硫酸钙人工骨联合同种异体骨与单纯人工骨治疗下肢良性骨肿瘤的对比研究

目的 评价硫酸钙颗粒人工骨联合同种异体骨与单纯使用硫酸钙颗粒人工骨植骨治疗下肢良性骨肿瘤的效果.方法 回顾性分析第二军医大学长海医院关节骨病外科2010年6月至2015年6月收治的符合研究条件的97例下肢良性骨肿瘤患者的临床资料,其中32例患者接受硫酸钙颗粒人工骨联合同种异体骨植骨治疗(联用组),另65例患者接受单纯硫酸钙颗粒人工骨植骨治疗(单用组).比较并分析两组患者术后的切口不良事件、人工骨完全吸收后的骨质愈合情况等.结果 联用组和单用组患者术后切口不良事件的发生率分别为15.6％(5/32)和26.2％(17/65),两组差异无统计学意义(P＞0.05).联用组和单用组患者在硫酸钙颗粒人工骨完全吸收后,遗留明确或可疑骨缺损的发生率分别为9.4％(3/32)和29.2％(19/65),两组差异有统计学意义(P=0.028).结论 硫酸钙颗粒人工骨联合同种异体骨植骨治疗下肢良性骨肿瘤具有良好的效果,两者的联合使用不会增加切口不良事件的发生风险,并且可能降低人工骨被完全吸收后遗留骨缺损的风险.     

硫酸钙植入兔股骨髁包容性骨缺损骨密度分析

目的探讨硫酸钙对骨修复活动的影响。方法建立兔股骨远端包容性骨缺损模型,用柠檬酸化硫酸钙和Osteoset片填充缺损,进行一般观察、大体x线及骨密度分析。结果普通X线观察提示缺损区填充的CCaS和Osteoset逐渐降解吸收,被新生的骨组织替代。3周时人工骨修复骨缺损区骨密度高于正常股骨髁;6周时缺损区骨密度下降,低于正常股骨髁;13周时较6周时增高接近正常股骨髁。骨修复过程中各个时间点骨密度两组无统计学差异,但是人工骨修复区骨密度显著高于空白对照组。结论硫酸钙体内能够降解吸收,不干扰新骨的形成,为骨的修复发挥骨传导作用。     

硫酸钙生物骨水泥在填补骨缺损手术中的应用

目的:分析和总结可注射硫酸钙骨水泥在填补骨缺损手术中的应用效果。方法:2008年1~11月采用可注射硫酸钙MIIG X3(minimally invasive injectable graft X3)填补骨的良性病变切除或创伤后遗留骨缺损8例。8例均为男性,年龄19~57岁,平均(41.1±14)岁。部位:脊柱1例,股骨远端1例,胫骨远端2例,肱骨近端1例,指骨1例。术后X线片随访评价MIIG X3吸收及自身骨长入替代的情况。结果:应用可注射硫酸钙填补骨缺损,术中即刻可获局部骨样强度,骨缺损充盈满意;本组所有患者均获随访,随访时间为4~12个月。X线片观察显示MIIG X3完全吸收并被自体骨替代需6~10周,吸收速度略快于骨长入。结论:可注射硫酸钙MIIG X3填补骨缺损,简单易行、并发症少;材料可吸收并被自身骨替代,是目前填充良性骨缺损的最佳人工材料之一。     

自体骨／固骼生移植治疗四肢良性骨肿瘤性骨缺损

目的探讨自体骨／固骼生复合物应用在四肢良性骨肿瘤、瘤样病变骨缺损中的应用和疗效。方法自2000年3月至2006年12月,38例患者病理证实为四肢良性骨肿瘤;术中将病灶于外科边缘彻底刮除,根据病损情况选择自体骨颗粒加固骼生彻底紧密填塞骨缺损空腔;术后固定关节6周,避免负重。结果38例患者术后随访1—8年,平均3年6个月。所有病例均未见病变复发,4例发生轻度病理性骨折,1例术后切口渗液较多,1个月后停止渗出,切口愈合。其余病例均一期愈合。所有骨移植体X线片上显示理想的再生形态。结论自体骨／固骼生复合物应用在四肢良性骨肿瘤、瘤样病变骨缺损中的应用效果良好。     

Selection of allografts for impaction bone grafting for bone defect reconstruction on the acetabular side

Objective To review the choices of allografts for bone defect reconstruction in acetabular revision surgery using the technique of impaction bone grafting.Data sources The data cited in this review were mainly obtained from articles listed in PubMed that were published from January 1993 to July 2009. The search terms were ＂impaction bone grafting＂, ＂particle size＂, ＂mechanical property＂and ＂biological behavior＂.Study selection Articles relevant to the choices of allografts and their results for bone defect reconstruction on the acetabular side were selected.Results Different choices of allografts, including the particle size, process of irradiation or fat reduction, composition and particle grade, are made to improve the survival rate of a prosthesis in acetabular revision surgery. This review,which compares both mechanical and biological factors, summarizes the experimental and clinical results for different techniques.Conclusions Fresh frozen cancellous allografts with particle sizes ranging from 7 to 10 mm are a favorable choice for reconstruction of bone defects of American Academy of Orthopedic Surgeons （AAOS） types Ⅱ （cavitary defect） and Ⅲ（combined cavitary and segmental defect） on the acetabular side. A fat-reducing procedure with saline or solvent/detergent is controversial. Adding autologous marrow into irradiated allografts, which provides reliable mechanical stability and biological safety, may be a substitute for fresh frozen allografts. Cortical bone can be a supplementary material in cases of insufficiency of cancellous allografts. Cartilage should be excluded from the graft material. Further research is required to demonstrate the best particle grade, and randomized controlled trials in clinical practice are required to obtain more information about the selection of allografts.     

吻合血管腓骨移植重建肢体肿瘤切除术后骨缺损

目的：总结和评价血管腓骨移植术重建肢体肿瘤切除术后骨缺损的疗效,探讨其适应范围。方法：回顾性研究了４３例吻合血管腓骨移植重建肢体肿瘤切除术后骨制损的病例。其中１２例恶性骨肿瘤,３１例良性肿瘤或瘤样病变。应用手入式微在线卫列诱导高温原位灭活术２８例,侵袭性良性肿瘤应用瘤段切除术７例,良笥肿瘤应用乔除术清除病灶８例,移植腓骨长度８ｃｍ～２５ｃｍ,平均１５．１ｃｍ。所有４３例,随访时间超过２４ｍｏ。分析     

COA:髋臼侧打压植骨重建骨缺损同种异体骨的选择

Object To review the choices of allografts for bone defect reconstruction in the acetabular revision surgery with the technique of impaction bone grafting. Data sources The data cited in this review were mainly obtained from the articles listed in PubMed, published from January 1993 to July 2009. The search terms were “impaction bone grafting”, “particle size”, “mechanical property” and “biological behavior”. Study selection Articles relevant to the choices and results of allograft for bone defect reconstruction in the acetabular side were selected. Results Different choices of allograft, including the particle size, irradiation, fat-reducing, composition and particle grade, are selected to improve the survival rate of implant in acetabular revision surgery. This review summarized the experimental and clinical result from different techniques, comparing both mechanical and biological factors. Conclusion Fresh frozen cancellous allografts with size range between 7 – 10 mm are a favorable choice for reconstruction of acetabular defect (AAOS type II and III).The fat-reducing procedure with saline or solvent-detergent is controversial. Adding autologous marrow into the irradiated allografts, which provides reliable mechanical stability and biological safety, may substitute fresh frozen allografts. Cortical bone can be supplemented in cases of insufficiency of cancellous allografts. Cartilage should be excluded from the graft material. Further research is required to demonstrate the best particle grade. And randomized controlled trials in clinical practice are required for more information about the selection of allografts.     

大段冷冻异体骨移植治疗骨肿瘤

目的：探讨冷冻大段同种异体骨和关节移植治疗骨肿瘤的临床应用及疗效。方法：回顾分析1991～1999年间,应用冷冻保存大段同种异体骨关节治疗骨肿瘤切除后遗留大块骨缺损。随访资料完整的54例,其中男30例,女24例,年龄18～71岁,平均42.5岁,异体半关节移植48例,骨段移植2例,异体骨 人工关节4例。异体骨移植长度12～25cm。普通髓内钉固定16例,交锁髓内钉固定18例,螺丝钉固定15例,重建钢板固定2例,克氏针 螺丝钉固定3例。结果：54例患平均随访时间4.5年（0.5～9年）,异体骨愈合53例,不愈合1例。主要并发症：肿瘤局部复发4例,感染4例,骨折2例,关节面塌陷3例,关节强直2例。关节功能按Mankin标准评定,优21例,良18例,中8例,优良率87%。结论：冷冻大段同种异体骨关节移植是修复骨肿瘤切除后骨缺损的有效方法,但应严格掌握其适应证。     

医用硫酸钙Osteoset在修复犬下颌骨骨缺损中的作用

目的 探讨医用硫酸钙Osteoset在犬下颌骨骨缺损中促进骨缺损的修复作用.方法 随机将4只犬的左右下颌骨分为实验组和对照组.实验侧下颌骨骨缺损时植入医用硫酸钙Osteoset颗粒,对照组植入羟基磷灰石(HA)颗粒,分别于术后4、8周处死2只犬,取下颌骨作为标本,术后大体观察、术后X片、环境扫描电镜及组织学观察成骨情况...     

复合环孢菌素同种异体骨与冻干同种异体骨修复兔桡骨缺损效果比较

目的对比研究复合环孢菌素同种异体骨(CAB)与冻干同种异体骨(FDAB)修复兔桡骨缺损效果。方法30只新西兰大白兔,随机分为材料提供组、实验组、对照组3组,每组10只。取材料提供组双侧髂骨制备CAB及FDAB。制备兔右侧桡骨中段10mm的骨与骨膜缺损,实验组植入CAB修复,对照组植入FDAB修复。术后4、12周每组各处死5只动物,进行大体标本、X线片和组织学观察。结果术后4周,实验组X线片评分高于对照组(P=0.001),缺损区新骨形成量及异体骨与受体骨融合性均高于对照组;术后12周,实验组X线片评分高于对照组(P=0.001),缺损区骨塑形效果优于对照组。结论CAB修复兔桡骨缺损效果优于FDAB,是否为局部免疫反应状态的不同造成这种差异需进一步探讨。     

自体腓骨头移植重建治疗桡骨远端骨巨细胞瘤5例分析

目的探讨自体腓骨头移植重建在桡骨远端骨巨细胞瘤切除术中的应用方法及效果。方法2004年7月~2005年10月对5例桡骨远端骨巨细胞瘤(Ⅲ级)患者在行桡骨远端瘤段切除的同时,行自体腓骨头移植重建手术。结果所有患者切口均Ⅰ期愈合,各手指活动均正常,无麻木及疼痛感,均能完全生活自理。所有患者均未出现骨巨细胞瘤的复发及肺转移。结论自体腓骨头移植是桡骨远端切除术后有效的腕关节重建方式。     

自体骨游离移植在下颌骨缺损修复中的临床应用分析

目的 探讨自体髂骨、肋骨游离移植修复下颌骨缺损的临床疗效。方法 回顾性总结分析42例自体髂骨、肋骨游离移植修复下颌骨缺损病例，经随访6个月～5a，观察移植骨存活、咬合关系与咀嚼功能及颌面部外形恢复情况。结果42例中，39例植骨区伤口Ⅰ期愈合，占92％；41例移植骨完全成活，占97％；35例咬合关系与咀嚼功能恢复良好，占83％；36例面部外形恢复满意，占85％。颜面外形及咀嚼功能恢复较差者多为大范围缺损行游离肋骨移植病例。结论 单纯自体骨游离移植修复下颌骨缺损相对术式简单，操作简便，只要严格掌握适应证、修复效果满意，在下颌骨缺修复中仍具有较大应用价值。     

Macrophages in degradation of calcium phosphate compound artificial bone: Anin vitro study

Summary The isolated mice peritoneal macrophages in degradation of calcium phosphate compound artificial bone-collagen/hydroxylapatite (CHA), hydroxylapatite (HA), beta-tricalcium phosphate (TCP) ceramics, have been studied by use of both Ca⁺⁺, P concentration assay in cultured supernatant and scanning electron microscopy (SEM). The solubility of Ca^{+ +}, composition of materials increased more significantly when macrophages were inoculated than when macrophages were not seeded (P< 0.001), and it was shown that the ground materials were wrapped and phagocytized or resorbed extracellularly by macrophages under SEM, suggesting that macrophages could mediate the degradation of calcium phosphate compound artificial bone by phagocytizing and/or degrading extracellularly. This project was supported by The National Natural Science Fundation.     

核素骨显像与MRI对肿瘤骨转移诊断的对比研究

目的 探讨核素平面骨显像（SPECT）与磁共振成像（MRI）对于诊断肿瘤骨转移的临床价值。方法 回顾性分析42例肿瘤患者接受骨显像和磁共振检查的结果。结果42例患者，骨显像阳性35例（83．3％），MRI扫描阳性30例（71．4％），两者比较差异无统计学意义（χ^2=1．70，P〉0．10）。骨显像阳性病灶数68个，MRI检出病灶数59个，两者比较差异无统计掌意义（P〉0．10）。骨显像和MRI共检出病灶数127个中，脊柱病灶最多。结论 核素平面骨显像仍为筛选肿瘤患者骨转移的首选检查，MRI是其必要的补充手段。     

带血管腓骨移植治疗骨肿瘤截除后骨缺损

对22例四肢骨肿瘤截除后骨缺损采用带血管腓骨移植修复，其中吻合血管腓骨移植15例，带血管蒂腓骨移位移植7例，手术效果满意。本术式的适应症为：长管骨良性或低度恶性肿瘤，肿瘤较局限，全身情况较好者，骨肿瘤截除后缺损在7cm以上者。同时讨论了该术式在骨肿瘤治疗中的价值。     

常温储存的人同种异体骨制备

目的：探讨常温储存的人同种异体骨制备流程。方法：遵循供体选择标准，无菌条件下取骨经脱脂、脱钙等处理，制备新鲜骨、脱钙骨基质(DBM)、表面脱钙骨、半脱钙骨，封装常温储存备用。结果：临床应用常温储存人同种骨植骨10例，成活良好。结论：常温骨库制备人同种骨流程可靠、实用。     

胸壁巨大肿瘤切除术后胸壁缺损的重建

目的探讨胸壁巨大肿瘤术后重建胸壁缺损的方式.方法分析该院1993年3月～2002年12月期间行胸壁大块组织切除及重建6例,均为恶性肿瘤.胸壁缺损面积于10.0 cm×14.0 cm～15.0 cm×18.0cm之间,2例用有机玻璃颅骨补片,2例用硅胶颅骨补片,1例用Prolene网补片,1例用钛网修复胸壁缺损.结果全组无手术死亡,术后有1例发生远处转移,其他病人恢复良好.结论重建胸壁缺损应以可塑性带网孔偏硬质材料为佳,既可防止术后反常呼吸,又可预防感染.     

人工韧带在耻骨肿瘤切除后重建下腹壁缺损中的应用

目的: 从患者的主观角度和临床客观指标评价人工韧带用于耻骨肿瘤切除后重建的临床效果。方法: 选择2012年2月至2018年2月因耻骨肿瘤就诊于北京大学人民医院骨与软组织肿瘤治疗中心,并接受手术切除和人工韧带重建的25例患者进行回顾性分析,评价其临床疗效以及相关并发症。结果: 所有患者均顺利接受手术,单纯切除耻骨上支的患者8例,耻骨下支5例,耻骨上下支一并切除的12例。平均出血量(774±580) mL,平均手术时间(138±25) min,平均住院时间(19±6) d。1例患者术后出现伤口愈合问题,经清创后愈合。平均随访时间为(37±21)个月,肿瘤复发1例,1例转移癌(肾癌)患者因原发肿瘤进展而死亡。无切口疝,无韧带感染以及局部异物感等相关并发症。23例患者术后活动不需要借助任何辅助设施,2例患者活动时需要拄单拐。19例患者未诉任何疼痛不适,3例患者诉活动时感轻度疼痛,3例患者中度疼痛。评价术后功能的MSTS评分平均为87±4。结论: 人工韧带可应用于耻骨肿瘤切除后下腹壁缺损的重建,此重建方式可以预防腹壁疝的发生,同时可以通过减小残腔而降低术后感染的发生率,从而获得患者术后较好的主观评价。     

A histomorphometric and molecular study on stress adaptability of freeze-dried bone allograft

Objective To Investigate stress adaptability of freeze-dried bone allograft.Methods Cortical and cancellous allograft were transplanted to each side of the midshaft diaphyseal ulna in two groups of 28 animals. The left transplanted allograft w as free from fixation and bore a normal physiological load, while the right tran splanted allograft was protected from loading by a simple external fixator and b ore less load. Animals were sacrificed at the 2nd, 4th, 8th, 16th week after tr ansplantation and specimens were taken out for bone histomorphometry studies an d analysis of collagen gene expression by in situ cDNA-mRNA hybridization.Results Labeled surface(LS) and bone mineral apposition rate(MAR) of the normally loaded graft-host bone interface were significantly higher than that of the less load ed side at the 4th,8th,16th week after transplantation. Parameters reflecting t he internal repair process of the allograft, such as LS in cortical and cancello us bone or MAR in cortical bone of the normally loaded side were significantly h igher than those of the less loaded side at the 16th week after transplantation . The result of in situ hybridization indicated that more osteoblast-like cell s expressing the type Ⅰ collagen gene were found in the interface or interior o f normally loaded grafts. Conclusion The stimulus of physiologic load can accelerate the early union of allograft-ho st bone interface and later new bone creep substitution to the necrotic allograft.     

PMMA骨水泥与磷酸钙骨水泥诱导成膜及其对成骨活性的差异

目的 比较PMMA骨水泥与磷酸钙骨水泥诱导周围形成膜的结构和成骨活性的差异.方法 32只健康成年新西兰大白兔按照随机数字表法分为PMMA组和磷酸钙组,每组16只,双侧桡骨制造15 mm骨缺损,分别植入PMMA和磷酸钙骨水泥,4、6周后每组选取2只兔子取出骨水泥周围包裹的诱导膜比较膜厚度及血管密度;第4周取出骨水泥并在膜内植入自体松质骨,植骨后8、12周分别通过放射学和组织学评估新生骨形成的情况.结果 ①4、6周时PMMA骨水泥组诱导形成的膜厚度分别为(1 108 ±26)、(945±42) μm,磷酸钙骨水泥组诱导成膜厚度为(945 ±34)、(778±22) μm,两组间差异有统计学意义(P＜0.05).PMMA骨水泥诱导的膜血管密度分别为6、3个/cm2,而磷酸钙骨水泥诱导形成的膜血管密度分别为2、2个/cm2.②放射学检测可见植骨后第8、12周PMMA组成骨按Lane-Sandhu X线评分(2.84 ±0.36)、(4.22±0.54)优于磷酸钙组(1.98 ±0.15)、(3.16 ±0.23),两组间差异有统计学意义(P＜0.05).③第8、12周组织学观察PMMA组按Nilsson组织学评分标准进行评分(3.14 ±0.29)、(4.63 ±0.37),成骨优于磷酸钙组(2.10 ±0.18)、(3.59±0.21),两组间差异有统计学意义(P＜0.05).结论 在新西兰兔桡骨骨缺损处PMMA骨水泥诱导形成的生物膜较磷酸钙骨水泥诱导形成的生物膜具有更强的促血管化和成骨活性.