淋巴细胞反应致金属对金属人工椎间盘假体早期失败

尽管有文献报道髋关节置换术后金属对金属假体周围出现的局部软组织反应可导致假体早期失败,但假体磨损产生的金属离子与早期的临床不良后果并无关系,对这些病例的组织学评估提示其与一种由细胞介导的迟发性超敏反应有关。     

以藻酸钙为载体的可注射组织工程骨行隆鼻术的实验研究

目的：研究可注射组织工程骨做为隆鼻术植入材料的可行性。方法：从兔髂骨中获取骨髓基质成骨细胞，将骨髓基质成骨细胞与25g/L藻酸钠溶胶混合形成藻酸钠/骨髓基质成骨细胞复合物，取其2mL与0.17g硫酸钙粉末混合均匀，注射于新西兰兔鼻背部骨膜下，观察成骨情况。结果：藻酸钙/骨髓基质成骨细胞复合物植入兔鼻背部皮下4周后有类软骨样组织形成，8周时有骨小梁、骨髓腔等骨组织结构。结论：以藻酸钙为载体的可注射性组织工程骨可用于隆鼻术植入材料。     

硅胶乳房假体表面改性的实验研究及CT评价

目的：研究乳房假体表面改性对减少纤维囊壁形成的影响及CT评价。方法：利用钴^60共辐射的方法把亲水性单体N-乙烯基吡咯烷酮(N-VP)接枝到硅胶乳房假体表面，改变其表面特性后植入兔的背部，以未经改性的正常假体作为对照组，隔一定时间通过组织切片及CT扫描的方法观察假体周围纤维囊壁的形成情况。结果：与对照组相比，改性后假体周围的炎症反应较轻，形成的纤维囊壁在各个时间段均薄于对照组；CT扫描显示术后8个月，改性的硅胶假体外形无明显改变，而未改性组外形显著改变。结论：在硅胶乳房假体表面接枝N-VP后可以有效地改善假体表面的组织相容性，减少周围纤维囊壁的形成。     

臭氧液对兔膝骨性关节炎滑膜炎症的影响

目的评价臭氧液对兔膝骨性关节炎滑膜炎症的影响。方法新西兰兔32只,采用随机数字表法分为四组,每组8只。A组不予任何处理;B组仅造模;C组造模成功后,关节腔注射20μg/ml臭氧液2ml,每周1次,连续3周;D组不造模,仅行关节腔注射臭氧液,方法同C组。观察膝关节滑膜形态,检测滑膜组织中IL-6和TNF-α含量。结果 A组滑膜组织无充血水肿,滑膜细胞无增生现象,滑膜组织结构正常;B组滑膜组织正常结构破坏,细胞重度增生,炎性细胞浸润明显,血管增生充血,滑膜厚度较A组明显增加;C组滑膜组织炎症细胞减少,充血水肿减轻,滑膜厚度较B组明显降低;D组滑膜无炎症表现。与A组比较,D组IL-6和TNF-α含量无明显增高,B、C组IL-6和TNF-α含量明显增高(P0.05),但C组明显低于B组(P0.05)。结论关节腔注射20μg/ml臭氧液2ml可以减轻滑膜炎症,降低滑膜中IL-6和TNF-α含量,且对正常关节滑膜组织无明显损害。     

兔膝关节置换假体感染模型的建立

目的 制作兔膝关节置换假体感染模型,为人工关节假体感染研究提供依据.方法 成年新西兰大白兔32只,雌雄不限,体重2.5～3.5 k,平均3.0 kg.将采用超高分子量聚乙烯(UHMWPE)制成的兔膝关节且垒骨假体植入兔膝关节.32只动物随机分为四组,关节置换术后1周分别向膝关节内注入无菌生理盐水、1×10~4 CFU、1×10~6 CFU和1×10~8 CFU的ATCC35984葡萄球菌菌液,模拟膝关节置换假体感染.1 周后取材,进行感染率和炎症程度评定、影像学和病理学检查、细菌学评定.结果 接种1×10~6 CFU的细菌足以致所有动物关节感染,超过此剂量则会引起败血症,细菌接种量在0～1×10~8 CFU时感染率和接种细菌量呈正相关(R~2=0.9939).大体观察感染膝关节充满脓液,关节滑膜红肿.激光共聚焦显微镜观察:假体表面黏附大量细菌,并有片状胞外黏质物.病理学检查为急性炎症反应.细菌定量分析发现关节液内细菌量明显高于假体表面和组织内细菌量.结论 制作的兔膝关节置换假体感染模型较好地模拟了临床膝关节感染情况,是一种较为成功的膝关节置换假体感染模型,可用于人工关节假体感染预防、诊断和治疗的研究.     

载阿仑膦酸钠骨水泥抑制钛磨屑诱导的假体周围骨溶解

目的 比较载阿仑膦酸钠丙烯酸骨水泥与皮下注射阿仑膦酸钠抑制钛磨眉诱导的骨溶解的效果.方法 48只成年雄性新西兰兔随机均分为无钛磨屑且无阿仑膦酸钠组(A组),有钛磨屑注射且无阿仑膦酸钠组(B组),钛磨屑分别注射0.1%、0.5%、1.0%载阿仑膦酸钠丙烯酸骨水泥组(C、I)、E组),钛磨屑注射且皮下手射阿仑膦酸钠组(F组),每组8只.将载阿仑膦酸钠骨水泥植入兔股骨远端.制备磨屑诱导骨溶解动物模型.术后8周对股骨行组织形态学分析、骨密度(bone mineral density,BMD)测定及界面力学测试结果 B组假体周围可见明显的骨溶解,而C、D、E、F组骨溶解明显少于B组.B组假体周围BMD和骨-骨水泥界面抗剪强度分别较A组下降17%和56%;D组假体周围BMD和界面抗剪强度较B组分别增加29%和62%;E组假体周围BMD和界画抗剪强度较B组分别增加37%和29%;F组假体周围BMD和界面抗剪强度较B组分别增加51%和69%;C组、D组、E组分别与F组比较,假体周围BMD和界面抗剪强度的差异均无统计学意义.结论 载阿仑瞵酸钠丙烯酸骨水泥与皮下注射阿仑瞵酸钠均可在一定程度上抑制磨屑诱导的骨吸收,增强界画抗剪强度.     

TNFα和VEGF在激素性股骨头坏死中的变化

[目的]通过应用马血清、激素作用新西兰兔，诱导激素性股骨头坏死动物模型。分析TNFα、VEGF在激素性股骨头坏死中的作用。[方法]将20只健康新西兰兔随机分成2组，每组10只。A组为模型组。每只用马血清10ml／kg。经兔耳缘静脉注射。间隔2周，按5ml／kg剂量连续2d注射马血清各1次。间隔2周后，注射醋酸泼尼松龙。按7．5mg／kg腹腔注射3次。B组：正常对照组。动物注射激素5周后，采血，应用ELISA法测血清中TNF-α浓度。处死模型组，标本进行常规组织病理学检查，免疫组化分析股骨头VEGF的表达。[结果]模型组兔血清TNF-α浓度明显高于正常组（P〈0．01）。组织病理学检查显示：部分血管栓塞。骨髓腔内造血组织明显减少。免疫组化结果显示：骨细胞及骨髓组织VEGF表达明显减少。[结论]血清中TNF-α浓度升高及股骨头骨髓组织VEGF表达减少可能是激素性股骨头坏死发生的重要因素。     

乳房假体周围纤维包囊的组织学研究

目的 观察分析不同内容物的乳房假体周围纤维包囊在组织病理学上的特点。方法 对20例隆乳术后因不同原因行假体取出者的假体周围纤维包囊进行组织学研究，行HE、Masson和Mallory染色后，在光学显微镜下观察不同假体包裹的组织构成和结构特征。结果 不同假体包囊均有胶原纤维的沉积、炎症细胞浸润和少量毛细血管增生，部分包囊内层可见有扁平上皮样细胞层。但不同假体包囊又各有其特点。结论 ①本组任何乳房假体都可引发纤维组织包囊形成。②部分假体纤维包囊的内层表面可能出现“滑膜化生”现象。③植物油假体纤维包囊胶原沉积过度，囊壁增厚，易出现硬化，不宜选用。④PVP假体包囊内大量的炎性细胞提示可能与嗜酸性粒细胞介导的迟发型超敏反应有关，应慎用。     

兔胫骨金黄色葡萄球菌慢性骨髓炎模型的制备

目的总结利用金黄色葡萄球菌制备新西兰大白兔胫骨慢性骨髓炎动物模型的方法及经验。方法30例健康新西兰大白兔，戊巴比妥钠全麻后利用5mm骨钻在胫骨近段钻孔，制造骨缺损，向骨髓腔内注射5μL鱼肝油酸钠（作为硬化剂）和金黄色葡萄球菌（注射总量为2×106cfu），骨蜡封闭后不做任何治疗。4周后采用大体观察、放射学、细菌学及组织病理学等方法评价动物模型的制备情况。结果所有大白兔都可以看到早期伤口流脓、局部组织肿胀、病腿跛行，不同程度食欲减退伴有体重减轻。术后早期有3例因菌血症死亡，27例放射学表现为典型的骨髓炎，具体表现为中度到广泛的皮质反应，皮质骨破坏，轻度到广泛新骨形成，在胫骨髓腔的近端多有死骨形成，均培养出金黄色葡萄球菌，病理学显示为慢性活动性炎症、骨溶解、并有新生编织骨，造模成功率为90．O％（27／30）。结论使用本方法可较为稳定可靠地制备出兔胫骨慢性骨髓炎动物模型，值得在骨髓炎的动物研究中推广应用。     

骨组织工程研究中的美学考量

目的：分别以珊瑚羟基磷灰石(CHA)、藻酸钙为成骨细胞载体，观察裸鼠体内的构建特定形态和可注射组织工程骨的可行性。方法：取兔髂骨，获取骨髓基质干细胞，经体外扩增培养诱导后，获得骨髓基质成骨细胞，分别与CHA和藻酸盐复合，植入和注射于裸鼠背部皮下，6、8周后进行大体观察、组织学和X线检查，观察软骨和骨的形成。以单纯CHA和藻酸盐植入作为对照。结果：植入CHA／成骨细胞组和注射藻酸盐/成骨细胞复合物组均有骨样组织形成，具备骨髓腔样结构，而对照组无骨形成。结论：CHA和藻酸盐均是较好的骨组织工程支架材料，复合成骨细胞后可构建特定形态和可注射组织工程骨。     

大颗粒聚乙烯对人工关节假体周围组织影响的实验研究

目的　制作松动人工关节的动物模型 ,了解大颗粒聚乙烯对实验动物人工关节假体周围骨组织的影响 ,并初步探讨其作用机制。　方法　选用健康新西兰白兔 2 0只 ,雌雄各半 ,体重 2 .3～ 2 .7kg。从两侧膝关节向股骨置入钴 -铬 -钼棒 ,分别于术后 2、4、6、8及 10周向一侧膝关节腔内注射聚乙烯微粒 (直径 10 0 μm)悬液 1.5 ml(实验侧 ) ,向另一侧膝关节腔内注射生理盐水 1.5 ml(对照侧 )。术后第 10周摄双下肢 X线片 ,了解假体周围是否有骨溶解和假体松动。术后第 12周处死动物。取 13只兔检查聚乙烯颗粒在关节囊分布情况 ,假体有否松动 ,周围有无新骨及界膜形成 ;取5只兔双侧股骨、膝关节囊作组织学检查 (实验过程中有 2只动物死亡 )。　结果　 1肉眼观察 :实验侧有 4侧金属假体被新生骨组织覆盖 ,9侧被纤维膜覆盖 ;对照侧有 11侧金属假体被新生骨组织覆盖 ,2侧被纤维膜覆盖 ,差异有统计学意义(P<0 .0 5 )。2 X线片观察 :假体位于股骨髓腔远端 ,其周围未见明显新生骨组织和骨溶解征像。3组织学观察 :实验侧关节囊见大量异物颗粒被成纤维细胞和多核巨细胞包绕 ,假体近端髓腔周围见成纤维细胞和纤维组织或新生骨组织形成 ,未见异物颗粒和多核巨细胞 ,靠近关节面部分见异物颗粒被成纤维细胞和多核巨细胞包绕     

Tissue Reaction and Metal Sensitivity: An Animal Study

An animal study is presented in which nickel sensitivity as determined by an in vitro test for leukocyte migration inhibition (LIF) is correlated with results of skin tests with NiCl₂ and with the degree of adverse tissue reaction to implanted stainless steel screws. Screws were implanted in the humeri of New Zealand white rabbits, one group of which received repeated injections of nickel chloride following an initial injection of nickel chloride in Freun d?s adjuvant. All the injected rabbits became skin test positive to nickel and demonstrated LIF production in the presence of nickel chloride. Some of the injected rabbits, 6–9 weeks after implantation of the screws, developed an inability for leukocyte migration even when the cells were incubated only with saline and serum. the tissue reaction to screws in the nickel sensitive animals showed a significant increase in inflammatory cells and foreign body giant cells when compared with the reaction in nonsensitive animals. the most severe reactions, some of which included regions of necrosis, were seen in animals which developed the condition of no leukocyte migration in the LIF test. the correlation between skin test and LIF test results demonstrates the effectiveness of the LIF assay for sensitivity testing without the risk of sensitization associated with skin testing. the histological results support the hypothesis that the condition of no cell migration in the LIF test is diagnostic for severe reactions to implants associated with metal sensitivity.     

Antigen challenge induces a supraglottic but not a subglottic edema in the rat larynx.

OBJECTIVE: To examine the reaction of mast cells in the larynx of sensitized rats after allergen challenge and determine whether a type I hypersensitivity reaction can elicit a supraglottic and subglottic edema. STUDY DESIGN: Rats were sensitized with ovalbumin (OA) and challenged 3 weeks later by intravenous injection of either OA or NaCl and perfused with glutaraldehyde. The larynges were removed and processed for light and electron microscopy. Sections from the epiglottis and subglottic region were examined. RESULTS: In challenged animals, the connective tissue mast cells (CTMC) in the epiglottic submucosa, but not the mucosal mast cells (MMC) in epithelium, were significantly reduced compared with the case of controls, and the connective tissue was edematous. In the subglottic region, the number of both MMC and CTMC was reduced (albeit not significantly), and there was no edema in the lamina propria. CONCLUSIONS: Allergen challenge induces a marked edema in the epiglottis but not in the subglottic area. SIGNIFICANCE: The results indicate that the supraglottic and subglottic regions react differently to allergen challenge.     

Tissue engineering of bone in muscle by using free periosteal grafts with a self-reinforced polyglycolide membrane scaffold. An experimental study in growing rabbits

For tissue engineering of predesigned rectangular bone from free tibial and calvarial periosteal grafts, using self-reinforced polyglycolide membrane (SR-PGA) as a scaffold, fourteen growing New Zealand White rabbits were used. In twelve animals, free tibial and calvarial periosteal grafts wrapped around membranes and grafts without membranes were implanted in muscle. In two control animals membranes only were implanted. Follow-up periods were 6 and 12 weeks. Bone formation and tissue reactions were evaluated macroscopically and histologically. Tibial grafts produced bone more often than calvarial grafts (11/12 vs. 5/12). At 6 weeks mature rectangular bone was obtained from tibial grafts with membranes, whereas none was obtained from calvarial grafts with membranes. At 12 weeks, bone ossicles obtained from both types of graft with membranes were clearly smaller than at 6 weeks and the rectangular form was lost. SR-PGA membrane can be used as a scaffold to obtain predesigned rectangular bone from free tibial periosteal grafts in growing rabbits. Transplantation should be performed before resorption occurs. Received: 10 May 1999 / Accepted: 23 June 1999     

Immunogenic potential of carpal implants

This study investigated whether a cellular or a humoral-mediated immunologic response to silicone carpal prostheses could be detected in animals previously sensitized to silicone. Silicone carpal prostheses were emulsified in Freund's complete adjuvant (FCA). This emulsion was injected into guinea pigs weekly for 6 weeks. Controls received only FCA. Four weeks later a carpal prosthesis was implanted. Histology showed the implanted prosthesis encapsulated by fibrous tissue in sensitized animals, with a mononuclear infiltrate within the fibrous periprosthetic capsule consistent with a cellular immune response. Skin testing of the sensitized animals showed a true correlate response to the silicone antigen challenge, whereas no response was observed in the control group. The passive cutaneous anaphylaxis reaction in sensitized animals was positive, emphasizing that the antigen-antibody response was passively transferred. Tissue adjacent to the silicone implant in sensitized animals revealed an IgG deposition around the silicone particles by the fluorescent antibody technique. Control animals showed none of these reactions. These results indicate that microparticulate matter from carpal implants can possibly initiate both a cellular immunologic response and the production of a circulating antibody.     

Study of tissue reaction to chromium magnetic steel]

For studying tissue reaction to stainless steel of 95Cr18, 01Cr25 brands after vacuum-thermal processing, 01Cr18T and magneto-elastic, the balls and disks of these materials were implanted to 40 experimental animals (rabbits). For comparison, 111Cr15 brand steel and titanium were used. The results obtained permit to recommend the chrome magnetic steel studied for implantation into the human and animal organism.     

Prefabricating bone in muscle by using free tibial periosteal grafts and self-reinforced polyglycolide and poly-L-lactide pins

To investigate the possibility of prefabricating bone of predetermined form in muscle using free tibial periosteal grafts and biodegradable pins, operations were performed on 12 growing rabbits. In each animal, (1) a graft around a self-reinforced polyglycolide (SR-PGA) pin, (2) a graft around a self-reinforced poly-L-lactide (SR-PLLA) pin, (3) a SR-PGA pin, and (4) a SR-PLLA pin were implanted in the dorsal muscles for 6 weeks. Histological and histomorphometric evaluations were performed. Bone formation from periosteal grafts was observed in all 12 animals. The shape of the newly-formed bone was grossly cylindrical in all specimens except one. Bone formation was stronger around the SR-PGA pins than around the SR-PLLA pins. The pins without grafts did not induce any bone formation, but fibrous tissue encapsulation instead. A mild foreign body reaction was elicited by SR-PGA pins, while it was almost absent with SR-PLLA pins. It is thus possible to prefabricate bone in a cylindrical form in growing rabbits using free tibial periosteal grafts and SR-PGA or SR-PLLA pins implanted in muscle.     

单次低剂量脂多糖联合甲基强的松龙诱导股骨头坏死的实验研究

目的 探讨单一低剂量脂多糖(lipopolysaccharide,LPS)及后续3次高剂量甲基强的松龙(methylprednisolone,MPS)注射引起激素性股骨头坏死(osteonecrosis of femoral head,ONFH)的发生情况及其发生机制. 方法 健康成年雄性26～30周龄新西兰大白兔25只,体重(3.0 ±0.3)kg.随机取19只为处理组,经耳缘静脉注射10 μg/kg LPS,24 h后于右侧臀肌注射20 mg/kg MPS琥珀酸钠,共3次,每次间隔24 h;余6只为对照组,于相同时间点注射等量生理盐水.于注射LPS前、3次注射MPS前及最后1次注射MPS后24 h行血液学检查.于最后1次注射MPS后6周行双髋部MRI扫描,于股骨头区抽吸骨髓检测局部干细胞活性,并取双侧股骨头行组织病理学检查. 结果 LPS注射后48 h,1只动物死亡,余动物均存活至实验完成.经组织病理学观察,处理组中16只动物为ONFH (病理),ONFH发生率为88.9%(16/18),坏死区域主要位于干骺端,微血管内有纤维血栓形成,髓内脂肪细胞体积明显增大并堆积;对照组股骨头均正常.MRJ诊断准确率为93.8%(15/16).处理组中16只ONFH (病理)动物,与正常值(注射LPS前)比较组织纤溶酶原激活剂/纤溶酶原激活剂抑制因子1(tisssue plasminogen aetivator/plasminogen activator inhibitor 1,t-PA/PAI-1)和活化部分凝血激酶时间(activated partial thromboplastin time,APTT)明显下降(P＜0.05),低密度脂蛋白/高密度脂蛋白明显增高(P＜0.05);对照组以上指标与正常值比较差异均无统计学意义(P＞0.05).各时间点处理组ONFH (病理)动物t-PA/PAI-1和APTT与对照组比较,差异有统计学意义(P＜0.05).处理组ONFH (病理)兔股骨头区骨髓产生的成纤维细胞集落形成单位总数为8.50 4±9.63,与对照组的70.17±7.78比较,差异有统计学意义(P＜0.05). 结论 单次低剂量LPS联合MPS是制备激素性ONFH模型的成功方法,血液的高凝和/或高纤溶状态、脂质代谢的紊乱、多能干细胞数量活性的降低等多因素作用可能是诱导激素性ONFH的关键.     

Injectable dextranomer-based implant: histopathology, volume changes and DNA-analysis

OBJECTIVE: To study the tissue reaction in and around the implant, the changes in implant volume and the DNA profile of the invading cells when a new substance, dextranomers in sodium hyaluronan solution (DiHA), was injected into experimental animals. MATERIALS AND METHODS: Nine pigs were followed up from 2 weeks to 3.5 months and 34 rats were followed up from 3 weeks to 16 months after injection of DiHA into the bladder in pigs and into the subcutaneous tissue in rats. Histopathological analysis was performed in 16 pig and 63 rat implants. In 31 of the rat implants the DNA profile was analysed. Changes in implant volume over time were estimated in 51 rat implants during the period up to 12 months after implantation. RESULTS: Histologically, in the early phases the area within and around the implant was fairly rich in cells, predominantly fibroblasts, inflammatory cells and giant cells of the foreign body type. Later in the process an increase in extracellular matrix around the microspheres and ingrowth of blood vessels was seen. No tissue necrosis or significant eosinophilia was observed around the implants. DNA measurements by flow cytometry revealed no aneuploid cells. There was a decrease in implant volume by 23% over a period of 12 months. CONCLUSIONS: DiHA does not induce any major tissue changes in and around the implants. No DNA changes were observed during the study period of 16 months. DiHA seem to be a safe and suitable injectable substance with good tissue-augmenting properties.     

Transplantation of tissue-engineered osteochondral plug using cultured chondrocytes and interconnected porous calcium hydroxyapatite ceramic cylindrical plugs to treat osteochondral defects in a rabbit model

Abstract:  The purpose of this study was to evaluate the macroscopic and histological results of transplanting a tissue-engineered composite plug made of tissue-engineered cartilage and interconnected porous calcium hydroxyapatite ceramics (IP-CHA) with a very high porosity of 94.9% to treat osteochondral defects. Twelve 12-week-old male Japanese white rabbits were used. Fresh articular cartilage slices were taken, and isolated chondrocytes (2 × 10⁶ cells) were embedded in atelocollagen gel. They were seeded on the top of IP-CHA plugs and cultured for 2 weeks. These tissue-engineered composite plugs were transplanted into the osteochondral defects in the patellar grooves (the experimental group). In the control group, the defects were treated with composite plugs without chondroytes. Twelve weeks after transplantation in the experimental group, the defects were repaired with cartilage-like tissue with good subchondral bone formation histologically. Histological scores in the experimental group were significantly better than those in the control group. This study clearly showed the defects that had been treated with tissue-engineered composite plugs.