自体骨膜活化多孔陶瓷块修复长骨干缺损的实验研究

目的：利用自体骨膜中所含成骨细胞及生长因子与多孔生物活性陶瓷复合，制备一种活化的骨替代材料，修复长骨干缺损。方法：从21只狗的股骨干上切取骨膜片，吸附包裹于25cm长1.5Cm，直径1.2Cm，中心有一孔的柱状陶瓷块表面；然后植入自体股部肌群内，1月后将其中4块取出作组织学观察。了解异位成骨情况，另21块直接移植替代相应大小的股骨干缺损，分别于2月，4月，6月取出替代骨段（含材料及相临骨组织）作生物力学测定。X线衍射分析和组织学观察。结果：植入肌内1月时，陶瓷块表面的骨膜增生变厚，骨膜-材料界面成骨细胞大量增生并向陶瓷空隙内爬行。可见新骨形成，植入骨缺损后，随时间延长，抗弯强度逐渐增加，6月时已接近正常骨的抗弯强度，X线衍射分析提示，2月时TCP迅速降解，6月时的X线转靶谱图已接近自体骨。组织学观察，2月时新生骨组织迅速增加，植入物与上下骨面融合，4月和6月时，大部分材料为新生骨组织所替代，新骨比例远大于陶瓷材料，植入物内大量骨小梁形成，哈佛系统清晰可见，成熟骨组织充满材料的孔隙并相互连接。结论：实验结果提示，用自体骨膜与双相多孔陶瓷复合在自体内培养，可使骨膜中的生长因子及成骨细胞活跃，从而提高陶瓷材料的生物活性，用于修复长骨干缺损可加速新骨形成，达到负重骨替代的目的。     

几种中药保存离体心脏的筛选比较研究

目的　在众多的具有心肌保护作用的中药中筛选出保存心脏作用显著的中药。方法　采用Langendorff离体心脏灌注模型 ,在改良的Euro Collins心脏保存液 (mEC液 )中添加各中药注射液 ,与单纯mEC液作对照 ,观察保存 3h后离体心脏的心功能及保存 7 5、9h后的心脏复活率。结果　与对照组相比 ,肌生、刺五加、红花注射液可提高小鼠离体心脏的保存效果 (保存 3h)及保存心脏的复活率 (保存 7 5h)。保存 9h后心脏复活率的高低顺序为红花 >肌生 >刺五加 =黄芪 =川芎嗪 >当归注射液 ;复跳需时以红花、肌生注射液最短。结论　红花注射液延长心脏保存时间的作用显著 ,肌生注射液次之     

早期"小乳房"乳腺癌保乳手术临床实践与思考

目的：探讨早期“小乳房”乳腺癌保乳手术指征和临床效果。方法：回顾性分析保乳手术22例的临床资料。结果：病理检查手术切缘均无癌组织残留：腋窝淋巴结转移7例。本组术后均未发生表皮坏死和上肢水肿，皮下积液1例(经穿刺抽液治愈)。随访38-86个月，中位56个月；腋窝局部复发1例；3年生存率100％，5年生存率95.5％(21/22)。结论：掌握手术指征和方法，对早期“小乳房”乳腺癌保乳手术是安全可行的。     

Periosteum: its role in the healing of dento-alveolar surgical wounds and the effect of mental nerve section on mandibular periosteal new bone

This two-part study investigated the osteogenic potential of rat mandibular periosteum.
In the first part, the importance of the periosteum as an osteogenic source in the healing of dentoalveolar surgical wounds was evaluated. A circumscribed bone defect was created in the buccal aspect of the right mandible of each animal and the overlying periosteum was excised in half of the animals. After sacrifice at a representative range of times between two and 60 days, histological examination of the surgical sites suggested that mandibular periosteum overlying a bone defect did not produce new bone and that healing was largely endosteal. It was noted that periosteum formed copious reactive bone away from the defect, the majority being on the buccal mandibular surface although some was noted also on the lingual aspect.
In the second part, the effect of mental nerve neurotmesis on deposition of reactive bone was investigated. The mental nerve was sectioned in half of the animals and left intact in the other half. The flap was replaced and sutured. Subsequent histological examination indicated that mental nerve neurotmesis did not influence the deposition of mandibular reactive bone.     

Establishment and characterization of the Masquelet induced membrane technique in a rat femur critical‐sized defect model

The Masquelet induced membrane technique for reconstructing large diaphyseal defects has been shown to be a promising clinical treatment, yet relatively little is known about the cellular, histological and biochemical make‐up of these membranes and how they produce this positive clinical outcome. We compared cellular make‐up, histological changes and growth factor expression in membranes induced around femur bone defects and in subcutaneous pockets at 2, 4 and 6 weeks after induction, and to the periosteum. We found that membranes formed around bone defects were similar to those formed in subcutaneous pockets; however, both were significantly different from periosteum with regard to structural characteristics, location of blood vessels and overall thickness. Membranes induced at the femur defect (at 2 weeks) and in periosteum contain mesenchymal stem cells (MSCs; STRO‐1⁺) which were not found in membranes induced subcutaneously. BMP‐2, TGFβ and VEGF were significantly elevated in membranes induced around femur defects in comparison to subcutaneously induced membranes, whereas SDF‐1 was not detectable in membranes induced at either site. We found that osteogenic and neovascular activity had mostly subsided by 6 weeks in membranes formed at both sites. It was conclude that cellular composition and growth factor content in induced membranes depends on the location where the membrane is induced and differs from periosteum. Osteogenic and neovascular activity in the membranes is maximal between 2 and 4 weeks and subsides after 6. Based on this, better and quicker bone healing might be achieved if the PMMA cement were replaced with a bone graft earlier in the Masquelet technique. Copyright © 2013 John Wiley & Sons, Ltd.     

Repair of long type IV posterior laryngeal cleft through a cervical approach using cricotracheal separation

A female infant with CHARGE syndrome and a long type IV cleft extending to within 5 mm of the carina underwent transcervical repair at 5 weeks of age. The trachea was transected from the cricoid cartilage and was peeled off the esophagus. The front of the esophagus and the back of the trachea were repaired while still ventilating the patient. The trachea was reconnected to the cricoid cartilage. This technique obviated the need for a sternal split, thoracotomy, cardiopulmonary bypass, or extracorporeal membrane oxygenation. It improved visibility, access, airway stability, and coverage of the anastomosis with periosteum permitting a three‐layer closure. Laryngoscope, 2013     

Biomechanical analysis of total elbow replacement with unlinked iBP prosthesis: an in vitro and finite element analysis

Background

Numerous models of elbow prostheses are being used and can be divided into two categories: one being a semi-constrained, linked type; and the other being non-constrained, unlinked type. Recent reports of National Elbow Arthroplasty Registers reveal no significant differences in the survival rates between linked and unlinked prosthesis brands, and the main cause appointed for revision for both types is loosening. Some previous biomechanical studies confirm the presence of abnormal bone stresses for the linked type, which can be associated with the risk of loosening. However for the unlinked type, biomechanical studies are not available that corroborate a loosening risk. It seems, that issue has not yet been fully answered and requires further analysis.

Methods

Cortex strains adjacent to the elbow joint were measured with strain gauges in synthetic humeri and ulnae, before and after replacement. To assess cancellous bone strains and cement stresses around the implant finite element models validated relative to measured strains were used.

Findings

Bone strains adjacent to the implant tip increased several times in the humerus and ulna. At the epiphyseal regions a generalised cancellous bone strain reduction was observed for both humerus and ulna relatively to the intact bones.

Interpretation

The unlinked elbow prostheses can be associated with the risk of bone fatigue failure by overload, particularly in the ulna, and bone resorption by stress-shielding at the epiphyseal regions. The identical structural behaviour relative to linked prostheses associated with the same loosening risks corroborates the results of recent arthroplasty published register reports.     

人骨膜细胞生物学特性的实验研究

目的 探讨人骨膜细胞体外培养的生物学特性. 方法 以胫骨骨膜组织为材料,采用组织块法分离细胞,完全培养基培养,通过倒置显微镜观察细胞形态学,锥虫蓝染色计数法检侧细胞增殖能力;流式细胞学分析细胞表面抗原.随机分为3组,成骨实验组和成软骨实验组分别加入不同的定向培养剂,对照组加入完全培养基,采用碱性磷酸酶染色、Von Kossa染色、甲苯胺蓝染色、Ⅱ型胶原免疫组化染色检测各组细胞的成骨和成软骨分化指标. 结果 骨膜细胞在体外培养条件下呈贴壁生长,细胞生长曲线证实骨膜细胞传至第9代仍保持良好的增殖能力,流式细胞仪检测证实细胞表面抗原CD90及CD105呈阳性;组织化学染色检测证实成骨实验组分化后细胞碱性磷酸酶及钙结节呈阳性,成软骨实验组分化后细胞蛋白聚糖及Ⅱ型胶原呈阳性,对照组各项指标均生阴性.结论 骨膜细胞体外培养细胞增殖能力强,具有间充质干细胞的特性和良好的成骨和成软骨分化潜能,其定向诱导分化的成骨细胞和软骨细胞均具有各自明显的细胞功能表达.     

Molecular Variations Related to the Regional Differences in Periosteal Growth at the Mandibular Ramus

Periosteal growth at human mandibular ramus is characterized by bone apposition at the posterior border and resorption at the anterior border. Molecular control of this regional variation is unclear. This study examined the expression of several molecules involved in bone apposition/resorption at these regions in vivo and in vitro. By using growing pigs as a model, the periosteal growth was assessed at the mandibular ramus by vital staining and histological observations. In parallel, periosteal tissues were harvested and pulverized for RNA and protein extraction. Periosteal cells were also isolated, expanded in osteogenic media, and subjected to a single dose of dynamic tensile strain (0, 5, or 10% magnitude at 0.5 Hz) to examine their responses to mechanical loading. Real‐time RT‐PCR and Western blot analyses were used to examine mRNA and protein expression from periosteal tissues and cultured cells. Histological observation confirmed an anterior‐resorption/posterior‐apposition pattern in the pig mandibular ramus. Both in vivo tissue and in vitro cells demonstrated greater mRNA expression of receptor activator of NF‐κB ligand (RANKL)/osteoprotegerin (OPG) ratio and bone morphogenetic protein 2 (BMP2) at the anterior region, while OPG expression at the anterior region was lower than the posterior region. In response to the application of a single dose of dynamic tensile strain, cultured periosteal cells appeared to change the expression profile of osteogenic markers but not that of RANKL/OPG and BMP2. These findings suggest that the unique regional variation of periosteal activity at the mandibular ramus is regulated by a differential expression of RANKL/OPG ratio (likely through differential induction of OPG) and BMP2. Anat Rec, 2010. © 2010 Wiley‐Liss, Inc.     

不同甲状腺次全切除术的临床疗效

目的比较两种甲状腺次全切除术治疗良性甲状腺疾病的临床效果。方法复习行甲状腺次全切除术病例的临床资料,分析保留上极的甲状腺次全切除术（观察组）与传统甲状腺次全切除术（对照组）的疗效差异。结果两组患者均治愈出院。观察组的手术时间及住院时间均明显短于对照组（P〈0．01）;两组并发症的发生率无统计学差异。结论保留上极的甲状腺次全切除术安全可靠,使住院时间缩短。