初产妇经阴道分娩所致耻骨和耻尾肌损伤的MRI研究

目的 探讨经阴道分娩所致耻骨损伤与耻尾肌损伤的发生差异以及2种损伤严重程度的相关性。方法回顾性分析88例初产妇经阴道分娩后的盆腔MRI影像。根据MR影像上有无耻骨损伤,将产妇分为耻骨损伤组（51例）和无耻骨损伤组（37例）。由2名高年资放射科诊断医师在MRI影像上判断和评估耻骨及耻尾肌损伤情况,包括耻骨的骨髓水肿、骨折,以及耻尾肌水肿、撕裂和断裂,并对损伤程度进行评分。采用独立样本t检验、MannWhitney U检验、卡方检验及Fisher精确概率检验比较有无耻骨损伤的2组临床资料和影像表现,不同耻骨损伤程度间的耻尾肌损伤发生率比较采用Fisher精确概率检验。采用Kendall`s tau-b相关分析耻骨损伤程度与耻尾肌损伤程度的相关性。结果 耻骨损伤组骨盆痛、压力性尿失禁及耻尾肌损伤发生率均高于无耻骨损伤组（均P<0.05）。耻骨损伤程度不同,其耻尾肌损伤发生率不同（P<0.05）,耻骨骨折,重度、中度及轻度骨髓水肿产妇的耻尾肌损伤发生率依次减低。耻骨损伤程度与耻尾肌损伤程度呈正性线性相关（r=0.297,P=0.036）。结论 经阴道分娩的初产妇如有耻骨损伤则往往伴...     

少见部位骨巨细胞瘤的临床及影像学表现分析

目的:提高对少见部位骨巨细胞瘤影像学表现的认识能力,降低误诊率。方法:回顾性分析13例经手术病理证实的少见部位骨巨细胞瘤的临床及影像学资料。本组病例均是在拍摄X线正侧位片时首先发现病灶。10例行CT扫描。结果:X线检查诊断为骨巨细胞瘤2例,骨囊肿6例,跟骨结核1例,椎体结核2例,椎体血管瘤1例,椎体骨髓瘤1例。CT扫描检查诊断为骨巨细胞瘤5例,骨囊肿4例,椎体结核1例。13例中Ⅰ级者9例,Ⅱ级者3例,Ⅲ级者1例。结论:少见部位的骨巨细胞瘤影像学特征不典型,易与骨囊肿、骨结核、单发性骨髓瘤相混淆。对特殊部位的骨质膨胀性破坏,皮质变薄,并见有细小骨嵴者应考虑本病。     

In vitro proliferation and differentiation of human mesenchymal stem cells on hydroxyapatite versus human demineralised bone matrix with and without osteogenic protein-1

Background: Allografting is currently used in lower limb reconstruction surgery. Demineralised bone matrix (DBM) is more osteoinductive compared with allografts but lacks mechanical strength. Osteogenic protein-1 (OP-1) can improve the osteoinductivity of the allograft, however recent reports indicate significant allograft resorption when it is combined with OP-1. Objectives: Our hypothesis was that hydroxyapatite (HA) with human-mesenchymal stem cells (h-MSCs) and OP-1 (HA+h-MSCs+OP-1) has similar osteoinductive properties to human-DBM+h-MSCs. The objective was to evaluate h-MSC proliferation (by tritiated thymidine incorporation, total DNA Hoechst 33258 and scanning electron microscopy) and osteogenic differentiation (from alkaline phosphatase activity) in human demineralised bone matrix (h-DBM) and HA, with or without OP-1. Results: H-MSC proliferation on HA+OP-1 was significantly higher compared with that on HA at all time points (p < 0.05) and compared with DBM alone [day 1, (198.4 vs 95.4) p = 0.042; day 14 (286.1 vs 119.9), p < 0.001]. H-MSC proliferation was higher in DBM+OP-1, at all time points compared with HA+OP-1 but the difference was not statistically significant (p > 0.05). H-MSC differentiation was significantly higher in HA+OP-1 compared with HA (p < 0.05) but not significantly different from diffferentiation on DBM alone (p > 0.05). Differentiation was significantly higher on DBM+OP-1 at all time points compared with HA (p < 0.05) and with HA+OP-1 [day 1, (21.1 vs 10.1) (p = 0.03); day 7 (39.4 vs 7.1) (p < 0.01); day 14 (40.2 vs 14.4) (p < 0.001)]. Conclusions: When HA+h-MSCs is combined with OP-1 in vitro its osteogenic potential is similar to that of DBM+h-MSCs alone which may be adequate for non-weight-bearing applications. Mechanical testing however is of great importance for weight-bearing applications and the in vivo testing of the composite graft HA+h-MSCs+OP-1 vs DBM+h-MSCs is recommended.     

人胎盘无细胞是悬液对骨髓造血干／祖细胞的体外扩增作用

为了探讨人胎盘无细胞悬液对骨髓造血干／祖细胞的体外扩增作用及与已知的几种细胞因子进行比较,用人胎盘无细胞悬液及ＩＬ－３,ＧＭ－ＣＳＦ,ＩＬ－３＋ＩＬ－６＋ＧＭ－ＣＳＦ＋ＦＰＯ作为刺激因子,并应用甲基纤维素半固体培养体 对骨髓ＧＭ－ＣＦＵ,ＧＭ－ＧＥＭＭ和ＢＦＵ－Ｅ进行了培养和比较,研究结果表明,人胎盘无细胞悬液对骨髓ＣＦＵ－ＧＭ,ＣＦＵ－ＧＥＭＭ和ＢＦＵ－Ｅ体外扩增最适蛋白浓度是２００－３００μｇ／Ｌ,人胎盘无细胞悬液作刺激因子对骨髓血干／祖细胞的体外扩增效果优于单独ＩＬ－３,单独ＧＭ－ＣＳＦ和ＩＬ－３＋ＩＬ－６＋ＧＭ－ＣＳＦ＋ＥＰＯ组。结论提示,人胎盘无细胞悬液可能含有多种细胞因子,用人胎盘无细胞悬液作扩增剂体外扩增骨髓造血干／祖细胞细胸具有有效而价廉的特点。     

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牙冠延长手术保留了大量的残根、残冠,但也带来了医疗纠纷的隐患。选择好手术适应证及充分的交流是手术成功的关键。临床检查包括断端的位置、角化龈的宽度、系带的附丽、冠根比、根分叉病变等情况。为了充分地暴露断端,保留角化龈的宽度,必须采取不同的手术方式。     

阿魏酸对去卵巢大鼠骨微结构的影响

目的 观察阿魏酸对去卵巢大鼠骨微结构改变的作用。方法 2月龄雌性大鼠40只,按随机数字表法分为假手术组、模型组和阿魏酸低、高剂量组,每组10只。除假手术组外,模型组和阿魏酸低、高剂量组均通过摘除大鼠双侧卵巢建立骨质疏松模型,分别采用等量生理盐水和20、80mg/（kg·d）阿魏酸灌胃,干预12周后,处死各组大鼠获取大鼠血清检测骨代谢指标,用Micro-CT检查记录大鼠股骨骨密度和骨微结构,切取干骺端骨质行HE染色,观察骨组织切片。结果 病理切片显示,模型组大鼠骨小梁变薄稀疏,髓腔增大;阿魏酸组大鼠骨小梁数目（Tb.N）和骨连接增加,骨小梁间隙变小。与模型组比较,阿魏酸低、高剂量组大鼠骨密度增加[（0.176±0.014）g/cm2、（0.198±0.027）g/cm2比（0.153±0.026）g/cm2,P均<0.05]、皮质骨骨小梁体积比率（BV/TV）增加[（34.521±6.364）%、（39.483±10.586）%比（26.357±8.243）%,P均<0.05]、骨小梁厚度（Tb.Th）增加[（0.116±0.031）mm、（0.129±0.028）mm比（0...     

Preclinical evaluation of injectable bone substitute materials

Injectable bone substitutes (IBSs) represent an attractive class of ready‐to‐use biomaterials, both ceramic‐ and polymer‐based, as they offer the potential benefit of minimally invasive surgery and optimal defect filling. Although in vitro assessments are the first step in the process of development, the safety and efficacy of an IBS strongly depend on validated preclinical research prior to clinical trials. However, the selection of a suitable preclinical model for performance evaluation of an IBS remains a challenge, as no gold standard exists to define the best animal model. In order to succeed in this attempt, we identified three stages of development, including (a) proof‐of‐principle, (b) predictive validity and (c) general scientific legitimacy, and the respective criteria that should be applied for such selection. The second part of this review provides an overview of commonly used animals for IBSs. Specifically, scientific papers published between January 1996 and March 2012 were retrieved that report the use of preclinical models for the evaluation of IBSs in situations requiring bone healing and bone augmentation. This review is meant not only to describe the currently available preclinical models for IBS application, but also to address critical considerations of such multi‐factorial evaluation models (including animal species, strain, age, anatomical site, defect size and type of bone), which can be indicative but in most cases edge away from the human reality. Consequently, the ultimate goal is to guide researchers toward a more careful and meaningful interpretation of the results of experiments using animal models and their clinical applications. Copyright © 2012 John Wiley & Sons, Ltd.     

Bio-Oss骨粉复合BMP-2及VEGF修复大鼠胫骨缺损的实验研究

目的探讨Bio-Oss骨粉复合骨形态发生蛋白2(BMP-2)和血管内皮生长因子(VEGF)修复骨缺损的成骨效果。方法选取SPF级SD大鼠54只,随机分为三组:单纯骨粉组、骨粉/BMP组、骨粉/BMP/VEGF组,每组18只。麻醉后在大鼠左侧胫骨前部、胫骨结节下1 cm处磨除5 mm长的骨块缺损(包括髓腔),余留后侧1/3骨皮质和腓骨起固定和支撑作用。按分组分别植入Bio-Oss骨粉、Bio-Oss骨粉复合BMP-2、Bio-Oss骨粉复合BMP-2/VEGF。术后2、4、8周每组各取6只大鼠行X线检查、HE染色、CD31免疫组化。结果 X线检查、HE染色显示术后2周时各组新骨形成极少,4、8周时骨粉/BMP/VEGF组新骨形成最多,骨粉/BMP组次之,单纯骨粉组最少。术后2、4周时,骨粉/BMP/VEGF组的CD31阳性细胞数目最多,单纯骨粉组最少,骨粉/BMP组居中,三组间比较差异具有统计学意义(P0.01)。术后8周单纯骨粉组CD31阳性表达较前增多,但骨粉/BMP组、骨粉/BMP/VEGF组的CD31阳性表达较4周时有所下降。结论 Bio-Oss骨粉复合BMP-2和VEGF修复骨缺损的成骨效果理想,明显优于单纯应用Bio-Oss骨粉及只复合BMP-2的效果。     

羟基聚磷酸钙钠与聚羟基丁酸酯膜联合修复骨缺损的实验研究

目的 评价羟基聚磷酸钙钠（Hydroxy-poly(calcium natrium phosphate）,HPA）与聚羟基丁酸酯（Polyhydroxybutiric ester,PHB）膜联合使用修复骨缺损的效果。方法 采用HPA充填狗股骨人工缺损区,同时覆盖PHB膜,与PHB膜覆盖及空白对照作比较,通过组织形态学及定量检测,观察1周、1、2、3个月缺损修复情况。结果 HPA与PHB联合用组,2个月内骨密度及形态优于PHB组,3个月后二组相当,均优于空白对照组。结论 HPA与PHB联合使用,可早期获得骨缺损修复强度与外形并举的效果。