生物型APC重建股骨近端瘤性骨缺损的保肢技术及疗效分析

目的 探讨生物型同种异体骨-假体复合物（allograft-prosthetic composite,APC）重建股骨近端肿瘤切除后骨缺损的手术方法和中期疗效。 方法 收集2007~2011年在我科接受股骨近端肿瘤切除、生物型APC重建的15例患者资料及病理结果;术后第1、3、6、9、12月及之后每半年对患者进行影像学检查及功能随访评估。影像学评估主要包括骨-骨界面愈合情况及大转子骨吸收情况;采用骨与软组织肿瘤协会评分（MSTS）及Harris髋关节评分（HHS）评估患者关节功能,采用查体评估患者外展肌肌力。结果 本组15例患者中,男7例,女8例,平均年龄25.1岁（17~56岁）;平均随访时间32.8月（18~48月）;病理学诊断:骨巨细胞瘤4例,骨肉瘤3例,软骨肉瘤3例,恶性纤维组织细胞肿瘤2例,骨母细胞瘤2例,尤文氏肉瘤1例。15例患者异体骨-宿主骨界面均获骨性愈合,愈合时间为5~9月;至末次随访时,未出现感染、异体骨-宿主骨愈合处骨吸收、髋关节脱位、异体骨超敏反应、髋臼磨损及肿瘤复发和转移等并发症。3例患者术中出现假体周围骨折,以钢丝环扎术固定。术后6例患者出现大转子骨吸收。15例患者平均MSTS评分和HHS评分,术前为11.3分（7~15分）和47.3分（40.3~58.5分）,末次随访时为26.1分（24~29分）和80.1分（66.2~92.7分）。结论 生物型APC应适用于年龄轻、预期生存时间长及术后功能要求高的股骨近端骨肿瘤患者。     

注射型可吸收聚氨基酸/硫酸钙复合材料动物体内的安全及组织相容性

背景：临床上应用的聚甲基丙烯酸甲酯和磷酸钙骨水泥可注射型骨修复材料在体内不能完全降解、吸收,且成骨能力较差。目的：评估新注射型聚氨基酸/硫酸钙复合材料在动物体内的安全性及组织相容性。方法：将注射型聚氨基酸/硫酸钙复合材料植入新西兰兔背部肌肉内,将其浸提液分别注射至昆明小鼠体内与新西兰兔背部皮内。结果与结论：注射材料浸提液后,小鼠一般情况良好,体质量均呈上升趋势,腹腔各脏器无明显水肿、粘连、坏死等;兔背部浸提液注射部位未出现红斑、水肿等皮内刺激反应。聚氨基酸/硫酸钙复合材料植入兔背部肌肉早期材料周围炎症反应明显,后逐渐减弱,包膜样结构逐渐被吸收,未见明显排斥反应;材料周围肌肉细胞色素氧化酶和乳酸脱氢酶等氧化相关酶活性无明显减弱。提示新型可注射复合材料在动物体内具有良好的安全性和组织相容性。     

可变刚度可降解-DL-聚乳酸泡沫衬垫材料与钛合金组成接骨板系统治疗胫骨骨折

背景：理想的骨折固定系统,在骨折早期应能达到坚强固定,后期要能防止应力遮挡作用诱发的固定骨段的骨质疏松。可降解骨科内固定材料无疑为此种骨折固定系统提供了理论可能。目的：旨在评估自制可变刚度接骨板系统（由可降解聚-DL-乳酸泡沫衬垫材料和钛合金接骨板组成）对兔胫骨干中段骨折的固定效果和对骨折愈合的影响。方法：新西兰大白兔64只采用随机数字表法分为实验组和对照组,线锯造成兔右侧胫骨中段骨折模型。用相对分子质量为200000的自制超高相对分子质量聚乳酸材料膜垫（厚1mm）和4孔钛合金Tc4接骨板制作成可变刚度接骨板系统固定实验组兔胫骨中段骨折,以单纯Tc4钛合金接骨板固定对照组。于第2,4,8,12周处死动物,从大体观察、X射线平片、组织学和骨生物力学等方面观察和评定骨折愈合情况。结果与结论：X射线及大体标本示术后两组对位效果佳,无移位。组织学观察可见术后同期实验组标本较对照组标本骨痂内骨小梁排列紧密、髓腔开通完全、新生骨组织改塑重建完整。生物力学结果显示8周时两组愈合骨最大抗弯曲强度差异无显著性意义。12周时实验组愈合骨抗弯曲刚度优于对照组。提示自制可变刚度接骨板系统用于兔胫骨骨折固定效果可靠,有利于骨折段骨痂改塑重建,利于骨折愈合,用于骨折内固定治疗效果优于单纯钢板,为其进一步临床应用研究提供了实验依据。     

Fe3O4纳米粒子的细胞相容性

背景:无论是作为化疗药物载体还是作为肿瘤热疗介质,Fe3O4纳米粒子与肿瘤细胞微观结构的作用都有待于深入研究。目的:分析Fe3O4纳米粒子的细胞相容性,探讨其在骨肉瘤化疗中作为药物载体的应用和存在的问题。方法:参照GB/T16886.5-2003(医疗器械生物学评价第5部分:体外细胞毒性试验)的评价标准和要求,偶联十六烷基三甲基溴化铵、聚乙二醇、油酸钠Fe3O4纳米粒子胶体溶液,分别与大鼠原发骨肉瘤细胞和人成纤维细胞共培养的方式对其进行细胞毒性测试。结果及结论:偶联油酸钠Fe3O4纳米粒子细胞相容性良好,参照GB/T16886.5-2003标准属于安全范围。偶联十六烷基三甲基溴化铵Fe3O4纳米粒子细胞相容性差,不适宜作为化疗药物载体进入人体。偶联聚乙二醇Fe3O4纳米粒子有一定的细胞相容性,作为磁靶向热化疗载体还需研究。     

Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture

Objective： To retrospectively analyse the clinical outcome of emergency treatment of senile intertrochanteric fractures with proximal femoral nail antirotation （PFNA）.
Methods： From September 2008 to March 2009, 35 senile patients with intertrochanteric fracture, aged from 65 to 92 years with an average age of 76.5 years, were treated with PFNA within 24 hours after injury. There were 10 type Ⅰ fractures, 19 type Ⅱand 6 type Ⅲ according to upgraded Evans-Jensen classification system. All patients were complicated with osteoporosis, and 19 patients had preexisting internal medical diseases. According to the rating scale of disease severity by the American Society of Anesthesiologists （ASA）, there were 9 grade Ⅰ, 14 grade Ⅱ, 8 grade Ⅲ, and 4 grade Ⅳ.
Results： The duration for operation ranged from 45 to 73 minutes with an average of 57.6 minutes. The volume of blood loss during operation ranged from 50 to 120 ml with an average of 77.5 ml. Patients could ambulate 2-4 days after operation （mean 3.5 days）. Hospital stay was 4-7 days （mean 5.3 days）. Full weight bearing time was 10-14 weeks （mean 12.8 weeks）. During hospitalization period, there was no regional or deep infection, hypostatic pneumonia, urinary tract infection and bedsore except for 2 cases of urine retention. All cases were followed up with an average period of 12.3 months, and bone healing achieved within 15-18 weeks （mean 16.6 weeks）. No complications such as delayed union, coxa vara or coxa valga, screw breakage or backout occurred and only 2 cases had troehanter bursitis because of thin body and overlong end of the antirotated nail. According to the Harris grading scale, the results were defined as excellent in 21 cases, good in 9 cases and fair in 5 cases, with the excellent and good rates of 85.7%.
Conclusion： The emergency treatment of senile intertrochanteric fracture with proximal femoral nail antirotation has the advantages of minimal invasion, easy manipulation, less blood loss, shorter length of stay, less complications, and the preliminary clinical effect is satisfactory.     

肩胛带S2区恶性肿瘤保肢术的疗效评价

目的 评估肩胛带S2区恶性肿瘤保肢术后的疗效.方法 2005年1月至2009年1月,17例肩胛带S2区恶性骨肿瘤患者行保肢术,男13例,女4例;年龄14～55岁,平均32.6岁;软骨肉瘤6例,骨肉瘤4例,纤维肉瘤、骨髓瘤、Ewing肉瘤、横纹肌肉瘤、非霍奇金淋巴瘤、恶性骨巨细胞瘤、复发的软骨肉瘤各1例.Enneking分期:Ⅰ B期4例,ⅡB期13例.按国际骨与软组织肿瘤协会(MSTS)肩胛带分区标准,11例累及S2区和外1/3 S1区,6例累及S2区和S1区.肩袖均不同程度受累,肩关节囊受累8例.14例行新辅助化疗.8例瘤体范围较广或肩关节囊受累者行人工全肩胛骨置换术,9例瘤体范围较小或肩关节囊可保留者行肩胛骨次全切除、异体肩胛骨重建、肩关节囊及肩袖修复术.结果 随访16～62个月,平均35.1个月.9例患者出现并发症,其中发生异体骨排斥反应和异体骨吸收1例,异体骨排斥反应1例,假体肩峰外露3例,异体骨吸收4例.局部复发1例,死亡3例,死亡原因均为术后肿瘤广泛转移.MSTS功能评分53.3%～93.3%,平均74.1%.结论 在肩胛带S2区保肢手术中,将肿瘤完整切除与功能重建行个体化平衡,可获得较满意的肿瘤学疗效及稳定、美观、功能良好的肩关节.

Abstract：

Objective To investigate and discuss the limb salvage strategies of malignant bone tumors in region S2 of shoulder girdle.Methods The data of 17 patients(13 males and 4 females)were retrospectivelv analyzed.All of them had malignant scapular tumor at least in region S2,and underwent limb salvage between January 2005 and January 2009.They aged from 14 to 55 years old(mean,32.6 years).The histologic types of them were chondrosarcoma in 6 patients,osteosarcoma in 4,fibrosareoma in 1,myeloma in 1,Ewing's sarcoma in 1,rhabdomyosarcoma in 1,non-Hodgkin lymphoma in 1,malignant giant cell tumor of bone in 1 and recurrent chondrosarcoma in 1.The tumors were staged according to Enneking surgical staging system:IB in 4 and IIB in 13.According to the MSTS classification system,the region S2 and lateral 1/3 of region S1 were effected in 11 cases,the region S2 and large part of region S1 were effected in 6 cases.The rotator cuff was involved to some extent in all patients,and the articular capsule were involved in 8 cases.Neo-adjuvant chemotherapy was given to 14 patients.The surgical strategies were depended on the range of tumor and preservation of articular capsule.The scapular prosthetic replacement was done in 8 cases with a relatively large range of tumor or resection of articular capsule,otherwise the scapular allograft replacement was done.Among the 11 cases with region S2 and lateral 1/3 of region S1 effected,the scapular allograft replacement was done in 9 cases with articular capsule preserved and the prosthetic replacement was done in 2 cases with articular capsule resected.And the prosthetic replacement was done in the other 6 cases.The articular capsule and partial rotator cuff were preserved and reconstructed preferentially.Results All patients were followed up 16-62 months (mean,35.1 months).Postoperative complications were noted in 9 patients, including mild allograft rejection and mild allograft resorption in 1 patient,allograft rejection in 1,prosthetic acromion exposure in 3,allograft resorption in 4.Local recurrence were noted in 1 patients.Three patients were dead because of extensive metastasis.The average function scores were 74.1%(range,53.3%-93.3%).Conclusion During the limb salvage surgery.it's very important to guarantee the en bloc resection of the tumor.In the meanwhile,the en bloc resection and functional reconstruction should be well balanced.     

组配式半骨盆假体置换术后围术期康复干预对患肢功能的影响

目的探讨围术期康复治疗对骨盆恶性肿瘤半骨盆切除、组配式半骨盆+全髋关节置换术后的患肢功能的影响。方法 2004年9月—2007年5月采用半骨盆切除、组配式半骨盆假体+全髋关节置换术治疗骨盆恶性骨肿瘤8例。术后根据肿瘤切除范围、人工假体置换术后稳定性和骨盆髋周动力肌修复后的平衡程度,决定术后患肢体位、患髋活动范围、是否使用髋部支具,同时指导患者分阶段、渐进地进行患肢足踝、膝、髋关节的主被动训练,下床负重时间和步态调整。结果随访8～30个月,平均13个月。术后8个月患肢功能评定:优2例,良6例。ISOLS评分:15～26分,平均19.5分。结论①术后患者的合理体位和良好的支具保护能有效的防止髋关节早期脱位;②患肢各关节的分阶段有序的主动训练能提高骨盆和髋周肌肉肌力及其平衡度,对术后患者行走和步态有重要意义。     

碱性成纤维细胞生长因子缓释微球的制备及其性质研究

目的 通过碱性成纤维细胞生长因子(bFGF)缓释微球的制备研究,为bFGF的缓释制剂提供科学依据。方法 以聚乳酸-聚乙二醇共聚物为包裹材料,采用复乳包囊法制备bFGF-聚乳酸-聚乙二醇共聚物缓释微球,并对微球的形态学、粒径分布、载药量、包封率和体外释药等进行研究。结果 所制备的微球表面光滑圆整,球体均匀度好;微球平均粒径为1.543±0.070 μm,平均径距为1.273±0.08;载药量和包封率分别为0.0267％和65.32％;微球的体外释药过程较为稳定,两周释药率为59.98％。结论 bFGF缓释微球比bFGF有明显的缓释作用。     

减压分离术联合微波消融治疗胸腰椎转移瘤的初步疗效分析

目的 比较椎弓根螺钉内固定术、单纯椎板减压与联合运用病灶微波消融术在胸腰椎转移性肿瘤中的临床疗效。方法 回顾性分析2017年1月至2021年5月就诊于四川省第四人民医院收治的45例胸腰椎转移瘤伴病理性骨折的临床资料。按照手术方式分为A组25例采用椎弓根螺钉内固定联合椎板减压术，B组20例在A组的基础上联合运用了病灶微波消融灭活。患者术前均行Tokuhashi评分、Tomita评分。并通过脊柱肿瘤不稳定评分系统(SINS)评估其脊柱稳定性，并运用硬脊膜外脊柱压迫(ESCC)评分系统对脊柱压迫程度进行评价。详细记录了患者术前神经功能障碍的时间、手术持续时间、术中出血量等。并于术前及术后记录所有患者的疼痛VAS评分和SF-36生活质量评分。通过Kaplan-Meier评价系统评估患者的总体生存期。结果 45例患者均获得随访，随访时间为5～41个月，中位时间分别为19个月和21个月。术前两组患者Tomita评分、改良Tokuhashi评分、SINS评分、ESCC评分和Frankle分级差异均无统计学意义(P>0.05),两组患者的手术持续时间差异也无统计学意义(P>0.05)。A组...