64排螺旋CT在骨关节骨折病变诊断中的应用

目的：探讨64排螺旋CT检查及图像后处理在复杂、较小的骨关节诊断中的应用。方法：回顾分析我院70例骨折患者,对其X线片及CT后处理图像进行对比、观察。结果：70例患者中X线漏诊49例,可疑21例。结论：CT二、三维成像经过多方位、多旋转、去伪影等功能,能够发现在小关节及复杂关节中X线不确定及未发现的骨折。     

生物人工材料人工骨修复下肢骨缺损的临床观察

目的 观察生物人工材料(biological artificial material,BAM)人工骨修复下肢负重骨骨缺损的临床效果. 方法 选择2008年1月- 2010年12月收治的采用BAM人工骨进行手术植入修复骨缺损的32例下肢负重骨骨缺损患者,年龄21 ～ 77岁,平均32.5岁.骨缺损体积为1.0 cm×2.0 cm×2.5 cm～3.0 cm×3.5 cm ×5.0 cm,平均15.4 cm3.骨缺损病因主要为粉碎性骨折、骨囊肿、骨纤维结构不良、慢性骨髓炎等.术后即刻及术后1,2,3,5,7,9,12,18个月进行随访,观察术后全身及切口局部反应、血钙／磷改变情况、骨缺损修复及患肢负重功能恢复情况. 结果 所有患者均得到有效随访9 ～18个月,平均10.5个月.术后至末次随访所有患者均无局部或全身移植物排斥反应.随访X线片示术后3个月BAM人工骨植入区与骨缺损周围的骨组织之间界限模糊,有新生骨形成;术后6个月BAM人工骨植入区明显有新骨长入,人工骨材料与骨组织融为一体,骨缺损已基本修复.术后患肢完全负重时间为术后2.5 ～4个月,平均3.2个月. 结论 BAM人工骨具有良好的生物相容性和骨诱导作用,其内结构可以保持一定的刚度和强度,可用于下肢负重骨骨缺损的修复.     

第一跖跗关节和舟楔关节轴向应力下活动度的实验研究

目的 通过测量第1跖跗关节和舟楔关节在足部结构完整状态时受距小腿轴向应力下不同平面的运动范围,了解其活动度,为临床诊治相关足部疾患提供实验依据和参考数据. 方法 利用电子万能实验机对7个成人新鲜冰冻足部完整状态标本分别加载以0、100、400、700 N垂直负荷并采集数据.通过数字散斑相关计算软件对由图像采集仪采集的原始灰度图像进行计算,最终获得第1跖跗关节在矢状面和水平面的转角位移以及舟楔关节在矢状面的转角位移. 结果 在700 N载荷下,第1跖跗关节矢状面转角位移仅为1.81°±0.63°,水平面仅为1.56°±0.59°,舟楔关节矢状面转角位移仅为1.09°±0.56°.结论 第1跖跗关节以及舟楔关节具有一定的活动度,但仍属于微动关节,在轴向负重下活动度较小.     

降钙素基因相关肽对血管内皮细胞体外血管生成的作用及机制研究

 目的 观察降钙素基因相关肽(calcitonin-gene-related peptide,CGRP)对人脐静脉血管内皮细胞(human umbilical vein endothelial cells,HUVECs)的成血管作用,初步探讨其在骨组织工程中的应用价值。方法 体外分离获取HUVECs,采用细胞免疫荧光检测其CGRP受体1的表达。体外成管实验检测CGRP的成血管作用,ELISA法检测CGRP直接作用于HUVECs时血管内皮生长因子(vascular endothelial growth factor, VEGF)的分泌水平。Q-PCR检测CGRP刺激HUVECs不同时间点VEGF、VEGF受体1(FLT1)、VEGF 受体2(KDR)及CGRP受体1 mRNA的表达,Western blot检测HUVECs不同时间点FLT1、KDR的蛋白表达。结果 细胞免疫荧光显示HUVECs表达CGRP受体1,体外成管实验显示CGRP有明显的成血管作用。ELISA显示CGRP能明显促进HUVEC分泌VEGF。Q-PCR结果显示不同浓度组CGRP受体1 mRNA的表达较对照组增高,且在第10天最为明显;Q-PCR及Western blot结果显示不同浓度组FLT1、KDR mRNA和蛋白的表达在各时间点较对照组均增高。结论 CGRP能明显促进HUVECs的体外生成血管,可能与其促进VEGF分泌,增强HUVECs的FLT1与KDR表达有关;同时,CGRP受体表达也增加,可进一步增强CGRP的促血管生成作用。     

Gray-scale and color Doppler ultrasonographic evaluation of reactivated post-traumatic/postoperative chronic osteomyelitis

Objective  We aimed to carry out a systematic assessment of gray-scale and color Doppler ultrasonography (CDUS) findings of reactivated post-traumatic/postoperative chronic osteomyelitis (COM) in adults. Materials and methods  Gray-scale and color Doppler ultrasonography were performed on 40 consecutive patients with a history of long-standing post-traumatic/post-operative chronic osteomyelitis and clinical suggestion of reactivation, in a 32-month-period. All patients had metallic implants: 16 internal fixations, nine external fixations, 11 hip arthroplasties and four knee arthroplasties. The final diagnosis of reactivated COM was based upon biopsy findings, with microbiological and histological examination (n = 27), or a combination of laboratory, clinical and magnetic resonance (MR) findings (n = 13). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sonographic signs, including fistulous tracts, periosteal thickening, cortical discontinuity, soft tissue abscess and cellulitis, juxtacortical fluid, distension of the pseudocapsule in arthroplasties, and periosteal vascularity, were estimated. Results  Statistically significant differences between patients with and without reactivated COM were found for fistulous tracts (P < 0.0001), juxtacortical fluid collections (P < 0.001) periosteal thickening (P < 0.01), distension of pseudocapsule (P < 0.05), and periosteal vascularity (P < 0.0001). Low-resistance arterial flow of periosteal vessels presented the highest sensitivity (92%), specificity, and PPV (100%), yielding only two false negative results in two obese patients. Among gray-scale findings, the presence of a fistulous tract yielded the highest specificity and PPV (100%), whereas periosteal thickening was the most sensitive (92%), though not specific, finding (specificity 50%). Conclusion  A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.     

不同X线类型的地方性氟骨症患者骨矿物质含量分析

用~(125)I光子吸收测定法测定了128例地方性氟骨症患者左前臂尺、桡骨的骨矿物质含量,结果表明:氟骨症患者骨矿物质含量低于正常人水平,其中早期改变、硬化型、疏松型和混合型四种不同类型的氟骨症患者骨矿物质含量也不相同,骨矿物含量水平由高至低排列顺序为硬化型>早期改变>混合型>疏松型。     

Effects of Cyclophosphamide on the Formation and Solubility of Collagen

Abstract: The effects of low (5 mg/kg × 7) and high (20 or 30 mg/kg × 7) doses of cyclophosphamide on the formation an solubility of collagen in subcutaneous, porous implants, bones and incisional skin wounds were studied in young, male rats. At the 5 mg/kg schedule, effects from the drug were only detected as an increased solubility of collagen in implant connective tissue. At the 20 mg/kg schedule, there was a significant reduction of the synthesis and solubility of collagen in bones and in skin wounds. The 30 mg/kg schedule significantly depressed all the parameters studied except the specific activity of hydroxyproline in implants. Collagen stability seems to be impaired at low dose levels, whereas one of the main effects of high doses appears to be inhibition of collagen synthesis.     

Precision of dual photon absorptiometry measurements: comparison of three different methods of selection of the region of interest

To determine the short-term reproducibility of bone mass calculations with dual photon absorptiometry of the lumbar spine (L2–L4), duplicate measurements in healthy subjects were used. Three different methods for selection of region of interest were compared: a rectangular region with variable height and width, an irregular region to be drawn freely by the operator and the standard calculation software supplied with the bone densitometer. Contributions of changes in size and location of the region of interest on calculated bone mineral mass were also investigated. An increase in height of the region by 2 scan lines caused an increase in bone mineral content (BMC) of 8.4%±1.8%. Enlargement in width by 2 pixels in each scan line caused an increase in BMC of 2.5%±1.3%. The difference between these region of interest changes was significant (P0.0005). The use of a rectangular region, optimized to enclose L2–L4 in each person but of the same size in both measurements, resulted in a reproducibility of 1.4% and 0.7% respectively for 2 observers, with an inter observer variation of 1.2%. The reproducibility of the duplicate measurements was worse for the other methods of region of interest selection. A further series of duplicate DPA measurements in normal subjects, but with a standard meal between the measurements, showed a larger variation in the results. Again the reproducibility of the calculations using the rectangular region was better than with the other methods, with much less inter observer variation. These data suggest that calculation of dual photon absorptiometry results with a constant region of interest is preferred for the detection of small changes in lumbar bone mass.     

Identification of avascular necrosis in the dysplastic proximal femoral epiphysis

Bilateral radiographic irregularities and deformities of the proximal femoral epiphyses are features of both multiple epiphyseal dysplasia and bilateral idiopathic avascular necrosis. In the past these entities have been difficult to differentiate. This report documents radiographically the occurrence of avascular necrosis in 10 patients with multiple epiphyseal dysplasia by recognizing the superimposition of sclerosis and subchondral fissuring on pre-existing symmetrically irregular proximal femoral ossification centers. Scintigraphic (photopenia) or magnetic resonance (loss of signal) criteria of avascular necrosis confirm its added presence and help to establish an imaging scheme to identify avascular necrosis superimposed on multiple epiphyseal dysplasia.