组织工程化骺板软骨修复兔部分骺板损伤的实验研究

目的 利用组织工程骺板软骨修复兔骺板缺损,防止肢体畸形发生.方法 取2周龄兔骺板软骨细胞,体外复合牛关节软骨细胞外基质后植入4周龄兔右侧股骨远端骺板缺损处,左侧仅造成缺损,无填充物,作为自身空白对照.于每周行X线检查,4、8、12、16周时行组织学和免疫组化检查.结果 X线显示移植侧股骨畸形明显比对侧轻,骺板缺损处未见明显骨桥生成,被结构紊乱的软骨组织填充,具有一定的生长能力.空白对照侧骨桥形成,骺板早闭.组织学显示移植侧骺板较窄,排列紊乱.免疫组化结果显示移植处染色阳性.结论 组织工程方法培养出骺板软骨不仅可以阻止骨桥产生,还具有一定的生长能力,有望成为治疗骺板早闭的一种合适的材料.     

骺板骨桥切除术治疗儿童骺板部分早闭

骺板是儿童骨骺与干骺端之间的生长活跃软骨区,具有纵向和横向生长的功能,骨折、感染、肿瘤、辐射均可导致骺板损伤。骺板损伤后可能在骨骺与干骺端之间的软骨区形成骨性连接即骨桥,使骺板全部或部分提前闭合,导致肢体短缩和（或）成角畸形。传统的治疗方法是针对临床表现的短缩和（或）成角畸形,采取诸如截骨矫形、骨骼延长或健侧骺板阻滞术等方法进行治疗。     

骺板骨桥切除后骺板恢复开放的X线观察

目的 观察儿童骺板骨桥切除术后４年以上者骺板恢复纵向生长的时间、速率及骨骺和干骺端的变化。方法 采取临床和系列Ｘ线片观察和测量的方法,并与健侧对比,计算手术侧骺板年生长率、骨骺和干骺端的变化。结果 本组４例平均随诊５．２年。术后３例骺板恢复开放,从测量骺板线与骨桥切除后填塞脂肪的骨孔向干骺端移位的距离,发现肢体多在术后４￣６个月开始恢复生长,患肢比健肢年平均短缩约０．２ｃｍ,其生长速率可达到正常侧     

骨桥切除治疗骺板部分闭合的初步报告

介绍骨桥切除的手术方法及３例术后随访结果。２例骺板骨桥位于股骨远端，另１例位于胫骨远端，均为中心型骨桥，并以肢体短缩为主要畸形。手术采取Ｐｅｔｅｒｓｏｎ所描述的方法，在电视Ｘ线透视下，通过干骺端应用微型电动骨钻作一骨隧道，逐渐磨除骺板骨桥，然后用自体脂肪填塞，以防止新骨形成。术后平均随访１８．６个月，Ｘ线片显示骺板仍保持开放，成角畸形也获得明显矫正，受累侧骺板继续生长。其中１例左股骨远端骺板骨桥，术后２０个月又增长１．８ｃｍ。结果表明，骨桥切除是治疗骺板部分闭合的有效方法，适用于骨桥面积小于受累骺板的５０％，其年龄距生理性能板闭合尚有２～３年的儿童。     

骨骺,骺板损伤的病理生理

骨骺、骺板损伤的病理生理吉士俊骨骺、骺板既具有特殊的结构，又有生长发育的功能，损伤的病理生理自然不同于一般骨骼，因此了解其损伤后一系列变化，对指导临床诊断与治疗有重要的意义。一、骺板损伤的生物力学骺板的形态学一方面受着遗传因素的控制，还要适应于肢体功...     

压力和张力对骨骺板软骨细胞的影响

新西兰幼兔１９只，在其右股骨下端安装带有拉力和压力传感器的外固定装置，向骺板近端分别施压力和张力，左侧股骨作为对照。４周后两侧股骨作长度测量和组织学检查。结果表明压力使骺板厚度全层变薄，肥大细胞数减少，骨生长表现为抑制状态。张力使骺板增殖层和肥大层厚度增加，肥大细胞数增多，骨生长活跃。机械力使骺板软骨细胞在组织学上的变化具有统计学意义。     

不同直径骺板贯穿伤对骺板发育影响的实验研究

目的　探讨不同直径克氏针造成骺板贯穿伤对骺板生长的影响。方法　选用封闭群系日本大耳兔 4 8只 ,随机分为两个实验组 ,每组 2 4只 ,采用直径分别为 1.5mm和 3 .5mm的克氏针纵形贯穿兔股骨远端骺板中心 ,于术后 1、3、6及 12周处死实验兔。测量骺板受损面积百分率 ,并从大体、组织学方面观察骺板发育情况。结果　 1.5mm和 3 .5mm组骺板损伤面积百分率分别为( 1.69± 0 .0 9) %和 ( 9.13± 0 .2 0 ) %。术后 12周 3 .5mm组实验侧股骨较对照侧短缩( 2 .0 8± 0 .4 6)mm(P <0 .0 1) ,而 1.5mm组未出现骨生长抑制。组织学观察发现术后 3周骨桥初步形成 ,术后 12周骨桥成熟 ,3 .5mm组骨桥周边区域骺板增殖细胞层明显变薄。 1.5mm组未发现骺板生长阻滞。结论　克氏针造成骺板贯穿伤与骺板受损面积有关 ,超过骺板表面积约 9.0 %就可能导致骨生长抑制     

骺板损伤早闭治疗的研究进展

骺板是儿童骨骼所特有的结构,它是骨骺与干骺端间生长活跃的软骨区,呈波浪状薄板样,具有纵向和横向生长的功能。其损伤会导致儿童长管状骨骨骺与干骺端之间形成骨性连接即骨桥,使骺板全部或部分提前闭合,造成肢体短缩和（或）成角畸形。近年来,由于对其病理、诊断和实验研究的不断深入及关节镜、显微外科等新技术的不断发展,在临床治疗方面已相继取得了新的进展。现将其作一综述。骨折、感染、肿瘤、辐射等因素均会导致骺板的损伤。而骺板损伤所致早闭往往在受累肢体出现成角畸形或短缩时才被发现。根据Ｘ线平片上骨桥位于骺板的部位…     

组织工程化骺板软骨修复兔部分骺板损伤的实验研究

目的 利用组织工程骺板软骨修复兔骺板缺损,防止肢体畸形发生.方法 取2周龄兔骺板软骨细胞,体外复合牛关节软骨细胞外基质后植入4周龄兔右侧股骨远端骺板缺损处,左侧仅造成缺损,无填充物,作为自身空白对照.于每周行X线检查,4、8、12、16周时行组织学和免疫组化检查.结果 X线显示移植侧股骨畸形明显比对侧轻,骺板缺损处未见明显骨桥生成,被结构紊乱的软骨组织填充,具有一定的生长能力.空白对照侧骨桥形成,骺板早闭.组织学显示移植侧骺板较窄,排列紊乱.免疫组化结果显示移植处染色阳性.结论 组织工程方法培养出骺板软骨不仅可以阻止骨桥产生,还具有一定的生长能力,有望成为治疗骺板早闭的一种合适的材料.

Abstract：

Objective The aim of this study is to establish the feasibility of acellular cartilage matrix as a scaffold for epiphyseal chondrocytes to form tissue engineering growth plate for the treatment of partial growth plate injury. Methods We collected and cultured the epiphyseal plate chondrocytes from 2 weeks old rabbit in vitro, seeded in acellular cartilage matrix to form a complex. It was then transferred to the rabbit right distal femur which was subjected to growth plate injury. The left femur was subjected to the same injury without further treatment (control). The femur recovery was monitored with weekly X-ray. The morphology was studied with hematoxylin- eosin stain and immunohistochemistry. Results The right femur recovery was significantly better than that of the left radiologically. Histology and immunohistochemistry studies revealed that the growth defects were filled with cartilaginous tissue, which has a similar structure as natural epiphyseal plate . On the left side (control), the epiphyseal defect was filled with bone bridge and epiphyseal plate growth was arrestted. Conclusions Epiphyseal cartilage tissue engineering prevents bone bridge generation and also has some growth potential. It may be a suitable treatment materials for repairing the epiphyseal plate defect     

骺板骨桥的发生机制及治疗研究进展

儿童长骨末端的骺板提供骨骼的纵向生长,骺板的各种损伤可导致骨桥的形成,进而导致肢体缩短和成角畸形。本文首先阐述了儿童骺板及骺板损伤的特点,然后对骺板骨桥的主要发生机制及治疗手段的研究进展进行综述。     

Imaging of traumatic dislocation of the hip in childhood

Background Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction.Objective To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy.Materials and methods A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions.Results In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis.Conclusions It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality.     

牵张骨骺板产生“软骨分离”式肢体延长的实验研究

采用新西兰幼兔３２只，在右股骨下端骨骺安装外固定架和拉压传感器，对骨骺板近端分别施加张力０Ｎ、５Ｎ、１０Ｎ，并定期进行张力调节。４周后５Ｎ、１０Ｎ张力组的右股骨长度值明显高于左侧股骨，也明显高于同侧对照组。Ｘ线片显示右股骨下端骨骺板与干骺端间隙增宽，组织学镜检无一例出现骨骺分离骨折。研究结果表明适量的张力能刺激骨骺产生无骺分离状态下的骨延长，从而避免或减少骨骺牵张术中最严重的并发症──骨骺早期封闭。     

Reversible skeletal changes after treatment with bevacizumab in a child with cutaneovisceral angiomatosis with thrombocytopenia syndrome

Cutaneovisceral angiomatosis with thrombocytopenia (CAT) syndrome is a rare vascular disorder of the skin and gastrointestinal tract for which there is no standard treatment. We present a case in which a child with CAT syndrome was treated with bevacizumab, a vascular endothelial growth factor inhibitor, and subsequently developed asymptomatic metaphyseal bone lesions. Though not previously described as a side effect, we hypothesize that the use of bevacizumab in a child with active epiphyseal growth plates caused these radiographic lesions. Because of the potential for altered bone growth and metabolism, children receiving VEGF inhibitors should be monitored closely for bony toxicity.     

Bone injuries during delivery

Bone injuries during the process of delivery were studied among 34, 946 live born babies over a 11 period. There were 35 cases of bone injuries giving an incidence of 1 per 1,000 live births. Clavicle was the commonest bone fractured (45.7%) followed by humerus (20%), femur (14.3%) and depressed skull fracture (11.4%) in the order of frequency. There was one case each of orbital fracture, epiphyseal separation of lower end of femur and dislocation of elbow joint. Lack of antenatal care, malpresentation often leading to obstructed labour and operative deliveries were found to be risk factors for bone injuries. Meconium stained liquor and birth asphyxia were more commonly associated with bone injuries than control cases. Cases with injuries had longer hospital stay and higher mortality. Improving the health infrastructure at the peripheral level with early identification of high risk mothers and their appropriate management can bring down the incidence of bone injuries.     

可吸收聚消旋乳酸棒垂直骺板植入对兔骺板生长的影响

目的 探讨可吸收聚消旋乳酸棒(poly-D,L-lactide acid,PDLLA)垂直骺板植入对幼兔股骨远端骺板生长的影响.方法 采用封闭群系5周龄日本大白兔24只,随机分为两组:1.0mm、2.0 mm组,每组12只.在幼兔右侧殴骨远端跨骺板中心分别垂直植入直径为1.0 mm、2.0 mm的PDLLA棒;左侧作为对照,只作膝关节切开,不钻孔,不植入.电脑计算骺板损伤面积,术后6、12、24周处死动物.通过测量双侧股骨长度、双侧膝关节外翻角、组织病理学、骨骺磨片和透射电镜等方法观察PDLLA棒对骺板生长的影响.结果 1.0 mm、2.0 mm的PDLLA棒垂直植入所造成的骺板损伤分别占骺板面积的(1.39±0.09)%、(3.33±0.92)%;术后6、12、24周各组内实验侧和对照侧相比,双侧股骨长度、外翻畸形无明显差异(P＞0.05).结论 可吸收聚消旋乳酸棒垂直骺板植入不会对兔骺板生长造成不良的影响.     

The value of MRI in early Perthes' disease: an MRI study with a 2-year follow-up

Eleven hips in nine patients with Perthes' disease were studied by plain radiography at 3-month and MRI at 6-month intervals over a period of 2 years. The aim was to clarify the value of MRI in estimating epiphyseal involvement and in predicting uncoverage of the epiphysis. Signal intensities of the epiphysis and metaphysis were visually evaluated from T1- (T1W) and T2-weighted (T2W) images. The extent of decreased signal intensity (DSI) in the epiphyses was volumetrically calculated from T1W images and then compared with follow-up radiographs. The area of epiphyseal DSI corresponding best with Catterall's classification was seen by MRI 3–8 months after the first symptoms. MRI images obtained earlier usually showed less involvement than the follow-up radiographs. However, two features predicting extensive epiphyseal necrosis were: (1) DSI on both T1W and T2W images covering over two-thirds of the epiphysis and (2) diffuse bone marrow oedema of the femoral neck and metaphysis. When T1W images showed a reappearance of high signal intensity patches in the lateral quarter of the epiphysis, no clinically significant uncoverage was seen during the follow-up. Extensive epiphyseal necrosis can, therefore, sometimes be predicted by MRI even within the first 3 months, but MRI visualises epiphyseal involvement more clearly 3–8 months after the first symptoms. Received: 27 March 1996 Accepted: 26 October 1996     

缺血对骺板移植影响的实验研究

目的 研究不同缺血时间对移植骺板组织结构和生长的影响。方法 在３６只８周幼兔的右下肢,对胫骨下端骺根的血供分别阻断２、４和８小时,在左侧胫骨相同部位埋置金属标志作为对照,利用Ｘ线测量术后第３个月的生长长度,并作切片观察骺板组织学改变。结果缺血２和４小时的骺根组织结构正常,生长速度与对照侧相同。缺血８小时可导致骺根中心散在变性、坏死,生长速度较对照侧慢。结论 ４小时以内的缺血对骺板的组织学和生长无     

The effects of the estrogen receptor blocker, Faslodex (ICI 182,780), on estrogen-accelerated bone maturation in mice.

Sex steroids accelerate bone maturation, but it is believed that estrogen action is needed for terminal epiphyseal fusion. In this study, we investigated the effects of a new estrogen-blocking agent, Faslodex (ICI 182,780), on estrogen-accelerated skeletal maturation in immature mice. On day-of-life 2 through 8, mice pups received either estradiol (5 microg/100 g body weight), Faslodex (100 microg/100 g body weight), a combination of Faslodex + estradiol, or vehicle alone. Skeletal maturation was assessed with a scoring system based on the size and appearance of epiphyseal plates in the forepaw and the lumbar spine. Estradiol caused acceleration of bone maturation in our mouse model (p < 0.05). Faslodex blocked the effect of estrogen, such that the mice receiving Faslodex + estradiol did not vary significantly from controls. Faslodex may prove useful in the treatment of patients with diseases causing rapid skeletal maturation, such as precocious puberty.