自体眶骨膜替代睑板植入修复外眦部眼睑缺损

目的观察自体眶骨膜修复眼外眦部眼睑缺损的临床效果。方法采用自体眶骨膜替代睑板联合滑行结膜瓣和眶周旋转滑行皮瓣修复外眦部眼睑缺损。共6例（6只眼）,术后随访6个月至3年。结果术后眼睑形态及功能满意,无收缩性上睑内卷,睑内外翻,植入骨膜瓣无吸收、移位及感染。结论自体眶骨膜替代睑板植入修复外眦部眼睑缺损简便易行,术后并发症少。自体眶骨膜是理想的睑板替代物。     

Effects of extensive circumferential periosteal stripping on the microstructure and mechanical properties of the murine femoral cortex

Extensive periosteal stripping (PS) is a risk factor for post-radiation pathologic fracture following surgery for extremity soft tissue tumors. The purpose of this study was to determine the effects of PS on bone structure and mechanical properties. Thirty-one skeletally mature mice underwent PS, with circumferential removal of periosteum from an 8-mm segment of the mid-diaphysis of the left femur. Thirty-one control mice underwent sham surgery in which the femur was isolated without manipulation of the periosteum. At 2, 6, 12, or 26 weeks following surgery, the left femora were examined by micro-CT to quantify cortical thickness (CtTh), cross-sectional area (CSA), bone volume (BV), and polar moment of inertia (PMI). Three-point mechanical bend testing was performed and peak load, stiffness, and energy to failure were determined. PS resulted in significantly decreased CtTh, CSA, BV, and PMI at all time points. Peak load, stiffness, and energy to failure were significantly reduced at 2, 6, and 12 weeks. There were no significant differences in mechanical properties at 26 weeks. In this mouse model, extensive circumferential PS resulted in sustained changes in bone structure that were still evident after 6 months, accompanied by reductions in bone strength that persisted for at least 3 months.     

A histological and histometric study of the periosteum in mandibular ramal and condylar areas of the rabbit

These structures were investigated with various histological stains and by polarization microscopy. The width of the periosteal layers was measured in nine ramal and condylar areas at five different ages (0, 2, 6, 12 and 30 weeks). The total periosteal width changed during growth, as did the absolute and relative thickness of its cellular and fibrous layers. The results suggest that in these areas periosteal tension may influence growth of the condylar cartilage, and that this may vary during growth.     

A new animal model for bone atrophic nonunion: Fixation by external fixator

A new small animal model of bone atrophic nonunion was established for investigating the process of bone regeneration by performing cauterization of the periosteum, removal of the local bone marrow, and stabilization with external fixation. The model allows the creation of an atrophic nonunion without the need for a critical size defect. Furthermore, it provides reproducible, well‐defined mechanical conditions and minimized physical interference of the implant with the biological processes in the healing zone. Eighty adult Sprague‐Dawley rats received an osteotomy of the left femur, stabilized with an external fixator. In half of the animals, the periosteum proximal and distal to the osteotomy was destroyed by cauterization and the adjacent bone marrow was removed (nonunion group). At 2 and 8 weeks after surgery, radiological, biomechanical, histological, and histomorphometrical analyses showed a typical physiological healing in the control group, while the nonunion group was characterized by resorption of the bone ends with some callus formation distant to the osteotomy. At both time points, the callus was composed of significantly less bone and significantly more connective tissue (p < 0.001). In addition, the torsional strength of the osteotomized femur was significantly less in the nonunion group than in the control group, which was comparable to that of the intact femur (p < 0.001). In conclusion, the present model allows the induction of an atrophic nonunion without the need of a critical size defect. It is reproducible, provides standardized biomechanical conditions, and allows minimized interaction of the implant with the healing zone. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res     

Role of periosteum in the formation of jaw bone

Abstract The aim of the present investigation was to evaluate the bone-forming capacity of the outer (fibrous) and inner (cambium) layer of the mandibular periosteum in skeletally mature rats. The experiment was carried out in 25 rats. The mandibular ramus was exposed on one side (experimental side) after elevation of a muscle-periosteal flap. A teflon capsule was placed with its opening facing the periosteum at the subsurface of the raised muscle-periosteal flap after suturing. In the contralateral side serving as control, the periosteum of the lateral aspect of the mandibular ramus was left intact. This time the teflon capsule was placed with its opening facing the periosteum left behind at the ramus. The histological analysis demonstrated that in all experimental and control specimens, some bone was produced at 7 days after operation. In the experimental specimens, however, both the incidence and the amount of newly-formed bone in the teflon capsules gradually decreased from 7 to 120 days, while increasing in the control capsules placed over the periosteum. At 120 days, the mean amount of new bone produced in the experimental capsules was 3% (range 0–15%) of the total space created by the capsule, while it was 68% (range 41–85%) for the control capsules. The results demonstrated that substantial amounts of bone can be produced predictably by the placement of an occlusive teflon capsule facing mandibular covered with periosteum. Bone produced from the periosteum and without continuity with existing bone becomes resorbed with time.     

下颌骨截除后骨膜成骨的实验研究

选用24只家兔,于右侧下颌骨嚼肌前缘与颏孔之间造成10mm×5mm大小的骨缺损,保留骨膜进行下颌骨骨膜成骨能力的研究。左侧以同样方式去骨但不保留骨膜作对照。动物最长饲养8周,分别用肉眼、X线、组织学和扫描电镜观察。所有实验侧骨缺损完全骨化,对照侧骨缺损未修复。本实验得出如下结论:①下颌骨同膜成骨是一种普遍现象;②成骨以膜内骨生成方式完成,③术后7天即有类骨质产生;④骨膜成骨伴大量血管增生;⑤骨膜成骨细胞生发层以灶性成骨开始。     

骨膜促进骨-肌腱结点愈合的研究

[目的]探讨骨膜对骨-肌腱结合部位愈合的影响,通过实验证明骨膜促进骨-肌腱结合部位细胞增生,进而促进该部位愈合.[方法]48只18周龄新西兰大白兔随机分为2组,实验组将骨膜游离并植入兔髌骨部分切除模型中骨-肌腱结点中,对照组只进行手术,不植入骨膜.在术后4、8、12周处死动物取标本进行大体和组织学观察.[结果]大体观察可见实验组骨-肌腱结合部位愈合较早.组织学检查显示实验组术后4、8周骨-肌腱结合部组织愈合明显,以从松质骨再生和骨-肌腱愈合接点纤维软骨带的再生为特征,较对照组迅速,提示早期实验组恢复较对照组迅速.[结论]骨膜可以促进骨-肌腱结合部位细胞增生,增加细胞基质合成,促进新生骨和纤维软骨移行带形成,促进其愈合.     

自体骨膜包裹同种异体肌腱重建前交叉韧带的前瞻性研究

目的通过与关节镜下单纯采用同种异体肌腱重建前交叉韧带(anterior cruciate ligament,ACL)比较,探讨自体骨膜包裹同种异体肌腱重建ACL对腱-骨愈合的影响。方法选择2008年3月-11月收治并符合纳入标准的68例ACL损伤患者,随机分为两组,其中31例采用自体骨膜包裹同种异体肌腱重建ACL(试验组),37例单纯采用同种异体肌腱重建ACL(对照组)。两组患者性别、年龄、损伤原因、病程及术前功能评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。两组均采用单束解剖重建ACL。结果两组术后2周各1例胫骨隧道切口处出现少量渗出,经对症处理后切口愈合;其余患者术后切口均Ⅰ期愈合。两组患者均获随访,试验组随访时间24～29个月,平均26个月;对照组24～32个月,平均27个月。CT检查示,术后2年两组骨隧道直径均较术后1个月有不同程度增加,但骨隧道扩大率试验组(5/31,16.1%)小于对照组(14/37,37.8%),差异有统计学意义(χ2=3.948,P=0.047)。术后2年,试验组23例(74.2%)Lachman试验阴性,25例(80.6%)轴移试验阴性;对照组分别为26例(70.3%)及30例(81.1%)。KT-1000检测显示,试验组关节前向松弛度为(1.74±0.88)mm,小于对照组的(2.36±0.83)mm,差异有统计学意义(t=—2.979,P=0.004)。术后2年,试验组Lysholm评分、美国特种外科医院(HSS)评分、Tegner评分、国际膝关节文献委员会(IKDC)评分与对照组比较,差异均无统计学意义(P>0.05)。结论与单纯采用同种异体肌腱重建ACL相比,采用自体骨膜包裹同种异体肌腱重建ACL可在一定程度上降低骨隧道扩大率,促进腱-骨愈合,近期疗效较好。     

抗酒石酸性磷酸酶在骨组织不同细胞中的表达

目的:明确抗酒石酸性磷酸酶(tartrate-resistant acid phosphatase,TRAP)活性和蛋白在骨组织不同细胞中的表达和定位?方法:取正常6周龄C57BL/6J小鼠的胫骨,制备石蜡切片,分别通过组织化学?免疫组织化学以及上述两者双重染色的方法检测TRAP活性和蛋白在骨组织不同细胞的表达和定位?结果:组织化学和免疫组织化学染色显示破骨细胞呈现TRAP强阳性反应,而且关节软骨细胞?生长板软骨细胞?成骨细胞和骨外膜细胞也呈现TRAP阳性反应?双重染色结果可见大多数免疫组织化学TRAP阳性细胞显示组织化学阳性反应,但也有少数细胞只显示免疫组织化学阳性反应?结论:TRAP活性和蛋白不仅在破骨细胞高表达,在软骨细胞?成骨细胞和骨外膜细胞中也有表达?     

拖出切除附加末端回肠造瘘在腹腔镜低位直肠癌保肛手术中的治疗分析

目的：探讨拖出切除及回肠造瘘在腹腔镜低位直肠癌根治保肛术中的应用效果。方法：回顾2009年6～10月对10例肿瘤下缘距齿线〈5 cm的低位直肠癌腹腔镜根治术,拖出切除及回肠造瘘的临床资料。结果：本组无死亡病例,平均住院时间13 d,无肠瘘,无梗阻发生,无肛门失禁。结论：拖出切除及回肠造瘘在低位直肠癌根治保肛术中,可以达到直肠癌根治和低位保肛的目的且效果良好。