右归饮防治人工关节假体周围骨溶解的实验研究

目的:观察右归饮和鲑鱼降钙素防治人工关节假体周围骨溶解的效果。方法:将8周龄大的32只SD雄性大鼠,体重(250±20)g,随机分为4组:空白对照组、模型组、鲑鱼降钙素组和右归饮组,每组8只。空白对照组不做处理,另24只大鼠水合氯醛麻醉后,经髌旁内侧入路行双膝关节手术暴露,从股骨髁间窝钻孔至股骨髓腔,将包含高密度聚乙烯颗粒的凝胶注入孔中,然后放入钛钉,用骨蜡封闭窗口后逐层缝合。造模完成后,空白对照组和模型对照组均用生理盐水灌胃,右归饮组灌服右归饮汤剂,降钙素组则采用臀大肌注射鲑鱼降钙素。给药10周后处死大鼠,取大鼠动脉血和双侧股骨组织进行血生化、影像形态学、组织病理学和分子基因生物学检测。结果:右归饮组和降钙素组破骨细胞激活的关键基因表达均受抑制。右归饮组OPG、Ca、ALP血清水平显著高于降钙素组(P<0.01);右归饮组血清RANKL含量显著低于降钙素组(P<0.01);两组RANK、Trap5b、P水平差异无统计学意义。结论:右归饮和降钙素均有延缓和治疗人工关节假体周围骨吸收的功效,且右归饮比鲑鱼降钙素更能促进成骨形成。右归饮促进成骨,抑制破骨的功效为人工关节假体周围骨溶解提供了一个新的治疗手段。     

关节假体周围感染诊断进展

关节假体周围感染（PJI）是全关节置换术（TJA）后严重的并发症之一,日益受到关注。尽管目前PJI的诊断方法有很多种,但仍缺乏金标准。已有研究发现,引入局部取材标本和提高病原检出率的方法有望提高PJI的诊断准确率。该文在讨论现有PJI诊断方法的基础上,提出临床和未来研究中诊断PJI的新视角,并重点介绍基因测序与超声裂解2种PJI诊断方法。     

人工关节置换术后的骨吸收和骨溶解

骨吸收和骨溶解是影响人工关节远期疗效的主要原因,已成为关节外科医师关注的焦点和难题。由于骨吸收和骨溶解在病因、诊断和治疗方面有共同点,也有不同点,容易混淆,笔者就人工关节置换术后的骨溶解和骨吸收综述如下。1病因骨吸收与骨溶解在病因学方面有着很大区别。骨吸收主要     

假体松动及假体周围骨溶解生物标记物研究进展

<正>全髋及膝关节置换术可以减轻关节疼痛、改善功能,与患者生活质量提高密切相关,关节置换手术量在接下来的20年会大量增长[1]。2011年,全世界有150万例膝关节置换术,100万例全髋关节置换术[2]。在英国,2005~2010年全髋关节置换术增长了16%;美国2005~2030年全髋关节置换术有望增加174%,高达572 000例,每年翻修术增加60%,从100 000例     

噬菌体疗法防治关节假体周围感染研究进展

关节假体周围感染（PJI）指人体关节植入的假体和假体周围存在病原微生物而导致的感染。PJI是髋、膝关节置换术后灾难性的并发症,治疗过程漫长且充满挑战,预后具有不确定性和高风险性。噬菌体是感染细菌、真菌、藻类、放线菌或螺旋体等微生物的病毒的总称,因部分能引起宿主菌的裂解,故称为噬菌体。噬菌体疗法在国外已有较多报道,临床效果显著。该文就噬菌体疗法防治PJI进行综述。     

细菌培养阴性的假体周围感染的诊断进展

假体周围感染(periprosthetic joint infection,PJI)是全髋关节置换术后和全膝关节置换术后最具挑战性的并发症之一。尽管在鉴定致病微生物方面医学界已经做出了广泛的努力,但培养结果往往具有较高的假阴性率。在没有阳性培养结果的情况下,感染的正确诊断、合理的治疗方法以及选择正确的抗生素就面临着巨大的挑战。因此,如何提高假体周围感染细菌培养的阳性率在临床上就显得极为重要。本文就近年来关于假体周围感染诊断的文章进行综述,以期提高临床上假体周围感染的确诊率。     

骨保护素系统与假体周围骨溶解机制研究

晚期关节疾病的患者在接受全髋关节置换手术治疗后，关节疼痛消失或明显减轻，关节功能获得改善，从而使生活质量得以提高。但由于假体使用寿命的限制，该治疗手段还主要局限于老年患者，一些中青年患者往往需要先进行其他过渡性的且效果又不令人满意的治疗，以等待人工关节置换的时机。目前多数学者认为假体周围骨溶解是导致假体松动、手术远期失败，最终影响假体使用寿命的主要原因。既往研究证实单核巨噬细胞、成纤维细胞、成骨细胞等在磨损颗粒刺激下产生大量肿瘤坏死因子、白细胞介素、前列腺素等骨吸收刺激因子，进而激活了破骨细胞，…     

病灶清除植骨保留髋臼假体的翻修术治疗假体周围局灶性骨溶解

目的 探讨病灶清除植骨保留髋臼假体的翻修术治疗全髋关节置换(total hip arthroplasty,THA)术后稳定固定的髋臼假体周围局灶性骨溶解的疗效.方法 2006年3月至2009年3月,THA术后髋臼假体稳定固定的假体周围局灶性骨溶解患者23例(23髋),男13例,女10例;年龄39～54岁,平均46.6岁.23例均为非骨水泥髋臼.初次THA至诊断髋臼假体周围骨溶解的时间为4.6～7.4年,平均5.5年.术前HarTis髋关节评分74分.手术经腹股沟入路,行髂骨内板开窗,清除髋臼骨溶解病灶、同种异体颗粒骨植骨;经后外侧人路更换聚乙烯内衬、股骨头假体,保留髋臼假体.翻修术后1、3、6、12个月及之后每年随访1次,以髋关节Harris评分评价临床疗效,摄X线片、CT扫描观察植骨区愈合、新发骨溶解病灶及假体移位情况.结果 16例获得随访,随访时间8～38个月,平均28个月.末次随访时Harris髋关节评分86～100分,平均93.8分.16例植骨区成骨均良好,12例植骨区完全被周围骨爬行替代,髋臼假体固定好,无髋臼假体松动及移位,无新发髋臼假体周围骨溶解,无异位骨化、脱位、深静脉血栓形成及感染等并发症.结论 清除病灶植骨、保留髋臼假体、更换聚乙烯内衬和股骨头假体的翻修术可有效减少聚乙烯磨损颗粒产生,避免骨溶解病灶进展导致的假体松动,近期随访结果良好.     

人工关节假体植入后骨溶解的研究进展

假体植入后松动是许多行关节置换术病人面临的严重问题,解决这一问题对于提高人工关节置换的疗效有重要意义.目前认为导致假体植入后松动的主要原因是关节活动使得假体表面之间长期摩擦,因此产生大量磨损微粒,微粒在骨-假体界面之间迁移,诱发局部环境中细胞分泌各种细胞因子导致假体周围的骨溶解.为此,本文主要研究磨损微粒的产生过程以及微粒的产生对关节假体使用寿命的重要影响,在此基础上探讨如何减少微粒的产生以及限制其在假体周围的迁移,以此来预防骨溶解发生.……     

假体隆颏术后骨吸收的研究进展

假体用于颏后缩或小颏畸形的纠正常可获得良好的临床效果。假体隆颏在临床应用中存在一些并发症, 影响术后效果。术后形态不佳、移位、感染等常见并发症报道及研究较多, 而对于术后骨吸收的现象, 目前相关研究及报道较少。该文就假体隆颏术后骨吸收现象及其可能的机制等内容进行了综述。     

Acid attack and cathepsin K in bone resorption around total hip replacement prosthesis.

Normal bone remodeling and pathological bone destruction have been considered to be osteoclast-driven. Osteoclasts are able to attach to bare bone surface and produce an acidic subcellular space. This leads to acid dissolution of hydroxyapatite, allowing cathepsin K to degrade the organic type I collagen-rich osteoid matrix under the acidic condition prevailing in Howship lacunae. Using a sting pH electrode, the interface membrane around a loosened total hip replacement prosthesis was found to be acidic. Confocal laser scanning disclosed irregular demineralization of the bone surface in contact with the acidic interface. Cathepsin K, an acidic collagenolytic enzyme, was found in interface tissue macrophages/giant cells and pseudosynovial fluid. Tissue extracts contained high levels of cathepsin K messenger RNA (mRNA) and protein. These observations suggest the presence of an acid- and cathepsin K-driven pathological mechanism of bone resorption, mediated not by osteoclasts in subosteoclastic space, but rather by the uncontrolled activity of macrophages in extracellular space.     

Mediators of bone resorption around implants.

An important cause of prosthetic loosening is bone resorption that results from the interaction of macrophages with implant surfaces and particulate debris. The mediators involved in this bone resorption were investigated in vitro. Medium conditioned by macrophages interacting with foreign materials was assayed for bone resorption stimulation and inhibition, and for prostaglandin E2 (PGE2). In some experiments, the medium was dialyzed, and in others indomethacin was added. Macrophages were found to release stimulators and inhibitors of bone resorption. The relative amount of these was variable. When macrophages interacted with foreign surfaces, their stimulatory effect was ten times their inhibitory effect. Further activation by phagocytosis caused a further 15-fold increase in stimulation, with no change in inhibition. It is probable that before macrophages encounter foreign materials their stimulatory and inhibitory effects are the same so that they do not cause net bone resorption. Important stimulatory and inhibitory mediators were not dialyzable and so were probably cytokines or possibly collagenase. Prostaglandins were neither important stimulators nor inhibitors. There was only enough PGE2 released to account for 2% of the bone resorption that was stimulated.     

假体周围骨溶解的机制研究及治疗进展

人工关节置换术后,假体磨损导致的假体周围骨溶解和无菌性松动是导致假体失败的主要原因。磨损颗粒刺激假体周围的巨噬细胞等产生多种细胞因子,活化破骨细胞使骨吸收增强,同时影响成骨细胞的分化及功能,抑制骨形成。目前的研究热点是骨溶解过程中相关分子信号转导通路,其在预防和治疗磨损颗粒引起的人工关节松动方面仍处于实验阶段,尚需临床实验数据和结果去论证和筛选。     

旋转铰链型人工膝关节置换治疗膝部恶性骨肿瘤

[目的]探讨应用旋转铰链型人工膝关节置换治疗膝部恶性骨肿瘤的手术方法和疗效。[方法]应用旋转铰链型人工膝关节置换治疗膝部恶性骨肿瘤14例,其中股骨下端9例,胫骨上端5例。[结果]14例均获随访,时间17~65个月,平均44个月,总优良率为85.7%。膝关节活动度:伸0°,屈90°~130°,平均为110°。其中股骨假体置换后活动度平均120°,胫骨假体置换后活动度平均95°。术后肿瘤局部复发1例,假体松动1例,感染1例。[结论]旋转铰链型假体减少了骨与假体之间的应力,大大降低了松动或疲劳折断的发生率,是膝部恶性骨肿瘤较理想的保肢方法。     

Longitudinal crack propagation in bone around femoral prosthesis

Intraoperative femoral fracture is a well-recognized technical complication of cementless total hip arthroplasty. This study was designed to establish an in vitro model for initiation and propagation of fractures of the proximal femur in cementless THA and to assess the effect of fracture fixation in the form of cerclage wiring and drilling a hole in the distal extent of the fracture line. Fourteen human anatomic femur specimens were studied. Longitudinal cracks were made and propagation was performed on a materials testing system machine. A drill hole at the tip of a longitudinal crack does not prevent crack propagation. However, cerclage wiring has a statistically significant effect (p less than 0.025) on the ability of the fractured femur to withstand increased load.     

关节假体感染的预防研究进展

针对膝、髋关节严重关节畸形及功能障碍,关节置换是治疗膝、髋关节终末病变的最为有效、安全的治疗措施。然而这一显著提高患者生活质量的手段还有很多并发症,其中人工关节感染是人工关节置换术后最严重的并发症,一旦发生感染,会给患者带来巨大的身体负担和经济压力。而预防是应对关节感染最为经济有效的措施。所以了解人工关节置换术中导致感染的危险因素,及时采取预防措施十分必要。本文针对这些问题作一综述。     

The mechanism of bone resorption in laying hens

The medullary bone in the femora of laying hens and of oestrogen-treated cocks has been examined by histological, histochemical, alpharadiographic and microroentgenographic techniques while undergoing both natural resorption and resorption induced by injection of parathyroid extract. In the hens, natural resorption was brought about by egg-shell formation and in the cocks by withdrawal of oestrogen. Natural resorption was accompained by increasing basophilia, azurophilia and metachromasia and by decreasing alpharadiographic and microradiographic density of the trabeculae of the medullary bone. These changes were observed initially in the central region (towards the marrow cavity) and subsequently in the peripheral regions also, where the number of osteocytes per unit area of bone was less. Parathyroid extract enhanced all these effects.It appears that resorption of medullary bone was brought about by osteocytic osteolysis and by osteoclasis, but it was not possible to determine whether both processes occurred concurrently or whether the osteoclasts attacked the trabeculae only after they had been partially degraded by osteolysis.These results are consistent with the hypothesis that the natural resorption of medullary bone during egg-shell formation in hens and following the withdrawal of oestrogen in cocks is induced by parathyroid hormone.

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Zusammenfassung Die Substantia spongiosa der Femora von Legehennen und von Hähnen die mit Östrogen behandelt waren, wurde während spontaner und künstlicher, mit Extrakten von Epithelkörperchen induzierter, Resorption einer histologischen, histochemischen, alpharadiographischen und mikroröntgenographische Untersuchung unterworfen. Die natürliche Resorption wurde bei den Hennen durch die Eischalenproduktion und bei den Hähnen durch Östrogenentzug hervorgerufen. Die natürliche Resorption war durch erhöhte Basophilie, Azurphilie und Metachromasie, sowohl als auch durch verminderter alpharadiographischer und mikroröntgenographischer Dichte der Trabeculae der Substantia spongiosa charakterisiert. Diese Veränderungen wurden zuerst in den zentralen, dem Cavum medullare nächstgelegenen, Teilen der Spongiosa wahrgenommen. Später waren auch die peripheren Teile, mit geringerer Osteocytenkonzentration, betroffen. Diese Veränderungen konnten durch Gaben von Epithelkörperchenextrakten verstärkt werden.Die Resorption der Spongiosa wird durch osteocytische Osteolyse und Osteoklasie bewirkt. Es konnte aber nicht entschieden werden ob diese beiden Prozesse gleichzeitig stattfinden, oder ob die Osteoklasten die Trabeculae erst angreifen, nachdem sie bereits teilweise durch Osteolyse abgebaut worden sind.Diese Resultate stimmen mit der Hypothese überein, daß die natürliche Resorption von Spongiosa während der Eischalenproduktion bei Hennen und nach Entzug von Östrogen bei Hähnen, durch Epithelkörperchenhormonen bedingt ist.

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Résumé L'os médullaire des poules au moment de la ponte ainsi que l'os néoformé de coqs soumis à des substances oestrogéniques, ont été examinés par les méthodes de l'histologie, de l'histochimie, de la microradiographie et de l'alpharadiographie afin de comparer la résorption naturelle à celle produite par la parathormone.Chez les pondeuses, la résorption a été provoquée par la formation de la coquille; chez les coqs, elle s'est produite à la suite de la diminution du taux des oestrogènes.La résorption naturelle de l'os médullaire a été marquée par un accroissement de la basophilie, de l'azurophilie et de la metachromasie, par la diminution graduelle de la densité organique et minérale.Ces modifications ont été observées d'abord dans la portion distale de l'os médullaire; elles se sont progressivement propagées à la région sous corticale.L'extrait parathyroidien semble avoir favorisé tous ces phénomènes, en stimulant l'ostéolyse ostéocytaire et l'ostéoclasie. Il ne nous a pas été possible cependant de nous rendre compte si les ostéoclastes ne se sont attaqués qu'aux portions des travées déja modifiées par l'ostéolyse.Ces résultats concordent avec l'idée que la résorption normale de l'os médullaire de la poule au temps où la coquille de l'oeuf se dépose, est déclanchée par la parathormone. Il en est de même chez le coq à la suite du retrait des oestrogènes.

     

The mechanism of bone resorption in laying hens

The medullary bone in the femora of laying hens and of oestrogen-treated cocks has been examined by histological, histochemical, alpharadiographic and microroentgenographic techniques while undergoing both natural resorption and resorption induced by injection of parathyroid extract. In the hens, natural resorption was brought about by egg-shell formation and in the cocks by withdrawal of oestrogen. Natural resorption was accompained by increasing basophilia, azurophilia and metachromasia and by decreasing alpharadiographic and microradiographic density of the trabeculae of the medullary bone. These changes were observed initially in the central region (towards the marrow cavity) and subsequently in the peripheral regions also, where the number of osteocytes per unit area of bone was less. Parathyroid extract enhanced all these effects. It appears that resorption of medullary bone was brought about by osteocytic osteolysis and by osteoclasis, but it was not possible to determine whether both processes occurred concurrently or whether the osteoclasts attacked the trabeculae only after they had been partially degraded by osteolysis. These results are consistent with the hypothesis that the natural resorption of medullary bone during egg-shell formation in hens and following the withdrawal of oestrogen in cocks is induced by parathyroid hormone.     

Osteogenic protein 1 device increases bone formation and bone graft resorption around cementless implants

In each femoral condyle of 8 Labrador dogs, a non weight-bearing hydroxyapatite-coated implant was inserted surrounded by a 3 mm gap. Each gap was filled with bone allograft or ProOsteon with or without OP-1 delivered in a bovine collagen type I carrier (OP-1 device). 300 microg OP-1 was used in the 0.75 cc gap surrounding the implant. After 3 weeks, the OP-1 device enhanced implant fixation by 800% (p <0.05) in the ProOsteon group, but OP-1 bad no significant effect on implant fixation in the allograft group. By adding the OP-1 device, the volume fraction of woven bone close to the implant increased from 12% to 20% (p < 0.05) in the bone allograft group and from 6% to 25% (p < 0.05) in the ProOsteon group. The volume fraction of bone allograft decreased from 29% to 9% (p < 0.05) in the OP-1 treated group versus 33% to 30% in the allograft group not treated with OP-1. No resorption of ProOsteen was found. In conclusion, OP-1 accelerates resorption of bone allograft and enhances new bone formation around cementless implants grafted with bone allograft or semisynthetic hydroxyapatite bone substitute. Our findings do not support the use of ProOsteon alone around cementless implants.     

Genistein对破骨细胞分化和骨吸收功能的影响及其机制探讨

目的 探讨三羟异黄酮类药Genistein对破骨细胞性骨吸收的作用及其机制。方法 1，25(OH)2D3诱导小鼠骨髓细胞形成破骨样细胞，分别加入0moL／L、10^-9moL／L、10～moL／L、10^-7moL／L、10～moL／L、10^-5moL／LGenistein，于培养3，5和8d分别计数抗酒石酸酸性磷酸酶阳性细胞个数；于培养12d利用图像分析系统对骨吸收陷窝的面积进行测量分析。另从小鼠颅盖骨分离培养获得原代成骨细胞，分别加入0，10^-8，10^-7，10^-6和10^-5moL／LGenistein并以10^-9moL／L^-7 β雌二醇为对照，采用RT-PCR的方法检测Genistein对骨保护因子(osteoprotegerin，OPG)及破骨细胞分化因子(receptor activator of NF-κB ligand，RANKL)mRNA表达的影响。结果 利用1，25(OH)2D3成功诱导出破骨样细胞；随Genistein浓度增加，抗酒石酸酸性磷酸酶阳性细胞(单核、双核和多核)个数和骨吸收陷窝面积呈剂量依赖性减少。同时，应用Genistein后原代成骨细胞中OPG和RANKL的mRAN表达都有增强，但其最终效应表现为剂量依赖性和时间依赖性地增大OPG／RANKL的浓度比。结论 Genistein通过抑制破骨前体细胞分化来抑制其体外骨吸收功能，其分子机制与OPG／RANKL mRNA表达比值的升高有关。