was carried out in mongrel dogs. Under general anaesthesia simultaneous pressure measurements were performed in the femoral artery, the knee joint and the tibia and femur adjacent to the knee joint. The intraarticular pressure was increased by infusion of saline. Increase in the knee joint pressure caused an increase in the femoral intraosseous pressure, while the tibial intraosseous pressure remained unchanged. The pressure increase in the femur was most pronounced in dogs with intact epiphyseal plates. It is suggested that the rise in the femoral pressure was caused by compression of the venous drainage from the bone. Further evidence to support this suggestion was obtained from anatomical studies, intraosseous phlebography and experiments with selective venous compression.     

Radioimmunoassay of bone marrow prostatic acid phosphatase

The clinical value of prostatic acid phosphatase (PAP) measurements in the bone marrow aspirate of patients with prostatic adenocarinoma has been unclear. Using a radioimmunoassay (RIA) to measure PAP, we have evaluated this potential indicator of occult metastases in 127 controls and in 300 patients with prostatic adenocarinoma. Elevations of the tumor marker were found in 9%, 10%, 19%, and 82% of patients with stages B, C, D₁, and D₂ adenocarcinoma respectively. Clinical follow-up ranging from 7 to 43 months (average 23 months) was available for 97 patients without any initial indication of metastasis by bone scan. In this group 11 patients had elevated levels of bone marrow acid phosphatase (BMAP) by RIA and four developed radiological evidence of bone metastais 21 – 25 months following initial staging. However, only three of the 86 patients with normal BMAP levels have developed bone metastasis. Our results indicate that measurement of bone marrow PAP by immunological methods has prognostic significance. Dilution of the bone marrow aspirate by peripheral blood, however, may limit the application of this technique.     

山羊血管化骨髓移植的解剖学基础研究

目的通过对山羊股骨、髂骨、胸骨、肋骨4个较为常见的血管化骨髓移植供区部位相关结构的测量观察,从移植手术的角度,分析其解剖特点,为下一步建立山羊血管化骨髓移植模型提供一定的解剖依据。方法取6只（共12侧）体质量相当的山羊做活体解剖研究。观测4个供区血液供应情况,并对比4种移植物体质量、体积、骨髓干细胞密度等因素。结果髂骨可见主要滋养血管为髂内动脉及其分支,另外紧贴骨面的臀部肌肉也会有细小动脉进入骨膜,髂内血管为较理想的血管蒂;股骨的主要滋养动脉有3条：股深动脉、旋股外侧动脉及膝降动脉,取髂外血管为血管蒂;双侧胸廓内动脉及伴行静脉为胸骨的主要滋养血管,双侧胸廓内动静脉的近端可作为游离血管蒂;肋骨以第7肋为例,其肋间后动脉及其伴行静脉为主要滋养血管,可以取到一定长度的游离血管蒂。结论山羊的髂骨及股骨是较为理想的血管化骨髓移植术供区,其游离血管蒂长度及其动静脉外径均可满足异体移植术的需求。     

Construction of ectopic xenogeneic bone marrow structure associated with persistent multi-lineage mixed chimerism by engraftment of rat bone marrow plugs into mouse kidney capsules

Abstract: Poor bone marrow (BM) engraftment in a xenogeneic combination results at least in part from the limited engraftment capacity of BM-derived stromal cells, which support hematopoietic repopulation in a species-specific fashion. We attempted to construct a BM stromal microenvironment by engraftment of BM plug fragments into kidney capsules in a rat-to-mouse combination. BM plugs from F344/N Jcl- rnu/rnu (F344 nu ) rats were transplanted into the kidney capsules of C.B-17 scid/scid (C.B-17 scid ) mice treated with rabbit anti-asialo-GM1 serum to deplete natural killer (NK) cells and then with 3 Gy of whole body irradiation. As a conventional control, an equivalent amount of F344 nu bone marrow cells (BMCs) was intravenously injected into C.B-17 scid mice treated with a similar conditioning regimen. In both mouse recipients of rat BM plug engraftment in the kidney capsules and recipients of intravenous injection of rat BMC suspension, comparable extents of donor rat class I⁺ cells were persistently detected in the peripheral blood. However, the differentiation of rat-derived B cells in the mouse recipients of rat BM plugs was more rapid than that in the recipients of rat BMC suspension. In the late phase (10 weeks after BM transplantation), the percentage of rat-derived T cells (CD4⁺ cells) in the mouse recipients of rat BM plugs was significantly higher than that in the recipients of rat BMC suspension. At this time point, ectopic BM structure consisting of bone, mesenchymal cells, and hematopoietic progenitors was constructed in the kidney capsules of mice that received rat BM plugs. Most of the cells in the ectopic BM were derived from the donor rat. Thus, engraftment of BM plugs into the kidney capsules results in the construction of a donor-derived BM microenvironment, facilitating multilineage mixed xenogeneic chimerism.     

骨髓间充质干细胞来源的外泌体对骨再生机制研究

目的本研究旨在检测骨髓间充质干细胞外泌体(BMSC-Exos)的特征,并通过体内体外实验探讨其对成骨分化的影响及对骨再生的机制。方法①原代培养人骨髓间充质干细胞(BMSCs),并对其表面抗原和多系分化潜能进行鉴定;②收集BMSC的P4～P6代细胞培养的培养上清液,应用试剂盒提取BMSC-Exos;③透射电镜观察BMSC-Exos的形态结构,免疫电泳检测BMSC-Exos的表面抗原;④茜素红、ALP染色验证BMSC-Exos在体外成骨分化中的作用;⑤通过大鼠颅骨缺损动物模型验证BMSC-Exos在体内骨再生的作用;⑥通过免疫电泳和qRT-PCR检测加入BMSC-Exos后的成骨细胞中相关蛋白和基因的表达情况。结果①分离培养的BMSCs形态呈多角形或长梭形,表面抗原CD90、CD29、CD44为阳性,符合间充质干细胞的特征;②BMSC-Exos呈双面凹的圆形或椭圆形,直径约40～120 nm(81.7±19.9),表面抗原与BMSC一致;③经茜素红染色和ALP染色后,染色强度与Exo浓度呈正相关;④通过对大鼠颅骨缺损模型拍摄X片、组织学分析,外泌体可促进大鼠颅骨缺损的修复和新生骨的形成;⑤免疫电泳显示经外泌体处理后,BMSC中的OCN、Runx2、β-catenin蛋白含量增加,qRT-PCR结果显示Runx2、β-catenin的基因表达上调。结论 BMSC-Exos有促进骨再生的能力,并与上调Wnt/β-catenin通路有关。     

白血病患者异基因骨髓移植后性激素含量的变化

观察了１９例白血病患者异基因骨髓移植后的性腺功能，测定了卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）和睾丸酮（ＴＴ）及雌二醇（Ｅ２）的血清浓度，结果女性患者都有性腺功能低下的临床表现，Ｅ２极低，均低于１８．４ｐｍｏｌ／Ｌ，ＦＳＨ和ＬＨ显著增高；男性患者性功能无明显减退，ＬＨ和ＴＴ正常或接近正常，９例男性患者ＦＳＨ增高。