Interrelationship between metacarpal bone mass and bone mineral content in renal transplant recipients

Metacarpal bone mass, bone mineral content in the forearm and bone mineral concentration were measured in 54 renal transplant recipients with a well functioning renal transplant a mean of 67 months after transplantation. Significantly decreased values of metacarpal bone mass, bone mineral content and bone mineral concentration were found. A highly significant correlation between metacarpal bone mass and bone mineral concentration was found in renal transplant recipients, probably indicating that changes in the amount of cortical bone and bone mineral occur simultaneously after renal transplantation.     

肌瓣作为BMP载体构建血管化骨组织修复骨缺损的形态学研究

为探讨肌瓣作为骨形态发生蛋白（BMP）载体构建血管化骨组织修复骨缺损的可行性及其生物学特征，制作兔桡骨下段15mm骨缺损，将去神经化的指深屈肌瓣转位至缺损区，作为BMP载体来修复骨缺损，通过大体、X线、组织学、原位末端标记（TUNEL）等方法观察骨缺损的修复过程及生物学变化。结果发现，骨骼肌逐渐发生萎缩，2周时肌瓣内可触及串珠状团位，有大量软骨细胞生成，沿肌间隙分布；6调 时骨桥与宿主骨紧密结合，软骨溶解区有大量纺织骨形成，出现骨髓腔并与宿主骨髓腔再通，肌纤维被增殖的间充质细胞、软骨细胞及结缔组织所分割；8周时肌纤维几乎完全消失，新生骨组织于条索状桥接两断端，组织学显示骨骼肌萎缩的同时，部分细胞核出现崩解，并有凋亡小体出现；TUNEL染色呈阳性。说明肌瓣可作为BMP的良好载体用于构建血管化的骨组织来修复骨缺损。     

Subperiosteal aneurysmal bone cyst with associated bone marrow oedema: an unusual appearance

A case of a subperiosteal aneurysmal bone cyst with adjacent bone marrow oedema is presented. Aneurysmal bone cysts have been well documented in the published literature; however, relatively few have been observed in a subperiosteal location, and associated bone marrow oedema in the absence of a demonstrable pathological fracture is a rare finding. Aneursymal bone cyst should be considered in the differential diagnosis of subperiosteal bone lesions and may be associated with bone marrow oedema.     

前列腺癌骨转移影像诊断方法研究进展

前列腺癌具有很高的骨转移倾向,在初次诊断时即有较高的骨转移率,所以前列腺癌患者早期筛查骨转移对前列腺癌的分期、治疗及预后判断具有重要意义。放射性核素骨显像是临床常用的骨转移影像学检查方法,对骨转移瘤早期即有较高的检出率,辅以X线平片、CT、MRI等手段,有助于进一步提高诊断的准确性。笔者就前列腺癌骨转移的影像学检查的研究现状做一综述,为临床早期诊断骨转移瘤提供影像学依据。     

人工骨修复材料的现状与展望

人工骨修复材料在现今骨移植手术中有着不可取代的重要作用,寻找具有良好生物特性的骨修复材料一直是骨科研究的热点.尽管现在国际上各种骨修复材料纷繁复杂,但迄今没有一种能够非常完美地替代人骨.本文旨在分析现今骨修复材料的应用价值,综合应用,取长补短,以期对现有人工骨修复材料进行改进与升级.     

Evaluation of bone graft viability

Radionuclide bone single photon emission computed tomography (SPECT) scintigraphy is an excellent method for the assessment of the vascular patency and bone viability. The scintigraphic findings are important in the management of microvascularized bone grafts used in the reconstruction of bone defects. These living bone grafts are necessary when the blood supply at the host site has been compromised as a result of radiation therapy or when the bone defect is greater than 6 cm. Bone scintigraphy is unique because the uptake of radiopharmaceutical is dependent both on an adequate delivery system and a living network of osteocytes. SPECT scintigraphy provides improved imaging characteristics and structural detail of the grafted bone. Eleven patients with microvascularized bone grafts to the mandible demonstrated marked bone reaction of the entire bone graft in the postoperative period. The accumulation of radiolabelled 99mTc methylene diphosphonate (MDP) correlated extremely well with postoperative findings and clinical response. SPECT bone scintigraphy was a safe, simple and effective method for the assessment of both patency of anastomosed blood vessels and the metabolic viability of the microvascularized bone graft.     

双能X线骨密度仪测定骨痂骨密度变化的实验研究

目的: 研究骨折愈合过程中骨密度的动态变化,判断双能X线骨密度仪评估骨痂骨密度的可行性.材料和方法:30只犬造成右胫骨中段骨折并分断端距离4mm,单边外固定支架固定.分别在术后4、6、8、10、12周取双侧胫骨,以双能X线骨密度仪测定骨折端1cm的骨密度,分析骨密度变化及骨密度增长率的变化.结果:骨折端骨密度随时间呈一定规律增加,在不同时间组间差异有显著意义(P<0.01).自身对照的骨密度比率也随时间增加,在各组间差异有显著意义(P<0.01).12周时骨折端骨密度达到正常侧水平.结论:在犬骨折愈合过程中骨痂骨密度持续增加,双能X线骨密度仪可用于骨愈合中骨痂的骨密度判断.     

纳米羟基磷灰石／聚酰胺66复合生物活性人工骨在肢体骨缺损应用87例

目的观察纳米羟基磷灰石／聚酰胺66（n—HA／PA66）复合生物活性人工骨在四肢骨缺损术中填充植骨的安全性和临床疗效。方法对87例四肢骨手术后骨缺损,包括四肢松质骨暴力压缩骨折导致骨缺损和干骺端良性骨肿瘤术后骨缺损的患者,采用n—HA／PA66复合生物活性人工骨填充植骨。术前、术后1周及3、6、12个月分别摄x线片及CT,观察骨缺损的修复生长和植骨融合情况。结果随访6～28个月（平均8个月）,伤VI均甲级愈合,无切口感染、非特异炎症反应和排斥反应;X线片和CT检查示：术后骨缺损区域填充良好,密度较松质骨稍低,材料与周围骨边界清楚;术后1个月,骨缺损区密度逐渐升高,可见植骨周围模糊,有少量新生骨痂形成;术后3个月,骨缺损区密度明显升高,植骨周围间隙开始向中心融合成片,更多新生骨痂影融合;术后6个月,骨缺损区密度明显升高,大量新生骨痂形成。临床骨愈合时间为术后3～7个月,平均3．8个月,愈合率为91．5％。结论纳米羟基磷灰石／聚酰胺66复合生物活性人工骨用于治疗四肢骨缺损,能与植骨区骨生长融合,无不良反应,疗效满意,是一种安全有效的骨缺损植骨填充材料。     

Assessment of penile bone graft viability by bone scintigraphy: A case report

A 20-year-old man, who had penile reconstruction surgery with an iliac bone graft a year ago due to malcircumcision at 6 years old underwent bone scintigraphy in order to detect bone graft viability. The accumulation of 99mTc-MDP in the penile region revealed the viability of the bone graft. This case report shows that bone scintigraphy can be used to assess the viability of a bone graft located inside the penis as well as bone grafts placed elsewhere in the extremities.     

Recent progress in morphology and diagnosis of bone diseases and bone tumors (author's transl)]

1. Bone structure is shaped by a specialized bone cell system comprising osteoblasts, osteocytes and osteoclasts. --2. The function of this bone cell system is impaired by metabolic bone disease altering bone structure, bone mass and mineral content. --3. In metabolic bone disease a striking improvement in morphologic diagnosis could be obtained recently using undecalcified preparations of bone tissue as well as histomorphometric methods. --4. For exact diagnosis and successful therapy of bone tumors interdisciplinary cooperation is mandatory. The advantages of modern morphologic methods are proven helpful in diagnosing benign and malignant bone tumors.     

Increased localization of 99mTc-pyrophosphate in a bone island: case report.

A positive 99mTc-pyrophosphate bone scan is reported in a proven case of large compact bone island. Pyrophosphate uptake in this case is presumed to be due to either large size or growth of the bone island. A radionuclide bone scan does not always differentiate bone islands from metastatic or inflammatory sclerotic bone lesions.     

18F-NaF PET/CT骨显像在甲状旁腺功能亢进性骨病中的应用

目的 探讨甲状旁腺功能亢进性骨病18F-NaF PET/CT骨显像的影像学特点及其应用价值。 方法 收集30例经临床及术后病理证实为甲状旁腺功能亢进症患者[男性11例、女性19例,年龄18～71（52.3±13.5）岁]的18F-NaF PET/CT骨显像及99Tcm -亚甲基二膦酸盐（99Tcm-MDP）全身骨显像资料,回顾性分析其18F-NaF PET/CT骨显像特点,对比两种骨显像方法对该病局部骨骼病灶的检出情况,并根据Mirels评分标准对棕色瘤进行评分。 结果 两种骨显像方法定性结果一致,即骨显像阴性15例,阳性15例。甲状旁腺功能亢进性骨病在18F-NaF PET图像上大部分表现为以全身多骨弥漫性骨代谢增高为主的多种代谢性骨病征象,并发棕色瘤、骨硬化及病理性骨折等时表现为单发或多发局灶性显像剂异常分布,其中棕色瘤表现为局灶性显像剂浓聚、显像剂稀疏或病灶中心显像剂分布缺损伴边缘显像剂不均匀浓聚;同机CT图像上均表现为全身多骨多种形式的骨质吸收,其中,表现为广泛骨质疏松13例、伴棕色瘤7例、骨质硬化6例、骨质软化3例、病理性骨折3例。15例甲状旁腺功能亢进性骨病患者共检出局部骨骼病灶（棕色瘤、骨硬化、病理性骨折、假骨折）53个,其中,18F-NaF PET/CT骨显像全部检出,99Tcm-MDP全身骨显像检出32个。7例甲状旁腺功能亢进性骨病患者伴棕色瘤,位于长骨的棕色瘤病灶数共24个,其中9个Mirels评分大于9分。 结论 甲状旁腺功能亢进性骨病在18F-NaF PET/CT骨显像上的全身骨代谢及解剖学表现有一定的特征性表现,18F-NaF PET/CT骨显像结合同机CT上全身骨骼病灶的详细信息,在甲状旁腺功能亢进性骨病的诊断、鉴别诊断及病情严重程度评估中有更好的应用价值。     

Pasteurized autogenous bone graft for reconstruction after resection of malignant bone and soft tissue tumors: imaging features

Our experimental study revealed that pasteurization was sufficient for killing all tumor cells in any massive bone and that the osteoinductivity and mechanical strength of pasteurized bone were about same as that of a fresh bone graft and better than boiled or autoclaved bone. We have performed reconstruction surgery using pasteurized autogenous bone graft since 1990. Resected bone was warmed for 30 minutes in a homeothermal heater set at 60 degrees C and then placed back to the original anatomic site. The graft was fixed with a plate or intramedullary nail with or without bone cement. Based on our experience in 31 patients, no local recurrence was seen in the grafts. Among 24 patients who can be adequately evaluated, incorporation of graft was complete in 17 cases and partial in 4 cases. In 18 of 21 patients, uptake of radionuclide in the grafted pasteurized bone was detected on bone scintigraphy approximately 6 months after surgery, and the uptake increased gradually, which suggested revascularization and remodeling of grafted bone.     

Pulmonary embolisation of bone fragments from penetrating cranial gunshot wounds

Bone embolism is a very rare event that usually occurs in trauma-induced septic bone lesions, after bone surgery or after bone marrow transplantation, and normally remains silent. To our knowledge, there are no previous reports of bone embolism after a gunshot to the head. We describe a case of pulmonary embolism associated with bone fragments after a gunshot to the head in which bone fragments surrounded by leukocytes, interstitial and intra-alveolar oedema and haemorrhage around the embolised vessels, leukostasis and fat and bone marrow embolism suggest that the survival time from the gunshot was sufficiently long to allow changes in lung microcirculation and lung tissue.     

Bone formation in transplants of human bone marrow stromal cells and hydroxyapatite-tricalcium phosphate: prediction with quantitative CT in mice

PURPOSE: To determine whether quantitative computed tomography (CT) can be used to estimate the extent of new bone formation in hydroxyapatite-tricalcium phosphate (HA-TCP)-based transplants. MATERIALS AND METHODS: Bone-forming transplants were generated by attaching cultured human bone marrow stromal cells to aliquots of HA-TCP particles and were placed in subcutaneous pockets in immunocompromised mice. After 8 weeks, the transplants were individually imaged; each scan included a phantom. Overall bone mineral density (BMD) of each transplant was obtained. Hematoxylin-eosin-stained sections of the same transplants were then examined histologically, which is the reference standard for assessing bone formation. The extent of bone in each transplant was scored on a semiquantitative scale ranging from 0 to 4 by three independent blinded observers; the bone score for each transplant was calculated by averaging the three observer scores. BMD was compared with the histologically determined bone score for each transplant. Statistical evaluations included (a) calculation of empiric receiver operating characteristic curves to determine optimum BMD thresholds and (b) determination of the relationship between BMD and bone score, including derivation of Pearson correlation coefficients. RESULTS: One hundred twenty transplants were evaluated. Average BMD of 600 mg/cm3 K2HPO4 or more was noted in transplants with appreciable bone formation (bone score > or = 3), while average BMD of less than 600 mg/cm3 K2HPO4 was seen in transplants with poor bone formation (bone score < 3) (P <.001). Among transplants with appreciable bone formation, the BMD was proportional to the extent of mineralized matrix present in the new bone. CONCLUSION: Use of quantitative CT offers a practical approach for the noninvasive determination of new bone formation in mineralizing bone marrow stromal cells and HA-TCP transplants.     

The occult fracture in the roentgen picture and its detection using bone scintigraphy

A retrospective study was made of patients with initially negative radiographs and positive radionuclide bone images. Comparison of conventional radiography and bone scanning in traumatology shows that the masked bone fracture can be seen in the bone scan but a focal accumulation of the radioactive material may not correspond to a bone fracture in every case. The ligamentous avulsion of a bone chip and/or the periosteum can yield the same image. Usually bones respond to trauma with an abnormal focal tracer accumulation because of irregular metabolic processes and the disturbance of the local blood circulation. By using a highly sophisticated technique (3-phases bone scanning) the focal disturbances can be seen. The greatest problem in scanning is the nonspecificity of abnormal tracer accumulation. Although bone scanning is very important in the diagnosis of any traumatic lesion of the bone it cannot replace the conventional radiograph.     

18F-FDG hPET/CT显像与99Tcm-MDP骨显像探测骨转移瘤的价值

目的　探讨1 8F 脱氧葡萄糖 (FDG)hPET CT与99Tcm 亚甲基二膦酸盐 (MDP)骨显像探测骨转移瘤的临床价值。方法　临床拟诊恶性肿瘤或肿瘤术后复发合并骨病变患者 34例 ,均于 2周内分别行FDG和MDP骨显像 ,其中 31例经手术或活组织病理检查证实为原发肿瘤患者 ,余 3例为原发灶不明但广泛骨转移者。结果　 34例患者中 2 6例有骨转移 ,共探测到 75个骨病灶 ,其中骨转移灶 6 3个 ,良性病灶 12个 (其中骨退行性变 8个 ,肋骨骨折 2个 ,结核和慢性炎症各 1个 )。1 8F FDGhPET CT显像探测骨转移瘤灵敏度为 90 5 % ,特异性为 83 3% ,准确性为 89 3% ;99Tcm MDP骨显像分别为 79 4 % ,75 0 %和 78 7% (P均 >0 0 5 )。结论　99Tcm MDP骨显像仍为诊断骨转移瘤的首选方法 ,1 8F FDGhPET CT显像对鉴别诊断骨转移瘤具有一定临床价值。     

Detection and measurement of simulated early rheumatoid lesions of the hand using digital subtraction radiography

The ability of digital subtraction radiography, a new technique to detect and quantify small bone lesions, is demonstrated. Discrete lesions in the metacarpals of cadaver hands simulated erosive bone loss. Radiographs made before and after removal of bone were digitized and subtracted. Density changes on subtraction images were determined, and bone loss was estimated by an automatic procedure that compared changes in radiographic density with a calibration wedge included in the radiographs. Comparison of estimated bone loss with the weight of bone removed showed reproducible detection and measurement of bone lesions as small as 4.6 mg, a size undetectable using current radiographic methods. Subtraction radiographs of bone chips overlaid on the hand of a volunteer indicated detection limits were similar in vivo. This technique enhanced the radiographic visibility of erosive lesions and thus has the potential to improve the detection of subtle bone changes in clinical settings.     

Detection of bone metastases in patients with endocrine gastroenteropancreatic tumors: bone scintigraphy compared with somatostatin receptor scintigraphy.

Scintigraphy with somatostatin analogs is a sensitive method for the staging and therapeutic management of patients with endocrine gastroenteropancreatic (GEP) tumors. The aim of this study was to compare prospectively somatostatin receptor scintigraphy (SRS) using 111n-pentetreotide with bone scintigraphy using 99mTc-hydroxymethylene diphosphonate for the detection of bone metastases. METHODS: One-hundred-forty-five patients with proven endocrine GEP tumors were investigated. Patients were classified according to the presence of bone metastases as indicated by CT, MRI or histologic data. Group I included 19 patients with confirmed bone metastases, and group II included 126 patients without bone metastases. RESULTS: In group I, SRS was positive in all 19 patients with bone metastases, and bone scintigraphy was positive in 17 patients. Bone metastases were found to occur predominantly in patients with liver metastases. In group 11, 5 patients had recent bone surgery for fracture or arthritis. SRS showed bone uptake in 4 of these patients, and bone scanning showed abnormal uptake in 5. In 7 of the remaining 121 group II patients, SRS was negative and bone scanning showed abnormal bone uptake suggesting bone metastases. The detection of bone metastases was of major prognostic value, because 42% of group 1 patients died during a 2-y follow-up. CONCLUSION: In patients with GEP tumors, the accuracy of SRS appears to be similar to that of bone scintigraphy for the detection of bone metastases.