骨髓基质细胞移植促进大鼠局灶性脑损伤血管生成的实验研究

目的研究骨髓基质细胞（BMSCs）移植对大鼠局灶性脑损伤血管生成的影响，探讨BMSCs移植修复大鼠脑损伤的机制。方法制备大鼠局灶性脑损伤动物模型，进行BMSCs移植，通过免疫组织化学、电镜等观察移植局部内皮细胞及微循环的变化。结果BMSCs移植后，局部凝血因子FⅧ染色阳性细胞数增加，染色加深，出现血管样结构；局部微血管内膜较光滑，内皮细胞间可见紧密连接，细胞核形态较规则，基底膜较完整，微血管管腔受压缓解。结论BMSCs移植促进损伤区周围内皮细胞增殖和新生血管形成。损伤区局部微循环得以改善进而修复脑损伤。     

Chronic GVHD in minor salivary glands and oral mucosa: histopathological and immunohistochemical evaluation of 25 patients

BACKGROUND: Graft-vs.-host disease (GVHD) is the major cause of morbidity and mortality in patients undergoing allogeneic Bone Marrow Transplantation (BMT). The aim of our study was to identify the most relevant histological features for diagnosis of chronic Graft-vs.-Host Disease (cGVHD) in oral mucosa and minor salivary glands of 25 patients, as well as to evaluate the immunophenotype of the inflammatory cells. METHODS: Sixteen patients that were submitted to allogeneic BMT but did not present cGVHD were selected as a control group. The sections were studied on H & E and CD68, CD45, CD4, CD8, CD20 staining. RESULTS: The most frequent histologic findings in oral mucosa at the day of diagnosis of cGVHD were: hydropic degeneration of the basal layer of the epithelium, apoptotic bodies, lymphocytic infiltration, and focal or total cleavage between the epithelial and connective tissue. In the labial salivary glands (LSG), lymphocytic infiltration, acinar loss and fibrosis were the main alterations. Cytotoxic CD8-T cells and macrophages were predominant both in the epithelium and connective tissue, as well as in minor salivary glands. CONCLUSIONS: Histological features were useful in the diagnosis of oral cGVHD. It is suggested that CD8-T cells and macrophages play important role in the pathogenesis of the disease.     

骨髓基质干细胞修复兔关节软骨缺损的实验研究

目的研究以多聚乙醇酸(PGA)为支架的骨髓基质干细胞(BMSCs)复合物修复兔膝关节软骨缺损的情况。方法体外培养扩增的自体BMSCs种植于PGA支架并培养72h,然后将支架-细胞复合物植入兔关节软骨缺损模型。术后12周处死动物,标本行大体观察、组织学检查及Ⅱ型胶原免疫组化染色。结果BMSCs-PGA复合物植入后形成丰富的透明软骨样修复组织,新生软骨无明显退变。对照组主要为纤维组织及软骨下骨修复。结论BMSCs-PGA复合物可修复关节软骨缺损。     

神经化组织工程骨构建的初步观察

目的评估两种组织工程骨体内神经化重建方法的成骨效果,研究神经化与成骨的相互关系。方法26只新西兰大白兔,其中24只随机分成四组:组织工程骨组(A组),感觉神经束植入组(B组),运动神经束植入组(C组),血管束植入组(D组);另2只为空白对照组。每只动物均制备左侧股骨长1.5cm的段缺性骨与骨膜缺损,钢板固定后骨缺损处分别植入用四种方法制备的组织工程骨。植入的神经分别是隐神经和股神经肌支。术后4、8、12周摄股骨正位X线片,用放射影像学评分和X线阻射影分析比较骨缺损修复情况。结果在组织工程骨中植入感觉神经束后,比单纯组织工程骨和运动神经束植入的修复效果均有明显提高,而在组织工程骨中植入运动神经束与单纯组织工程骨修复骨缺损的效果相比较无明显差异,感觉神经束植入与血管束植入的成骨效果比较无明显差异,血管束植入组的成骨效果优于其它两组。结论利用感觉神经束植入的方法可以提高组织工程骨的成骨作用,而植入运动神经束却无此作用。     

同种异体骨与自体骨移植治疗青少年脊柱侧凸的比较研究

[目的]观察同种异体骨移植与自体骨移植治疗青少年脊柱侧凸的临床效果.[方法]对1996～2006年本科收治的63例青少年脊柱侧凸患者的临床资料,采用回顾性"病例-对照"研究方法进行分析,A组(同种异体骨移植组)32例,10～15岁,平均12.2岁;Cobb's角38°～113°,平均62°;B组(自体髂骨移植组)31例,年龄9～14岁,平均12.4岁;Cobb's角41°～105°,平均54°.所有患者均选择中华长城椎弓根内固定系统经后路矫正,术后定期随访并对临床效果进行评估.[结果]出院后2个月即开始随访,随访时间18～24个月,平均26个月;亦无严重并发症发生;A组的手术时间、失血量较B组患者减少,组间具有统计学意义(P＜0.01).[结论]两组患者具有相似的临床效果,在严格掌握适应证,充分术前准备、正确手术操作、及时术后处理的前提下,同种异体骨移植能够有效替代自体髂骨移植治疗青少年脊柱侧凸.     

软骨细胞诱导骨髓基质干细胞构建带内支撑的组织工程化软骨

目的 探讨以聚羟基乙酸(PGA)包裹特定形态的医用假体材料--多孔高密度聚乙烯(HDPE,商品名为MEDPOR)为支架,应用软骨细胞诱导骨髓基质干细胞(BMSCs),共培养构建特定形态的带内支撑组织工程化软骨医用假体的可能性.方法 以直径3 mm、长5 mm的圆柱形HDPE,外裹 1 mm厚PGA为支架,将体外分别培养的新生猪BMSCs和耳郭软骨细胞按7∶3混合,以10×10 7/ml细胞浓度接种于支架上,同时以相同浓度的单纯软骨细胞和单纯BMSCs分别接种,作为阳性对照组(PC组)和阴性对照组(NC组).经体外培养2周及在裸鼠皮下移植4、8周后取材 ,行大体观察、组织学、组织化学及免疫组化检测.结果 各组细胞均与材料黏附良好.实验组和阳性对照组均形成了大体形态良好的HDPE-软骨复合体,内支撑的HDPE与外层软骨结合紧密.组织学可见成熟的软骨陷窝结构,软骨渗入HDPE孔隙内部、异染基质及Ⅱ型胶原呈强阳性表达.结论 以HDPE为内支撑,外裹PGA的支架,接种混合细胞,可于皮下构建特定形态、组织学良好的HDPE-软骨复合体.     

双节段人工腰椎间盘置换术的疗效与探讨

[目的]观察采用以双段SB Charite Ⅲ人工椎间盘置换术治疗退变性腰椎间盘疾病的l临床结果并探讨其可行性。[方法]自2000年10月至2006年8月，对22例L4-S1退变的病例采用双节段人工腰椎间盘置换术，男16例，女6例；年龄43～54岁，平均48岁；均获得随访，随访时间10—61个月（平均37．4个月），分别于手术前后对患者的情况进行JOA评分和影像学对比。[结果]术后病例JOA评分较术前显著提高（P〈0．05）。按FRANKLE标准，JOA评分改善率1年后优12例，良7例，可3例；3年后共获得随访18例，其中优10例，良5例，可3例。术后X线片显示人工椎间盘位置正确，椎间隙高度恢复正常，椎间活动度得到维持。15例患者返回原工作，2例变换工作，1例退休。所有病例无假体功能并发症发生，无假体松动、半脱位、下沉。[结论]在严格适应证的前提下，双节段人工椎间盘置换术是可以获得满意临床疗效的，可在有条件的医院积极开展。     

Postmenopausal Women With Colles'' Fracture Have Lower Values of Bone Mineral Density Than Controls as Measured by Quantitative Ultrasound and Densitometry

Measurement of ultrasonographic parameters provides information concerning not only bone density but also bone architecture. We investigated the usefulness of ultrasonographic parameters and bone mineral density (BMD) to evaluate the probability of Colles' fracture. Two-hundred eighty-nine postmenopausal women (62.3 +/- 8.7 yr) with (n = 76) and without (n = 213) Colles' fracture were studied. BMD of lumbar spine and proximal femur was evaluated in all women by dual-energy X-ray absorptiometry (DXA) and speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness in the calcaneus were measured by a Sahara ultrasonometer (Hologic). Patients suffering from Colles' fracture had lower values of BMD adjusted by height at the lumbar spine, L2-L4 (0.797 g/cm2 vs 0.860 g/cm2), femoral neck (0.685 g/cm2 vs 0.712 g/cm2 ), SOS (1518 m/sg vs 1525 m/sg), and stiffness (74.6 vs 77.7) (p < 0.05). Nevertheless, BUA values were similar in both groups. After stepwise logistic regression analysis, the area found under receiver operating characteristic (ROC) curves was 0.60 for L2L4 and 0.63 for a formula combining L2L4 and height. Our data suggest that patients suffering from Colles' fracture have lower values of BMD by DXA, SOS, and stiffness. However, the ability of these techniques to discriminate is low because the values for the area under ROC curve are 0.60 for L2-L4 and 0.63 for a formula derived of the combination of L2-L4 and height.     

Improved Performance of Hip DXA Using a Novel Region of Interest in the Upper Part of the Femoral Neck: In Vitro Study Using Bone Strength as a Standard of Reference

We tested the hypothesis that bone mineral density (BMD) and bone mineral content (BMC) in proximal human femur specimens in the upper neck region of interest (ROI) and femoral neck axis length (FNAL) provide a significantly better prediction of femoral bone strength than standard ROIs in vitro. BMD and BMC were measured in 110 proximal femur specimens using a standard dual-energy X-ray absorptiometry (DXA) scanner. The analysis included a new ROI in the upper neck as well as the standard ROIs. FNAL was obtained from the scan images. The specimens' failure-load was measured in a mechanical loading device, simulating a fall on the greater trochanter. For the standard ROIs, correlations between failure-load and BMD ranged from R2 = 0.64 (shaft ROI) to R2 = 0.70, p < 0.001 (femoral neck). Prediction of strength by BMD did not significantly differ from those of BMC (R2 ranging from 0.65 to 0.75, p < 0.001). In the upper neck ROI, for both BMD and BMC correlations with failure-load were higher (R2 = 0.76 and 0.81, respectively; p < 0.001). A lower, yet still significant, correlation was found between FNAL and bone strength (R2 = 0.23, p < 0.001). Normalization of failure-load with respect to FNAL did not significantly increase the correlations with densitometric measures. This study provides in vitro evidence indicating that among the ROIs of the proximal femur the newly defined upper neck ROI provides the best prediction of bone strength. Only a weak association was observed between failure load and FNAL.