清创后Ⅰ期植骨治疗慢性骨髓炎的远期疗效

目的 探讨清创后Ⅰ期植骨治疗慢性骨髓炎的远期效果.方法 1999年3月-2003年5月,79例(28例骨不连)慢性骨髓炎患者接受清创后Ⅰ期自体、同种异体或混合骨移植治疗.随访时间60～111个月,平均77个月.结果 79例患者中,6例(8%)患者感染复发,其中自体骨移植2例,异体骨移植3例,混合骨移植1例.三种植骨方法感染复发率差异无统计学意义.28例骨不连患者,27例(96%)感染治愈并获得骨愈合,其中自体骨移植(23例)和异体骨移植(2例)均获得骨愈合,无感染复发;混合骨移植3例,2例骨愈合,1例感染复发伴骨不连.结论 清创后Ⅰ期骨移植治疗慢性骨髓炎可以获得90%以上的感染治愈率及骨愈合率,感染复发多在术后1年内,远期疗效稳定.     

自体肋骨移植修复下颌骨缺损

下颌骨可因多种原因造成缺损,导致面部畸形、咬合错乱、咀嚼功能障碍等。修复缺损的方法较多,有自体肋骨或髂骨移植、同种异体骨移植、病变下颌骨切除冷冻或煮沸后再植、钛合金等代用骨植入以及羟基磷灰石等人工生物材料移植。但迄今为止,因自体肋骨游离移植在成骨性、骨缺损弯度与长度的适应性和骨供区充分,制取简便易行,术后供区畸形小,病人易接受等优点,仍不失为修复下颌骨缺损较为理想的方法。现将我科完成的10例报告总结如下。1　材料和方法1.1　临床资料:本组男6例,女4例;手术年龄16～43岁,平均30岁。其中造釉细胞瘤7例,角化囊肿3…     

同种异体植骨修复取骨区预防骨-髌腱-骨重建前交叉韧带术后膝前痛的探讨

目的探讨关节镜下自体髌腱中1/3重建膝关节前交叉韧带术中供区骨槽骨缺损行同种异体植骨对术后膝前症状的影响. 方法关节镜下取自体髌腱中1/3重建前交叉韧带51例,其中35例行供区同种异体植骨修复骨缺损,16例未特别处理. 结果术后随访6～12个月,比较两组之间供区的压痛、跪地痛以及髌股关节症状.植骨组膝前供区压痛、跪地痛的改善情况明显优于未植骨组,但是对于髌股关节痛并无影响. 结论关节镜下髌腱中1/3重建交叉韧带术中,供区骨槽行同种异体植骨可有效降低供区压痛和跪地痛发生率.     

医用硫酸钙在四肢骨缺损中的临床应用

目的观察医用硫酸钙治疗四肢骨缺损的临床效果。方法应用医用硫酸钙作为骨移植替代物,治疗因外伤和良性肿瘤导致的四肢骨缺损32例,分别在术后第1、6、12 w及6、12个月进行X线复查,观察成骨效果,对临床资料进行回顾性分析。结果随访平均8个月,硫酸钙植入后3～4个月吸收,11～12个月骨缺损处被新生骨替代。结论医用硫酸钙是一种成骨性能优良的骨移植替代物。     

深低温冷冻同种异体月骨移植临床应用6例报告

目的　研究深低温冷冻同种异体月骨移植治疗月骨无菌性坏死的临床疗效。方法　应用深低温冷冻同种异体月骨移植治疗月骨无菌性坏死 6例 ,随访 10年以上。结果　 6例患者切口一期愈合 ,术后无明显排异反应及手术并发症。随访 10年以上 ,摄X线片显示月骨轮廓清晰 ,大小正常 ,骨小梁排列整齐 ,整个月骨密度均匀一致无明显脱钙 ,腕关节活动无疼痛 ,活动范围屈和 (或 )伸 3 0～ 0～ 2 5°能完成日常劳动 ,病人关节功能恢复满意。结论　深低温冷冻同种异体月骨移植治疗月骨无菌性坏死疗效满意。     

异体骨移植治疗纤维结构不良疗效分析

目的对异体骨移植内固定术治疗纤维结构不良的效果进行分析总结。方法对2001年1月～2011年12月在我院行异体骨移植内固定手术治疗的52例纤维结构不良病例进行回顾性分析,其中男性27例,女性25例,平均27.1(8～70)岁;单发46例,多发6例;股骨24例(股骨近端18例),胫骨16例,肱骨8例,其他部位4例。临床表现:疼痛34例,病理性骨折8例,畸形5例,肿块2例,其他3例。平均病程2.8年(2个月～11年)。采用病灶彻底刮除、同种异体骨植骨及内固定术,对伴有畸形者同时予以截骨矫形。结果 42例患者平均随访2.4年(6个月～9年)。3例患者出现植骨吸收,其中1例截骨矫形出现钢板螺钉松动。结论彻底病灶刮除、同种异体植骨及有效的内固定是治疗纤维结构不良的有效方法。     

新鲜及冷冻同种异体胎兔软骨移植实验研究

新鲜及冷冻同种异体胎兔软骨移植实验研究张云昌，刘植珊，沈志鹏，郑亚萍，张福洲，张培忠，丁吉元２５００３１济南济南军区总医院中图法分类号Ｒ６８１．３异体胎儿软骨移植修复股骨头无菌坏死导致的关节软骨缺损［１］，是近几年采用的一种新的植骨术。但移植后软骨成...     

大段同种异体骨移植在治疗四肢恶性骨肿瘤中的应用研究

 目的观察大段同种异体骨移植在治疗四肢恶性骨肿瘤切除后骨缺损的疗效.方法对130例四肢骨肿瘤,切除范围以Enneking分期为原则;异体骨移植术式分:1/4关节、1/2关节、部分骨干、全骨段、全骨段+人工假体、1/2关节+自体带血管骨瓣;内固定分:钢板+螺丝钉、螺丝钉、普通髓内钉、带锁髓内钉;疗效按Mankin提出的评定标准,将结果分:优、良、中、差.结果随访6～156个月,本组治疗满意率为63.8%,主要并发症是感染、骨折、骨不愈合,其发生率为39.2%,保肢率为76.3%.结论大段同种异体骨移植,在治疗四肢恶性骨肿瘤切除后骨缺损方面,不失为一种有效可行的方法.其并发症发生与肿瘤外科分期、是否化疗、移植骨大小、受骨区软组织条件好坏、内固定种类等有关.     

髋臼骨缺损髋关节置换31例

目的 探讨非感染性髋臼骨缺损的人工髋关节置换经验。方法 回顾分析31例非感染性髋臼骨缺损的髋关节置换经验，研究植骨、固定、髋臼置换和功能康复的新方法。本组男18例，女13例；年龄23—73岁，平均55．5岁。根据美国骨科学会(AAOS)的分类方法：节段型骨缺损5例，空腔型骨缺损7例，混合型骨缺损5例，骨折型骨缺损6例，关节融合型骨缺损8例。结果 本组手术全部成功，术后无感染发生。手术后随访24例，随访时间6—68个月，平均24．3个月，随访时关节无疼痛，对手术结果满意，髋关节功能较术前显著改善。结论 (1)对节段型和混合型骨缺损，大块植骨时应辅以颗粒骨，并尽量选用较稳固的钉板系统固定。(2)使用带缝匠肌髂骨瓣植入重建髋臼缺损为活骨移植，成骨较好。(3)建议对髋臼非感染性骨缺损的髋关节置换尽量采用非骨水泥型臼杯。     

扩大清创后Ⅰ期同种异体或混合骨移植治疗慢性骨髓炎

目的探讨采用同种异体或混合骨移植重建慢性骨髓炎清创术后骨缺损的可行性.方法 1999年2月-2002年4月,对26例慢性骨髓炎患者采用扩大清创后Ⅰ期同种异体(19例)或混合(7例)骨移植的方法进行治疗. 结果随访13～51个月,26例患者中,23例(88%)获得愈合,1例(4%)切口持续渗液14个月后愈合,2例(8%)感染复发. 结论在扩大清创的基础上,行Ⅰ期同种异体或混合骨移植治疗慢性骨髓炎可以获得较高的成功率,不应再视为禁忌证.     

Aneurysmal bone cyst of the temporal bone

Aneurysmal bone cyst (ABC) of the temporal bone is rare. The nature of the underlying disorder that converted into the ABC might, however, be difficult to ascertain on imaging as well as on histopathology. The unusual CT and MRI findings in a case of ABC of the temporal bone are presented. This had transdural intracerebral spread with a large component of solid enhancing matrix but no peripheral calcific rim. The patient was an adult of 45 years with a history of headache for more than 1 year.     

Aneurysmal bone cyst of the temporal bone

Summary Aneurysmal bone cysts occurring within the calvarium are uncommon. The following case report describes the radiological and pathological findings of a temporal bone aneurysmal bone cyst with intra- and extracranial manifestations. The pertinent literature is reviewed.     

Aneurysmal bone cyst of the frontal bone

BACKGROUND: Aneurysmal bone cyst (ABC) is a benign, expansive, osteolytic lesion that mainly occurs in young people, and involves the skull bones only exceptionally. The origin of ABC is controversial: secondary reactive bone lesion, or primary disease that represents an independent nosological entity. Blunt head trauma was suggested as a possible etiological factor. CASE REPORT: A case of a 19-year-old man with primary ABC of the right frontal bone was reported. The lesion was totally excised through frontal craniotomy, and the skull bone defect primarily reconstructed with an acrilate cranioplasty. Five years after the surgery, the patient was without signs of local recurrence. CONCLUSION: Clinical and neuroradiological presentation of the skull ABC was not specific. Pathohistology confirmed the diagnosis. Total excision was the treatment of choice.     

Aneurysmal bone cyst of the ethmoid bone

Aneurysmal bone cysts is a benign, slow growing expansile lesion usually found in long bones or vertebrae. Only 5 cases of ABC of the ethmoid bone have been reported in the literature. Plain radiographs are not specific. CT and MRI are very useful to depict the extent of the lesion and demonstrate the presence of blood-fluid levels, which is a characteristic finding of ABC. We present one atypical case of ABC of the ethmoid bone in a 15-year-old female characterised by its extensive involvement and its rare location.     

Aneurysmal bone cyst of the temporal bone

Aneurysmal bone cysts are benign fibrosseous lesions of the bone that are rarely detected in the temporal bone. Seventeen cases of aneurysmal bone cysts with histological confirmation involving the temporal bone were reported in the literature. We report a case of left temporal aneurysmal bone cyst in a 52-year-old male with the clinical findings of periauricular painful swelling, decreased hearing, and facial paralysis. A magnetic resonance image of the patient showed a well-circumscribed multi-loculated expansile lesion of the left temporal bone during the first admission to the hospital. The lesion recurred 1 year after the subtotal resection with a more solid appearance. In addition, we review the literature for these rare lesions.     

异种脱蛋白骨修复山羊长骨大段缺损的成骨观察

目的 评估改良法制备异种脱蛋白骨(deproteinzated bone,DPB)作为组织工程支架材料修复大动物大段长骨缺损的能力,为异种DPB的临床应用提供实验依据.方法 山羊24只,在每只山羊右侧胫骨中下段截除胫骨总长度20%形成节段性骨缺损,按分组情况植入不同材料.A组为单纯异种DPB,B组为自体骨,C组为异种DPB+自体骨髓间充质干细胞(BMSCs)+重组人骨形态发生蛋白2(rhBMP2),均采用半环槽式外固定器固定.术后4～24周每隔4周进行X线及术后24周取新生骨进行双能X线(DEXA)、组织学、生物力学检测,评价骨缺损修复效果. 结果 术后4～24周,在同一时相点,X线Lane-Sandhu法评分B组》C组》A组,并且术后24周新骨的骨密度、骨矿含量、组织学和生物力学检测经统计学分析,C组与B组比较,差异无统计学意义(P>0.05). 结论 改良法制备的异种DBP复合自体BMSCs和rhBMP2修复山羊胫骨大段缺损成骨能力与自体骨相当,可以作为组织工程支架材料试用于临床.     

Giant-cell tumor of bone and aneurysmal bone cyst

A correlated histologic and radiographic study of nine giant-cell tumors, six aneurysmal bone cysts, and one combined lesion is presented. Clinical findings and plain radiographic appearances were found to overlap. Angiographically, the giant-cell tumors were richly vascularized, with a marked intratumoral contrast uptake, occasional irregular tumor vessles, a prominent peritumoral arterial net-work, and early draining veins. Microscopic examination revealed fine, capillary-like and somewhat larger, angulated, sinusoid vessels, and occasional small, bloodfilled cysts within the tumor. Conspicuous arteries, veins, and capillaries surrounded the tumor. The aneurysmal bone cysts at angiography were predominantly avascular in the interior, surrounded by a thin hyperemic zone in the peritumoral tissue, with sometimes early filling of veins. Microscopically, the aneurysmal bone cysts showed large, anastomosing, bloodfilled vascular channels, and a moderate number of capillaries within the solid, fibrous areas and the granulation tissue. It is concluded that angiography, particularly with a subtraction technique, may be a valuable diagnostic method in the pre-operative differentiation of giant-cell tumors from aneurysmal bone cysts.