UNCONVENTIONAL BONE GRAFTING IN FE.MORAL NECK RECONSTRUCTION REPORT OF A CASE

A 15 year old girl had an aneurysmal bone cyst involving her left femoral neck and the greater trochanter for 17 months The lesion was resected and the femoral neck and tro- chanter reconstruc;ted with 4 illiac grafts pinned together with a trifin nail, the tip of which was hammered into the head and the tail fixed to the shaft. 16 months postoperatively, corro- sion of the screw joining the nail and plate caused separation of the neck and shaft. This necessitated a revised operation and reinforce- ment with bone grafts. The anatomical and functional rets.ults were satisfactory 5 years after the second operation. The present bone grafting design is worth using in exceptional or selected cases requiring femoral neck recon- Struction.     

周围神经损伤远端延长修复自身缺损的实验研究

目的探讨能否利用损伤的神经远端延长法修复自身缺损。方法观察A组（即刻快速延长10%）、B1组、B2组（神经损伤2周后再行延长,延长率分别为10%、20%）神经耐受程度和恢复情况。结果A组平均延长（10.00±1.71）%,长度为（4.00±0.74）mm,神经传导速度恢复率(75.71±19.05)%、有髓神经纤维（NNF）再生率为(72.60±15.76)%;B1分别为（10.50±1.12）%、（4.20±0.44）mm、(82.08±4.76)%、(76.22±8.60)%;B2组分别为（21.40±4.03）%、（8.50±1.61）mm、(70.87±20.86)%、（64.67±12.42)%。即刻延长10%和损伤2周后快速延长10%、20%都有一定功能的恢复。结论变性周围神经的即刻延长在10%延长范围内耐受性好,而延长20%仍有再生,可以利用周围神经损伤远端即刻延长的方法来修复神经缺损。     

1202个人工膝关节置换术的临床特点分析

目的通过对14年所行1202个人工膝关节置换术的分析,探讨我国行膝关节置换术患者的特点及不同的处理方法。方法1987年4月～2001年8月对833例1202膝行关节置换,其中单膝关节置换464例,双膝同期置换369例738膝。原发疾病为骨关节炎、类风湿性关节炎、强直性脊柱炎、色素绒毛结节性滑膜炎等。畸形包括内翻、外翻、屈膝挛缩、屈膝骨性强直、屈膝半脱位骨性强直及强直性脊柱炎、类风湿性关节炎患者的多发关节破坏。结果有些被文献认为是膝关节表面置换禁忌的严重畸形,术后关节功能和生活质量均有明显改善。通过手术技术的改进,高度屈膝畸形的术后并发症比早期起步阶段明显减少。结论我国人工膝关节置换术在病例的难度、传统观念、患者经济承受能力等方面比发达国家有更多的困难;假体选择必须尽早定型以便得到更好的临床效果;康复对临床疗效至关重要,应建立专职康复队伍;假体早日国产化,是推动我国人工膝关节置换发展的关键。     

多孔面金属植入物骨长入生物固定作用

骨长入生物固定指通过骨组织长入多孔面达到植入物固定,是骨骼系统植入物固定的新概念和新方法。因其可能达到假体的永久性固定并具有其他优点,故受到广泛重视和研究。临床应用十年经验表明,骨长入生物固定有广阔的发展前景。     

骨肿瘤DNA流式细胞术定量分析

应用流式细胞术对６２例未经化疗或放疗的原发骨肿瘤的石蜡包埋标本细胞核ＤＮＡ进行了测定，其中３例为良性肿瘤或瘤样病变，３３例为骨巨细胞瘤，２６例为其他恶性骨肿瘤。结果表明，良性骨肿瘤与瘤样病变中未见异倍体，骨巨细胞瘤中ＤＮＡ异倍体的发生率也很低，而其他恶性骨肿瘤中异倍体的发生率非常之高，故异倍体可作为恶性骨肿瘤的一个较特异的标志。且单个骨肿瘤在活检与大体标本、原发与复发肿瘤上表现了稳定的倍性，而基于病理学基础上的骨肉瘤的分型与分级在ＤＮＡ含量上并无明显的区别。     

CINEMICROGRAPHIC OBSERVATIONS OF BONE GIANT CELL TUMOR CULTURED IN VITRO

Time lapse cinemicrographic observations of 9 bone giant cell tumors cultured in vitro were undertaken during 2 years. Features of multinucleated giant (MG) cell migration are recorded. First, a tongue-like cytoplasmic process with a ruffled or semicir- cular border protrudes from the edge of the ex- plants. It takes about 10 hours for a MG cell to ruove out of the explants completely. These isolated free MG cells usually showed active ameboid movements. The veil-like CYtoplasm with an undulating membrane incessantly changes contour. The nuclei of MG cells mostly collect in the central portion and only occasionally in the peripheral cell zone. Vacuoles of varying size are frequently found in the cyto- plasm, but most of them resolve in a short time. An outspread MG cell at times contracts, forming a spherical or oval cell in which the nuclei are no longer seen distinctly. Vigorous MG cell and stromal (St) cell pinocytosis and phagocytosis are visible. St cell mitosis has been recorded, but this process is not seen in the MG cell in this study. Cellular contact accompanied by intracyto- plasmic granule delivery exchange through the intercellular gap junction is shown. This pheno- menon probably represents cellular direct com- munication. The most interesting finding ob- served is natural fusion of 2 MG cells. The fused giant cell dies in 24 hours and St cells soon gather around it and vigorously phagocytize the remains which clear up in 7 days.     

《肩关节外科学》简介

《肩关节外科学》一书属于骨关节外科领域。由冯传汉、郭世绂、黄公怡主编,顾问郭子衡,特邀编著者〖日本〗信原克哉,天津科学技术出版社出版。全书69万字,440幅图,参考文献440条,本书分为三部分,14章。第一部分:肩的胚胎发育、解剖、生理和生物力学共二章。由天津医科大学解剖学及骨科学教授郭世赋教授编写第一章。第二章由北京医院肩关节外科研究中心正副主任黄公怡、薛庆云编写。第二部分:肩关节疾病诊断及治疗总论,共三章,包括病史、临床检查、影像学检查、电生理、     

经椎弓根脊柱侧凸体外矫正──附4例报告

目的：研制一种经椎弓根脊柱侧凸体外矫正系统并初步用于临床。方法；常规方法处理脊柱侧凸病变后，在上端中立椎体之上一推凹侧椎弓根与下端Harrnigton稳定区的一推弓根安置推弓银钉，其尾部露于皮外，以器械逐渐矫正畸形。结果：经3．5～4年随访，3例先天性脊柱侧凸，C0bb50°～90°效果满意。1例退行性腰椎侧凸获得症状改善。结论：经椎弓根外矫正固定术矫正力强，符合脊柱结构的生物力学特征，安全，避免了再次手术取出内固定物，并可直接对撑开棍作力学监测。     

RECENT PR.OGRESS IN ORTHOPEDIC SURGERY

This article rounds up research in and treatment of fracture healing, bone tumor, spinal diseases, arti- ficial joints and foot surgery since 1979. Ultrastrvctural study of experimental fracture healing has been studied extensively using both transmission electron microscope and scanning elec- tron microscope. Clinical use of direct electric cur- rent stimulation, pulsating electromagnetic fields and osteogenic stimulating factor (a metabolic product of staphylococcus) yields encouraging results in frac- tures; Nation-wide bone tumor registration has just been started. Femoral head prosthesis and total hip joint replacement are used with good results in many provinces.     

骨膜移植和钻孔术修复关节软骨缺损的实验比较

用中国白兔２４只，在股骨关书面造成６ｍｍ×８ｍｍ全层软骨缺损，分别进行游离骨膜自体移植和钻孔术。术后４、８周取材做组织学及电镜观察并进行比较。结果表明：（１）钻孔、移植骨膜和对照组的优势修复组织分别为类透明软骨、幼稚软骨和纤维组织。（２）修复组织平均数量，移植骨膜明显优于钻孔和对照组。（３）骨膜移植、钻孔和对照组修复组织来源分别为骨膜本身、髓腔和软骨下骨及与缺损毗连的软骨。初步结论：移植骨膜和软骨下骨钻孔均能修复关节软骨缺员，单纯刮除后修复能力最差。