应用动力髁螺钉联合骨肽注射液治疗股骨髁上骨不连疗效观察

目的观察应用动力髁螺钉联合骨肽注射液治疗股骨髁上骨不连的疗效。方法53例股骨髁上骨不连患者随机分为两组：对照组（26例）和治疗组（27例）,两组均应用动力髁螺钉治疗,治疗组加用骨肽注射液治疗。随访,进行疗效评价,记录骨愈合时间和测定疼痛指数。结果治疗组疗效优于对照组。结论应用动力髁螺钉联合骨肽注射液治疗股骨髁上骨不连可提高疗效。     

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。     

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。     

Biology and Biomechanics in Osteosynthesis of Proximal Humerus Fractures

Abstract Surgical treatment of proximal humeral fractures still remains a challenge. This is primarily due to the fact that sufficient implant fixation in humeral head fractures is often not achieved due to substantial bone tissue loss with increasing age. In the last few years the locking plates and locking nails have been introduced into clinical practice with varying results. The biomechanical studies have focused on locking plate osteosynthesis as well. The following paper focuses on bone quality, biomechanical studies and biology of proper osteosynthesis and reviews the most recent literature.     

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。     

经皮双针囊内注射类固醇治疗小儿孤立性骨囊肿

目的探讨经皮双针囊内注射类固醇治疗小儿孤立性骨囊肿的疗效. 方法 1996年1月～2004年1月,对28例小儿孤立性骨囊肿,在X线透视下,将2根细的骨穿针或腰穿针分别自囊腔顶部和底部刺入骨囊肿内,抽去囊液,冲洗囊腔后注入类固醇. 结果 27例随访10～62个月,平均28个月,无并发症发生.根据Chigira等X线骨囊肿愈合评价标准,Ⅳ级20例,Ⅲ级5例,Ⅱ例1例,Ⅰ级1例,治愈率92.6%(25/27).25例骨囊腔愈合时间3～10个月,平均4.5个月. 结论经皮双针囊腔内注射类固醇适合于小儿孤立性骨囊肿,简单,安全,治愈率高.     

Warping of cross sections in the torsion of long bones with internal fracture fixation plates

Torsion of noncircular beams results in warping of each cross section. When noncircular cross sections are constrained to remain plane, the resulting shear stress distribution is different from what Saint Venant torsion (with warping) would predict. This has practical implications to the stress analysis of plated long bones subjected to torsional loadings. Analyses in which warping is not allowed predict incorrect stress fields in the plate and bone and overpredict the amount of stress shielding associated with fracture plate fixation.     

双头加压螺纹钉贴股骨距内固定治疗股骨颈骨折

在Ｘ光电视下采用双头加压螺纹钉贴股骨距内固定治疗新鲜股骨颈骨折４２例，随访平均２．５年，其中１６例随访３年以上，骨折愈合率９５．２％，骨折不愈合并股骨头缺血性坏死率４．７６％。认为加压螺纹钉贴股骨距内固定可使钉的受力由较大剪应力变为较大轴向力承受，减少骨折处的剪应力，并加压于骨折端能促进骨折愈合。具有操作简单、进钉准确、创伤小、固定牢靠、并发症少等优点。     

Prevention of early postmenopausal bone loss using low doses of conjugated estrogens and the non-hormonal,bone-active drug ipriflavone

Hormone replacement therapy is the optimal therapeutic choice for postmenopausal syndrome. While low doses of estrogens (0.3 mg/day of conjugated estrogens) can counteract neurovegetative menopausal symptoms, higher doses (0.625 mg/day of conjugated estrogens) are required to prevent bone loss in postmenopausal women. Experimental and clinical studies have shown that ipriflavone, a non-hormonal isoflavone derivative, is effective in the prevention and treatment of postmenopausal osteoporosis. The aim of the present investigation was to evaluate the efficacy and toler-ability of ipriflavone and very low doses of equine conjugated estrogens on bone loss in early postmenopausal women. Eighty-three healthy postmenopausal women (50.3±0.7 years) were enrolled for this 1-year multicenter study. All subjects were randomly allocated to receive: double placebo (n=24; group A), placebo plus conjugated equine estrogens 0.30 mg/day (n=31; group B) or conjugated equine estrogens 0.30 mg/day plus oral ipriflavone 200 mg tris in die at meals (n=28; group C), according to a double-masked design. Among women who completed the treatment period (valid completers), those of group A showed a progressive decrease in forearm bone density (FBD; measured by dual photon absorptiometry) that reached 1.7% after 12 months. The women in group B maintained their FBD in the first 6 months of treatment but, at the end of the study, showed a bone loss of 1.4% compared with basal values. By contrast, women in group C showed a significant increase in FBD after 1 year of treatment (+5.6%;p<0.01). Bothvalid completers andintention to treat analyses revealed a significant difference (p<0.05) between group A and group C over the study period. None of the treatments produced significant changes of biochemical markers of bone turnover, while hot flushes and other climacteric symptoms were significantly reduced after the sixth month of treatment in women receiving estrogens. Adverse events were generally mild, and did not differ among the groups. The results of this study suggest that low doses of estrogens combined with ipriflavone could represent a new therapeutic approach to the treatment of the postmenopausal syndrome.     

Ridge number density: A new parameter for in vivo bone structure analysis

An advanced analysis of the mechanical properties of bone should include information about the microarchitecture of cancellous bone in addition to its density. It has recently been shown that high-resolution quantitative computed tomography and magnetic resonance imaging have the potential to assess such information in a noninvasive way in patients. Both techniques, however, lack sufficient spatial resolution to image the individual trabeculae with true precision. In this work, a new parameter, Ridge number density (RND), is introduced. RND is a measure for the trabecular number, which can be extracted directly from high-resolution three-dimensional (3D) images of patients. We applied the RND technique to a test group of nine healthy, postmenopausal women measured repetitively with a high-resolution 3D peripheral quantitative computed tomography (3D-pQCT) system with 165 × 165 × 165 μm³ voxel size. Simultaneously with the RND determination, the trabecular bone density (TBD) was also assessed in the same volume of interest. The examination site was the distal radius. The intersubject variability of the measured test group was 10.5% for RND and 26.3% for TBD. The root mean square error between first and second examinations (midterm reproducibility) was 1.6% and 1.1%, respectively. RND is determined independently from TBD and pertains to the structure of the cancellous bone. As such, it might add crucial information in cases where bone mass or bone density measurements alone give ambigous results.