骨形成蛋白在胫骨截骨快速延长成骨过程中的表达及意义

目的:探讨快速延长成骨过程中骨形成蛋白(BMP)的表达及意义. 方法: 制作兔胫骨截骨快速延长动物模型,分别于延长第5, 10, 15, 20, 30和40日在延长区取材,以抗骨形成蛋白单克隆抗体(BMP-McAb)行SP法免疫组化染色光镜观察. 结果: 在骨延长的整个过程中均有BMP的表达,不同时相BMP表达的部位不同. 除炎症细胞、类骨样组织及骨小梁外,几乎所有细胞及组织均有BMP存在. 间充质细胞、软骨细胞、成骨细胞、骨细胞、骨髓细胞BMP呈高表达. 结论: BMP在骨延长成骨过程中发挥着重要作用. BMP表达量不足可能是导致快速骨延长骨不连接的重要因素.     

创伤性胫前皮肤缺损骨不连医源性因素分析及防治

目的探讨外伤性胫前皮肤缺损骨不连医源性因素、治疗方法及预防措施.方法对136例外伤性胫前皮肤缺损,进行回顾性研究,分析医源性因素,提出预防措施,随访治疗效果.采用7种局部转移皮瓣和6种游离皮瓣移植治疗皮肤缺损,骨不连、骨缺损均采用带血管的骨移植.结果136例中121例得到6～28个月随访,平均17个月.局部皮瓣转移全部成活,游离皮瓣移植中7例术后发生血管危象,经探查4例成活,3例失败,二期以带胫后血管的对侧小腿内侧皮瓣为受区血管蒂的皮瓣移植修复治愈.骨不连、骨缺损行骨移植后均在术后3个月愈合,骨髓炎治愈.结论医源性技术缺陷是外伤性胫前皮肤缺损骨不连的重要因素,针对各种不同的因素进行预防、合理治疗可获得满意效果.     

The risk assessment model of fracture nonunion after intramedullary nailing for subtrochanteric femur fracture

To investigate the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fractures and to construct a risk assessment model.Based on the multicenter retrospective analysis of 251 patients, all patients were divided into modeling group and verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture-related factors, surgical reduction-related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Logistic regression model was used for multifactor analysis to construct the risk assessment model. Based on the logistic regression model, the risk prediction model was constructed by drawing the Nomogram diagram. Through the verification group, the influencing factors were evaluated again, and the differentiation and calibration of the model were evaluated. The calibration degree was evaluated by Hosmer-Lemeshow test, goodness of fit test, and calibration curve. The discriminant degree was evaluated by the receiver operating characteristic curve.Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 14 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure, and reduction of fracture with large incision were the risk factors of fracture nonunion. The medial cortex fracture was seen reduced on X-Ray was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram is drawn. Twenty-four cases of fracture nonunion occurred in the verification group. The area under the receiver operating characteristic curve was area under curve =0.883 > 0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the Hosmers-Lemeshow test (X² = 2.921, P = .712 > .05) showed that the model had a good calibration.After intramedullary nailing of subtrochanteric fracture, hip varus, failure of intramedullary nail fixation and wide surgical dissection are the risk factors of fracture nonunion, and the postoperative reduction of medial cortex fracture is protective factor.National key research and development projects: 2016YFC0105806     

环形外固定架联合骨膜烧灼构建大鼠胫骨萎缩性骨不连的新模型

文题释义：萎缩性骨不连：骨折修复过程完全停止,骨端萎缩吸收,骨痂无明显生长,髓腔封闭不通,断端之间无骨性连接,是骨折术后常见的并发症之一,其发生与骨折端周围血供破坏明显、固定不稳、感染、口服药物及全身因素相关。 动物模型：在医学研究中,在动物身上建立或形成类似人类疾病的模型,通过动物模型可直接或间接反映疾病的发生或发展过程,在了解疾病的基础上开创或改进疾病的治疗。 背景：建立标准萎缩性骨不连动物模型是研究萎缩性骨不连的发生机制与治疗的必要条件,而目前常见的造模方法不能准确模拟萎缩性骨不连的临床实际。 目的：构建一种新型萎缩性骨不连动物模型。 方法：30只雄性SD大鼠随机分成实验组和对照组,均行右侧胫骨中下段截骨,采用环形外固定架固定,维持4 mm 缺损间距;其中实验组烧灼截骨端周围1 mm骨膜,对照组不处理骨膜。实验于2018-01-02经广州中医药大学第一附属医院实验动物伦理委员会批准,批号：TCMF1-2018002。结果与结论：造模后每组分别出现1例外固定架松动,2组均未发生感染;影像学检查显示造模后6周,2组胫骨骨折断端间均无骨性连接,且无进一步愈合迹象;实验组第12周时影像学与组织学显示呈典型萎缩性骨不连表现;对照组第12周影像学显示8只模型呈现肥大性骨不连特征,6只模型影像学具有萎缩性骨不连特征。提示采用环形外固定支架配合烧灼断端骨膜可成功构建萎缩性胫骨骨不连模型。ORCID: 0000-0002-9406-3242(张严) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

股骨干骨折内固定术后骨不连外科治疗

目的 探讨股骨干骨折内固定术后骨不连的手术治疗方法与效果.方法 18例股骨干骨折内固定术后骨不连患者,于手术取出原内固定后,采用交锁髓内针固定12例,动力加压钢板固定并辅以自体骼骨植骨6例.结果 术后1例失访,17例获随访14～26个月,骨性愈合时间4～11个月;术后12个月,膝关节活动度为0～100°,疗效优6例,良8例,可3例,优良率为82.3％;1例术后4个月远端2枚锁钉断裂,同法更换髓内针后11个月骨折愈合;1例术后原切口感染,抗生素治疗2周切口愈合;1例术后1 a植骨处有顽固性疼痛.结论 骨缺损尤其是压力侧骨缺损是导致股骨干骨折内固定术后骨不连的主要原因;采用含骨皮质的髂骨作为植入骨治疗骨不连疗效确切.     

An improvement on the technique of transosseous tunnels for the fixation of lower pole patella fracture: Cerclage around the patella

The technique of transosseous tunnels is widely used in lower pole patella fracture (LPP). Though the extensor mechanism can be restored, distal avulsion fragments are usually unstable. The subsequent fracture gap and nonunion impair the extensor mechanism in turn. Cerclage is a promising method for treating the condition. The aim of this prospective cohort study is to determine if cerclage around the patella combined with the technique of transosseous tunnels stabilizes the avulsion fragments and brings out improved outcomes on LPP.Twenty two patients with LPP were treated with the hybrid technique. The patients were followed up and evaluated clinically and radiographically. The functional outcome was assessed by the average range of knee movement and Lysholm knee rating system at 6 months after surgery, as well as the final follow-up. Radiologically, Insall-Salvati ratio and the time from surgery to bone union were assessed.Postoperatively, with a mean followed-up of 12 months. All of the patients regained stability of the knee with an average range of movements of 131.8 degrees at 6 months after operation and 138.2 degrees at the final follow-up. On the Lysholm knee rating system, all cases were classified as excellent. The average score was 93.2 at 6 months after operation and 95.9 at the final follow-up. In radiological assessment, no fracture gap or nonunion occurred. The average Insall-Salvati ratio (I-S ratio) was 1.03.The hybrid technique offers further stabilization for the avulsion fragments and strengthens attachment of the patellar tendon, which brings forward time of rehabilitation and achieves good clinical outcomes.     

吻合血管的胎儿骨膜皮质骨瓣移植治疗骨不连

目的　报道吻合血管的胎儿骨膜皮质骨瓣移植治疗骨不连的效果。　方法　采用吻合血管的胎儿骨膜皮质骨瓣治疗骨不连 19例 ,其中胫骨骨不连 8例 ,尺骨近段骨不连 5例 ,肱骨远段骨不连 3例 ,桡骨远段骨不连 2例 ,股骨骨不连 1例。　结果　 19例病人经过一年以上随访 ,其中术后 12～ 18周愈合 17例 ,术后 2 3周愈合 2例。　结论　胎儿骨膜皮质骨瓣由骨膜和骨皮质组成 ,能够促进骨不连愈合 ,胎儿骨膜皮质骨瓣抗原性差。本方法安全、可靠、操作简单 ,移植后塑形方便 ,一个切口内完成手术 ,适用于骨不连和小范围的骨缺损     

Ectopic ossification of the triceps muscle after application of bone morphogenetic protein-7 to the distal humerus for recalcitrant nonunion: a case report

We report a case of triceps muscle ectopic ossification and resultant elbow stiffness after application of recombinant human bone morphogenetic protein to a distal humerus nonunion site. We recommend caution when using this product in the upper extremity in regions where there is close approximation of soft tissue to bone and where loss of motion would be problematic.     

股外侧肌上端肌支股骨骨（膜）瓣的解剖与临床应用

目的报道股外侧肌上端肌支股骨骨(膜)瓣的应用解剖及临床应用。方法在40侧成人下肢标本上解剖观测股外侧肌上端血管肌支的分支分布情况,设计以股外侧肌支为蒂的股骨骨(膜)瓣移位术,并进行了摹拟手术。1989年2月～1999年2月,以股外侧肌支为蒂切取股骨骨(膜)瓣移位修复股骨上段骨不连、骨缺损7例。结果股外侧肌上端肌支来自旋股外侧动脉横支,肌支在大转子尖下(16.8±3.0)cm发出肌骨膜支和骨膜支,肌骨膜支外径1.4～1.7mm,长度2.7～5.6cm,骨膜支外径0.4～0.6mm,长度1.2～1.5cm。骨膜血管向下或水平走行,达骨膜后发出吻合支,参与形成股骨血管网,分布于股骨上段。临床应用的7例,术后经18～42个月的随访,骨折于术后10～18周获得骨性愈合。髋关节活动度在180°者4例,120°者2例,65°者1例。供区愈合良好,无不适。结论以股外侧肌上端肌支为蒂的股骨骨(膜)瓣,可用于修复股骨中上段的骨不连、骨缺损。