带血管蒂骨瓣联合Herbert螺钉治疗新鲜腕舟骨骨折42例

目的探讨新鲜腕舟骨骨折的切实治疗方法.方法对42例新鲜腕舟骨骨折后血管蒂骨瓣联合Herbert螺钉治疗作回顾性分析.结果42例全部愈合,愈合时间为10～18周,功能恢复良好.结论血管蒂骨瓣联合Herbert螺钉是新鲜舟骨骨折的有效治疗措施,值得推广.     

CT and radionuclide study of BMP-2 gene therapy-induced bone formation

RATIONALE AND OBJECTIVES: Gene therapy techniques have the potential to treat numerous diseases, from cancer to diabetes. One promising application is the use of bone morphogenetic protein (BMP) gene transfer to induce bone formation. Previous studies have demonstrated that both direct and ex vivo BMP gene therapy have the capacity to initiate the normal endochondral pathway, leading to rapid mature bone formation. In the present study, computed tomography (CT) and radionuclide imaging was used to assess bone formation induced by BMP gene therapy accurately and noninvasively. MATERIALS AND METHODS: Athymic nude rodents were treated with 1.25 x 10(10) particles of adenovirus-BMP-2 (Ad-BMP-2) (treatment group) or adenovirus-beta-gal (control group). At various intervals after treatment, the animals underwent CT, planar digital radiography, and planar radionuclide scintigraphic imaging. RESULTS: Radionuclide scintigraphy clearly demonstrated active bone deposition that began as early as 15 days after treatment and peaked at approximately 36 days, only at the Ad-BMP-2 injection sites. CT clearly demonstrated ectopic bone induction over time at the Ad-BMP-2 treatment sites, in perfect correlation with the scintigraphic findings. CONCLUSION: This study clearly illustrates that gene therapy-induced osteogenesis can be studied with multimodality imaging and supports the use of these approaches in future preclinical and clinical studies.     

Postero-anterior radiography of the wrist: scapholunate ratios and joint projection shape analysis

A normal database of qualitative and quantitative data, obtained from standard posteroanterior wrist radiographs has been established which might be useful in clinical practice. Variations in the parameters obtained could provide an explanation for the variable carpal kinematics and multiple concepts of carpal instability described in the literature. Selected landmarks were digitized on 80 posteroanterior wrist radiographs of asymptomatic volunteers. Besides classical parameters, measurement of carpal dimensions and angular relationships were also taken. Two new parameters, the scapholunate ratios, are described which evaluate the relative lengths of the frontal projections of the scaphoid and lunate these ratios might prove useful in the diagnosis of carpal instability. The shapes of the frontal projections of the radiocarpal, midcarpal and STT joint spaces were also analysed. Average values for parameters already reported in the literature agreed with previous findings. Some parameters, however, displayed important individual variations, the standard deviations ranging from 1 to 3 mm for dimensions and from 3 to 13° for angular measurements. The posteroanterior and anteroposterior scapholunate ratios averaged 1.41 ± 0.21 and 0.66 ± 0.13 respectively. The potential clinical benefit of these ratios is discussed. Different types of joint space projection shapes could be determined. With respect to the difficulty of obtaining reliable lateral wrist radiographs, compared to posteroanterior radiographs, it is suggested that the clinical significance of the proposed parameters must be evaluated.     

Anatomical study for an update comprehension of clubfoot. Part I: Bones and joints

Purpose The aim of our study was to elucidate the gross anatomical changes of bones and joints in idiopathic clubfeet. Methods Gross dissection was carried out on seven idiopathic clubfeet of fetuses aborted between the 25th and 37th week of gestation and compared to two normal feet (27th and 36th week of gestation). Particular attention was paid to the articular surfaces, shapes and angles of all bones and their skeletal relationships. Results The talar neck–trochlea angle in clubfeet ranged from 37° to 41°, in normal feet from 27° to 33°. In clubfeet the deviation of the neck of the talus relative to the body was between 28° and 43°, in normal feet between 22° and 24°. The posterior joint surface was in an anterolateral position and even flat transversely. The head of the clubfeet tali was turned along a longitudinal axis in the opposite direction compared to the normal ones. Instead of a typically saddle-shaped posterior talar surface of the calcaneus, it was triangular and flat transversely, and a bony stability in the subtalar joint was not achieved. The angle of torsion of the calcaneus showed no significant difference between normal and clubfeet. The anterior surface was flat, medially twisted and orientated upwards. Conclusions We presume that the calcaneus is the primary fault, which might be explained by pathologic biomechanical forces during development. The second part of this article is available at /10.1007/s11832-006-0004-2.     

Incidence of hip osteonecrosis among renal transplantation recipients: a prospective study

AIM: To investigate whether a lessened glucocorticoid cumulative dose would lead to a decreased incidence of femoral head osteonecrosis. METHODS: Newly transplanted in-patients (n = 49) underwent hip radiographs and magnetic resonance imaging (MRI) a mean of 17.0+/-4.3 (range 8-29) days after renal transplantation. For the 48 patients without evidence of prevalent osteonecrosis, imaging at a mean of 5.9+/-0.8 (range 4.8-8.7) months after renal transplantation was graded for presence/absence of femoral head osteonecrosis by two blinded radiologists. Sociodemographic and disease characteristics of patients were compared to identify potential associations with incident osteonecrosis. RESULTS: At 6-month follow-up, only two patients (4%) had osteonecrosis of the femoral head (three hips). The two primary radiologists had excellent agreement between osteonecrosis diagnosis (kappa coefficient=0.78). Both cases of a definite MRI diagnosis of osteonecrosis occurred in patients who were in the highest tertile of glucocorticoid dosage. CONCLUSION: Osteonecrosis was uncommon among a prospective cohort of renal transplant recipients within 6 months after engraftment.     

MRI of osteonecrosis

Osteonecrosis is a relatively common condition, which may be idiopathic or secondary to a variety of clinical situations. It may involve the subarticular region of a joint, when it is commonly referred to as ischaemic necrosis, or the metaphyseal regions of long bones, when it is referred to as bone infarction. In both situations, early lesions may be radiographically occult. However, magnetic resonance imaging (MRI) is very sensitive in identifying and characterizing osteonecrosis. This review illustrates the varied MRI features of osteonecrosis that enable a confident diagnosis to be made. Complications and differential diagnosis are also considered.     

Aneurysmal bone cyst: value of MR imaging and conventional radiography

Our objective was to investigate the accuracy and the diagnostic value of different imaging features of primary aneurysmal bone cysts (ABC) in conventional radiographs and MRI. Conventional radiographs and MR images of 34 patients with a suspected aneurysmal bone cyst were reevaluated by six independent radiologists in a blinded fashion. Morphological features, MR signal characteristics, and contrast enhancement patterns were assessed. Diagnoses were correlated with histology. Sensitivity and specificity of the different imaging findings for each imaging technique were calculated. In 24 patients ABC was histologically proven. In 10 cases diagnoses other than ABC were established. Conventional radiography and MRI each demonstrated a sensitivity of 76.4 and 77.8% with a specificity of 55.0 and 66.7%, respectively. With combined use of both imaging modalities sensitivity and specificity increased to 82.6 and 70%, respectively. The ABC was significantly more often seen as circumscribed lesion with bone expansion, lobulation, septa, and pathological cortical bone reaction than those cases with different diagnoses. Septal contrast enhancement proved to be a useful MR imaging finding in suspected ABC. The combined use of conventional radiographs and MRI revealed the highest sensitivity in the diagnosis of ABC in relation to histology. Magnetic resonance imaging provides improved diagnostic specificity and valuable information on soft tissue changes. Electronic Publication     

Quantitative scintigraphy of the sacroiliac joints

The effects of age and laterality on sacroiliac (ST) to sacral indices and ratios were assessed in 62 patients. For the 14 controls, the left mean SI to sacral index was significantly higher than the right one. There was no correlation between age and SI to sacral ratio ( = average of right and left index). The mean ratio in 36 patients with sacroiliitis and 12 patients with low back pain was not significantly different from that of the controls, with a clear overlap of indices between controls and sacroiliitis patients.     

Enzymes of protein and phosphate catabolism in rat bone

A study was made of several enzymatic activities in rat femur and tibia. Quantitative assays were developed for the determination of acid and alkaline phosphatase, lactate dehydrogenase, proteolytic activity, leucine aminopeptidase, glycylglycine dipeptidase, glutamate dehydrogenase, aspartate transaminase, and alanine transaminase. Some properties of these enzymes were studied using metaphyseal homogenates. The distribution of activity in the metaphysis, diaphysis, and marrow was determined. The activity per mg of DNA was highest in the metaphysis and lowest in marrow. The activities in general were 40–70% lower in the diaphysis than in the metaphysis. Metaphyseal enzymatic activity was the same in 29- and 49-day-old rats but lower in 82-day-old rats. Proteolytic activity at pH 8.0 differed from the other activities studied being higher in marrow than in bone and increasing markedly with age.

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Zusammenfassung Verschiedene Enzymaktivitäten in Femur und Tibia der Ratte wurden untersucht. Es wurden quantitative Prüfmethoden für die Bestimmung von saurer und alkalischer Phosphatase, Lactatdehydrogenase, proteolytischer Aktivität, Leucinaminopeptidase, Glycylglycin-Dipeptidase, Glutamatdehydrogenase, Aspartat-Transaminase und Alanin-Transaminase entwickelt. Einige Eigenschaften dieser Enzyme wurden in Metaphysenhomogenaten untersucht. Die Verteilung der Enzymaktiväten in Metaphyse, Diaphyse und Knochenmark wurde bestimmt. Die Aktivität pro mg DNA war am höchsten in der Metaphyse, am niedrigsten im Knochenmark. Allgemein waren die Aktivitäten 40–70% tiefer in der Diaphyse als in der Metaphyse. Die metaphysäre enzymatische Aktivität war dieselbe bei 29 und 49 Tage alten Ratten, hingegen tiefer bei 82 Tage alten Ratten. Die proteolytische Aktivität bei pH 8 war von anderen untersuchten Aktivitäten verschieden; sic war höher im Knochenmark als im Knochen und zeigte deutliche Zunahme mit dem Alter.

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Résumé Les activités de différentes encymes du fémur et de la tibia du rat étaient étudiées. Pour mesurer acide et alkaline phosphatase, lactatdehydrogenase, activité protéolytique, leucinaminopéptidase, glycylglycindipéptidase, glutamatdehydrogenase, aspartate transaminase et alanintransaminase, une méthode quantitative était developpé. Quelques réactions characteristiques étaient examinées das n des homogénates de la métaphyse. La distribution des encymes dans la métaphyse, diaphyse et dans la moelee osseuse était étudié. L'activité la plus grande per mg DNA était observé dans la métaphyse, celle la plus basse dans la moelle osseuse. En générale les activités étaient 40–70% abaissées dans la diaphyse comparé avec la métaphyse. L'activité encymatique de la métaphyse n'était pas différente l'une de l'autre chez les rats agés de 29 et 49 jours mais elle diminuait chez celles de 82 jours. L'activité protéolytique a pH 8 ne correspondait pas avec les autres encymes: elle était plus haut dans la moelle osseuse que dans l'os et augmentait visiblement avec l'age.

     

Beitrag zur funktionellen Anpassung der Corticalis der R?hrenknochen. Untersuchung an drei rachitisch deformierten Femora

Zusammenfassung Die funktionelle Anpassung der Röhrenknochendiaphyse durch eine der Spannungsverteilung entsprechende Materialverteilung über den Querschnitt wird am Beispiel dreier rachitisch deformierter Femora demonstriert.Die drei Femora sind während der rachitischen Erweichung unter der Belastung jeweils in verschiedener Richtung verbogen und nach Ausheilen der Erkrankung in dieser Gestalt verfestigt worden.Von jedem Femur wurde ein Querschnitt in Höhe des Krümmungsscheitels untersucht. Unter Zugrundelegen einer Beanspruchung durch schiefe Biegung wurde durch Bestimmung der größten Widerstandsmomente für jedes Präparat die Richtung der größten Biegefestigkeit ermittelt. Es zeigte sich, daß die Femora in der Reihenfolge der Präparatenummern 2, 1 und 3 verschieden gut an die thereotisch bestimmte Biegebeanspruchung angepaßt sind.In einer theoretischen Untersuchung wurde die Spannungsverteilung in der Wandung eines Diaphysenrohres mit elliptischem Querschnitt für Beanspruchung durch schiefe Biegung berechnet. Entsprechend der lokalen Spannungsgröße wurde am Rohrquerschnitt Material weggenommen, bzw. zugefügt. Am Ende dieses Umbaus stand eine Querschnittsform, die der Gestalt des Femur 3 äußerst ähnlich war. Daraus wurde geschlossen, daß die beobachtete Verteilung des Knochenmaterials in den Querschnitten der rachitisch deformierten Femora durch Knochenan- und-abbau entsprechend der ungleichmäßigen Spannungsverteilung zustande gekommen war.Die Tatsache, daß sich die Richtungen der theoretisch ermittelten Hauptbiegungsebenen aller drei untersuchten Querschnitte nahezu im selben Punkt schneiden, und daß ferner dieser Schnittpunkt in Nähe des Durchstoßpunktes der am normalen Femur bestimmten Kräfteresultierenden durch die Schnittebene liegt, wurde als Hinweis darauf angesehen, daß die Anpassung der Materialverteilung über den Querschnitt an eine Biegebeanspruchung durch die Resultierende aller am Femur angreifenden Kräfte erfolgte.

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Contribution to the functional adaptation of the corticalis of long bones. Investigation on three femora, deformed by rickets

Summary Three femora, weakened by rickets and deformed under the normal load, have been studied under biomechanical viewpoints. Each one was deformed in a different direction, but in all three there was observed an elliptical contour of the cross-section at the summit of the curvature. In each cross-section the direction of greatest resistance against flexion was determined by calculating the axis of the greatest moment of inertia. This investigation revealed in each femur a different degree of adaptation to the presumed flexion stresses.In a model (wall of a tube with elliptical cross-section) the distribution of stresses was determined for oblique flexion, and the distribution of material was theoretically remodeled in relation to the local stress values. The result of this remodeling was a model cross-section, very similar to that of the best adapted femur. From this it was derived, that the distribution of material in the femur cross-sections is reached by bone formation and resorption, depending on the higher and lower local stresses.Finally it was observed, that the directions of the main flexion planes of the three deformed femora cross nearly at the same point, not far from the projection of the resultant of forces stressing the normal femur. This is regarded as an indication that the functional adaptation of the cross-section form is caused also in the deformed femora by a resultant force similar to that of the normal one.

Mit Unterstützung der Deutschen Forschungsgemeinschaft.