Catabolic Properties of Microdissected Human Endosteal Bone Lining Cells

Bone lining cells cover >80% of endosteal surfaces of human cancellous bone. Current research assigns to them a dual role: (1) as a biological membrane regulating exchange of substrates between the bone fluid compartment and the extracellular fluid of bone marrow and (2) as a signaling link between the osteocytic network as mechanical receptor and the osteoclastic cell pool for local induction of bone resorption. Furthermore, a catabolic role has been considered. We therefore examined the presence of matrix-metalloproteinases (MMPs) and their physiological tissue inhibitors (TIMPs) as putative proteolytic elements. Firstly, human cancellous bone from 60 patients was examined by immunofluorescence with antibodies against MMPs and TIMPs. Secondly, we applied laser-assisted microdissection (LMD) to isolate bone lining cells from frozen sections of human trabecular bone. mRNA analysis was performed using a single-cell PCR protocol. Three laser microdissection systems were tested: the new generation of Leica LMD and P.A.L.M. laser pressure catapulting (LPC) were compared to P.A.L.M. laser microdissection and micromanipulation (LMM). In a few pooled cell profiles, mRNA of MMP13, MMP14, TIMP1, and CBFA-1 was clearly detected. By immunofluorescence MMP13 and -14 as well as TIMP1 and -2 were strongly present in lining cells, while MMP2, TIMP3, and TIMP4 showed weak or negative signals. Although the functional impact of these enzymatic components remains open, there is additional evidence for a catabolic function of lining cells. The new diode-laser microdissection with LMD and LPC proved to be especially suitable to gain new insights into the properties of bone lining cells.     

青娥丸对绝经后骨质疏松症患者骨密度、骨代谢指标和骨硬化蛋白的影响

目的观察青娥丸(QEW)对绝经后骨质疏松症患者骨密度、骨代谢指标和骨硬化蛋白的影响。方法 2016年1月至6月期间,我院收治的120例门诊和住院PMOP患者随机分为QEW组(给予钙片和青娥丸),ALF组(给予钙片和阿法骨化醇)和对照组(给予钙片)(每组n=40),随访期为1年。测量基线和治疗1年后血清骨硬化蛋白、25羟维生素D和骨转换标志物(β-CTX,N-MID和T-PINP)的水平。结果 QEW组和ALF组治疗后1年血清骨硬化素水平显著高于对照组(P0. 05),但QEW组和ALF组比较差异无统计学意义(P0. 05)。治疗后1年QEW组和ALF组血清β-CTX,N-MID和T-PINP水平均降低,而两组间差异无统计学意义(P0. 05)。但QEW组和ALF组血清β-CTX,N-MID和T-PINP水平显著低于对照组(P0. 05)。结论 QEW调节绝经后骨质疏松症患者骨代谢的机制可能与QEW增加硬化蛋白表达的作用有关。     

肢体骨巨细胞瘤复发特征与治疗

目的 总结肢体骨巨细胞瘤复发特征及治疗措施。方法 随访复发性肢体骨巨细胞瘤30例,对其临床表现、影像学特征、病理及治疗方法进行回顾性分析。结果 复发病例大多为病灶刮除术后,3年内复发占73．33％,其中有症状者26例,以局部疼痛、肿胀为主;无症状者4例。影像学主要表现为局部植骨吸收,出现不规则密度减低区,病变范围扩大。组织学检查27例复发后仍呈良性,3例恶变。复发治疗;早期病例行再次病灶清除植骨术17例,其中再复发3例;行瘤段切除关节置换4例、关节融合术3例、截肢术6例,均未再复发。结论 定期随访可以早期发现病灶;早期病例可采用彻底的病灶清除加植骨术,晚期病例可采用瘤段切除人工关节置换或截肢等手术。     

锁定跟骨钢板治疗新鲜跟骨骨折

目的 探讨采用锁定跟骨钢板治疗新鲜跟骨关节内移位骨折的临床疗效.方法 2004年10月至2006年10月,治疗34例男性闭合性跟骨关节内移位骨折患者,年龄19～42岁,平均34岁;左足14例,右足20例;高处坠落伤22例,车祸伤12例.受伤至手术时间7～21天,平均13天.术前均对伤足摄正、侧位X线片及跟骨的CT轴位片.根据Sanders分型,Ⅱ型16例,Ⅲ型18例.采用扩大外侧入路对34例患者进行手术,骨折复位后利用锁定跟骨钢板完成骨折内固定.结果 28例患者获得随访,随访时间6～40个月,平均20个月.切口均甲级愈合.B(o)hler角由术前平均7.41°±4.08°改善至术后第7天的29.74°±5.56°和术后3个月的30.00°±5.53°;Gissane角由术前平均163.71°±9.31°改善至术后第7天的122.59°±14.11°和术后3个月的125.85°±19.31°.骨折均愈合,愈合时间为6～12周.术后无一例患者发生撞击或神经、血管损伤等并发症,未出现骨折移位或内固定失败等情况.术前美国足踝外科学会(American Orthopaedic Foot & Ankle Society,AOFAS)评分系统的踝-后足评分为(17.68±9.34)分,术后3个月和6个月分别为(74.79±4.01)分和(74.28±17.92)分.结论 应用锁定跟骨钢板治疗新鲜跟骨骨折,可以获得满意的临床效果,利于患者的功能恢复.

Abstract：

Objective To evaluate the clinical outcome of operative management of displaced intraarticular fractures of the calcaneus using locking plates. Methods From October 2004 to October 2006, 34patients with close displaced intraarticular fractures of the calcaneus were fixed with Calcaneal locking Plates through the extensive lateral approach. The right foot was involved in 20 patients. The mean age was 34 yesrs with a range of 19 to 42 years. Accordiing to Sanders' classification system, there were 16 patients in style Ⅱ and 18 in style Ⅲ The mean interval between injury and operation was 13 days Standard reduction and fixation techniques were performed to realign all components of the intra-articular calcaneal fracture using a locking calcaneal fracture plate. The result were evaluated with AOFAS (American Orthopaedic Foot & Ankle Society) ankle-hindfoot scale. Results Twenty-eight patients were followed up. The follow-up duration ranged from six to forty months, with the mean of twenty months. angle and were measured at, The average B(o)hler angle was 29° and 30° and the average Gissane was 122° and 125° seven days and three months after operation. Bone union was achieved in all cases. All incisons had healed smoothly. No patient sustained lateral impingement syndrome or soft tissue complications The mean AOFAS scores that was measured three months and six months after operation was 74. Conclusion The application of the calcaneal locking plates through extended lateral approach is proved to be an effective treatment for displaced intra-articular calcaneal fracture, offering the combination of good reduction and early rehabilitation.     

拔牙位点保留后骨胶原联合自体软组织瓣植入对前牙拔牙后美学满意度的影响

目的:探讨拔牙位点保留后骨胶原联合自体软组织瓣植入对前牙拔牙后美学满意度的影响。方法:选择2018年1月-2019年7月笔者医院就诊的84例有前牙拔除需求的患者为研究对象,采用随机数字表法分为42例对照组(Bio-Oss Collagen植入),42例观察组(Bio-Oss Collagen+自体软组织瓣植入)。比较两组患者术后拔牙位点愈合情况及两组患者术前、术后6个月牙槽骨高度、牙槽骨宽度,记录两组患者术前、术后6个月牙槽骨密度、垂直向骨吸收量、唇腭向骨吸收量,术后美学效果、满意度,随访1年,观察植后种植体周围骨高度、宽度吸收情况。结果:术后2周拆线,观察组可见拔牙位点愈合良好,无感染、坏死情况,硬腭带蒂结缔组织移植的成活率为100%,对照组拔牙位点愈合良好,但牙槽嵴呈现不同程度的萎缩。两组患者术前牙槽骨宽度、高度、密度比较,差异无统计学意义(P>0.05);术后6个月,两组牙槽骨宽度、高度、密度均低于术前,观察组牙槽骨高度、密度、宽度均高于对照组,差异均有统计学意义(P<0.05)。术后6个月,观察组垂直向骨吸收量、唇腭向骨吸收量均低于对照组,差异有统计学意义(P<0.05)。术后6个月,观察组美学效果、满意度评分较对照组高,随访1年,观察组种植体周围骨吸收低于对照组,差异有统计学意义(P<0.05)。结论:骨胶原联合自体软组织瓣植入可减缓拔牙后牙槽骨高度、宽度及骨密度的下降,在保留骨量方面具有一定的临床价值,能够有效改善患者牙槽美学效果。     

Does Waldenstrom’s macroglobulinemia also cause bone destruction? A rare case report

Waldenstrom’s macroglobulinemia (WM) is a rare type of malignant B-cell lymphoma. The main feature of WM is elevated serum monoclonal immunoglobulin M, similar to multiple myeloma (MM). Unlike in MM, the rarity of destructive bone lesions in WM has been repeatedly emphasized. We report a unique case of WM with a vertebral compression fracture as the first symptom. This case highlights that the presence or absence of bone destruction may not clearly distinguish between WM and MM. The possibility of WM should be considered in patients with vertebral fracture and destruction as the first presentation. Performing vertebral bone marrow aspiration biopsy during percutaneous vertebroplasty is a convenient and effective method to assist in the diagnosis of WM.     

超细骨碳除氟效果及影响因素的观察

目的:观察超细骨碳除氟效果及其影响因素。方法:比较三种吸附材料(竹碳、骨碳、活性碳)的超细颗粒对饮水中氟离子的吸附能力,pH值、聚合氯化铝对除氟效果的影响以及在自来水中的除氟效果。结果:骨碳与其他几种吸附材料相比具有较好的除氟效果,骨碳和混凝剂联合除氟效果比骨碳单独除氟效果要好,但达不到两者之和,在自来水中的除氟效果比在蒸馏水中要好且时间短。结论:骨碳超细粉有一定的除氟效果,但达到吸附饱和大约需9 0 min,与实际应用还有一定的距离。     

骨旁脂肪瘤临床影像学表现与病理分析(文献综述附14例报告)

[目的]结合文献探讨骨旁脂肪瘤的命名、病因、临床病理表现和影像学特点。[方法]将国内文献的20例一起列入临床资料分析,包括作者14例共34例术前均行X线摄片,18例行CT检查,4例行MRI检查。[结果]本病发生于任何年龄,成人多见,以四肢长管状骨为好发,其次发生于扁平骨(骨盆、肩岬骨、髌骨、肋骨)、不规则骨(胸椎、腰椎、骶尾椎)、短管状骨和跗骨;本病临床误诊率为41.17%,X线误诊率26.47%,CT及MRI诊断率100%;34例均手术切除,病理报告为脂肪瘤,3例低度恶变;随访2~10年,仅1例复发并恶变。[结论]骨旁脂肪瘤是最佳的命名,病因未明,但与遗传和先天因素及创伤和炎症因素有关;病理表现为带骨蒂的脂肪瘤,细胞学形态为脂肪组织;影像学具有特征性表现。     

核医学显像对不明性质颈痛患者的诊断价值

目的 探讨核医学显像在诊断不明性质颈痛中的价值.方法 70例不明性质颈痛患者,X线、CT或MRI结果提示骨质破坏或占位性病变,无法确定病变性质,拟手术治疗入院.为明确诊断,行99m Tc-亚甲基二磷酸盐(99mTc-MDP)全身骨显像.显像后1周内行手术或病灶穿刺活检,获得病理学结果.10例骨显像多发骨转移瘤的患者进行了符合线路18F-脱氧葡萄糖(FDG)肿瘤代谢显像.结果 骨显像阳性62例.33例颈部单发病灶,其中原发恶性肿瘤4例,转移瘤6例,良性病变23例.29例为多发病灶,其中转移瘤24例.25例患者骨显像后改变了治疗方案.10例转移瘤患者中的7例18F-FDG肿瘤代谢显像找到了原发病灶.结论 全身骨显像应作为诊断不明性质颈痛的重要辅助手段.18F-FDG肿瘤代谢显像与全身骨显像联合应用对于不明性质颈痛的明确诊断,分期,指导临床治疗有着重要的意义.     

牛去细胞骨基质的生物相容性研究

目的 研究新型骨修复材料牛去细胞基质骨的生物相容性,为其在骨缺损修复领域中的临床应用提供实验依据.方法 对牛去细胞骨基质进行急性毒性实验、热源实验、溶血实验、兔肌肉内种植实验和兔桡骨骨缺损修复实验研究.结果 牛去细胞骨基质无毒性、无热源性、不引起溶血反应,植入兔肌肉后逐渐发生生物降解并被纤维组织取代,兔骨缺损区植入后可被骨组织取代.结论 牛去细胞骨基质具有良好的生物相容性,是理想的骨支架材料.