基于CT数据的腰椎皮质骨轨迹螺钉经皮置入的可行性研究

目的通过腰椎CT扫描及三维重建图像模拟置入皮质骨轨迹螺钉并进行形态学测量, 探讨经皮皮质骨轨迹螺钉置入的可行性。方法收集100例成人腰椎病变患者的CT数据, 利用Mimics 17.0软件进行CT三维重建, 以腰椎椎弓根最小冠状断面的内缘与下缘交界处在椎板上的投影点为进钉点, 测量头倾角、外倾角、最大螺钉长度、最大螺钉直径、轨迹与棘突的距离、上终板比率等参数, 同时利用三维重建图像观察该轨迹与棘突的关系。结果 L1～L5的外倾角分别为9.3°(8.9°, 9.8°)、9.6°(8.9°, 9.8°)、10.4°(9.5°, 11.3°)、11.81°±1.24°和13.6°(12.5°, 14.5°), 头倾角分别为26.6°(26.0°, 27.0°)、26.2°(25.7°, 26.5°)、26.9°(26.5°, 27.4°)、25.94°±0.92°和24.3°(22.7°, 25.4°), 头倾角、外倾角各节段间的差异均有统计学意义。L1～L5的最大螺钉直径分别为(5.65±0.49) mm、(6.38±0.60) mm、(6.91±0.67) mm、(7.42±0.76) ...     

Microstructural and histomorphological features of osteophytes in late-stage human knee osteoarthritis with varus deformity

ObjectivesTo illustrate the microstructural and histomorphological characteristics of osteophytes in the human knee osteoarthritis (OA).MethodsTibial plateau specimens, including osteophytes and subchondral trabecular bone (STB) from weight-bearing and non-weight-bearing regions, were obtained from 81 patients with OA after total knee arthroplasty surgery. All the patients had varus deformity of the knee. Micro-CT was applied to evaluate the microstructure characteristics of the tibial plateau, which was segmented into 6 regions of interest (ROIs). After micro-CT scanning, decalcified and undecalcified bone histology were performed to assess histological features and bone remodeling status in these different ROIs.ResultsIn both medial and lateral plateaus, osteophytes exhibited a less sclerotic microstructure and higher bone remodeling level compared with STB from weight-bearing and non-weight-bearing regions. Moreover, the medial osteophyte tended to have a more sclerotic microarchitecture and a relatively low level of bone metabolism than its lateral counterpart. Osteophyte, which consists of mesenchymal connective tissue cap, cartilage and mineralized bone tissue, demonstrated evident chondrocyte hypertrophy and endochondral ossification in the cartilage-to-bone interface. Compared with the non-weight-bearing region, the weight-bearing region showed more severely deteriorated cartilage, and more sclerotic subchondral bone with high remodeling status.ConclusionOsteophytes exhibited a sparse microstructure and high bone remodeling level in knee OA, but demonstrating region-dependent variations. In addition, the microstructure, bone metabolism status and pathological alterations of osteochondral complex were distinct between weight-bearing and non-weight-bearing regions in the tibial plateau. Biomechanical stress might play a pivotal role in osteophyte formation and deterioration of osteochondral complex.     

A comparison of outcomes of posterior arthroscopic subtalar arthrodesis with or without bone graft for treatment of subtalar arthritis

BackgroundIt remains unclear whether to perform a bone graft is necessary during posterior arthroscopic subtalar arthrodesis. The present research aimed to comparatively analyze the outcomes of arthroscopic subtalar arthrodesis through a 3-portal posterior approach with or without bone graft.MethodsA total of 93 patients with subtalar arthritis who underwent posterior arthroscopic subtalar arthrodesis were retrospectively examined. The patients were divided into two groups according to whether they received bone graft or not. The clinical outcomes were compared for analysis.ResultsAmong the 93 patients included, 53 received bone graft and 40 did not. The union rate and time to osseous fusion suggested no significant difference between the two groups. The improvement of clinical outcomes were comparable between the two groups at the final follow-up.ConclusionsIn the present study, bone graft could not effectively reduce the risk of nonunion and improve the outcome.     

康复医学在21世纪的发展趋势

本文主要介绍21世纪以来康复医学领域的基础理论、神经康复、骨关节康复、内脏康复、慢性疼痛、康复教育和康复器材的发展趋势。     

残留白血病细胞抗药再生长的实验研究

目的：阐明残留白血病形成及抗药再生长的机制。方法：用可移植性白血病模型Ｌ６１５和Ｌ７８１１小鼠骨髓作长期培养，用柔红霉素模拟体内治疗。结果：发现少数粘附于基质滋养层的残留白血病细胞逃避了柔红霉素的杀伤作用，并在药物作用下再生长。粘附的白血病细胞群中含有许多分化程度较低的静止期细胞，表达ｂｃｌ－２基因，有一定抗药能力，是残留白血病细胞的来源。结论：骨髓基质细胞滋养层是残留白血病细胞生存和再生长的微环境，可能通过上调ｂｃｌ－２基因表达增强其抗药能力。     

骨髓间质干细胞（MSCs）移植对高血压大鼠动脉传导速度的影响

目的通过对于ISH模型鼠及SHR大鼠接受MSC移植干预后脉搏波传导速度及脉压变化的研究,探讨MSCs在改善病变动脉功能中的作用。方法选取自发性高血压大鼠(SHR)及单纯收缩期高血压大鼠作为研究对象,采用左心室直接注射的方法进行干细胞移植,在体条件下对于实验动物的血压及脉搏传导速度进行检测,并对结果进行分析。结果MSCs移植对于实验动物收缩压的变化没有影响,并不改变血压变化的趋势,但能够降低ISH动物脉压水平(32.407±2.55),同时降低PWV(178.6526±18.5494),与同组对照相比具有统计学差异(P<0.01)。SHR组接受细胞干预的亚组并没有呈现相同的变化趋势。进一步的相关分析发现,PP与PWV的变化具有正向相关性,相关系数为0.665。结论MSC移植治疗能够改善损伤动脉的传导速度,降低动脉的僵硬程度,部分逆转血管重塑的过程,从而延缓高血压动脉损伤的进程,降低心血管恶性事件的发生率。     

神经母细胞瘤多发性、对称性骨转移1例

患者女,5岁,双下肢渐进性疼痛一年,面色及皮肤苍白半年,发现腹部饱满1个月,双髋、双膝疼痛不能直立行走一周而就诊.查体:脉搏115次/分,中度贫血貌,全身浅表淋巴结肿大,无压痛.双肺呼吸音粗,未闻及湿啰音.腹部膨隆,肝脾明显增大,肝脏表面可触及大小不等结节,压痛明显,移动性浊音阴性.化验检查:WBC 2.8×109/L,RBC 2.26×1012/L,PTL 395×109/L,LY 23.4%,AKP明显增高.骨髓穿刺(髂骨)细胞检查:神经母细胞瘤骨髓转移改变.     

股骨头坏死的细胞因子治疗

股骨头坏死是骨科临床中的难题之一,目前的治疗方法效果多不理想。近年来,细胞因子已成为骨科研究中的热点,在股骨头坏死的研究中应用颇多,其作用日益显现。现介绍在股骨头坏死治疗中有关的细胞因子:骨形态发生蛋白、碱性成纤维细胞生长因子、血管内皮细胞生长因子等。旨在使读者对其有一个整体的理解和认识,并简要讨论该领域目前存在的问题及前景展望。     

骨髓基质干细胞、骨诱导活性材料和两者复合物治疗兔早期股骨头坏死的疗效比较

目的：比较骨髓基质干细胞（BMSC）、骨诱导活性材料（OAM）和两者复合物对早期股骨头坏死（ANFH）修复的疗效。筛选出最佳方案。为临床应用提供依据。方法：28只新西兰大白兔随机分为A、B、C组，A、B组又分左、右侧组，采用液氮冷冻法建立双侧ANFH模型，A、B右侧组植入BMSC＋OAM构建的组织工程复合物，A左侧组植入复合自体BMSC的明胶海绵，B左侧组植入OAM，C组植入空白明胶海绵，术后2、4、6、8周随机取A、B两组各3只动物、C组1只动物，影像学检查后处死，取双侧股骨头标本进行组织学检查。结果：（1）X线显示，自实验第4周后A、B右侧组钻孔缺损区成骨明显优于左侧组及C组，表现为中心密度增高，缺损腔缩小，边缘模糊．6周时出现骨小梁结构，8周时有正常骨小梁结构；左侧组仅表现为随时间的延长，中心密度及边缘密度逐渐增高，形成硬化线，但无骨小梁结构，C组缺损区出现囊性变扩大并有塌陷。（2）组织学显示，A、B右侧组缺损区，2周时有成骨细胞。4周时有骨小梁及类骨质填充，6周时有成熟骨小粱和骨髓组织出现，8周时骨小梁成熟和骨髓组织形成：A、B左侧组在相同的时间内其组织学修复及新骨塑性与改建均不如各自的右侧组。结论：自体BMSC4-OAM构建的组织工程复合物对免早期ANFH修复作用优于单独应用BMSC和OAM，是目前治疗ANFH的最佳治疗方法