钛合金板置入内固定修复老年肱骨远端骨折的生物相容性

BACKGROUND: Fracture of the distal humerus is a common type of fracture. Conservative treatment or metal implant fixation can be used during the clinical treatment of elderly patients, but the choice of specific treatment options still lacks of clear conclusion. OBJECTIVE: To explore the clinical repair effect and biocompatibility of titanium alloy implant internal fixation for aged patients with distal humeral fractures. METHODS: A total of 41 elderly patients with humeral fractures, who were hospitalized in Danzhou Municipal First People’s Hospital from July 2011 to July 2014, were enrolled in this study. In accordance with the wishes of patients, repair program was selected. 22 patients in the control group received conservative treatment. 19 patients in the observation group received titanium alloy implant fixation. After 12 months of follow-up, elbow joint activity, elbow joint function recovery and adverse reactions were observed and compared in the two groups. RESULTS AND CONCLUSION: After conservative treatment and internal fixation, each index score and total score of range of motion of shoulder joint were significantly higher in the two groups as compared with pre-treatment (P < 0.05). Each index score and total score were significantly higher in the observation group than in the control group (P < 0.05). Curative effect evaluation results showed four excellent patients and three good patients in the control group, eight excellent patients and four good patients in the observation group. The excellent and good rate was significantly lower in the control group than in the observation group (P < 0.05). Two patients suffered from mild inflammatory hyperplasia during taking out the fixator in the observation group, and the remaining patients did not affect inflammatory hyperplasia or capsular tissue. In the observation group, after surgery, one case experienced numbness of the ulnar nerve, which disappeared after treatment with trophic nerve. One case suffered from wound infection, which was controlled by antibiotic treatment, and did not induce a serious outcome. After follow-up, none of them had nonunion or internal fixation loosening. The results show that titanium alloy implant fixation for the treatment of distal humerus fractures can get better repair effect compared with conservative treatment, can effectively improve the elbow joint function, and titanium alloy material has good biocompatibility.      

人工关节置换、鞍式假体重建及异体骨移植在髋周围骨肿瘤治疗中的应用

背景：髋周围骨肿瘤是全身骨肿瘤好发部位,由于累及负重区,肿瘤切除难度大,对手术技术要求较高,同时往往需要重建骨盆及髋关节功能。 目的：比较髋周围骨肿瘤切除后3种不同修复重建方法的效果。 方法：收集2007年1月至2012年12月于武汉大学中山医院进行手术治疗的髋周围骨肿瘤患者20例,其中良性7例,交界性和恶性13例。均以手术切除治疗。8例采用异体骨移植,8例采用人工关节置换,4例采用鞍式假体重建。 结果与结论：20例均获得随访,随访时间5-60个月,平均40个月。根据Enneking评分标准,优8例﹑良5例﹑中4例﹑差3例,评估优良率65%。证实髋周肿瘤采用手术切除治疗,切除后采用异体骨移植、人工关节置换或鞍式假体重建能提高患者生存率,改善患者生活质量,是髋周肿瘤有效治疗方法。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

内固定植入物与外固定支架修复胫骨骨折骨不连的策略及辅助治疗

BACKGROUND: Nonunion is a common clinical problem in the prognosis of tibial fracture. The treatment method of tibial fracture nonunion is extensive and develops rapidly. Different repair plans should be taken to the nonunion of tibial fractures caused by different factors.     

股骨近端防旋髓内钉与联合加压交锁髓内钉治疗股骨转子间骨折的短期疗效比较北大核心

背景:股骨转子间骨折是老年患者常见的骨折类型,何种内固定方式的疗效最佳尚存在争论。目的:比较股骨近端防旋髓内钉与联合加压交锁髓内钉系统治疗老年股骨转子间骨折的短期临床疗效。方法:根据患者接受的内固定方式不同,分为股骨近端防旋髓内钉固定组和联合加压交锁髓内钉固定组。股骨近端防旋髓内钉固定组19例,联合加压交锁髓内钉固定组26例。比较2组患者手术时间、术中出血量、住院时间、术后并发症发生率和术后3个月髋关节Harris功能评分。结果与结论:(1)股骨近端防旋髓内钉固定组患者平均手术时间为(125.8±21.5)min,较联合加压交锁髓内钉固定组短(156.2±54.5)min,差异有显著性意义(P<0.05);(2)股骨近端防旋髓内钉固定组患者平均术中出血量为(226.3±107.2)mL,较联合加压交锁髓内钉固定组少(300.0±150.3)mL,但差异无显著性意义;(3)2组患者的平均住院时间、术后并发症发生率和术后3个月髋关节Harris功能评分方面差异无显著性意义;(4)结果提示,除了在手术时间方面股骨近端防旋髓内钉系统更具优势外,两种内固定系统治疗老年股骨转子间骨折在术中出血量、住院时间、术后并发症发生率和术后3个月髋关节Harris功能评分等方面无明显差异,术后短期内均具有良好的安全性和有效性。     

两种寰椎侧块螺钉固定方法的可行性比较

背景：寰椎侧块螺钉固定技术按其入钉点的不同可分为寰椎后弓下侧块螺钉固定和经寰椎后弓侧块螺钉固定(又称寰椎椎弓根螺钉固定),这2种固定方法各有优缺点,以往缺乏关于2种寰椎侧块螺钉固定方法骨性解剖可行性的比较研究, 目的：以测量国人寰椎相关骨性解剖数据为依据,比较2种寰椎侧块螺钉固定方法的可行性。 方法：收集30例(60侧)成人颈椎病患者的寰椎螺旋CT扫描数据,利用CT工作站对数据重建,分别测量寰椎侧块螺钉固定的关键骨性解剖数据,适合行经寰椎后弓侧块螺钉固定的标准为寰椎椎动脉沟处后弓高度和宽度≥ 4 mm;适合行经寰椎后弓下侧块螺钉固定的标准为寰椎后弓下侧块高度≥ 4 mm。 结果与结论：寰椎椎动脉沟处后弓高度为(4.54±1.17) mm,椎动脉沟处后弓宽度为(8.69±1.12) mm,寰椎后弓下侧块高度为(4.98±1.07) mm。寰椎后弓椎动脉沟高度大于4 mm(适合经寰椎后弓螺钉固定组)有41侧,占68%;寰椎后弓下侧块高度大于4 mm(适合经寰椎后弓下侧块螺钉固定)有52侧,占87%,2组差异有显著性意义(P < 0.05)。提示经寰椎后弓下侧块螺钉固定较经寰椎椎弓根螺钉更具可行性。术前利用CT测量寰椎关键解剖结构数据对制定个性化手术方案具有重要意义。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

不同骨科植入物对放射治疗的影响

分析商用的不锈钢植入物、钛基合金植入物以及自制的碳纤维植入物在放射诊断中的影像学区别及对放射治疗剂量的影响,探讨碳纤维植入物在放射治疗方面的应用前景.把3种不同材质的骨科植入物通过手术先后植入同一只家猪的同一只后腿,用普通模拟定位机和CT模拟定位机观察不同材质的骨科植入物对影像的影响,进而利用放射治疗计划系统分析不同植...     

髋部骨折植入物的选择及其并发症

背景：临床上髋部骨折常通过手术进行治疗,但是由于老年患者各脏器功能衰退而增加了术后继发合并症的危险。 目的：综述近年国内外髋部骨折植入物及其并发症的研究进展。 方法：第一作者应用计算机检索1994年1月至2015年10月PubMed和CNKI中文期刊全文数据库有关髋部骨折植入物及其并发症的文章,英文检索词“hip fracture,implants,complications”;中文检索词“髋部骨折,植入物,并发症”。共检索到128篇相关文献,52篇文献符合纳入标准。 结果与结论：20%的髋部骨折患者会发生并发症,包括医学方面及手术治疗本身的。文章依据髋部骨折的临床分类不同,分两方面对髋部骨折植入物并发症进行了阐述。一方面以髋部骨折手术常用植入物为切入点阐述其常见的并发症;另一方面以髋部骨折部位为切入点阐述髋部骨折植入物并发症。髋部骨折植入物相关的常见并发症有髋内翻、关节脱位、植入物退出或切割股骨头等。早期内固定、抗血栓和预防感染、围手术期疼痛管理、精神错乱的及时发现和控制、正确的尿路管理、预防营养不良、补充维生素D、骨质疏松症的治疗和早期功能活动的改善,是髋部骨折患者的最佳保养建议。近年来随着内固定技术及术后处理的日益完善,以及早期康复的介入,更多的学者主张早期内固定治疗,目的是加快患者髋关节功能恢复以及防止再跌倒。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

三维重建结合钛板或拉力螺钉微创修复复杂肩胛骨骨折

背景：复杂肩胛骨骨折多采用植入物内固定治疗,标准的内固定入路(Judet入路)切口长,创伤较大。随着螺旋CT及三维重建技术的应用,使得临床医师可在植入物内固定前设计微创切口并完成内固定治疗,减少创伤,提高修复效果。 目的：观察三维重建设计结合重建钛板或拉力螺钉微创内固定修复复杂肩胛骨骨折的效果。 方法：纳入2007年2月至2012年1月秦皇岛市第一医院骨科收治的33例复杂肩胛骨骨折患者,植入物内固定前进行CT三维重建扫描,明确需要复位及内固定的部位,依此设计微创植入物内固定切口,减少皮肤、皮下组织及肌肉的剥离,进行复位,并应用重建钛板及/或拉力螺钉内固定。 结果与结论：33例患者手术时间90-130 min,术中出血300-400 mL,骨折全部愈合,愈合时间为2-4个月。植入物内固定后随访12-24个月,根据Hardegger标准评价肩关节功能,优17例,良12例,可3例,差1例,优良率为88%。提示三维重建设计组合小切口微创修复复杂肩胛骨骨折,能够以较小的创伤完成骨折的满意复位及植入物内固定,获得良好的修复效果。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

腕舟状骨骨折影像学评价:哪种手术入路对骨折愈合影响最小更安全合适北大核心

背景:腕舟状骨由于其形态不规则且和腕关节相邻诸骨部分重叠,故对腕舟状骨骨折的诊断及治疗带来很大困难,究竟哪种影像学检查方法对腕舟状骨骨折的诊断率最高、哪种手术入路对舟状骨骨折愈合影响最小目前学术界尚存在不少争议。目的:综述目前腕舟状骨骨折的影像学检查及手术入路方面的研究进展。方法:由第一作者用中国期刊全文数据库和PubM ed数据库,检索时间:2005至2015年,检索词分别为"腕舟状骨"、"骨折"、"影像学"、"手术入路"和"scaphodl bone"、"fracture"、"iconography"、"surgical approach",语言分别设定为中文和英文。纳入腕舟状骨骨折的影像学检查及手术入路相关的研究,排除陈旧及重复的文献,共检索到3 021篇文章,按纳入标准对文献进行筛选,共纳入24篇文章进行综述分析。结果与结论:(1)腕舟状骨骨折腕关节旋前60°和旋后45°、斜位片及侧位这4种体位可以从不同角度显示腕舟状骨,具有较好的互补作用,可以作为评价腕舟状骨骨折较为理想的X射线检查体位,从而提高诊断的准确性。现阶段采用CT检查最可靠也最直观,但是CT检查尚缺少一些精确的量化参数来判断腕舟状骨骨折,尤其对微小的骨折来说更是如此。MRI不仅能很好地评价腕舟状骨结构的完整性,更重要的是能准确地反映腕舟状骨的血液灌注情况。采用核素骨扫描比反复进行X射线检查或CT检查的准确率更高;(2)目前文献报道的腕舟状骨骨折手术入路包括掌侧入路、背侧入路、桡腕侧入路等,但尚无一种公认的理想手术入路;(3)综合文献报道,较为理想的舟状骨骨折手术入路应能满足6个条件:能方便地显露舟状骨、便于骨折复位、尽可能少破坏舟状骨的残余血供、便于确定舟状骨长轴以便内固定器材的植入、微创化、总体手术过程简便易行,目前上述手术入路仍难以完全满足这6个条件,有待于临床上进一步探索。     

Cellular and molecular dynamics in the foreign body reaction

Intracorporally implanted materials, such as medical devices, will provoke the body to initiate an inflammatory reaction. This inflammatory reaction to implanted materials is known as the foreign body reaction (FBR) and is characterized by 3 distinct phases: onset, progression, and resolution. The FBR proceeds in the creation of a dynamic microenvironment that is spatially well organized. The progression of the FBR is regulated by soluble mediators, such as cytokines, chemokines, and matrix metalloproteinases (MMPs), which are produced locally by tissue cells and infiltrated inflammatory cells. These soluble mediators orchestrate the cascade of cellular processes in the microenvironment that accompanies the FBR, consisting of cellular activation, angiogenesis, extravasation, migration, phagocytosis, and, finally, fibrosis. The nature of the FBR requires that the soluble mediators act in a spatial and temporally regulated manner as well. This regulation is well known for several inflammatory processes, but scarce knowledge exists about the intricate relationship between the FBR and the expression of soluble mediators. This review discusses the key processes during the initiation, progression, and resolution phase, with emphasis on the role of soluble mediators. Besides other sites of implantation, we focus on the subcutaneous implantation model.     

The in vitro adsorption of cytokines by polymer-pyrolysed carbon

This study investigated a range of phenol-formaldehyde-aniline-based pyrolysed carbon matrices and their component materials, for their ability to adsorb a range of inflammatory cytokines crucial to the progression of sepsis. The efficiency of adsorption of the target molecules from human plasma was assessed and compared to that of Adsorba 300C, a commercially available cellulose-coated activated charcoal. Results indicate that a number of the primary carbon/resin materials demonstrate efficient adsorption of the cytokines studied here (TNF, IL-6 and IL-8), comparable to other adsorbents under clinical investigation. Our findings also illustrate that these adsorbent capabilities are retained when the primary particles are combined to form a pyrolysed carbon matrix. This capability will enable the engineering of the carbon matrix porosity allowing a blend of carbonised particle combinations to be tailored for maximum adsorption of inflammatory cytokines. The present findings support further investigation of this carbon material as a combined carbon-based filtration/adsorbent device for direct blood purification.     

Inflammatory and immune processes in the human lung in health and disease: evaluation by bronchoalveolar lavage.

Bronchoalveolar lavage is an invaluable means of accurately evaluating the inflammatory and immune processes of the human lung. Although lavage recovers only those cells and proteins present on the epithelial surface of the lower respiratory tract, comparison with open lung biopsies shows that these constituents are representative of the inflammatory and immune systems of the alveolar structures. With the use of these techniques, sufficient materials are obtained from normal individuals to allow characterization of not only the types of cells and proteins present but their functions as well. Such observations have been useful in defining the inflammatory and immune capabilities of the normal lung and provide a basis for the study of lung disease. Lavage methods have been used to characterize inflammatory and immune processes of the lower respiratory tract in destructive, infectious, neoplastic, and interstitial disorders. From the data already acquired, it is apparent that bronchoalveolar lavage will yield major insights into the pathogenesis, staging, and therapy decisions involved in these disorders. (Am J Pathol 97:149--206, 1979).     

Inflammation and Alzheimer's disease

Inflammation clearly occurs in pathologically vulnerable regions of the Alzheimer's disease (AD) brain, and it does so with the full complexity of local peripheral inflammatory responses. In the periphery, degenerating tissue and the deposition of highly insoluble abnormal materials are classical stimulants of inflammation. Likewise, in the AD brain damaged neurons and neurites and highly insoluble amyloid beta peptide deposits and neurofibrillary tangles provide obvious stimuli for inflammation. Because these stimuli are discrete, microlocalized, and present from early preclinical to terminal stages of AD, local upregulation of complement, cytokines, acute phase reactants, and other inflammatory mediators is also discrete, microlocalized, and chronic. Cumulated over many years, direct and bystander damage from AD inflammatory mechanisms is likely to significantly exacerbate the very pathogenic processes that gave rise to it. Thus, animal models and clinical studies, although still in their infancy, strongly suggest that AD inflammation significantly contributes to AD pathogenesis. By better understanding AD inflammatory and immunoregulatory processes, it should be possible to develop anti-inflammatory approaches that may not cure AD but will likely help slow the progression or delay the onset of this devastating disorder.     

In vivo biocompatibility of gelatin-based hydrogels and interpenetrating networks

The in vivo host response to two gelatin-based hydrogel systems of varying crosslinking modalities and loaded with the anti-inflammatory agent dexamethasone sodium phosphate was investigated. Either gelatin was chemically crosslinked with glutaraldehyde, or polyethyleneglycol diacrylate was photopolymerized around gelatin to form interpenetrating networks. The subcutaneous cage implant system was utilized to determine differential leukocyte concentrations in the inflammatory exudate surrounding the materials as indices for biocompatibility and drug efficacy in vivo. Most of the crosslinked gelatin-based materials, either via glutaraldehyde fixation or interpenetrating network formation, elicited stronger inflammatory responses than either of the starting materials, gelatin and polyethyleneglycol diacrylate. In general, dexamethasone delayed and intensified the inflammatory response. The loss of material mass did not correlate directly with the degree of cellular inflammatory response, but increased with longer implantation time and decreased with more extensive fixation.     

Spatiotemporal effects of a controlled-release anti-inflammatory drug on the cellular dynamics of host response

In general, biomaterials induce a non-specific host response when implanted in the body. This reaction has the potential to interfere with the function of the implanted materials. One method for controlling the host response is through local, controlled-release of anti-inflammatory agents. Herein, we investigate the spatial and temporal effects of an anti-inflammatory drug on the cellular dynamics of the innate immune response to subcutaneously implanted poly(lactic-co-glycolic) microparticles. Noninvasive fluorescence imaging was used to investigate the influence of dexamethasone drug loading and release kinetics on the local and systemic inhibition of inflammatory cellular activities. Temporal monitoring of host response showed that inhibition of inflammatory proteases in the early phase was correlated with decreased cellular infiltration in the later phase of the foreign body response. We believe that using controlled-release anti-inflammatory platforms to modulate early cellular dynamics will be useful in reducing the foreign body response to implanted biomaterials and medical devices.     

In vitro inflammatory response of nanostructured titania, silicon oxide, and polycaprolactone

Nanostructured materials are ubiquitous in tissue engineering, drug delivery, and biosensing applications. Nonetheless, little is known about the inflammatory response of materials differing in surface nanoarchitecture. Here we report human monocyte viability and morphology, in addition to inflammatory cytokines (IL-1alpha and B, IL-6, IL-10, IFN-alpha and gamma, TNF-alpha, IL-12, MIP-1alpha and beta), and reactive oxygen species production on several nanostructured surfaces, compared to flat surfaces of the same material. The surfaces studied were titiania nanotubes, short and long silicon oxide, and polycaprolactone nanowires. The results indicate that inflammation on titanium, polycaprolactone, and silicon oxide materials can be reduced by restructuring the surface with nanoarchitecture. Nanostructured surfaces display a reduced inflammation response compared to a respective flat control, with significant differences between titanium and nanotubular titanium. Little difference is observed in the inflammatory response between short and long nanowires of PCL and silicon oxide. All surfaces are significantly less inflammatory than the positive control, lipopolysaccharide. Additionally, we show that flat titanium is more inflammatory than silicon oxide and polycaprolactone. This study shows that nanoarchitecture can be used to reduce the inflammatory response of human monocytes in vitro.     

In vivo biocompatibility of gelatin-based hydrogels and interpenetrating networks

The in vivo host response to two gelatin-based hydrogel systems of varying crosslinking modalities and loaded with the anti-inflammatory agent dexamethasone sodium phosphate was investigated. Either gelatin was chemically crosslinked with glutaraldehyde, or polyethyleneglycol diacrylate was photopolymerized around gelatin to form interpenetrating networks. The subcutaneous cage implant system was utilized to determine differential leukocyte concentrations in the inflammatory exudate surrounding the materials as indices for biocompatibility and drug efficacy in vivo. Most of the crosslinked gelatin-based materials, either via glutaraldehyde fixation or interpenetrating network formation, elicited stronger inflammatory responses than either of the starting materials, gelatin and polyethyleneglycol diacrylate. In general, dexamethasone delayed and intensified the inflammatory response. The loss of material mass did not correlate directly with the degree of cellular inflammatory response, but increased with longer implantation time and decreased with more extensive fixation.     

Understanding inflammatory pain: ion channels contributing to acute and chronic nociception

Inflammatory pain results from the increased excitability of peripheral nociceptive sensory fibres produced by the action of inflammatory mediators. This excitatory effect, in turn, is a result of the altered activity of ion channels within affected sensory fibres. This review will consider the molecular consequences of inflammation within the peripheral nerves with particular focus on the effects of different inflammatory mediators on the ion channels in sensory neurons. We will discuss the main signalling pathways triggered in neurons by inflammatory mediators; the ionic mechanisms underlying inflammatory hyperalgesia and spontaneous inflammatory pain and finally will briefly consider ion channels underlying pain in chronic inflammation.     

The influence of scaffold material on chondrocytes under inflammatory conditions

Cartilage tissue engineering aims to repair damaged cartilage tissue in arthritic joints. As arthritic joints have significantly higher levels of pro-inflammatory cytokines (such as IL-1β and TNFα that cause cartilage destruction, it is critical to engineer stable cartilage in an inflammatory environment. Biomaterial scaffolds constitute an important component of the microenvironment for chondrocytes in engineered cartilage. However, it remains unclear how the scaffold material influences the response of chondrocytes seeded in these scaffolds under inflammatory stimuli. Here we have compared the responses of articular chondrocytes seeded within three different polymeric scaffolding materials (silk, collagen and polylactic acid (PLA)) to IL-1β and TNFα. These scaffolds have different physical characteristics and yielded significant differences in the expression of genes associated with cartilage matrix production and degradation, cell adhesion and cell death. The silk and collagen scaffolds released pro-inflammatory cytokines faster and had higher uptake water abilities than PLA scaffolds. Correspondingly, chondrocytes cultured in silk and collagen scaffolds maintained higher levels of cartilage matrix than those in PLA, suggesting that these biophysical properties of scaffolds may regulate gene expression and the response to inflammatory stimuli in chondrocytes. Based on this study we conclude that selecting the proper scaffold material will aid in the engineering of more stable cartilage tissues for cartilage repair, and that silk and collagen are better scaffolds in terms of supporting the stability of three-dimensional cartilage under inflammatory conditions.