应力对大段骨缺损修复影响的实验兔模型探讨

目的 建立用于研究应力对大段骨缺损修复作用的实验兔动物模型.方法 选用20只健康成年大耳白兔,随机分成两组,在右侧肱骨中下段制造13 mm的大段骨缺损后植入泡沫碳化硅人工骨,实验组选用具有固定和持续轴向加压双重作用的镍钛记忆合金接骨器,对照组选用同种材料和规格的仅有固定作用的接骨器,术后常规护理,待取材观察.结果 20只实验兔中,7只在苏醒后当天,10只术后1～3 d,3只术后4～7 d,出现植入体从植入部位脱出游离至皮下现象.结论 用于研究应力对大段骨缺损修复作用的实验兔动物模型未成功建立,镍钛记忆合金接骨器对兔肱骨大段骨缺损处人工骨的固定和持续加载,在实验兔肱骨难以实现.     

组织工程化软骨与富血小板血浆复合可促进软骨缺损修复

为探讨组织工程化软骨与富血小板血浆复合修复软骨缺损的效果,本研究选取了8周龄健康新西兰兔24只,依据随机数表法分为观察组(组织工程化软骨与富血小板血浆复合)和对照组(单纯软骨缺损模型),发现术后4周、8周、12周,观察组实验动物的大体评分均明显高于对照组(p0.05)。观察组实验动物的Collagen TypeⅠ、Collagen TypeⅡ相对表达水平明显高于对照组(p0.05)。两组实验动物的Collagen TypeⅩ相对表达水平无显著差异(p0.05)。观察组实验动物的软骨缺损直径和缺损深度分别为(1.02±0.35)mm、(0.96±0.27)mm,对照组实验动物的软骨缺损直径和缺损深度分别为(4.27±1.09)mm、(5.43±1.85)mm(p0.05),表明组织工程化软骨与富血小板血浆复合修复软骨缺损效果明显,能够刺激软骨相关基因表达,缩小软骨缺损范围,促进缺损软骨愈合。     

两种壳聚糖仿生复合材料对家兔桡骨骨缺损修复的实验研究

目的:评价壳聚糖/碳酸钙三维复合材料(CS/CaCO3)和壳聚糖/羟基磷灰石复合材料(CS/HA)用于骨缺损修复的可行性.方法:家兔24只,随机分为对照、CS/CaCO3、CS/HA三组.左前肢去毛后,2%巴比妥钠(30mg/kg,iv)麻醉,距桡骨远端3cm处截骨1cm,形成骨缺损,分别植入相应材料.术后4w、8w、12w分别处死动物,X线摄片后,取骨缺损标本,进行大体与组织学观察.结果:术后4周植入块颜色变红,周围有较多量的新生骨样组织包裹,骨痂增多,向植入块内移行;术后8周,植入块周围有明显新骨生成,将材料分隔包围,新骨中央区可见材料呈蜂窝状残留.术后12周缺损区大部分编织骨被成熟的板层骨组织替代,并形成髓腔.结论:CS/CaCO3和CS/HA两种仿生复合材料能明显促进兔桡骨骨缺损修复,诱导骨痂生成.     

绵羊羊膜上皮细胞治疗兔桡骨缺损模型的研究

为了确定绵羊羊膜上皮细胞在体内向骨组织的分化能力,实验在分离培养绵羊羊膜上皮细胞并对其进行干细胞特性的鉴定的基础上,制作新西兰大白兔桡骨13mm骨缺损模型,随机分组对其进行注射绵羊羊膜上皮细胞实验。高剂量组:移植细胞5×107个;低剂量组:移植细胞5×106个;对照组:生理盐水。细胞移植后2、4、8周拍摄X光片观察骨缺损部位的缺损修复情况;相应时段取骨缺损部位新生骨进行组织学观察:分析骨小梁生成数量和骨的改建时期。实验结果显示,高剂量实验组在移入细胞第8周,骨缺损完全修复,且同期高剂量组新骨生成的数量和质量明显高于低剂量组,低剂量组优于对照组。由此可见,绵羊羊膜上皮细胞不仅可以在不同种动物间进行移植,而且对骨缺损有良好的修复能力。     

成年犬股骨微波灭活骨缺损模型的建立

目的　建立成年犬股骨微波灭活骨缺损的实验动物模型 ,为骨缺损修复的研究提供实验依据。方法应用自行研制的骨肿瘤微波治疗仪 ,以 1 5kHz频率、70W功率加热至 5 0～ 5 5℃ ,维持 2 0min ,造成犬股骨中段不同大小的骨缺损。结果　在保持犬股骨连续性的前提下 ,长度 1 5cm的骨缺损 9个月时有 1 2被新生骨填充 ,长度2 5cm和 3 5cm的骨缺损 9个月时无愈合倾向 ,但后者骨折的发生率高。结论　成年犬股骨微波高温造成的骨缺损 ,长 2 5cm、宽 1 0cm 9个月不能自愈 ,适宜于各种骨修复材料的填充 ,是理想的实验模型     

T型锁定接骨板治疗老年桡骨远端不稳定性骨折的临床疗效

目的:探讨老年桡骨远端不稳定性骨折采用桡骨远端T型锁定接骨板治疗的临床疗效及安全性。方法:选择2013年7月-2015年4月在我院接受治疗的老年桡骨远端不稳定性骨折患者80例,根据手术方式不同分为观察组和对照组。观察组患者采用桡骨远端T型锁定接骨板治疗,对照组采用外固定支架治疗。观察并比较两组患者的临床疗效及手术安全性。结果:观察组骨性愈合时间少于对照组,掌倾角及尺偏角大于对照组,差异有统计学意义(P0.05)。观察组治疗后腕关节功能优于对照组,差异有统计学意义(P0.048)。观察组患者腕关节慢性疼痛、骨折感染的发生率低于对照组,差异有统计学意义(P0.05)。结论:桡骨远端T型锁定接骨板治疗老年桡骨远端不稳定性骨折具有复位效果好、创伤小且安全性高的特点,有一定的临床推广价值。     

负压封闭引流对兔颅骨外露创面愈合效果的实验研究

目的:探讨负压封闭引流技术(VSD)对兔颅骨外露缺损创面愈合的治疗效果。方法:选取成年新西兰大白兔76只,平均分为四组并建立兔颅骨外露实验模型。其中,A组(19只):于兔颅骨上方制作直径为2.0cm的圆形创面,保留骨膜,采用-120mmHg负压引流和常规换药治疗;B组(19只):实验动物处理同A组,仅采用常规换药治疗;C组(19只):在兔颅骨上制作直径2.0cm的圆形创面,剔除骨膜,治疗方法同A组;D组(19只):实验动物处理同C组,治疗方法同B组。每组各抽取10只,观察创面愈合率和创面愈合时间;其余9只分别在第7天、10天、20天、30天进行取材检测,分析疗效机制。结果:A组创面愈合时间为19.40±1.65天,B组为24.00±2.31天;C组为25.40±4.43天,D组为30.00±5.50天。运用VSD治疗和常规治疗创面愈合时间比较有统计学意义(P0.05)。结论:VSD治疗兔骨外露缺损创面能有效缩短创面愈合时间,促进血管再生,胶原蛋白合成。     

表面改性双相陶瓷复合自体骨髓干细胞修复兔骨缺损的实验研究

目的:应用自体骨髓基质干细胞(Bone Marrow Stromal Cells,BMSCs)复合经低晶态羟基磷灰石(Low Crystalline Hydroxyap- atite,LcHA)涂层的双相陶瓷(Biphasic Calcium Phosphate,BCP)构建的组织工程化骨(LcBCP)修复兔桡骨节段性缺损。方法:体外分离培养、诱导扩增兔BMSCs,取第三代细胞复合LcBCP(实验组)后修复15只兔左侧桡骨15mm缺损;右侧桡骨缺损处植入复合BMSCs的BCP(对照组),于植入后4、8和12周处死动物,通过大体形态、组织学、影像学和扫描电镜检测骨缺损修复效果。结果:BMSCs-LcBCP复合物生长良好,随时间延长,X线显示实验组连接处骨痂形成,对照组连接处始终愈合稍差,12周大体观察实验组骨修复良好,髓腔再通;组织学显示板层骨形成,连接处骨性愈合,实验对照组连接处虽然也为骨性愈合,但尚有较多编织骨形成。结论:自体BMSCs复合LcBCP形成的组织工程化骨可修复兔桡骨节段性缺损,低晶态羟基磷灰石涂层能够增强双相陶瓷的早期成骨。     

生长激素-海藻酸钠-壳聚糖微胶囊促进骨折愈合的组织学研究

目的:观察生长激素-海藻酸钠-壳聚糖微胶囊促进兔挠骨骨折愈合的作用。方法:实验将新西兰兔80只,在制备新西兰兔右桡骨中段3mm骨缺损模型的基础上,随机分成四组:口服生长激素-海藻酸钠-壳聚糖微胶囊组、皮下注射生长激素组、口服空微胶囊组和生理盐水对照组。实验组口服生长激素-海藻酸钠-壳聚糖微胶囊和皮下注射生长激素,对照组口服空微胶囊。并于术后9、17、30、42d定期HE染色和地衣红染色观察各组的骨折愈合情况。结果:本实验HE染色结果表明,由于在骨缺损部位成纤维细胞产生的大量胶原纤维为基质,形成透明软骨及成骨细胞,骨小梁生长的基础,连接骨痂形成和骨髓腔贯通。而观察到生长激素微胶囊组各期提前生长及改建提前的形态。地衣红染色图像结果分析及直方图的分析表明:生长激素微胶囊组胶原纤维产生促进骨小梁提前形成,进而骨折处骨性骨痂的提前愈合和髓腔的提前贯通。结论:生长激素-海藻酸钠-壳聚糖微胶囊口服能促进骨折修复愈合。     

微创经皮钢板接骨术与Henry入路钢板内固定治疗桡骨远端骨折的疗效观察

目的:研究微创经皮钢板接骨术与Henry入路钢板内固定治疗桡骨远端骨折的疗效。方法:选取2013年2月到2014年2月我院收治的桡骨远端骨折患者86例,按照随机数字表法将患者分为Ⅰ组和Ⅱ组,每组43例,Ⅰ组患者给予微创经皮钢板接骨术治疗,Ⅱ组患者给予Henry入路钢板内固定治疗,术后随访患者1年,比较两组临床疗效。结果:Ⅰ组手术时间、术中出血量显著优于Ⅱ组,两组比较差异具有统计学意义(P0.05);Ⅰ组术后1年DASH评分显著优于Ⅱ组,两组比较差异具有统计学意义(P0.05);两组并发症比较无统计学意义(P0.05)。结论:微创经皮钢板接骨术治疗桡骨远端骨折具有较好的临床疗效,能缩短手术时间、降低术中出血量,改善患者上肢功能。     

不同术式对雌兔内分泌和骨代谢的影响

目的观察不同子宫、卵巢切除术式对兔术后早期内分泌激素和骨代谢的影响。方法45只健康成年雌兔随机分为5组,Ⅰ组：单纯子宫全切除组;Ⅱ组：子宫全切＋单侧卵巢切除组;Ⅲ组：子宫全切＋双侧卵巢切除组;Ⅳ组：双侧卵巢切除组;Ⅴ组：对照组。测量术前、术后1、2、3个月的体重、雌二醇（E2）、甲状旁腺素（PTH）、血钙、血清碱性磷酸酶（ALK）和骨密度（BD）。结果术后第2、3个月,Ⅲ组、Ⅳ组出现烦躁不安和体重减轻的实验兔要显著高于Ⅰ组和Ⅱ组;术后第2个月,Ⅱ组E2浓度（17．66±6．06）pg／mL,显著降低,术后第3个月,血钙增高（3．86±0．11）mmol／L,第2椎骨骨密度显著降低,与对照组相比（P〈0．05）,有显著差异;Ⅱ组术后第3个月PTH增高,但与对照组相比无显著差异（P〉0．05）。Ⅲ组、Ⅳ组术后第2个月起,E2、PTH、血钙、ALT和BD,与对照组相比均有显著改变。结论子宫切除术会影响雌兔内分泌的变化,只保留单侧卵巢时不能维持相应的正常生理功能。     

The influence of transplanted culture of bone marrow stromal cells on reparative osteohistogenesis in parietal bone defect

Recently the problem connected with transplantation of bone marrow stromal cells for optimization of reparative osteogenesis is very actively studied. However, the objective methods allowing to observe the behavior of transplanted cells in a bone wound and to estimate character of regenerative osteogenesis after cell transplantation are used in an insufficient measure in both experimental and clinical researches. The aim of this study is to clarify the fate of stromal cells in a bone wound and to investigate the influence of bone marrow stromal cells on the process ofposttraumatic osteogenesis after cell transplantation in parietal bone defect. The experiments were carried out on 38 rabbits with artificially made parietal bone defect (diameter 1.0 cmm). The rabbits were divided into three groups: the first group was a control one; the rabbits of the second group were injected autogenic cultivated bone marrow stromal cells (10(6)); the rabbits of the third group were injected with autogenic cultivated bone marrow stromal cells (10(6)) in collagn gel. The methods of light and fluorescent microscopy, histomorphometry and statistical treatment of the data were used to estimate the results. The obtained data showed that transplanted cells were viable at least during 18 days after transplantation and efficiently took part in the reparative process. The transplantation of cultivated bone marrow stromal cells in collagen gel caused 30% increase in the part of bone tissue in the bone regenerate tissue in comparison with control after 120 days.     

Effect of bovine fetal growth plate as a new xenograft in experimental bone defect healing: radiological,histopathological and biomechanical evaluation

Bone grafting is used to enhance healing in osteotomies, arthrodesis, and multifragmentary fractures and to replace bony loss resulting from neoplasia or cysts. They are source of osteoprogenitor cells and induce bone formation and provide mechanical support for vascular and bone ingrowth. Autografts are used commonly but quantity of retrieved bone is limit. This study was designed to evaluate autograft and new xenograft (Bovine fetal growth plate) effects on bone healing process. Twenty male White New Zealand rabbits were used in this study. In autograft group the defect was filled by fresh autogenous cortical graft, in xenograft group the defect was filled by a segment of bovine fetal growth plate and was fixed by cercelage wire. Radiological, histopathological and biomechanical evaluations were performed blindly and results scored and analyzed statistically. Statistical tests did not support significant differences between two groups at the 14th and 28th postoperative day radiographically (P > 0.05). There was a significant difference for remodeling at the 42nd postoperative radiologically (P < 0.05). Xenograft was superior to autograft at the 56th postoperative day for radiological bone formation (P < 0.03). Histopathological and biomechanical evaluation revealed no significant differences between two groups. The results of this study indicate that satisfactory healing occurred in rabbit radius defect filled with calf fetal growth plate. Complications were not identified and healing was faster than cortical autogenous grafting. It was concluded that the use of calf fetal growth plate as a new xenograft is an acceptable alternative to cortical autogenous graft and could reduce the morbidity associated with harvesting autogenous graft during surgery.     

Construction of Radial Defect Models in Rabbits to Determine the Critical Size Defects

Many studies aimed at investigating bone repair have been conducted through animal models in recent years. However, limitations do exist in these models due to varying regeneration potential among different animal species. Even using the same animal, big differences exist in the size of critical size defects (CSD) involving the same region. This study aimed to investigate the standardization of radial bone defect models in rabbits and further establish more reliable CSD data. A total of 40 6-month-old New Zealand white rabbits of clean grade totaling 80 radial bones were prepared for bone defect models, according to the principle of randomization. Five different sizes (1.0, 1.2, 1.4, 1.7 and 2.0 cm) of complete periosteal defects were introduced under anesthesia. At 12 weeks postoperatively, with the gradual increase in defect size, the grades of bone growth were significantly decreased in all 5 groups. X-ray, CT scans and H&E staining of the 1.4, 1.7, and 2.0-cm groups showed lower grades of bone growth than that of the 1.0 and 1.2-cm groups respectively (P < 0.05). Using rabbit radial defect model involving 6-month-old healthy New Zealand white rabbits, this study indicates that in order to be critical sized, defects must be greater than 1.4 cm.     

硫酸钙作为微小颗粒骨载体的实验研究

目的：研究硫酸钙作为微小颗粒骨载体,解决微小颗粒骨的自身缺点的实际效果,为其临床应用提供依据。方法：将49只日本大耳白兔随机分成4组并通过手术造成双侧桡骨中段1．5cm骨缺损,以植入硫酸钙为载体的自体微小颗粒骨为实验组,同时设立单纯植入自体微小颗粒骨,单纯植入硫酸钙和不植入任何物质的空白对照组。术后4周和8周分别行大体观察。X线摄片,组织学观察,骨生物力学测定。结果：以硫酸钙为栽体的自体微小颗粒骨组比单纯自体微小颗粒骨组及单纯硫酸钙组能更有效地修复骨缺损,单纯颗粒骨组成骨效果优于单纯硫酸钙组。空白组无骨愈合迹象;组织学观察示以硫酸钙为载体的自体微小颗粒骨实验组的成骨效果最好,单纯自体微小颗粒骨组次之;生物力学测定证明以硫酸钙为载体的自体微小颗粒骨实验组的力学强度优于单纯自体微小颗粒骨组及单纯硫酸钙组。结论：硫酸钙是微小颗粒骨的优良载体,以硫酸钙为载体的自体微小颗粒骨成骨速度快,成骨量多,质量高,骨的机械强度高,修复骨缺损的能力较单纯应用微小颗粒骨和硫酸钙强;二者结合可充分发辉各自的优势。     

Experimental bone defect healing with xenogenic demineralized bone matrix and bovine fetal growth plate as a new xenograft: radiological, histopathological and biomechanical evaluation

The following study was designed to evaluate xenogenic bovine demineralized bone matrix (DBM) and new xenograft (Bovine fetal growth plate) effects on bone healing process. Twenty male White New Zealand rabbits were used in this study. In group I (n = 10) the defect was filled by xenogenic DBM and in group II (n = 10) the defect was filled by a segment of bovine fetal growth plate and was fixed by cercelage wire. Radiological, histopathological, and biomechanical evaluations were performed blindly and results scored and analyzed statistically. Statistical tests did not support significant differences between two groups radiographically (P > 0.05). There was a significant difference for union at the 28nd postoperative radiologically (P < 0.05). Xenograft was superior to DBM group at the 28th postoperative day for radiological union (P < 0.03). Histopathological and biomechanical evaluation revealed no significant differences between two groups. In conclusion, the results of this study indicate that satisfactory healing occurred in rabbit radius defect filled with xenogenic bovine DBM and xenogenic bovine fetal growth plate. Complications were not identified and healing was faster in two grafting groups.     

紫芝子实体对大鼠桡骨骨折的促进愈合作用的研究

本文通过建立大鼠桡骨骨折生理性模型,探讨了紫芝子实体不同极性提取物促进骨折愈合的作用。首先制备紫芝的石油醚、乙酸乙酯、乙醇、水等提取物,对选取的144只雌雄各半大鼠制作桡骨骨折模型,之后随机分为8组,每组分别给紫芝不同极性的提取物,并于连续灌胃10d、20d、30d用X射线仪和光学显微镜观察各给药组大鼠的骨痂组织生成和大鼠脏器及骨折部位的病理组织学改变情况,检测大鼠血清中钙、磷、碱性磷酸酶含量。结果表明,影像学观察后紫芝不同提取物对大鼠骨折具有不同程度的促进愈合作用,其中,水煎组显示出明显的促进愈合作用,于30d时骨痂已形成,骨性愈合,骨折线消失,骨髓腔复原,骨折已经基本痊愈,水提取物组其次,而其他3组与模型对照组骨折大鼠愈合时间相近。病理组织学观察表明水提取物组和水煎组对大鼠脾、胸腺、肝、肾脏各脏器无任何影响。对骨组织切片染色后观察,灌胃10d后可见造模的7组大鼠骨折边缘均出现大量间充质细胞,而水煎组出现软骨连接;于20d观察两种水提物组骨折边缘间充质细胞退化,少量胶原纤维包绕骨折骨,断骨近端软骨细胞退化,骨小梁相互连接向板层骨转变,而其余各组均形成软骨连接;于30d观察发现7组骨折边缘间充质细胞均出现退化,而水煎组骨折处胶原纤维与正常骨膜无明显差异。对钙含量的检测中,水煎提取物组与模型对照组比较,具有极显著差异（P<0.01）;对磷含量的检测中,石油醚、乙酸乙酯、水煎提取物组与模型对照组比较有极显著差异（P<0.01）;对碱性磷酸酶含量的检测中,水煎组与阳性对照组、与模型对照组相比均呈上升趋势。结果表明紫芝子实体水煎组具有较好地促进大鼠桡骨骨折的愈合作用。     

Experimental study and clinical use of the fasciosteal flap

Thirty-seven domestic rabbits, 4 dogs, and 2 freshly amputated human limbs were divided into three groups as three different models of fasciosteal flaps that were taken from the distal radii or the tibiae. Through the methods of histology, fluorochrome bone labeling, and perfusing stain, it was confirmed that viability of the bone graft can be maintained by blood flow by means of the fascial route. This technique was used for treating eight patients with nonunion of such different fractured sites as the scaphoid, the talus, and so forth or with osteomyelitic tibial defects or both skin and tibial defects. With 8 to 15 months of follow-up, the osteomyelitis cleared uneventfully and the fracture healed. Patients recovered their normal function. We think that there are at least three routes for the blood supply from deep fascia to bone: direct blood supply, blood supply by means of bone membrane, and blood supply by means of the intermuscular septum. We feel that the fasciosteal flap is an ideal random-pattern vascularized bone graft.