脱钙异体骨关节移植的初步实验研究

目的探索利用脱钙异体骨关节移植修复节段性骨关节缺损。方法在２４只新西兰兔的双侧桡骨近段造成２０ｍｍ的长的骨关节缺损,分别移植脱钙异体骨关节和不移植骨关节,对照观察骨关节缺损的修复情况。术后２－２４周作Ｘ线照片、组织学检查和生物力学试验。结果脱钙异体骨关节移植后,诱导生成新的骨关节,其形态和力学特征近似正常骨关节,没有出现关节退变、粘连或僵硬,关节功能基本正常。结论脱钙异体骨关节具有低抗原性和高骨诱     

重组异体脱蛋白骨关节移植修复骨关节缺损的实验研究

目的 探讨钙磷骨水泥（CPC）复合重组人血管内皮细胞生长因子（rhVEGF）＋重组人骨形态发生蛋白-2（rhBMP-2）与异体脱蛋白骨（DPB）关节移植修复骨关节缺损的能力。方法 成年杂交犬36只，随机分成3组：A组为CPC／rhVEGF／rhBMP-2／DPB关节移植；B组为rhVEGF／rhBMP-2／DPB关节移植；C组为单纯的DPB关节移植。术后观察血管发生和新骨形成情况。结果 A组在各时相点再血管化、成骨能力和软骨形成检测结果均优于B、C两组，B、C组间在各时相点差异无统计学意义。结论 重组脱蛋白骨关节材料具有较强的再血管化和成骨能力，可早期与受体达到骨愈合修复骨关节缺损并最终成为自身组织。     

长骨节段性缺损的治疗

长骨节段性缺损是骨科临床上最难治的一种骨缺损。修复时不仅需要诱导成骨 ,还要解决骨传导问题 ,使新骨具有支撑功能。因此 ,大段植骨成为必要的治疗手段。一、吻合血管的自体骨游离移植带血管移植的自体骨有正常的血液供应 ,和宿主骨之间的连接是个一般骨折的愈合过程 ,不像不带血管的大段骨移植那样需要爬行替代 ,疗程短而效果好。临床上用于修复长骨节段性缺损的供骨有腓骨、髂骨和肋骨。腓骨长而直 ,其管状骨属性使它具有较强的支撑力 ,是修复长骨较长节段性缺损的首选供区。肋骨虽然也富含皮质骨 ,但比腓骨细 ,而且形状弯曲 ,修复长骨…     

异体脱蛋白松质骨在修复颌骨骨腔性缺损中的应用

异体脱蛋白骨作为骨修复材料，尽管不如自体骨，但同样有诱导成骨的性能，并且取材方便，骨源充足，近来普遍受到重视。我院在1997—2002年采用异体脱蛋白松质骨作为移植材料，填补颌骨骨腔性缺损22例，获得满意效果．现报告如下。     

同种异体关节移植的现状

同种异体关节移植较广泛应用于修复各种原因造成的大段骨关节端缺损，同种异体骨关节移植中存在的免疫排斥反应及骨延迟愈合、不愈合、疲劳骨折、创伤性关节炎、感染等并发症是影响治疗效果的重要因素。本文综述了近几年国内外临床及实验研究文献中对以上问题的分析及新近提出的有效应对措施，如在移植骨上复合生长因子促进移植骨与宿主骨愈合，利用骨膜和软骨膜移植、修复软骨缺损，利用碱性成纤维细胞生长因子（bFGF)、肝细胞生长因子（HGF）、血小板诱导生长因子（PDGF）、转移因子β（TGF－β）等生长因子促进软骨修复等措施。此外，还简要引述了制备、贮存供体材料的新观点。     

自体骨髓间充质干细胞复合β-磷酸三钙修复犬下颌骨节段缺损

目的 探讨骨髓间充质干细胞（BMSCs）复合β-磷酸三钙（β-TCP）构建的组织工程骨修复犬下颌骨节段缺损的可行性。方法 体外成骨诱导犬BMSCs，将第2代细胞复合β-TCP后修复6只犬右侧3cm的下颌骨节段缺损；6只犬以单纯β-TCP植入作为对照，术后4，12，26，32周分别通过影像学、大体形态、组织学和生物力学检测判断骨缺损的修复效果。结果 诱导后第2代细胞已具成骨活性。4～26周X线片示实验组新骨形成增加，密度增高，对照组则材料吸收形成明显阴影区，只有少量骨痂。32周实验组骨愈合良好，有较多板层骨；对照组为纤维性愈合骨不连，骨密度检测实验组显著高于对照组。实验组力学强度与正常下颌骨差异无统计学意义。结论 自体成骨诱导BMSCs复合β-TCP形成的织工程骨可良好修复犬下颌骨节段缺损。     

下颌自体骨煮沸再植

下颌骨缺损以自体新鲜骨移植修复效来最好，但塑造下颌骨外形较为困难；某些金属或非金同修复材料，虽可为机体接受，但不能为新骨所取代；而同种异体骨或异种骨，如深冷冻胚胎骨”’、部分脱蛋白骨‘”、部分脱钙骨[3]、复合骨[4]等生物修复材料来源有限，且需要特殊设备或复杂的处理程序及保存措施。因此，上述材料作为下颌骨修复材料均不理想。50年代国外开始有下颌骨煮沸后再植的病例报告，近年来国内也陆续开展了此类修复手术，并且取得了初步的治疗效果。本文对其适应证、手术方式、愈合机制和临床应用进行综述。互适应证下颌骨的某些…     

脱钙骨基质治疗长骨骨折延迟愈合及骨不连的远期临床观察

目的 探讨脱钙骨基质治疗长骨骨折延迟愈合和骨不连的远期疗效。方法 从1984年至1994年用脱钙骨基质治疗长骨骨延迟愈合、骨不连共96例，其中采用手术植入治疗骨不连38例，经皮注射治疗骨折延迟愈合37例及骨不连21例。结果 96例患者均获随访，随访时间4-16年，平均7．5年。脱钙骨注射治疗骨折延迟愈合的37例中，骨折愈合35例，2例胚骨骨折未愈合，愈合率94．6％；脱钙骨注射治疗骨折骨不连21例中，骨折愈合17例，4例未发生愈合，其中胫骨3例、肱骨1例，愈合率81．0％，愈合时间3-8个月，平均4．5个月。脱钙骨基质移植治疗骨不连38例中，36例愈合，2例胫骨下1／3骨折未发生愈合，愈合率94．7％。结论 脱钙骨基质无论是采用注射移植还是手术方法移植，都能取得较好的效果，甚至达到自体骨移植的疗效。同时，脱钙骨基质的制备经过脱水、脱脂、脱钙、照射消毒等处理，比其他骨移植安全，免疫性小，可以长期保存，便于平时和战时应用。     

^99mTc—MDP骨显像动态观察珊瑚羟基磷灰石人工骨修复骨…

目的：应用核素骨显像观察不同骨移植物对实验动物骨干缺损修复的动态过程，评价术后不同时期移植骨成活状态。材料与方法：用ＲＯＩ方法定量地比计算三种材料樾入区和正常骨区放射性浓度集比值。结果：Ａ组（单纯人工骨组）６．０１：Ｂ组（红骨髓复合人工骨组）７．９５；Ｃ组（自体移植骨组）５．７７。结论：单纯人工骨组和自体移植骨组植入后成骨代谢无显著差异，加入自体红骨髓的复合工人骨组移植区成骨代谢明显估于前两组，在     

缝匠肌骨瓣修复人工全髋关节置换中髋臼缺损的实验研究

目的建立缝匠肌骨瓣修复人工全髋关节置换（THR）中髋臼节段性缺损的动物模型，并观察其初步修复结果。方法16只成年山羊进行左侧THR，并造成髋臼上方负重区40％的节段性骨缺损。随机分成2组，分别以缝匠肌髂骨瓣和游离髂骨瓣移植修复，术中行骨瓣血运、带血管蒂缝匠肌骨瓣活动长度的观察，术后行大体、X线和组织学观察。结果术中缝匠肌髂骨瓣血运良好，有足够的活动长度；术后X线显示移植骨块及置换假体位置良好，固定牢靠；缝匠肌髂骨瓣仍然保持基本正常松质骨结构，与髋臼可以形成类似骨折愈合的连接。结论缝匠肌骨瓣可以很好地修复髋臼节段性缺损，效果优于游离骨瓣。     

Comparison of fresh osteochondral autografts and allografts: a canine model

BACKGROUND: Osteochondral autografts and allografts have been widely used in the treatment of isolated grade IV articular cartilage lesions of the knee. However, the authors are not aware of any study that has prospectively compared fresh osteochondral autografts to fresh allografts with regard to imaging, biomechanical testing, and histology. HYPOTHESIS: The imaging, biomechanical properties, and histologic appearance of fresh osteochondral autograft and fresh allograft are similar with respect to bony incorporation into host bone, articular cartilage composition, and biomechanical properties. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen adult dogs underwent bilateral knee osteochondral graft implantation after creation of an Outerbridge grade IV cartilage defect. One knee received an autograft, and the contralateral knee received a fresh allograft. Nine dogs were sacrificed at 3 months, and 9 dogs were sacrificed at 6 months. Graft analysis included gross examination, radiographs, magnetic resonance imaging, biomechanical testing, and histology. RESULTS: Magnetic resonance imaging demonstrated excellent bony incorporation of both autografts and allografts. Biomechanical testing demonstrated no significant difference between autografts versus allografts versus control at 3 or 6 months (P = .36-.91). A post hoc calculation showed 80% power to detect a 30% difference between allograft and control. Histologic examination showed normal cartilage structure for both autografts and allografts. CONCLUSION: Fresh osteochondral autograft and fresh allograft tissues are not statistically different with respect to bony incorporation, articular cartilage composition, or biomechanical properties up to 6 months after implantation. CLINICAL RELEVANCE: The use of fresh allograft tissue to treat osteochondral defects eliminates morbidity associated with harvesting autograft tissue without compromising the results of the surgical procedure.     

带血管骨膜和同种脱钙骨基质联合移植与自体骨移植修复骨缺损的比较研究

目的了解带血管骨膜（ＶＰ）和同种脱钙骨基质（ＤＢＭ）联合移植替代自体骨移植修复大段骨缺损的可能性。方法以兔桡骨中央２５ｍｍ的大段骨缺损为模型，通过Ｘ线观察、Ｘ线平片骨缺损修复Ｌａｎｅ评分、组织学观察、骨组织形态计量分析和生物力学测试，比较术后４，８，１６周时ＶＰ＋ＤＢＭ联合移植与自体骨移植修复骨缺损的效果。结果术后４周ＶＰ＋ＤＢＭ联合移植及自体骨移植均已较好地完成了缺损的修复，而前者的Ｌａｎｅ评分、皮质骨密度、力学抗扭刚度均显著高于后者（Ｐ＜０．０５）。但术后８，１６周时两者之间已无显著性差异（Ｐ＞０．０５）。结论ＶＰ＋ＤＢＭ联合移植早期修复兔桡骨大段骨缺损的效果好于自体骨移植。后期两种方法修复效果基本一致。ＶＰ＋ＤＢＭ联合移植后，两者之间建立了相互协同、相互促进的关系。     

新型互锁双钢板治疗长骨干节段性骨缺损

采用髓内皮质骨移植和松质骨充填，互锁双钢板固定治疗长骨干节段性骨缺损，观察移植骨和宿主骨的修复愈合过程和转归特点。结果显示：１２－２４周时植骨愈合良好，１２周时髓内植骨两端已与宿主骨愈合，２４周时髓内植骨两端呈松质骨化，充填的松质骨部分已改建为板层骨，骨缺损已大部分修复。新骨的形成是以哈氏系统为中心向外呈同心圆扩展，不同时期的新骨形成清晰可见。本法不仅可以恢复骨结构的完整性、固定可靠，而且具有良好     

A review of the evaluation and management of cartilage defects in the knee

In the orthopedic community, there is controversy regarding the management of articular cartilage defects of the knee. Nonoperative treatment is indicated for initial management. Surgical options include autologous chondrocyte implantation, osteochodral autograft transfer, osteoarticular allografts, and microfracture. More than 70% of patients who have surgery using these techniques have reported overall good results, and the literature does not clearly support the use of one technique over another. Treatment recommendations for each technique are based on differences in outcomes with respect to the size of the defect and the relative advantages and disadvantages of each. This article describes an approach to the evaluation and management of cartilage defects of the knee.     

自体半腱肌腱重建兔前交叉韧带腱骨愈合和止点形成实验研究

目的:观察应用自体半腱肌腱重建兔前交叉韧带术后12个月内腱骨愈合的组织学变化过程。方法:取新西兰大白兔同侧自体单股半腱肌腱重建前交叉韧带,分别于术后2周,1、2、4、6、12个月取材,采用HE和甲苯胺蓝染色观察骨道内腱骨间愈合和止点形成的组织学变化过程。结果:术后2周,腱组织坏死,腱骨间形成肉芽组织界面,其中的新生组织细胞向坏死腱内长入、替代,术后1个月腱骨间形成Sharpey纤维连接和纤维软骨,术后4个月形成潮线样结构,6个月形成直接止点的四层结构,12个月更加成熟。结论:前交叉韧带重建后腱骨间的愈合是一个由间接止点转化为直接止点的骨源性渐进过程。     

Weightbearing ovine osteochondral defects heal with inadequate subchondral bone plate restoration: implications regarding osteochondral autograft harvesting

Purpose

It is unknown what causes donor site morbidity following the osteochondral autograft transfer procedure or how donor sites heal. Contact pressure and edge loading at donor sites may play a role in the healing process. It was hypothesized that an artificially created osteochondral defect in a weightbearing area of an ovine femoral condyle will cause osseous bridging of the defect from the upper edges, resulting in incomplete and irregular repair of the subchondral bone plate.

Methods

To simulate edge loading, large osteochondral defects were created in the most unfavourable weightbearing area of 24 ovine femoral condyles. After killing at 3 and 6?months, osteochondral defects were histologically and histomorphometrically evaluated with specific attention to subchondral bone healing and subchondral bone plate restoration.

Results

Osteochondral defect healing showed progressive osseous defect bridging by sclerotic circumferential bone apposition. Unfilled area decreased significantly from 3 to 6 months (P?=?0.004), whereas bone content increased (n.s.). Complete but irregular subchondral bone plate restoration occurred in ten animals. In fourteen animals, an incomplete subchondral bone plate was found. Further common findings included cavitary lesion formation, degenerative cartilage changes and cartilage and subchondral bone collapse.

Conclusions

Osteochondral defect healing starts with subchondral bone plate restoration. However, after 6 months, incomplete or irregular subchondral bone plate restoration and subsequent failure of osteochondral defect closure is common. Graft harvesting in the osteochondral autograft transfer procedure must be viewed critically, as similar changes are also present in humans.

Level of evidence

Prognostic study, Level III.     

The use of a single osteochondral autograft plug in the treatment of a large osteochondral lesion in the femoral condyle: an experimental study in sheep

BACKGROUND: The use of osteochondral autograft plugs can be restricted because of limited amount of donor material. HYPOTHESIS: A small osteochondral autograft plug placed in the center of a large defect in a sheep femoral condyle will yield results superior to either an untreated or a bone-grafted defect. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve adult sheep underwent bilateral hindlimb surgery. On 1 limb, a 6-mm circular osteochondral autograft plug was placed in the center of a 10-mm circular defect in the medial femoral condyle. The gap between the plug and the condyle was filled with bone graft. On the contralateral side, the defect was either left untreated or filled with bone graft (control specimens). Animals were studied at 6 and 12 months under gross examination, high-resolution radiography, and histologic evaluation. RESULTS: At 6 months, 4 of 6 plugs healed and showed good maintenance of the joint surface and cartilage viability in the plugs. One plug fractured and resorbed, and 1 plug settled but healed. At 1 year, all 5 plugs healed, 1 having settled slightly (1 animal died earlier). The plug specimens showed better maintenance of the condyle contour at both times, and the central plug had hyaline-appearing cartilage. The control specimens were more irregular, had a fibrocartilage fill, and appeared flatter, although no gross cavitation or collapse was indicated. Composite cartilage scores on histologic evaluation were significantly higher for the plug specimens after 6 months (P = .02) and 1 year (P = .036) compared with controls. CONCLUSION: At 6 months and 1 year, a 6-mm osteochondral plug placed in a 10-mm defect better preserved the articular surface and contour of the condyle compared to untreated or bone-grafted defects. CLINICAL RELEVANCE: Osteochondral autograft plugs may be able to treat larger articular lesions without complete fill of the defect.     

Clinical, histologic, and radiographic outcomes of distal femoral resurfacing with hypothermically stored osteoarticular allografts

BACKGROUND: Fresh osteoarticular allograft transplantation has a long history of clinical success. These grafts have typically been implanted less than 1 week from donor asystole. HYPOTHESIS: Osteoarticular allografts stored 4 to 6 weeks represent a viable alternative to treat full-thickness cartilage and osteochondral defects of the distal femur as measured by clinical, histologic, and magnetic resonance imaging (MRI) criteria. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Osteoarticular allografts were implanted after a mean graft storage time (at 4 degrees C) of 36 days (range, 28-43). Sixty-seven patients received massive hypothermically stored osteoarticular allografts. Ten knees in 8 of these patients underwent second-look arthroscopic evaluation and biopsy at a mean of 40 months (range, 23-60) after implantation. Clinical assessment was performed using multiple outcome measures and sequential MRI evaluations. Biopsy specimens were obtained from the graft as well as from native articular cartilage at the time of second-look arthroscopy for histologic analysis. RESULTS: The mean International Knee Documentation Committee scores were as follows: preoperative, 27 (range, 9-55); postoperative, 79 (range, 56-99); P = .002. The mean Lysholm scores were as follows: preoperative, 37 (range, 12-47); postoperative, 78 (range, 55-90); P = .002. The mean Short Form-36 physical scores were as follows: preoperative, 38 (range, 24-55); postoperative, 51 (range, 39-61); P = .002. The mean Tegner scores were as follows: preoperative, 4.3 (range, 1-9); postoperative, 5.3 (range, 4-7); P = .16. The mean International Cartilage Repair Society score at follow-up was 10 (nearly normal) (range, 7-11). The mean modified Outerbridge scores were as follows: preoperative, 4.3 (range, 3-5); postoperative, 0.6 (range, 0-1); P = .002. The mean graft and native cartilage cellular density and viability were not statistically different. CONCLUSIONS: Fresh-stored osteoarticular grafts for full-thickness articular surface defects of the distal femur appear to offer a viable biological method to restore knee function. Our study suggests that osteoarticular grafts stored in cell culture medium at 4 degrees C for 4 to 6 weeks provide successful short-term clinical outcomes.