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151.
手部创伤性骨关节缺损的处理 总被引:4,自引:0,他引:4
治疗手部骨关节缺损常采用植骨内固定、关节融合、关节成形及关节置换等方法.为总结经验,对1989年以来101例手部创伤性骨与关节缺损进行分析。单纯掌、指骨缺损39例,行直接短缩对位,克氏针内固定6例,1例发主骨不连;对33例缺损较大者用自体骨块植入克氏针交叉内固定,部分病例同时植人RBX或异体骨粒,10例发生延迟愈合,余全部正常愈合。骨与关节部分或完全缺损62例,采用关节成形术46例,其中以肋软骨移植效果最好,骨膜移植次之,筋膜衬垫或硅胶膜植入法较差;行关节融合术11例.均达顺利融合;采用自体关节置换5例,均成活,术后关节活动度均>70°。我们认为:自体骨块植入克氏针交叉内固定,必要时植入RBX骨粒.是治疗手部创伤性骨缺损的有效方法。关节缺损应按关节的重要性,分别采用关节融合术、关节成形术或关节置换术。 相似文献
152.
G. J. Breur M. D. Lapierre K. Kazmierczak K. M. Stechuchak G. P. McCabe 《Calcified tissue international》1997,61(5):418-425
In this study, we tested the hypotheses that (a) both the domain volume (volume of the cell and the matrix it has formed)
and matrix volume of juxtametaphyseal hypertrophic chondrocytes in the growth plate is tightly controlled, and that (b) the
domain volume of juxtametaphyseal hypertrophic chondrocytes is a strong determinant of the rate of bone length growth. We
analyzed the rate of bone length growth (oxytetracycline labeling techniques) and nine stereologic and kinetic parameters
related to the juxtametaphyseal chondrocytic domain in the proximal and distal radial and tibial growth plates of 21- and
35-day-old rats. The domain volume increased with increasing growth rates, independent of the location of the growth plate
and the age of the animal. Within age groups, the matrix volume per cell increased with increasing growth rates, but an identical
growth plate had the same matrix volume per cell in 21- and 35-day-old rats. The most suitable regression model (R
2= 0.992) to describe the rate of bone length growth included the mean volume of juxtametaphyseal hypertrophic chondrocytes
and the mean rate of cell loss/cell proliferation. This relationship was independent of the location of the growth plate and
the age of the animal. The data suggest that the domain volume of juxtametaphyseal hypertrophic chondrocytes, as well as the
matrix volume produced per cell, may be tightly regulated. In addition, the volume of juxtametaphyseal hypertrophic chondrocytes
and the rate of cell loss/rate of cell proliferation may play the most important role in the determination of the rate of
bone length growth.
Received: 2 December 1996 / Accepted: 24 March 1997 相似文献
153.
目的:总结32例经椎弓根椎间融合与AF治疗胸腰椎骨折的经验。方法:应用经伤椎椎弓根椎体间融合并AF系统复位内固定,以提高复位效果与脊柱的稳定性。结果:全部病例获随访,时间3~23个月,伤椎均与上位椎体间融合,无矫正角度与高度丢失,无断钉及螺钉松动,神经功能平均1.5级以上的恢复。结论:经椎弓根椎间融合与AF治疗胸腰椎骨折,操作简单,复位可靠,可重建脊柱的稳定性,椎体间融合更符合生物力学内环境的持久稳定。 相似文献
154.
155.
N. Zamberlan R. Castello D. Gatti M. Rossini V. Braga E. Fracassi Prof. S. Adami 《Osteoporosis international》1997,7(2):133-137
Treatment with gonadotropin-releasing hormone (GnRH) agonist leads to enhanced bone turnover and accelerated bone loss in premenopausal women with endometriosis, uterine leiomyomatomas and hirsutism. Sodium etidronate is a powerful inhibitor of bone resorption which has been proven efficacious in the prevention and treatment of postmenopausal osteoporosis. The objective of this study was to evaluate the skeletal effects of 6 months of therapy with the depot preparation of the GnRH agonist triptorelin (decapeptil 3.75 mg intramuscularly every 4 weeks) in 24 hirsute patients, aged 24–33 years, with hyperandrogenic chronic anovulation. Ten patients also received cyclical etidronate in an oral dose of 400 mg/day for 2 weeks, followed by an 11-week period of 500 mg/day elemental oral calcium (one cycle). The remaining 14 patients received 500 mg/day of elemental calcium continuously. After 6 months all treatments were discontinued for at least a further 6 months. Bone mineral density (BMD) at lumbar spine and hip (dual-energy X-ray absorptiometry, Sophos LXRA, France) and biochemical markers (serum alkaline phosphatase, osteocalcin, urinary N-telopeptide and hydroxyproline/creatinine ratio) were evaluated at baseline, 6 months and 12 months. In the group given GnRH agonist alone BMD fell significantly at all measured skeletal sites during the first 6 months. In the patients treated with etidronate a significant decrease in BMD was observed at lumbar spine but not in the femoral neck and trochanter, and the changes at lumbar spine and trochanter were significantly smaller than those in the control group. At 6 months bone turnover was also increased in patients treated with GnRH and calcium. Cyclical etidronate prevented the increase in biochemical markers of bone formation and resorption, with the exception of calcium/creatinine excretion, which was significantly increased in both groups. Six months after treatment withdrawal BMD did not recover in either group. Biochemical markers (N-telopeptide, serum alkaline phosphatase) remained increased in those patients previously treated with calcium alone while they remained close to baseline values in the patients treated with cyclical etidronate.Our study indicates that: (1) GnRH agonist therapy causes remarkable bone loss in young individuals with androgen excess who are expected to have increased bone mass; (2) this bone loss can be partially prevented by intermittent cyclical etidronate therapy. 相似文献
156.
Marcel Stokkel Aeilko Zwinderman Jaap Zwartendijk Ernest Pauwels Berthe van Eck-Smit 《European journal of nuclear medicine and molecular imaging》1997,24(10):1215-1220
Between 10% and 25% of patients with newly diagnosed prostate cancer without bone metastases at the time of diagnosis will
develop metastases during follow-up. To determine the value of clinical and biochemical parameters for assessment of prognosis
at the time of diagnosis, a retrospective study was performed in 124 consecutive patients with newly diagnosed prostate cancer
without bone metastases. The mean follow-up was 41 months, during which time 36 patients died and 15 patients developed metastases.
Bone scans were classified from 0 (=normal) through 2 (=abnormal, but not typical for metastases) and were correlated with
age, alkaline phosphatase (AP), prostate-specific antigen (PSA), tumour grade, T-stage and N-stage. In patients with a class
2 scan, additional roentgenograms and follow-up were used to exclude metastases at initial stage. All parameters, including
therapy, were finally correlated with the development of metastases and survival. For survival 38 patients with proven metastases
were used as controls. For all parameters tested, no statistically significant differences were found between the three bone
scan classifications. The interval between diagnosis and the development of metastases ranged from 12 to 72 months. For the
risk of development of metastases only PSA was found to be a significant correlate (P=0.0075). However, when tumour stages were clustered in limited disease (T0–2) and extensive disease (T3–4), the incidence
of metastases was significantly higher in patients with extensive disease than in those with limited disease (P=0.0021). Finally, age, PSA and Anderson classification were found to be significant correlates of survival, but in stepwise
analysis PSA was selected as the most prognostic variable (P<0.0001). In contrast with a typical pattern of metastases on bone scintigraphy, an abnormal scan (class 1 and 2) at the time
of diagnosis is not a poor prognostic parameter of the risk of death. In conclusion, in patients with prostate cancer without
bone metastases at the time of diagnosis, pretreatment PSA and tumour stage can be used for the assessment of risk of development
of metastases during follow-up and survival. For this purpose, tumour stage should be clustered in limited and extensive disease.
Received 14 April and in revised form 9 June 1997 相似文献
157.
E. Casari M. Alfano M. Valente G. D. Clarke G. Ferni V. Grazioli 《Osteoporosis international》1997,7(6):539-543
The ovariectomized rat is the most commonly used animal model of human postmenopausal osteoporosis, exhibiting a high rate
of bone turnover with resorption exceeding formation. At present, bone turnover is quantified directly by dynamic histomorphometry.
The aim of the present study was to determine whether the measurement of the urinary output of some specific bone collagen
catabolites — pyridinolines and hydroxylysine glycosides — could be used to indirectly monitor the initial phase of bone turnover
increase in ovariectomized 90-day-old rats. Ninety-day-old female rats were randomly divided into three groups (n=6): ovariectomized, sham-operated and non-treated controls. Urine samples (24 h) were collected 6 days before surgery and
twice weekly for the 4 weeks following ovariectomy. Urinary excretion of pyridinoline (PYD), deoxypyridinoline (DPD), glucosyl-galactosyl-hydroxylysine
(GGHYL) and galactosyl-hydroxylysine (GHYL) were measured. As expected, ovariectomy was associated with a significant decrease
in bone mineral density in both the proximal tibial and distal femoral metaphysis. Compared with both sham-operated and control
animals, ovariectomized rats showed significant increases in PYD, GGHYL and GHYL urinary output 8 days after surgery and in
DPD output after 15 days. These changes were maintained throughout the study. The results confirm that measurement of the
urinary excretion of pyridinolines and hydroxylysine glycosides represents a powerful tool for detecting the onset of bone
turnover in ovariectomized 90-day-old rats. 相似文献
158.
That maternal inflammation adversely affects fetal brain development is well established. Less well understood are the mechanisms that account for neurodevelopmental disorders arising from maternal inflammation. This review seeks to begin an examination of possible sites and mechanisms of action whereby inflammatory cytokines - produced by the mother or by the fetal brain - could impact the developing fetus. We focus first on the placenta where cytokines maintain the immunological environment that prevents maternal rejection of the fetus. Following a brief examination of placental transfer of maternal cytokines, the focus turns on embryonic microglia, early and ubiquitous residents of the developing brain. Finally, a more intense examination of interleukin-6 (IL-6) and bone morphogenetic proteins (BMPs) provides examples of glial- or maternal-derived cytokines that are known to have profound effects on developing systems and that could, if dysregulated, have undesirable consequences for brain development. 相似文献
159.
160.
具有骨诱导活性的仿生骨基质材料的制备 总被引:9,自引:2,他引:7
目的将一种具有与骨形态发生蛋白2相似骨诱导活性的多肽p24共价结合于改性聚(丙交酯-co-乙交酯)基质材料上,以制备出具有骨诱导活性的仿生骨基质材料。方法将活性多肽p24通过交联剂共价结合于改性PLGA材料上作为实验组;以未加交联剂多肽溶液和材料简单混合反应为对照组,通过X射线光电子光谱法和扫描电镜检测交联情况;同时对两组材料进行钙离子吸附实验,初步评价其仿生矿化能力。结果XPS检测结果表明,实验组及对照组材料表面均已结合硫元素,两者含有硫元素含量分别为1.50%及0.09%;钙离子吸附实验结果表明,12h及24h时实验组材料的钙离子吸附量分别为0,126mg及0.231mg;12h及24h时对照组材料的钙离子吸附量分别为0.053、0.102mg。多肽交联之材料较混合之材料的钙离子吸附能力显著增强。结论在改性PLGA三嵌段材料上固定了BMP2活性多肽,为以后发挥其骨诱导活性修复骨缺损奠定了良好基础。 相似文献