自固化磷酸钙复合BMP及同种异体骨修复兔股骨大段骨缺损

[目的] 观察一种新型自固化磷酸钙（CPC）复合BMP与同种异体骨修复兔股骨节段性骨缺损的效果，为临床复合应用大段同种异体骨移植提供参考。[方法] 54只新西兰大白兔随机分成3组，于一侧股骨中上段造成2cm长皮质骨缺损模型，分别进行：A组复合BMP与CPC的新鲜冷冻同种异体骨移植；B组单纯新鲜冷冻同种异体骨移植；C组自体大段骨移植。移植骨均用直径3mm三棱髓内针固定。于术后4、8、12周，进行影像学、组织学检查，对比各组移植骨愈合过程与修复效果。[结果] CPC复合BMP大段同种异体骨移植早期骨修复效果优于单纯异体骨移植（P〈0．01），与自体骨移植修复效果相似，至12周3组均达骨性愈合，以A组及C组骨修复塑形较好。CPC复合BMP组骨痂量较多，分布于移植骨与宿主骨结合部及移植骨周围，形成皮质骨外骨桥，并较早在异体骨外表面形成破骨与成骨，异体骨内哈佛氏管扩大，衬垫细胞、成骨细胞、破骨细胞及血细胞较其它组多。CPC随着新骨的形成及改建塑形逐步缓慢降解。[结论] CPC复合BMP对大段同种异体骨移植的愈合及替代有增强和促进作用。     

骨形态发生蛋白在异体骨段移植愈合中的表达及临床意义

目的：研究骨形态发生蛋白（BMP）在异体骨段移植愈中的表达及临床意义。方法：采用新西兰大白兔股骨中段切除1．5cm骨干和骨膜实验动物模型。方法：36只兔随机分实验组和对照组。实验组植入深低温保存的异体骨,对照组植入自体新鲜骨,均用髓内针固定,分别于术后第1、2、3个月用免疫组织化学染色法观察BMP在异体骨愈合过程的表达情况,结果：深低温保存的同种异体骨移植愈合BMP表达与体骨相似,移植骨段BMP表达阴性,新生骨及其周围类基质表达阳性。新生编织骨BMP表达活跃,成熟板层骨BMP表达减弱（P＜0．01）。结论：异体骨移植愈合中骨吸收和骨诱导是同时,骨诱导在异体骨愈合早期发挥了重要作用。     

同种异体骨软骨移植修复关节软骨缺损研究现状

关节软骨缺损常因软骨再生能力低而难以自行修复.新鲜的同种异体骨软骨移植修复关节软骨缺损的疗效稳定,成功率逐渐提高.冷冻保存的同种异体骨软骨移植修复关节软骨缺损的成功率可与新鲜的同种异体骨软骨移植媲美,梯度降温法是目前保存软骨细胞存活率最好的冷冻方法.该文就同种异体骨软骨移植的实验和临床研究、免疫排斥问题及其相关研究动态作一综述.     

重组转化生长因子-β复合同种异体骨移植修复骨缺损的实验研究

目的：评价重组转化生长因子－β（TGF－β）复合同种异体骨移植修复骨缺损的效果。方法：用基因重组的方法提取TGF－β,与同种异体骨复合后植入兔桡骨缺损区,采用同体双侧对照方法,进行X线摄片,组织学及放射性核素骨扫描检查,结果：术后8－12周,复合物移植侧移植骨与桡骨断端全部连接,成骨,单纯植骨侧移植骨与桡骨断端无连接,成骨差,结论：重组TGF－β复合同种异体骨移植修复缺损效果良好。β     

大鼠和家兔辐照灭菌去抗原—自溶同种骨移植片骨移植研究

利用大鼠颅骨钻孔移植和家兔尺骨缺损移植实验观察经不同方法制备的去抗原-自溶同种骨移植片(AAA)骨的愈合效果,并与自体骨、新鲜同种骨、不脱灰AAA骨及异种骨相比较,结果发现脱灰AAA骨具有较好的骨诱导活性;25kGy剂量的辐照可以明显降低移植大鼠颅骨的愈合效果,但对家兔影响甚小。辐照AAA骨的愈合效果明显优于新鲜同种骨。     

异体复合骨环前路腰椎间融合术的实验研究

目的 比较异体复合骨环和自体髂骨块行腰椎椎间融合的实验结果。研究异体复合骨环行腰椎椎间融合的生物学特点。方法 用8只成年杂种犬,实验以犬腰椎椎间盘摘除后的椎间隙作为实验模型。分别交叉配对植入复合骨环和自体髂骨块,植入1、2、4和6个月后,每组每时间点取2只犬行X线正侧位摄片和组织学观察。结果 X线片和组织学观察见异体复合骨环愈合速度快,术后4个月弩 达到椎间融合的目的,表现出与大段同种异体骨移植不同的成骨方式,而髂骨组以常见的自体骨移植方式愈合,术后6个月,自体髂骨块与周围骨质融合。结论 复合骨环行前路腰椎椎间融合有独特的丹掺入方式,是理想的移植材料。     

大段同种异体骨移植愈合的实验研究

目的　研究大段同种异体骨移植愈合过程和特点。方法　采用新西兰大白兔股骨中段切除 1 5cm骨干和骨膜实验动物模型。将 36只兔随机分成实验组和对照组。实验组植入深低温保存的同种异体骨 ,对照组植入自体新鲜骨 ,均用直径 3mm的髓内针固定。于术后第 1、 2、 3个月分别行X线摄片、ECT、大体标本、组织学观察 (四环素荧光标记、HE染色 )以及BMP免疫组织化学染色。结果　深低温保存的同种异体骨移植愈合与自体骨相似 ,ECT显示术后第 1个月骨代谢活跃 ,2、 3个月趋于稳定。移植骨BMP表达阴性 ,新生骨及其周围类基质表达阳性。其愈合是从宿主骨向移植骨 ,从周围向中央 ,从哈佛氏管向其四周逐渐进行爬行替代的过程。结论　同种异体骨移植愈合过程是移植骨全方位活化的过程 ,即全方位再血管化、新骨形成和宿主与移植骨接连的过程。其主要通过骨传导实现成骨 ,骨诱导亦发挥积极作用     

胎骨移植的实验研究

本文用兔子做为实验对象,用胎骨做为移植骨的材料,用自体骨移植做为对照。分别进行了新鲜同种异体胎骨移植,同种异体胎骨移植、异种异体胎骨移植和自体骨移植。通过大体标本及组织学对成骨情况的观察;说明胎骨做为植骨材料优于库存骨和自体骨,同时也说明新鲜的同种异体胎骨是一种最理想的植骨材料。为胎儿骨在临床上应用提供了理论上的依据。     

同种异体骨移植免疫学

１８８０年Ｍａｃｅｗｅｎ首先施行了人类同种异体骨移植术,本世纪四十年代末建立了骨库,使同种异体骨移植的临床应用更为安全可行,骨移植已成为仅次于输血最常用的移植术。同种异体骨移植与实质脏器移植有所不同,诱发的宿主免疫排异反应一般不引起危及生命的严重后果,但免疫排异反应往往干扰移植骨愈合,影响治疗效果。１　同种异体骨关节移植抗原骨骼中的矿物质不具有抗原性,胶原和非胶原蛋白仅是弱抗原,同种异体骨移植的抗原刺激主要来自其细胞膜表面组织相容性抗原（ＭＨＣ）。ＭＨＣ抗原分为两大类,Ⅰ类抗原在人类为ＨＬＡ－Ａ…     

大段同种异体骨移植愈合的实验研究

目的研究大段同种异体骨移植愈合过程和特点。方法采用新西兰大白兔股中段切除１．５ｃｍ骨干和骨膜实验动物模。将３６只随机分成实验组和对照组。实验组植入深低温保存的同种异体骨,对照组植入自体新鲜骨,均用直径３ｍｍ的髋内针固定,于术后第１、２、３个月分别行Ｘ线摄片、ＥＣＴ、大体标本、组织学观察（四环素荧光标记,ＨＥ染色）以色ＢＭＰ免疫组织化学染色。结果深低温保存的同种异体骨移植愈合与自体骨相似,ＥＣＴ显示     

Histological and immunohistochemical analysis of an allogenic bone graft engineered with autologous bone marrow mononuclear cells in the treatment of a large segmental defect of the ulna. A case report

The treatment of large (6 cm) segmental bone defects, especially in areas associated with soft tissue damages and exposure, is challenging. Massive bone allografts are widely used in reconstructive surgery to replace missing bone parts such as critical size defects, nevertheless, early vascular invasion is a critical factor in bone allograft incorporation and in the consequent success of the surgery. Unfortunately, it has been proven that only slow and incomplete bone integration is possible by using frozen allografts in the treatment of large bone defects. An allogenic frozen bone graft was engineered with bone marrow mononuclear cells (BMMCs) to repair a large ulna defect in a male patient. When infection and sinus developed at the graft site 4 months after implantation, the partially reabsorbed graft was removed and send to the lab for examination. The histological and immunohistochemical analysis performed on a graft removed from the central zone of the defect demonstrated areas of neo-vascularisation, indicating that a remodelling process was actively occurring even in an area not usually repopulated with the conventional techniques. For these reasons, we may hypothesise that the use of BMMCs has a role in the re-building of large segmental defects.     

Experimental study on vascularized bone allografts for reconstruction of massive bone defects

To study the healing mechanism of vascularized bone allografts under short-term as well as long-term immunosuppression with cyclosporin A, experimental vascularized intercalary bone allograft transplantation was carried out between inbred rats using the tibiofibula graft model. Bone scintigram and radiographs were used as an indicator for early detection of rejection after transplantation and bone union. In vascularized bone allografts under long-term immunosuppression with cyclosporin A, early bone union and continuous incorporation were similar to that observed in vascularized bone autograft transplantation. When administration of cyclosporin A was discontinued before completion of bone union, the graft was rejected and bone union was delayed. Apparent swelling on the operated limb associated with a decrease in bone scintigram uptake suggested the occurrence of rejection of the allograft. Vascularized bone allograft transplantation is useful for reconstruction of massive bone defects only if immunosuppressants are used and maintained at least until bone union is obtained. © 1994 Wiley-Liss, Inc.     

骨膜瓣复合开窗异体骨移植修复大段骨缺损

目的探讨带血管薄层皮质骨-骨膜瓣嵌入开窗的异体骨修复大段骨缺损的效果。方法将兔胫骨去抗原后制备异体骨标本,制作大段骨缺损动物模型,以带血管薄层皮质骨-骨膜瓣复合开窗的异体骨进行修复。术后观察骨缺损的X线影像,对移植物及其周围软组织行组织学和免疫组织化学观察。结果实验组骨缺损骨痂形成和改造塑形,新生血管长入骨缺损处,新骨形成和骨单位成熟较对照组早。结论以带血管薄层皮质骨-骨膜瓣嵌入开窗的异体骨修复大段骨缺损的手术方法优于以骨膜瓣直接包裹异体骨,缩短骨缺损修复的时间。     

A novel murine segmental femoral graft model.

To further understand the cellular and molecular mechanisms underlying cortical bone graft healing, we have developed a novel mouse femur model that permits quantitative and molecular analysis of structural bone graft healing. A 4 mm mid-diaphyseal femoral segment was removed and replaced by either immediate implantation of a fresh autograft, a frozen, genetically identical isograft or a frozen allograft from a different strain of mouse, which was secured with a 22-gauge metal intramedullary pin. Healing was evaluated by radiology, histomorphometry, and in situ hybridization. Autograft repair occurred by endochondral bone formation at the host-graft junction and by intramembranous bone formation along the length of the graft bed at 2 weeks, with maturation and remodeling apparent by 4 weeks. Bone repair in allografts and isografts completely relied on endochondral bone formation at the host-graft cortical junction, with absence of periosteal bone formation along the length of the graft, suggesting that live periosteal cells from the donor tissue are necessary for this response. This small animal model of structural bone grafting can be used to evaluate tissue-engineered allografts and novel bone graft substitutes using quantitative and molecularly defined outcome measures.     

Periosteal progenitor cell fate in segmental cortical bone graft transplantations: implications for functional tissue engineering.

A murine segmental femoral bone graft model was used to show the essential role of donor periosteal progenitor cells in bone graft healing. Transplantation of live bone graft harvested from Rosa 26A mice showed that approximately 70% of osteogenesis on the graft was attributed to the expansion and differentiation of donor periosteal progenitor cells. Furthermore, engraftment of BMP-2-producing bone marrow stromal cells on nonvital allografts showed marked increases in cortical graft incorporation and neovascularization, suggesting that gene-enhanced, tissue engineered functional periosteum may improve allograft incorporation and repair. INTRODUCTION: The loss of cellular activity in a structural bone allograft markedly reduces its healing potential compared with a live autograft. To further understand the cellular mechanisms for structural bone graft healing and repair and to devise a therapeutic strategy aimed at enhancing the performance of allograft, we established a segmental femoral structural bone graft model in mice that permits qualitative and quantitative analyses of graft healing and neovascularization. MATERIALS AND METHODS: Using this segmental femoral bone graft model, we transplanted live isografts harvested from Rosa 26A mice that constitutively express beta-galactosidase into their wildtype control mice. In an attempt to emulate the osteogenic and angiogenic properties of periosteum, we applied a cell-based, adenovirus-mediated gene therapy approach to engraft BMP-2-producing bone marrow stromal cells onto devitalized allografts. RESULTS: X-gal staining for donor cells allowed monitoring the progression of periosteal progenitor cell fate and showed that 70% of osteogenesis was attributed to cellular proliferation and differentiation of donor progenitor cells on the surface of the live bone graft. Quantitative muCT analyses showed a 3-fold increase in new bone callus formation and a 6.8-fold increase in neovascularization for BMP-2/stromal cell-treated allograft compared with control acellular allografts. Histologic analyses showed the key features of autograft healing in the BMP-2/stromal cell-treated allografts, including the formation of a mineralized bone callus completely bridging the segmental defects, abundant neovascularization, and extensive resorption of bone graft. CONCLUSIONS: The marked improvement of healing in these cellularized allografts suggests a clinical strategy for engineering a functional periosteum to improve the osteogenic and angiogenic properties of processed allografts.     

同种异体骨移植在骨肿瘤手术中的应用

目的：探讨同种异体骨移植在骨肿瘤手术中应用的范围、效果以及排异反应等问题.方法：1983年10月～2003年3月在骨肿瘤手术中使用异体骨移植120例。其中肿瘤刮除、异体松质骨移植102例；肿瘤刮除、异体大块皮质骨和松质骨移植12例；肿瘤段切除、异体股骨干移植2例；肿瘤段切除、异体半关节移植3例；肿瘤切除、大块异体骶骨移植l例：结果：120例中只有2例出现较轻的排异反应，表现为手术后切口渗出较多，3个月后停止渗出，切口愈合.其余病例均一期愈合.结论：同种异体骨在骨肿瘤手术中应用范围，一、效果好、很少出现排异反应,在骨缺损填充物中占有重要位置.     

多孔磷酸三钙人工骨修复腔隙性骨缺损的随机对照研究

目的 评价多孔磷酸三钙(β-tricalcium phosphate,β-TCP)修复腔隙性骨缺损的临床效果,探讨其成骨愈合机制.方法 2003年1月至2008年12月,随机选择应用多孔β-TCP人工骨颗粒材料修复孤立性骨囊肿刮除术后骨缺损55例(实验组),或应用异体骨颗粒材料修复40例(对照组).术后1周、1、2、3、6、12、24及48个月摄X线片,采用自定的X线影像学半定量方法观察植骨材料的降解和成骨情况,计算植骨材料降解率,分析不同年龄组、不同随访时间段、不同植骨方式的材料降解率.组织病理学检查观察β-TCP人工骨降解成骨过程.结果 全部病例随访7～48个月,平均28.4个月.终末随访X线片示β-TCP人工骨和异体骨均能修复骨缺损.实验组(81.5%±23.2%)与对照组(77.9%±19.4%)材料降解率无统计学差异(t=0.803,P=0.424).实验组与对照组均表现出年龄越小植骨降解率越高的趋势;术后3年以上,实验组降解率高于对照组(t=29.893,P=0.04);采用打压植骨法时对照组降解率高于实验组(t=39.233,P=0.00),实验组组内比较疏松植骨法降解率高于打压植骨法(t=8.342,P=0.03).组织病理学结果显示β-TCP降解与成骨同时进行,新骨内可见骨细胞和骨陷窝.结论 多孔β-TCP人工骨修复腔隙性骨缺损的临床效果和异体骨相似,随时间延长降解效果逐渐优于异体骨.

Abstract：

Objective To evaluate the clinical outcomes of a hovel porous β-tricalcium phosphate (β-TCP)and control allograft for the repair of lacunar bone defects caused by solitary bone cyst curettage.Methods From January 2003 to December 2008,the patients with solitary bone cyst were randomized into an experimental(55 cases)and a control(40 cases)group.The control group received particulate allograft bone as the graft material,and the experimental group received β-TCP.At 1 week,1,2,3,6,12,24,48months after surgery,a new radiographic scoring system was employed to calculate the biodegradation of bone graft and evaluate the influence of multiple factors.Histologic characteristic of the degradation process of β-TCP were also evaluated.Results All the cases were followed up for average 28.4 months.Radiographic semi-quantitative analysis revealed that the biodegradation effieiencies were not significantly difierent between β-TCP and allografts(P=0.424).Degradation percentage of the implanted β-TCP or allograft was higher in younger patients than those in the older ones.Degradation of β-TCP was significantly higher than that of allografts over 3 years after surgery(P=0.04).In the experimental group,β-TCP degradation was greater in the loose packing treatment than that in the dense packing treatment (P=0.03).Histological observation demonstrated that the process of new bone formation accompanied the degradation of β-TCP.Conclusion The interporous β-TCP could be an advantageous alternative to allografts for repair bone defects caused by bone cyst.The clinical application of β-TCP is safe and reliable,which shows better biodegradation and osteogenesis than allografts in long-term follow-up.     

Subtalar Joint Distraction Arthrodesis Utilizing a Titanium Truss: A Case Series

Subtalar joint distraction arthrodesis has been recommended for the treatment of conditions such as nonunion or malunion of subtalar joint arthrodesis posttraumatic arthritis. Both conditions are difficult to treat, because the deformities created in the frontal and sagittal planes of these conditions are complex. If these malalignments are not addressed, ankle joint instability and wear occur over time. In general, either autograft or allograft bone has been used to perform distraction arthrodesis of the subtalar joint. Although studies have shown successful use, there have been complications. Autografts have resulted in donor site morbidity and limitations on graft size, and allografts have shown high nonunion rates. Both autografts and allografts have shown graft collapse over time. Recent literature has discussed the use of tantalum technology to span large defects in bone healing. Studies have shown that tantalum provides superior strength and bone incorporation compared with autografts and allografts. This case series presents 2 cases in which tantalum truss technology was used for distraction arthrodesis. Although this series is limited in patient numbers, both cases show effective graft incorporation with no loss in height over time and earlier return to activity compared with previous studies that used autograft and allograft wedges.     

自体与同种异体骨移植修复四肢长骨骨缺损的对比研究

目的比较自体与同种异体骨移植修复四肢长骨骨缺损的临床效果。方法回顾性分析132例异体骨和97例自体骨修复重建四肢长骨骨缺损患者的临床治疗资料,比较两种方法愈合时间、骨性愈合评分（按Jorgenson标准）、并发症发生率及植骨失败率。结果异体骨重建组132例,4例因感染致植骨失败需行病灶清除灌洗加自体骨移植,10例发生局部排斥反应,其余118例患者术后骨缺损获得良好修复,愈合时间（17．6±1．9）周。骨性愈合评分2．7±0．5。自体骨重建组97例,9例出现供区疼痛、切口感染及局部皮肤麻木等供区并发症,骨缺损均获得良好修复,愈合时间（17．4±23）周,骨性愈合评分2．84±0.3。两组之间在愈合时间、并发症发生率以及愈合评分方面的差异无统计学意义（P〉0．05）;在植骨失败率方面的差异有统计学意义（P〈0．05）。结论运用同种异体骨和自体骨移植重建四肢长骨骨缺损,均能获得满意结果且疗效相似。异体骨移植术后感染致植骨失败以及排斥反应发生率较高,而自体骨移植则多表现为供区的并发症。     

治疗节段性骨缺损的一种新方法—新型重组合异种骨与带血循骨膜联合移植

目的探讨治疗节段性骨缺损新方法一新型重组合异种骨(NRBX)与带血循骨膜联合移植方法的效果。方法将基因重组人BMP2(rhBMP