骨髓基质干细胞体外培养及临床应用研究

目的 :通过对人骨髓基质细胞的体外培养、扩增和初步回植的研究 ,探讨MSCs临床应用疗效和前瞻性。方法 :从人髂骨抽取骨髓液 ,体外培养、传代和扩增 ,细胞周期、细胞形态和细胞分裂方式观察 ,并初步对骨科疾病进行回植治疗。结果 :建立一套完整、简单、成熟的体外分离、培养、扩增MSCs的系统方法 ,获得初步良好的临床疗效。结论 :人骨髓基质细胞能在体外大量培养扩增 ,为今后的理论研究和临床应用奠定了基础     

Radiation-induced alterations of fracture healing biomechanics

The effects of irradiation on the normal temporal progression of the physical properties of healing fractures were studied in a rat model. Fractures were surgically produced in the femur, stabilized with an intramedullary pin, and irradiated. One group of rats was exposed to 2,500 rads in divided doses over 2 weeks, beginning 3 days after fracture, and compared to a control group with fractures which were not irradiated. Animals were sacrificed at periodic intervals and the bones were tested to failure in torsion. The torque, stiffness, and energy increased and the angle decreased for the nonirradiated specimens in the expected fashion. This progression was deleteriously altered in the irradiated femurs.     

Treatment of infected nonunion of the tibia with electrical stimulation combined with local muscle flaps

Summary The widely documented treatment of nonunion with various clinical applications of electrical stimulation has met with an excellent success rate (70–93.6%). Local muscle flaps are widely accepted in the treatment of osteomyelitic lesions, and in our departments a combined, one-stage application of electrical stimulation with local muscle flap has been used on six cases of infected nonunion of the tibia with excellent results.     

应用LISS治疗下肢骨不连的初步报告

目的报告应用微创内固定系统(LISS)治疗股骨及胫骨骨不连的初步临床效果。方法自2003年2月～2004午8月间，应用LISS固定与植骨治疗5例股骨下段骨折小连接，4例胫骨上段骨折不愈台；其中内固定失效7例，外固定治疗火败和感染各1例；病程10～111个月，平均29个月。结果个部患随访6～16个月，平均8个月；骨折均住术后4～6个月牢固连接，平均愈合时间4．7个月，无内植入物松动等并发症。结论LISS因其先进的设计，能有效治疗股骨下段和胫骨上段骨折不连接。     

Operative treatment for femoral shaft nonunions, a systematic review of the literature

The objective of this article is to systematically review the currently available literature to formulate evidence-based guidelines for the treatment of femoral shaft nonunions for clinical practice and to establish recommendations for future research. Articles from PubMed/MEDLINE, Cochrane Clinical Trial Register, and EMBASE, that presented data concerning treatment of nonunions of femoral shaft fractures in adult humans, were included for data extraction and analysis. The search was restricted to articles from January 1970 to March 2011 written in the English, German, or Dutch languages. Articles containing data that were thought to have been presented previously were used once. Reports on nonunion after periprosthetic fractures, review articles, expert opinions, abstracts from scientific meetings, and case reports on 5 or fewer patients were excluded. The data that were extracted from the relevant articles included: type of nonunion, type of initial and secondary treatments, follow-up, union rate, and general complications. Most studies had different inclusion criteria and outcome measures, thus prohibiting a proper meta-analysis. Therefore, only the union rate and number of complications were compared between the different treatments. Methodological quality was assessed by assigning levels of evidence as previously defined by the Centre for Evidence-Based Medicine. This systematic review provides evidence in favour of plating if a nail is the first treatment; after failed plate fixation, nailing has a 96 % union rate. After failed nailing, augmentative plating results in a 96 % union rate compared to 73 % in the exchange nailing group.     

胫骨髓内钉开髓点取骨植骨治疗胫骨骨折不愈合的疗效

目的探讨胫骨髓内钉开髓点取骨植骨治疗胫骨骨折不愈合的临床疗效。方法选择2009年3月～2010年9月我科胫骨骨折不愈合51例随机分为两组,对照组断端硬化骨去除后胫骨髓内钉固定,观察组在断端硬化骨去除后使用胫骨髓内钉开髓点的取骨进行植骨及胫骨髓内钉固定。比较两组治疗后患者的骨折愈合及功能情况评价其治疗效果。结果患者获得随访10～14个月(平均12个月),观察组与对照组骨折愈合时间分别为(30.3±0.5)周和(36.1±0.6)周,差异具有统计学意义;患膝关节活动度ROM评分优良率及关节功能HSS评分优良率方面,两组相比差异无统计学意义。结论应用胫骨髓内钉开髓点取骨植骨治疗胫骨骨折不愈合有着更多的优势,值得临床推广。     

A Qualitative Evaluation of Scaphoid Remodeling in Bone-Grafted Scaphoid Nonunions

The purpose of this case series is to identify and illustrate the phenomenon of scaphoid remodeling in skeletally mature subjects following bone grafting for scaphoid nonunion. Nine patients with scaphoid nonunions were treated with interpositional bone grafting (with iliac crest bone graft) and K-wire fixation. The mean length of follow-up was 28.6 ± 9 months. Radiographs and CT scans were reviewed and assessed for degree of union and a qualitative assessment of scaphoid architecture. Following surgery, there was marked distortion of the scaphoid. Once healed, the contour of the scaphoid was still significantly distorted in all nine patients. Remodeling then became evident along the articular surfaces between 8 and 12 months. By 3 years, the scaphoid was completely recontoured and the normal architecture was completely restored in all nine patients. We conclude that the articular surface of the scaphoid remodels over time in skeletally mature subjects.     

Surgical treatment of aseptic nonunion in long bones: review of 193 cases

The surgical treatment of aseptic nonunion often represents a more challenging situation for the orthopaedic surgeon than treatment of the primary fracture. In fact, it may be necessary not only to "rivitalize" the nonunion area, but also to exchange the bone fixation devices and to place some refill material in the bone gap. Several surgical techniques and different kinds of bone gap refills have been reported in the literature for the treatment of long bone nonunion. We present the results of 193 cases of long bone nonunion that have been treated in a period of 11 years (1992–2003) by a mostly open approach to the nonunion site with or without autologous bone graft interposition. The site (27 humerus, 44 forearm, 48 femur, 74 tibia) and the type of nonunion (179 atrophic, 19 hypertrophic) were considered in the surgical planning as were the mechanic and biological problems. New osteosynthesis was performed in 139 cases: with plate and screws in 82 cases, with intramedullary nails in 31 cases, with external fixators in 15 cases and with other devices in 11 cases (e.g. interfragmentary screws, k-wires). Cancellous or corticocancellous bone graft, always autologous from the iliac crest or from the anterior tibial tuberosity, was used in 183 cases (94.8%). Healing of the nonunion was successful in 179 cases (92.7%) in a mean time of 5.8 months. 14 patients (7.2%), all atrophic nonunion, healed with further surgery in a mean time of 19.2 months. Best results were obtained by the use of the intramedullary nail (31 cases): 99% healed in 5.2 months for the lower limb and 100% healed in 7.4 months for the upper limb. Good results have been achieved by plate (82 cases): 89.5% healed in 4.5 months for the lower limb and 94.1% in 6 months for the upper one. The worst results were observed with external fixation (15 cases). However, this device was used in the most complex situations, when severe soft tissue sufference was present. In this group, the mean healing time was 7.1 months (69.2% of cases) in the lower limb and 8 months (50%) in the upper one. Bone graft alone (54 cases) led to healing in 34 of 35 cases (97%) in the lower limb in 6 months and in 17 of 19 cases (89.4%) in 6.4 months in the upper limb.     

交锁髓内钉联合骨瓣、骨膜瓣治疗四肢骨不连及骨缺损

目的　探讨应用交锁髓内钉联合带血管的骨瓣、骨膜瓣治疗四肢骨不连、骨缺损的临床效果。方法　应用交锁髓内钉联合带血管的骨瓣、骨膜瓣移植治疗四肢骨不连、骨缺损 2 4例。全部患者得到随访 ,平均随访时间 1 6年。其中采用带血管腓骨移植 1 5例 ;带血管蒂腓骨转移 2例 ;带血管髂骨瓣 3例 ;带血管股骨内髁骨瓣移植 1例 ;带血管腓骨骨膜移植 4例 ;带血管胫骨骨膜瓣转移 1例。结果　 2 4例患者全部临床愈合 ,未出现感染、髓内主钉及锁钉断裂等并发症 ,关节功能良好。结论　应用交锁髓内钉联合带血管的骨瓣、骨膜瓣移植治疗四肢骨不连、骨缺损是一种确实有效的方法。