延长速度对兔胫骨延长区骨膜及成骨方式的影响

本文报告30只兔胫骨上干骺端截骨延长的实验结果。作者通过X线和组织学检查方法观察了1mm/d、2mm/d及3mm/d 3种延长速度对延长区骨膜及成骨方式的影响。结果发现以1mm/d速度延长时延长区骨膜不仅完整存在而且成骨活跃,且以膜内和软骨内成骨二种方式同时进行。提示缓慢牵伸时的低牵张力可以刺激骨膜迅速增殖而不致于在延长过程中被撕裂。     

胫骨血液供应的实验和解剖学研究

本文对45侧下肢标本和15只狗进行了胫骨血供的实验和解剖学研究。胫骨血供是以滋养动脉为主干,并与骺血管和骨膜血管存在广泛吻合。切除狗胫骨大面积骨干骨外膜并同时切断滋养动脉后,创面渗血仍然存在,经2—20周观察未见出现骨质的缺血性坏死,表明胫骨各个供血系统相互间代尝作用很强。     

带血供胫骨骨膜瓣转位术的临床应用(附7例报告)

目的：解决胫骨中下1／3存折、骨缺损愈合困难问题，探讨带血供胫骨骨膜瓣转位术术式的优点。方法：设计以胫前或胜后血管节段性向胫骨发出的分膜支、肌骨膜支为蒂，作成带血供胫骨内、外侧骨膜瓣转位覆盖骨折、缺损部位，观察骨愈合情况。结果：治疗胫骨中下1／3骨折伴骨缺损7例，失访1例，骨临床愈合时间为5～12周，术后3个月可恢复正常工作生活，拆除内固定时间为8～10个月。结论：带血供胫骨骨膜瓣转位术不损害肢体主要血管，手术操作简单，可在一个切口中完成，手术损伤小，能迅速促进骨愈合，缩短疗程。     

携带胫骨骨膜骨块的小腿内侧皮瓣游离移植修复下肢骨及软组织 …

探索携带胫骨骨膜骨块的小腿内侧皮瓣修复下肢骨及软组织缺损的效果。方法 １９８５－１９８７年，我科使用携带胫骨骨膜骨块的小腿内侧皮瓣治疗了５例下肢骨及软组织缺病人。结果 ３例随访１０年供区和受区胫骨外形及功能均接近正常，皮瓣色泽佳，弹性好。     

带血供胫骨节段性骨膜瓣治疗胫骨骨不连

胫骨骨不连是骨科常见的疾患之一,其发病率居四肢长管骨之首,而中下1/3段骨折骨不连更为常见[1].如何更有效地修复胫骨骨不连一直是骨科领域中的热点.惠州市惠城区水口医院自2002年3月至2009年3月利用以胫前血管骨膜支为蒂的节段性胫骨骨膜瓣转位术加外固定架固定治疗19例胫骨骨不连,取得了满意的效果,报告如下.     

胫骨骨膜瓣移植治疗Ficat2期股骨头坏死近期临床疗效分析

目的 评价吻合血管胫骨骨膜瓣移植+取髂骨植骨治疗2期股骨头坏死的临床疗效.方法 从2008年2月至2010年2月,在我院采用吻合血管胫骨骨膜瓣移植+取髂骨植骨治疗股骨头坏死25例,其中男17例,女8例,平均年龄36.2岁(25~48岁).手术凿刮骨坏死囊变组织,取髂骨松质骨填塞、压实,取游离带血管胫骨骨膜瓣与旋股外升支...     

长管状骨再生骨膜形态学和成骨能力的实验研究

目的 探讨长管状骨骨膜切取移植后供骨再生骨膜的组织结构，生成机制和成骨能力。方法 实验杂种犬１６条，随机分为４组，每组４条。第１组行胫骨骨膜次全切除；第２组：同第１组＋滋养血管切断；第３组；同第２组＋干骺血管切断（１－３组均为双侧胫骨手术，左侧术后分期切取标本行光，电镜检查；右侧术后８周行胫骨锯断钢板内固定，分期拍片）；第４组为对照组，仅行右胫骨锯断内固定和拍片观察。     

羊胫骨的微血管构筑

采用血管Ｘ线造影法和血管墨汁切片法，观察了８例羊胫骨的微血管构筑。结果表明：①胫骨的血供来源为滋养动脉，骺－干骺动脉和骨膜动脉；②骨皮质与骨膜之间的交通血管为微动脉，毛细血管，微静脉；③骨干骨皮质由滋养动脉和骨肢动脉共同供应，滋养动脉供应骨皮质深层２／３区域，而骨膜动脉供应骨皮质浅层１／３区域，从而提示骨干骨皮质的血流是“双向”的。既可由骨内膜流入骨皮质，亦可由骨外膜流入皮质。     

带血供骨膜瓣与同种异体脱钙骨联合修复大段骨缺损的实验研究

目的　探讨带血供骨膜瓣与同种异体脱钙骨联合修复大段骨缺损的效果。方法　以兔桡骨中段 15mm的大段骨缺损为模型 ,通过X线lane评分、组织学观察、电镜扫描 ,评价术后 4、8、12、16周时带血供骨膜瓣与同种异体脱钙骨联合修复骨缺损的效果。结果　带血供的骨膜瓣与同种异体脱钙骨联合修复效果明显好于单纯脱钙骨组 ,前者在Lane评分 (P <0 .0 5 )、组织学观察等方面均优于后者。结论　带血供骨膜瓣与同种异体脱钙骨联合修复大段骨缺损效果优于单纯脱钙骨。     

自体骨—骨膜转移修复关节软骨缺损的实验研究

目的：通过自体骨－骨膜移植修复兔关节软骨缺损，探讨骨膜间充质细胞对关节透明软骨组织全层缺损修复的作用与机制。方法：以成年兔胫骨内上侧的骨－骨膜组织作为供体，镶嵌式植入兔自体髌股关节之股骨滑车关节软骨等大、相同形状的全层缺损区，术后4－24周分别对缺损修复情况进行大体、组织学及电镜观察。结果：自体骨－骨膜移植组织与缺损周围组织完全愈合，组织学及电镜观察显示修复组织为透明软骨组织。结论：自体骨－骨膜组织移植修补关节软骨缺损可以诱导关节软骨缺损以透明软骨方式进行修复，这为临床应用自体骨－骨膜组织移植修复关节软骨缺损提供了理论依据。     

低强度脉冲超声对新生骨成熟过程的影响

目的:探讨低强度脉冲超声对兔四肢骨延长模型新生骨成熟过程的影响。方法:60只成年新西兰兔随机分为低强度超声治疗组和空白对照组,所有动物行胫骨中段截骨并以Orthofix M103型迷你外固定架延长器固定,术后7 d后以0.5 mm/12 h延长10 d,超声治疗组在骨延长完成后以超声骨折治疗仪治疗4周,对照组不予治疗。分别于骨延长完成后4周、8周、12周处死治疗组及对照组实验动物,并收集新生骨标本。在骨延长后12周摄X光片,用ImageJ图像分析软件进行影像学分析,比较骨痂生长情况。用双能X线吸收测量法(dual energy X-ray absorptiometry, DEXA)测量兔胫骨中段骨密度。取8周组、12周组双侧兔胫骨标本做扭转生物力学测试。结果:以图像分析软件测量X线片上的12周组新生骨灰度值,发现12周治疗组的灰度值明显高于对照组(P<0.05)。DEXA测量显示8周和12周治疗组新生骨的骨密度大于对照组(P<0.05)。生物力学测试中,8周和12周治疗组的最大扭力、极限扭转强度、破裂能各指标均优于对照组(P<0.05)。结论:低强度超声可作为一种生物物理刺激促使兔胫骨骨折部位成骨。     

纤维性骨皮质缺损的MRI诊断与鉴别诊断

目的探讨纤维性骨皮质缺损的MRI表现及其鉴别诊断。方法对32例经随访观察1～4年（26例）、临床病理证实（6例）的纤维性骨皮质缺损患者的临床资料及MRI表现进行分析,并加以鉴别诊断。结果 32例纤维性骨皮质缺损中,位于股骨远侧干骺端16例,股骨骨干下段3例,股骨近侧干骺端3例,胫骨近侧干骺端8例,胫骨骨干上段2例;右侧17例,左侧15例;且病灶大多位于病骨后侧份,内侧份皮质区;病灶大多呈类圆形、椭圆形,边界清楚,周围未见骨膜反应及软组织肿胀,病灶大小约0.5～2.6cm,多呈稍长T1稍长T2、稍短T2信号,并周围见低信号线样改变,11例增强扫描均有不同程度强化,多为轻～中度。14例经随访观察,其中7例病灶无改变,5例病灶稍有缩小,2例发展为非骨化性纤维瘤。结论纤维骨皮质缺损的MRI表现有一定的特征性,有助于该病的诊断,并能进行鉴别诊断。     

The progression of bone and muscle atrophy in mice hind limb with immobilization

This study investigated the time course of changes of bone and muscle atrophy in mice with immobilization by denervation and fixation. The animals were fifty-two male C57 BL/6J mice, aged 10 weeks old. Eight mice were used as the base line, and the remaining ones were cut at the sciatic nerve of the left hind limb and fixed with a plaster cast. At week 1, 2, 3, and 4 after the operation, a cross-sectional area of the rectus femoris muscles and bone mechanical strength with a three-point bending test of the femur and tibia were measured. The time course of changes of the bone mechanical strength and of the cross-sectional area of the rectus femoris muscles between the intact and experimental limbs in each period compared with the control limbs, was determined. The bone mechanical strength of the femur, tibia, and the cross-sectional area of the rectus femoris muscles of the experimental limbs significantly decreased compared with those of the intact limbs at week 4, 3, 2 and 1 after the operation (p<0.05). Compared with the intact limbs, the bone mechanical strength and the cross-sectional area of the rectus femoris muscles of the experimental limbs declined approximately 10% and 30%, respectively, during the experiment (p<0.05). It was demonstrated that bone and muscle atrophy occurred at an early stage after immobilization by denervation and fixation, and that both types of atrophy progressed simultaneously in the present study.     

携带胫骨骨膜骨块的小腿内侧皮瓣游离移植修复下肢骨及软组织缺损

目的探索携带胫骨骨膜骨块的小腿内侧皮瓣修复下肢骨及软组织缺损的效果。方法1985-1987年，我科使用携带胚骨骨膜骨块的小腿内侧皮瓣治疗了5例下肢骨及软组织缺损病人。结果3例随访10年供区和受区胫骨外形及功能均接近正常，皮瓣色泽佳，弹性好。结论作者认为该瓣在修复大块骨、软组织复合缺损时有许多显著的优点。     

Change of bone mechanical strength in rats after spinal cord injury over a short term

This study investigated the time-course of changes in bone mechanical strength in rats with spinal cord injury (SCI). Sixty-four male Wistar rats underwent spinal cord transection at the thoracic nerve. Control rats underwent a sham procedure (SHAM). Animals were sacrificed at day 1, 4, 7 and 14 after operation. The mechanical strength of the left femur and tibia was measured by the three-point bending strength test. The bones were dried, weighed and burned to ash. A specimen of right tibia was prepared and examined under a microscope. Bone mechanical strength, dry bone weight, and ash content of the femur and tibia in SCI rats were significantly lower than those in SHAM animals. Dry bone weight and ash content began to decrease from the 4th day after SCI and reached their lowest at day 7 after operation. Bone mechanical strength had reduced significantly by the 14th day. Gaps and spaces were observed in the trabecular area at the same time. After SCI, calcified cartilage decreased and the reduction of bone mass occurred rapidly. Moreover, a decline of bone mechanical strength is caused within 2 weeks. Thus, SCI led to the atrophy of bone and caused the reduction of mechanical strength at an early stage. It is thus necessary to prevent bone loss after SCI immediately.     

游离穿支孪生复合组织瓣修复第1跖骨头及软组织缺损

目的探讨应用带胫骨（膜）瓣及隐神经的胫后动脉穿支孪生复合组织瓣游离移植修复足弓及第1跖骨头部感觉神经及软组织缺损的临床应用效果。方法2008年02月一2012年02月临床应用5例,均为拇趾及第1跖骨头毁损、前足软组织缺损,前足纵横弓完整性破坏。选择以胫骨滋养动脉或胫后动脉发出的骨（膜）皮穿支血管为蒂,切取带胫骨（膜）瓣及隐神经的胫后动脉穿支血管供血的孪生复合组织瓣游离移植修复第1跖骨头及软组织缺损,骨瓣切取大小为1．5cm×0．8cm×0．6cm～4．0cm×1．5cm×1．0cm,皮瓣切取为5．0cm×3．5cm～7．0cm×6cm。结果术后皮瓣全部成活,术后3个月足部皮瓣有部分感觉恢复。随访6～24个月,皮瓣外形满意,骨折骨性愈合,可负重行走,行走步态接近正常,前足部皮瓣感觉恢复达S3。结论该术式保留了足弓外形及负重支撑点,行走和负重良好,外形及功能满意,有感觉。具有创伤小、供区部位隐蔽、不牺牲主干血管,手术操作简便等优势,一次手术即可使第一跖骨及周围组织达到满意的解剖塑形及良好功能。是一种较理想的治疗方法。     

不同刚度接骨板内固定后骨改建的电镜观察

实验用40只成年新西兰兔,4只作为对照,另36只分为3组。采用有机玻璃、钛合金和不锈钢三种不同刚度接骨板,分别在兔左侧胫骨中段作未截骨内固定。术后2、4,8和12周截取接骨板下皮质骨,在扫描电镜下观察骨胶原纤维。钛合金和有机玻璃接骨板内固定可产生不同形态的骨吸收腔,但骨吸收腔之间的胶原纤维紧密平行排列。不锈钢接骨板内固定不仅可产生巨大骨吸收腔,而且使位于骨吸收腔之间的胶原纤维发生断裂及排列紊乱。     

兔胫骨干骺端截骨延长术骨膜成骨作用的实验研究

本实验对４５只大耳白兔行左胫骨干骺端截骨延长术。动物被分成３组。其中Ａ组保留骨内外膜；Ｂ组环形切除截骨端上下部分骨外膜；Ｃ组截骨后刮除截骨端上下部分骨髓及内膜组织。所有动物延长速度为１ｍｍ／ｄ。结果发现Ａ组延长区新骨形成和塑形快，质量好，愈合后新骨的力学性能强；Ｂ组延长区新骨形成慢，新骨的力学性能差；Ｃ组延长早期成骨受一定影响，后期新骨的组织形态与力学性能均接近Ａ组。骨膜随缓慢牵拉同步增长，成骨十     

Early outcome of reamed interlocking nail for non-union of tibia

Aseptic non-union is a major problem following complicated fracture tibia, which carries significant morbidity and prolonged course of treatment. Plate fixation and autogenous bone grafting has been established as a method of treatment. However the risk of infection, implant failure and donor site morbidity are high. We reviewed twelve consecutive cases of established non-union tibia treated by closed reamed interlocking nail in our centre. All patients had clinical and radiological union at three months. Three patients were complicated with infection and one required removal of implant and re-reaming to eradicate infection. Reamed interlocking nailing is an alternative treatment for selected non-union of fracture tibia with promising results.