活络骨康丸联合髓芯减压及自体骨移植术治疗早期股骨头坏死疗效观察

目的:观察活络骨康丸联合髓芯减压及自体骨移植术治疗早期股骨头坏死的临床疗效。方法:采用髓芯减压及自体骨移植术治疗早期股骨头坏死患者24例28髋,术后所有患者均口服活络骨康丸,服药时间为24个月,随访观察治疗前后髋关节功能Harris评分及临床疗效。结果:所有患者均获得随访,末次随访见患者髋关节功能较治疗前均有明显改善,未发生关节塌陷及二次手术者;术前及术后2年Harris评分比较,差异有统计学意义(P0.05)。结论:活络骨康丸联合髓芯减压及自体骨移植术治疗早期股骨头坏死可明显缓解疼痛症状、改善关节功能,效果满意。     

髓芯减压多孔钽棒联合自体骨移植治疗Ficat Ⅱ期股骨头坏死的疗效

目的探讨髓芯减压多孔钽棒植入联合自体骨移植治疗FicatⅡ期股骨头坏死的临床疗效。方法选择我院2015年3月至2017年5月收治的90例FicatⅡ期股骨头坏死患者为研究对象,以随机数字表法分为对照组与观察组,每组45例。对照组患者行髓芯减压结合自体骨移植治疗,观察组行髓芯减压多孔钽棒植入联合自体骨移植治疗,对两组患者髋关节恢复情况、Harris评分与疼痛视觉模拟评分(visual analogue scale,VAS)、并发症发生率进行观察。结果观察组患者术后髋关节功能恢复优良率为97.78%,明显较对照组80.00%高(P0.05);两组患者术前VAS评分与Harris评分无明显差异(P0.05),观察组术后VAS评分较对照组低,Harris评分较对照组高,差异均有统计学意义(P0.05)。观察组患者术后并发症发生率为4.44%,明显较对照组24.44%低(P0.05)。结论髓芯减压多孔钽棒植入联合自体骨移植治疗FicatⅡ期股骨头坏死效果满意,安全性高,可促进术后髋关节功能恢复,也能降低疼痛程度,值得推广。     

髓芯减压植骨支撑结合空心钉固定治疗股骨头缺血性坏死的疗效观察

目的 探讨髓芯减压、松质骨植骨、异体腓骨支撑、空心加压螺钉固定治疗股骨头缺血性坏死的效果.方法 对162例(223髋)股骨头坏死采用髓芯减压、松质骨植骨、异体腓骨支撑、空心加压螺钉固定术治疗.结果 随访6～24个月,优良率86.1%.Harris评分由术前平均61分增加到术后24个月时的平均85分.结论 髓芯减压、松质...     

髓芯减压植骨联合富血小板血浆与髓芯减压植骨治疗非创伤性股骨头坏死的Meta分析

目的 比较髓芯减压植骨联合富血小板血浆（Platelet-rich plasma,PRP）与髓芯减压植骨治疗非创伤性股骨头坏死的临床疗效。方法 计算机检索Cochrane、PubMed、Embase、中国知网数据库关于比较髓芯减压植骨联合PRP与髓芯减压植骨治疗非创伤性股骨头坏死的文献,检索时间设置为2000-01-01—2022-02-15。观察指标为术后Harris髋关节评分、疼痛VAS评分、Harris髋关节评分优良率、股骨头塌陷率、全髋关节置换率。采用Review Manager 5.3软件进行Meta分析。结果 纳入10篇文献,9篇随机对照试验,1篇前瞻性病例对照研究。10篇文献中病例数共660例,其中观察组（髓芯减压植骨联合PRP）334例,对照组（单纯髓芯减压植骨）326例。Meta分析结果显示,观察组术后Harris髋关节评分、疼痛VAS评分、Harris髋关节评分优良率、股骨头塌陷率、全髋关节置换率均优于对照组,差异有统计学意义（P<0.05）。结论 髓芯减压植骨联合PRP可以改善髋关节功能,缓解髋关节疼痛,有效抑制或延缓非创伤性股骨头坏死。     

早期股骨头缺血性坏死的微创治疗

目的 应用髓芯减压自体骨髓细胞结合重组合异种骨移植的方法治疗早期股骨头缺血性坏死,探索早期股骨头缺血性坏死的微创治疗方法.方法 自2000～2002年采用上述术式治疗早期股骨头缺血性坏死患者48例（64侧）,年龄19～56岁,平均37岁;ARCO分期为Ⅰc期8侧,Ⅱa期23侧,Ⅱb期19侧,Ⅱc期14侧,全部病例均行髓芯减压自体骨髓细胞结合重组合异种骨移植术.术后随访2～4年,根据手术前后Harris评分变化,X线影像学表现及是否需要进一步治疗进行随访观察.结果 术后患者Harris评分平均提高16分（平均术前79分,术后95分）,影像学表现49侧保持稳定,2例（3侧）分别于术后9～20个月改行人工全髋关节置换术或带血管蒂骨瓣股骨头修复术而治愈.结论 髓芯减压自体骨髓细胞结合重组合异种骨移植治疗早期股骨头缺血性坏死,手术操作简单、减少了供区的并发症、术后恢复快,是一种值得提倡的微创手术方法.     

手术配合生骨饮Ⅱ号方治疗塌陷前期非创伤性股骨头坏死的临床研究

目的:探讨髓芯减压打压支撑植骨术配合生骨饮Ⅱ号方治疗塌陷前期非创伤性股骨头坏死的疗效。方法:非创伤性股骨头坏死患者19例(23髋),采用髓芯减压打压支撑植骨术配合术后生骨饮Ⅱ号方口服治疗,随访8个月～5年,从X线片的股骨头塌陷程度和髋关节功能Harris评分两方面对疗效进行评价。结果:未发生塌陷的20髋,2髋塌陷加重不超过2mm,1髋塌陷2～4mm,Harris评分,术后(88.62±4.80)分。优19髋,良3髋,可1髋。结论:髓芯减压打压支撑植骨术配合生骨饮Ⅱ号方治疗非创伤性股骨头坏死有利于骨坏死修复,能够预防股骨头坏死塌陷。     

髓芯减压自体髂骨打压植骨联合骨形态发生蛋白2治疗早中期股骨头坏死疗效观察

目的:观察髓芯减压自体髂骨打压植骨联合骨形态发生蛋白2治疗早中期股骨头坏死的临床疗效。方法:选取股骨头坏死早中期患者38例(52髋),均采用髓芯减压自体髂骨打压植骨联合骨形态发生蛋白2治疗,术后随访9~20个月,中位数12个月。根据手术前后Ficat分期改变及Harris髋关节功能评分评价其疗效。结果:根据Ficat分期法,术前Ⅱ期34髋,术后改变为Ⅰ期33髋,未改变1髋;术前Ⅲ期18髋,术后改变为Ⅱ期10髋,改变为Ⅰ期7髋,未改变1髋。Harris评分:术前(65.74±11.56)分,术后(87.25±12.58)分,手术前后比较,差异有统计学意义(P0.05)。结论:髓芯减压自体髂骨打压植骨联合骨形态发生蛋白2治疗早中期股骨头坏死操作简便,近期疗效确切。     

椎间孔镜辅助下髓芯减压病灶刮除并植骨治疗Ficat Ⅱ、Ⅲ期股骨头无菌性坏死的可行性分析

目的总结分析椎间孔镜辅助下髓芯减压坏死病灶刮除并植骨治疗FicatⅡ、Ⅲ期股骨头无菌性坏死的临床可行性。方法自2016-08—2017-08采用椎间孔镜辅助下行髓芯减压坏死病灶刮除并植骨治疗FicatⅡ、Ⅲ期股骨头无菌性坏死共12例12髋。结果 12例均获得随访,随访时间14～26(19.11±3.66)个月。术后12周功能评定采用Harris评分:优7髋,良2髋,可2髋,差1髋。末次随访时疼痛VAS评分、Harris评分,较术前明显改善,差异有统计学意义(P 0.05)。结论椎间孔镜下可辨别坏死病灶,能指导铰刀刮除方向、判断减压深度,联合髓芯减压、病灶刮除及自体骨植骨治疗FicatⅡ、Ⅲ期股骨头坏疗效肯定,具备临床应用可行性。     

关节镜下微创综合治疗早期股骨头缺血性坏死

目的通过与单纯闭合髓芯减压术比较,探讨关节镜下髓芯减压结合自体松质骨复合BMP植骨治疗早期股骨头缺血性坏死的疗效。方法回顾分析2007年1月-2010年3月收治的28例33髋早期股骨头缺血性坏死患者临床资料,其中采用关节镜下髓芯减压结合自体松质骨复合BMP植骨治疗18例21髋(试验组);单纯闭合髓芯减压术治疗10例12髋(对照组)。两组患者性别、年龄、病程、病因及骨坏死分期等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果术后两组切口均Ⅰ期愈合,无感染等并发症发生。两组患者均获随访,随访时间1～3年,平均2.5年。术后患者疼痛均明显缓解,髋关节功能改善。末次随访时,试验组Harris评分为(85.67±4.78)分,对照组为(81.33±7.03)分,差异有统计学意义(t=—2.10,P=0.04)。试验组FicatⅡ期1髋,对照组FicatⅠ期2髋、Ⅱ期2髋发生股骨头塌陷,行人工髋关节置换术;两组手术总有效率分别为95.24%及66.67%,比较差异有统计学意义(χ2=4.85,P=0.03)。结论与单纯闭合髓芯减压术比较,关节镜下髓芯减压结合自体松质骨复合BMP植骨治疗早期股骨头缺血性坏死具有定位准确、清除坏死骨彻底,能有效缓解疼痛,改善关节功能,延缓股骨头坏死进程的优点。     

髓芯减压并自体松质骨带髓植骨治疗早期股骨头坏死

目的 观察在髓芯减压基础上行自体松质骨带骨髓植入的方法治疗早期股骨头坏死的临床疗效.方法 自2008年10月至2011年10月采用髓芯减压并自体松质骨带髓植入术治疗14 例（15髋）早期股骨头坏死患者,其年龄均在23～50 岁之间,均为Ficat分期Ⅰ、Ⅱ期.术前患者的疼痛视觉模拟评分（visual analogue scale,VAS）平均分为（5±0.62）分,髋关节Harris评分为（50.8±6.5）分,MRI所示的低信号区占股骨头体积的（32.6±6.4）%,术后对症治疗,定期拍片复查.结果 本组全部获得随访,随访时间12～16个月,平均14个月.术后12个月时髋关节Harris评分明显优于术前,上升为（92.2±6.4）分,患者髋部疼痛明显改善,关节活动度较术前增大;MRI显示无一例发生股骨头表面塌陷,股骨头坏死区域明显较术前缩小,差异有统计学意义（P＜0.05）.结论 髓芯减压并自体松质骨带髓植入术治疗早期股骨头坏死稳定率好,可显著缓解疼痛,改善髋关节活动功能,延缓该病的继续发展,具有肯定的临床疗效.     

应用显微外科技术修复骨肿瘤骨缺损

目的：介绍骨肿瘤骨缺损的显微外科治疗及临床疗效。方法：回顾性的总结15例骨肿瘤巨大骨缺损的显微外科手术治疗资料。病灶处理：切刮12例，段截3例。作带血管蒂的的骨块转位移植12例，吻合血管的游离腓骨移植3例。结果：全部病例获长期随访，平均随访3年。所有病例在术后3～4月达骨愈合，无一例复发。结论：应用显微外科技术修复骨肿瘤巨大骨缺损，能缩短骨愈合时间，复发少，患功能恢复好。     

硫酸钙人工骨填充良性骨肿瘤刮除后骨缺损愈合情况的临床研究

目的分析硫酸钙人工骨填充良性骨肿瘤刮除后骨缺损的愈合情况,探讨人工骨在骨肿瘤切除重建中的作用。方法自2005年12月至2008年3月,应用Osteo Set硫酸钙人工骨移植治疗72例原发良性骨肿瘤,其中随访资料完整的47例。根据术后随访期X线片所见评估人工骨降解、吸收和骨愈合生长情况,评估38例含脱钙骨基质（demineralized bone matrix,DBM）和9例未含DBM硫酸钙人工骨的愈合情况,研究植骨量对愈合情况的影响,同时采用肌肉骨骼肿瘤协会（Musculoskeletal Tumor Society,MSTS）功能评分评价关节功能。结果 47例患者获3～55个月随访,平均随访时间16.3个月。均有人工骨颗粒与宿主骨间隙变模糊以及颗粒间变模糊,平均用时3.1（1～6）个月;42例完全吸收,用时4.2（1～12）个月;27例重新塑形,用时7.3（3～17）个月。人工骨愈合良好39例（83.0%）,未出现不愈合病例。含DBM硫酸钙与不含DBM硫酸钙人工骨植入患者的愈合率分别为89.5%和77.8%。植骨量≤5mL组愈合率95.6%,用时6.8（3～12）个月;植骨量〉5mL组愈合率79.2%,用时5.5（3～17）个月。对两组愈合率、愈合时间进行比较,差异无统计学意义（Z=-0.100,P=0.920;Z=-0.650,P=0.516）。MSTS功能评分平均28.8分。术后2例出现伤口不愈合。结论对于良性骨肿瘤切除后骨缺损的重建,硫酸钙人工骨愈合效果满意,是一种安全、有效的移植材料。     

活骨移植治疗四肢骨肿瘤切除后长段骨与关节缺损

目的:探讨四肢骨肿瘤的广泛或边缘切除后,长段骨关节缺损的修复方法及其疗效。方法:四肢骨肿瘤切除术后骨缺损14例,男10例,女4例;年龄4~37岁。骨巨细胞瘤4例,骨化性纤维瘤1例,非骨化性纤维瘤2例,韧带样纤维瘤1例,骨纤维结构不良3例,侵袭性骨母细胞瘤1例,软骨母细胞瘤1例,瘤样病损致骨溶解1例。14例四肢侵袭性良性骨肿瘤行肿瘤广泛或边缘切除,应用吻合血管的腓骨、带腓骨头腓骨近端和带旋髂深血管的髂骨瓣移植修复骨缺损、重建桡腕关节和重建肩关节。移植体行简单内固定加外固定。术后定期复查X线片、多普勒血管超声,其中3例行ECT核素骨扫描,并作关节功能评定。结果:随访3个月~5年,13例均于手术后3个月后达Ⅰ期愈合,其中1例因内固定松动再次手术而愈合。1例肿瘤局部复发,再次行肿瘤切刮与植骨术后愈合;2例畸形愈合行截骨矫形后愈合。关节功能评定:优9例,良3例,差2例。结论:骨肿瘤切除后行骨移植修复骨缺损、重建关节,手术切除彻底,复发率低,植骨愈合可靠,重建后的关节功能良好。     

颗粒骨的制备及修复骨缺损的研究

目的 观察聚磷酸钙纤维(CPPF)磷酸钙骨水泥(CPC)、微小颗粒骨复合物体外降解特性及体内修复骨缺损的能力.方法 将CPPF、CPC、微小颗粒骨按质量比1∶4∶4制成复合人工骨,通过PH值、重量、抗压强度的变化,观察人工骨在pH7.4的37℃磷酸盐缓冲液(PBS)中的降解性能.通过大体、X光片、组织学观察及力学测试来检测复合人工骨的体内修复骨缺损的能力.结果 体外实验证实:CPPF/CPC/颗粒骨复合材料孔隙率为72.1%,CPC/颗粒骨孔隙率为58.2%;扫描电镜显示CPPF/CPC/颗粒骨复合材料的孔径为100～400 μm,CPC/颗粒骨为50～300 μm;两组样品溶液pH值在12周内基本维持恒定;CPPF/CPC/颗粒骨复合材料0～4周重量变化较小,4～8周下降较快,12周为初始重量50%,CPC/颗粒骨复合材料在0～6周变化较小,6周后重量下降较快,12周时为初始重量70%;CPPF/CPC/颗粒骨复合材料初始抗压强度9.28 MPa,CPC/颗粒骨复合材料初始抗压强度6.21 Mpa,两者有统计学意义.CPPF/CPC/颗粒骨强度在0～4周下降较慢,4周后下降较快,12周时为0.1,8 MPa,CPC/颗粒骨强度均匀下降,12周时为0.24 MPa.体内实验:CPPF/CPC/颗粒骨复合材料修复骨缺损效果优于其他各组,且差异有统计学意义(P＜0.05).结论 复合材料以其优良的生物学性能有望成为理想的骨替代材料.     

同种异体骨移植治疗儿童骨囊肿

骨囊肿常见于长骨的干骺端，目前治疗多趋于手术。自2004年至2006年共采用山西医用组织库提供的同种异体骨治疗儿童骨囊肿26例，收到满意效果。既减少患者白体取骨带来的新创伤，又解决了青少年患者自体骨来源有限的临床问题。     

异体松质骨移植治疗骨肿瘤切除后骨缺损

目的：探讨应用异体松质骨移植治疗肿瘤切除后骨缺损的生物材料填充方法。方法：总结应用深低温冷冻保存异体松质骨移植治疗骨肿瘤切除后骨缺损57例。年龄6－56岁,平均年龄17．4岁。结果：除1例因感染异体骨取出外,其余56例均取得满意的骨愈合,愈合时间平均为4．5个月。依骨腔大小或植骨量的不同愈合时间 亦有所不同。单纯异体松质骨移植与异体松质骨加自体松质骨混合移植相比,愈合时间没有明显不同。植骨量越大,骨愈合时间越长。此组患者中未见明显排异反应及并发感染者。肿瘤复发率为7％。结论：同其他骨缺损填充方法和大块异体骨的使用相比,此种方法可行性较好,安全性较高。在骨愈合率,骨愈合时间上及复发以外并发症的发生上同自体松质骨植骨无明显差异。     

Cortical bone senescence and mineral bone density of the humerus

Summary Study of the humeral cortex of 89 acute cadavers showed that an important factor contributing to the physiologic bone loss of aging is increasing bone porosity. Mean cortical porosity increases in both sexes with age, from 4.6% in men and 4% in women at 40 years of age to 10% and more at age 80. In the population studied, no significant difference of porosity was observed between men and women. Apparent mineral density is linked to porosity, and decreases markedly with age in women. Changes in men are lesser in magnitude and show a larger difference of density values. Correction of the apparent mineral density, by a factor reflecting the proportion of vascular and resorption spaces in the cortical bone, produces a true mineral density which does not vary significantly with age in either sex. The density values obtained for the proximal humerus differ from those in the literature which represent the femur. However, they are more readily compared with the results of clinical densitometry and may have greater clinical applications.     

Prediction of bone loss using biochemical markers of bone turnover

Summary The association between baseline levels of eleven bone turnover markers and 5-year rate of bone density change was prospectively studied in a population-based sample of 601 75-year-old women. Several bone formation and resorption markers as well as urinary osteocalcin were modestly correlated to rate of bone density change. Introduction Prediction of bone loss by bone turnover markers (BTMs) has been investigated with conflicting results. There is limited information in the elderly. Methods Eleven bone turnover markers were analyzed in 75-year old women in the OPRA study (n = 601) and compared to the 5-year change of areal bone mineral density (aBMD) in seven skeletal regions. Results Annual aBMD change varied between +0.4% (spine) and −2.0% (femoral neck). Significant associations (p < 0.01) were found for four different serum osteocalcins (S-OCs) (standardized regression coefficient −0.20 to −0.22), urinary deoxypyridinoline (−0.19), serum TRACP5b (−0.19), serum CTX-I (−0.21), two of the three urinary osteocalcins (U-OCs) (−0.16) and aBMD change of the leg region (derived from the total body measurement). After adjustment for baseline aBMD, associations were found for all S-OCs (−0.11 to −0.16), two of the three U-OCs (−0.14 to −0.16) and aBMD change at the total hip, and for three of the four S-OCs (−0.14 to −0.15), S-TRACP5b (−0.11), two of the three U-OCs (−0.14 to −0.15) and aBMD change at the femoral neck. There were no significant results concerning aBMD change at the spine. Conclusion This study indicates that BTMs are correlated with aBMD loss in some skeletal regions in elderly women.     

核素骨断层扫描对颈椎融合器内植骨成活的评价

目的:探索评价颈椎螺纹融合器内植骨成活情况的无创性方法。方法:选择因颈椎病行颈前路减压钛合金螺纹融合器植骨融合 钢板内固定术的41例患者作为观察组,术后随访3～15个月,以99锝标记的亚甲基二膦酸盐(99mTc-MDP)为显像剂行颈椎核素骨断层扫描,根据计算机“感兴趣区”技术,定量计算出植骨部位与自体胸骨上窝水平胸椎的放射性计数比;另选颈椎病术前患者20例作为对照组,行核素骨断层扫描,计算病变间隙相邻椎体与自体胸骨上窝水平胸椎的放射性计数比作为对照。所有观察组患者同期行颈椎CT重建,分别在矢、冠、轴位观察融合器内植骨融合情况,然后将核素扫描与CT结果对比分析。结果:观察组放射性计数比为1.880±0.293,对照组为1.084±0.016,两组间差异有显著性(P<0.05),观察组植骨成活率为100%。CT重建显示观察组中3例骨性融合较差,骨性融合率为92.7%。结论:应用核素骨断层扫描法可对颈椎融合器内移植骨成活情况做出分析,且骨融合一定说明骨成活,植骨成活却不一定完全骨性融合。     

Cellular events associated with the induction of bone by demineralized bone

Implantation of demineralized bone (DB) in the form of powder or intact segments in extra skeletal sites stimulates new bone formation. Urist and co-workers presented substantial evidence that there is a noncollagenous protein that has the ability to induce bone formation. One aim of this study was to trace the process of bone formation when DB, in the form of perforated rectangular plates, is implanted subcutaneously in 2-month-old rats. A second objective was to determine whether cartilage cells play a role in the formation of bone in this model. Various DB plates with 0.25 mm diameter holes were implanted subcutaneously for 1-4 weeks in rats. One week after implantation, DB plates were covered by vascularized connective tissue that invaded the perforations. Aggregates of chondrocytes were observed within the holes and on periosteal surfaces in only a few specimens. Further cartilage proliferation was not observed, and by the 2nd week there was no evidence of endochondral bone formation. Where these cartilage-like cells were present, a thin layer of mineral was deposited around them; resorption and fibrous tissue infiltration followed. This aborted form of endochondral calcification was not followed spatially by bone formation. Patent vascularized channels were invaded by alkaline phosphatase-positive mononuclear cells and fibroblasts, and became enlarged by the enzymatic action of macrophages. The next step involved the calcification of DB plates adjacent to the wide spaces. Osteoclasts now appeared leading to the resorption of this recalcified matrix. The eroded and now enlarged lacunar surfaces were lined by newly formed bone and osteoblasts. This process continued so that, at the end of 4 weeks following implantation, the original DB plates were replaced by trabecular bone. Biochemical data on calcium and alkaline phosphatase levels in the implants paralleled the morphological observations.