富含血小板血浆在骨科的应用前景

富含血小板血浆是近几十年来出现的一种血液制品,由于制备方法和应用方式不同而备受争议,但是由于其自身特点及其独特优势目前受到了很多关注。现在随着骨科病人增多和病种增多,很多病人出现了骨不连及骨折部位愈合不良的现象。在骨科领域应用富含血小板血浆,促进骨折愈合,为研究骨折愈合相关机制开辟了一个更广阔的领域。     

富血小板血浆在脊柱脊髓损伤治疗中的应用进展

富血小板血浆是近些年来比较热门的一种血液制品,其来源于自体,且制备方法简单,又富含大量血小板及多种生长因子,能够加速骨愈合,增强骨再生,促进软组织及神经损伤恢复,因此得到了广泛的关注。国内外的研究人员根据富血小板血浆所具有的特点,针对各个方面对其进行了大量的研究实验,并且在临床骨科疾病的治疗中也已经开始了实验性应用,如骨缺损、骨再生,肌腱、韧带及软组织损伤,脊柱脊髓损伤等。尤其是在脊柱脊髓损伤的治疗方面,无论是单独应用富血小板血浆治疗,还是联合应用富血小板血浆与脊髓神经前体细胞、骨髓间充质干细胞等有利于脊髓神经损伤恢复的细胞因子复合物共同治疗,均取得了突破性的进展,为研究脊柱脊髓损伤的治疗提供了新的方向。     

生长因子在骨折愈合过程中作用的研究进展

骨折愈合是一个复杂的病理生理过程,涉及多种细胞和生长因子的协同作用。随着分子生物学和基因工程的发展,生长因子在骨折愈合过程中的基础研究和临床应用取得了较大的进展。本文就转化生长因子β．碱性成纤维细胞生长因子、血小板衍生生长因子、表皮生长因子、神经生长因子等五种生长因子在骨折愈合过程中的作用及近年来的研究进展作一综述,并分析五种生长因于在法医学中的应用前景。     

上海交通大学医学院附属新华医院崇明分院检验科

目的:探讨富血小板血浆(platelet-rich plasma,PRP)结合组织工程皮肤对裸鼠巨大创面修复的影响。方法:首先,利用密度梯度离心法制备富含生长因子的浓缩血小板的血浆,并测其所含生长因子的量;其次,在裸鼠的背侧部分构建大面积皮肤创面,分别用人工真皮,组织工程皮肤,碱性成纤维细胞生长因子组织工程皮肤,表皮生长因子组织工程皮肤和PRP结合组织工程皮肤修复裸鼠巨大创面;最后,手术后不同时间间隔收集组织标本,采用HE染色,PAS染色和免疫组化等方法评估创面愈合情况。结果:PRP结合组织工程皮肤组创面修复愈合情况最好。     

富血小板血浆联合同种异体骨治疗非感染性骨不连的临床应用

目的:评价富血小板血浆联合同种异体骨治疗非感染性骨不连的临床疗效。方法:回顾性分析我院创伤骨科2010年2月-2015年1月的非感染性骨不连患者,比较同种异体骨加富血小板血浆混合物与自体髂骨植骨治疗非感染性骨不连的疗效。结果:两组共随访非感染性骨不连患者69例,全部进行了术中断端植骨,其中富血小板血浆联合同种异体骨植骨组(PRP组)21例,其中愈合19例,未愈合2例,临床愈合率90.5%。自体髂骨植骨组(自体骨组)48例,愈合44例,4例未愈合,临床愈合率91.6%。PRP组平均手术持续时间为(108.73±13.91),自体骨组为(120.54±13.87)min,两组间有统计学意义(P0.05)。术后3月,PRP组患者X线骨痂评价标准平均评分值为(2.54±0.43)分,自体骨组为(2.62±0.45)分,两组间差异无统计学意义(P0.05)。结论:富血小板血浆混合同种异体骨植骨治疗骨不连较传统自体髂骨植骨可缩短手术时间,避免供骨区并发症,修复效果良好,为骨不连的治疗提供了一个新的方法。     

血流变学指标及血清学指标在骨折延迟愈合患者中的临床意义

目的:探讨血流变学和血清学指标在骨折延迟愈合患者中的变化及其临床意义。方法:随机选取2010年1月~2016年6月在我院进行手术治疗的骨折延迟愈合及骨折正常愈合患者各90例,分别为观察组与对照组,对比分析两组患者术后第1、8、12周时血清可溶性血管细胞黏附分子1(sVCAM-1)、胰岛素样生长因子1(IGF-1)、血小板衍生生长因子(PDGF)及人可溶性细胞间黏附分子1(sICAM-1)和红细胞刚性指数、红细胞聚集指数、血浆黏度的差异。结果:术后第1、8、12周两组血清学及血流变学各指标整体相比差异均具有统计学意义(均P0.05),且组内两两比较均具有统计学差异(均P0.05)。术后8、12周观察组血清s ICAM-1、sVCAM-1、红细胞刚性指数、红细胞聚集指数、血浆黏度均高于对照组,而血清PDGF、IGF-1均低于对照组,比较差异均具有统计学意义(均P0.05)。结论:骨折患者血清sICAM-1、PDGF、IGF-1、sVCAM-1及红细胞刚性指数、红细胞聚集指数、血浆黏度水平会随着病程进展发生变化,并且血清sICAM-1、sVCAM-1及红细胞刚性指数、红细胞聚集指数、血浆黏度水平的升高,血清PDGF、IGF-1水平的降低可能是引起骨折延迟愈合的重要因素,对于骨折患者的临床治疗具有重要临床意义。     

烧伤合并四肢骨折治疗的探讨

目的:对适用于烧伤合并四肢骨折手术所采用的方法,选择的时机和疗效进行了回顾性分析。研究方法:总结分析了自2008至2014年1月份的28例烧伤合并四肢骨折病人的手术案例。结果:采取内固定手术方法的患者骨折全部愈合。采取外固定支架手术的患者有1例出现针适感染,在手术后8个月患者的骨折愈合,并做外固定支架的拆除处理;有3例患者在手术后骨折愈合,但小腿的烧伤创面不愈合,窦适。有1例患者的小腿近于髓端出现骨折,采取外固定支架方法进行治疗,该方法使患者的踝关节功能受到很大限制。结论:对烧伤合并四肢骨折的治疗应在制定治疗方案时做到综合考虑,在早期实施手术治疗,依据烧伤的程度和骨折程度、烧伤和骨折部位以及患者身体条件选择适当的固定治疗方式。     

某些药物对老年病人的影响

老年病人因同时患有多种疾病,治疗时应用药物的种类较多,约有1/4老年病人同时用4~6种药物治疗,因此药物副作用发生率较大,约15%,且其发生率与用药种类成正比,因此,老年人用药问题值得注意。现将老年人用药易出现的问题及处理原则加以介绍。(1)对乙酰氨基酚:虽无明显的副作用,但由于在老年人的血浆中半衰期明显延长,故应加以注意。(2)肝素:60岁以上的病人用药后出血发生率增加,特别是女性患者。故在用药期间应密切观察出血倾象,并避免同时应用抗血小板功能的药物(如阿斯匹林)。(3)华法林:老年人用药后作用及副作用均增强,可能因老年人血浆蛋…     

富血小板浓缩物在鼓膜穿孔中的疗效及研究进展

鼓膜穿孔(tympanic membrane perforation,TMP)是耳鼻咽喉科常见的疾病。急性TMP多数能自愈,而慢性TMP现主要使用手术治疗,然而现有手术治疗方法均存在缺陷,例如需要全麻、费用较高、技巧复杂等,故探究更佳的治疗方法显得尤为重要。富血小板浓缩物主要包括富血小板血浆(platelet-rich plasma,PRP)和富血小板纤维(platelet-rich fibrin,PRF),其富含生长因子和白细胞,故可有效促进组织再生,并降低感染发生率。以往作为新型修复材料,PRP和PRF已被应用于耳科治疗TMP,并被证实在TMP愈合中具有良好的疗效。因此,该文将对近年来血小板浓缩物用于TMP修复的文献进行回顾与总结分析。     

骨科创伤感染采取VSD治疗的临床效果探讨

目的:观察并分析在骨科创伤感染中应用VSD疗法的应用价值。方法:选取80例骨科创伤患者,依据治疗方法的不同将其列入观察组与对照组,每组各为40例。对照组行常规治疗,观察组行VSD治疗,观察两组的疗效。结果:两组治疗有效率和骨折愈合时间比较,差异均有统计学意义(P均0.05)。结论:在骨科创伤感染的治疗中,VSD技术的应用效果显著,可推广。     

NGF与Neuritin在脑外伤伴四肢骨折病人血清中的表达及意义

目的：通过检测脑外伤患者、脑外伤合并骨折患者、骨折患者及正常人外周血中NG3F,neuritin不同时间段的表达,根据其含量的变化,判断与骨折愈合速度的相关性,寻找骨折愈合的关键因子。方法：收集单纯脑外伤、单纯骨折患者各80例、脑外伤合并骨折患者60例、健康体检人群20例。选取外伤后3天、10天、2周抽取所有实验对象的静脉血,应用ELISA技术测定标本中NGF与Neuritin的含量。结果：损伤后每个时间段里,患者血清中NGF、neuritin含量有不同程度升高,均高于正常对照组,其中又以脑外伤合并骨折组最高。血清NGF在骨折合并脑外伤组伤后第3天含量明显升高,为（0．86±0．21）,伤后10天为（1．47±0．29）。14天为（2．07±0．21）,脑外伤合并四肢骨折组neuritin血清含量在伤后第3天略有升高为（83．47±18．85）,10天（108．50±31．65）,2周（91．86±21．12）．脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,差别均有统计学意义（P〈0．05）。结论：脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,说明与骨折愈合有着密切的相关性,两种因子可能在骨折愈合修复过程中共同起作用,从而,推测可能是脑外伤后骨折愈合加速的重要因素。     

New insights into and novel applications for platelet-rich fibrin therapies

The therapeutic use of autologous platelet-rich plasma constitutes a relatively new biotechnology that has been a breakthrough in the stimulation and acceleration of soft-tissue and bone healing. The efficiency of this process lies in the local and continuous delivery of a wide range of growth factors and proteins, mimicking the needs of the physiological wound healing and reparative tissue processes. Consequently, the application of platelet-rich plasma has been extended to many different fields, including orthopedics, sports medicine, dentistry, cosmetic and periodontal medicine and cosmetic, plastic and maxillofacial surgery. This article highlights the use of this technology and discusses some of the obstacles and challenges that need to be addressed to maintain progress in this field.     

Osteoporosis influences the late period of fracture healing in a rat model prepared by ovariectomy and low calcium diet

To elucidate the influence of osteoporosis on the fracture healing, we produced a rat osteoporosis model by ovariectomy and by maintaining a low calcium diet; and monitored the healing process radiographically, histologically, and biomechanically for 12 weeks. Radiologic, histologic and biomechanical findings of the fracture areas 6 weeks after making the fractures were almost identical in both the osteoporosis group and the control group. However, 12 weeks after making the fractures, newly generated bones in the osteoporosis group showed histological osteoporotic changes and their bone mineral density on the fracture site decreased. These findings show that estrogen-deficient and low calcium conditions greatly affect the bone in the later period of the healing process, but do not affect remarkably the early healing period. This is clinically important when we consider fracture treatments for patients with osteoporosis due to menopause.     

Calcitonin effects on cartilage and fracture healing

The literature about the effects of systemically administered calcitonin on fracture healing and in the prevention of disuse osteoporosis after fracture are reviewed in this study. Fracture healing is a biological process of great importance for the survival of the injured animal. Endochondral ossification is augmented in the fracture site followed by fast remodeling of the produced woven bone. There is strong evidence of the direct effects of calcitonin on cartilage proliferation as well as the vascularization of the callus. Calcitonin is found to promote the cartilaginous phase of fracture healing. On the other hand, the innervation of callus reveals an extensive distribution of sensory fibers containing a calcitonin gene-related peptide, a neuropeptide with potent vasodilatory actions. From several experimental studies, salmon calcitonin administration has been found to have a beneficial effect on fracture healing. Studies in humans also concur that calcitonin may speed up the time of fracture repair and facilitate early mobilization of the injured limb. Finally, calcitonin prevents post-fracture bone loss due to increased post-injury remodeling and lowers hydroxyproline and calcium excretion of patients who underwent internal fixation of fracture on the hip.     

强骨胶囊对老年股骨头近段骨折延迟愈合患者血清BMP-2 及IGF-1水平的影响

目的:探究强骨胶囊对老年股骨头近段骨折延迟愈合患者血清骨形态发生蛋白-2(BMP-2)及胰岛素生长因子-1(IGF-1)水平的影响。方法:选择我院收治的股骨近端骨折延迟愈合的老年患者41例,随机分为实验组及对照组。对照组19例予钙片;实验组22例予强骨胶囊。对比两组的临床疗效及治疗前后血清BMP-2及IGF-1水平的改变。结果:实验组总有效率(95.5%)高于对照组(78.9%),差异具备统计学意义(P0.05)。两组血清BMP-2及IGF-1水平均较治疗前显著升高(P0.05),且实验组血清BMP-2和IGF-1水平较对照组高(P0.05)。治疗后,两组血浆粘度均下降、骨密度值(BMD)均升高(P0.05);与对照组相较,实验组血浆粘度降低、BMD较高(P0.05)。结论:强骨胶囊能够有效改善老年股骨头近段骨折延迟愈合,促进骨折断端的愈合,推测其机制与增加患者血清BMP-2及IGF-1水平有关。     

NGF 与Neuritin 在脑外伤伴四肢骨折病人血清中的表达及意义

目的:通过检测脑外伤患者、脑外伤合并骨折患者、骨折患者及正常人外周血中NGF,neuritin不同时间段的表达,根据其含量的变化,判断与骨折愈合速度的相关性,寻找骨折愈合的关键因子。方法:收集单纯脑外伤、单纯骨折患者各80例、脑外伤合并骨折患者60例、健康体检人群20例。选取外伤后3天、10天、2周抽取所有实验对象的静脉血,应用ELISA技术测定标本中NGF与Neuritin的含量。结果:损伤后每个时间段里,患者血清中NGF、neuritin含量有不同程度升高,均高于正常对照组,其中又以脑外伤合并骨折组最高。血清NGF在骨折合并脑外伤组伤后第3天含量明显升高,为(0.86±0.21),伤后10天为(1.47±0.29),14天为(2.0 7±0.21),脑外伤合并四肢骨折组neuritin血清含量在伤后第3天略有升高为(83.47±18.85),10天(108.50±31.65),2周(91.86±21.12).脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,差别均有统计学意义(P<0.05)。结论:脑外伤合并骨折病人血清NGF、neuritin表达明显高于其他对照组,说明与骨折愈合有着密切的相关性,两种因子可能在骨折愈合修复过程中共同起作用,从而,推测可能是脑外伤后骨折愈合加速的重要因素。     

骨科损伤控制救治对四肢骨折患者血清骨代谢和炎症反应的影响

为探究骨科损伤控制(damage control orthopaedics, DCO)救治对四肢骨折患者血清骨代谢及炎症反应的影响,本研究选取40例四肢骨折患者,随机分为治疗组和对照组,各20例。治疗组采用骨科损伤控制救治四肢骨折患者,对照组则采用常规骨折治疗方法。酶联免疫法检测试剂盒检测骨代谢指标:骨钙素(bone gla protein, BGP)、Ⅰ型前胶原羧基端前肽(propeptide carboxy-terminal procollagen, PICP)水平、血清碱性磷酸酶(alkaline phosphatase, ALP),骨愈合相关指标:可溶性细胞间粘附分子-1 (soluble intercellular adhesion molecule 1, s ICAM-1)、胰岛素样生长因子-1 (insulin like growth factor-1, IGF-1),以及炎症反应相关因子白细胞介素-1 (interleukin-1, IL-1)、白细胞介素-6 (interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor-alpha, TNF-α);统计分析各组患者手术后疼痛程度以及肿胀程度评分。结果表明,骨科损伤控制治疗组的血清骨钙素(BGP)、Ⅰ型前胶原氨基酸末端前肽(PICP)水平、血清碱性磷酸酶(ALP)、可溶性细胞间粘附分子-1 (sICAM-1)和胰岛素样生长因子-1 (IGF-1)水平明显高于对照组;炎症反应因子IL-1、IL-6和TNF-α水平明显低于对照组;骨科损伤控制救治可明显降低四肢骨折患者术后的疼痛程度以及肿胀程度评分。综上所述,骨科损伤控制救治可明显提高四肢骨折患者血清骨代谢和骨愈合水平、降低炎症反应、疼痛以及肿胀程度。     

Is Sonic Hedgehog Involved in Human Fracture Healing? - A Prospective Study on Local and Systemic Concentrations of SHH

Introduction

Sonic Hedgehog (SHH) is a new signalling pathway in bone repair. Evidence exist that SHH pathway plays a significant role in vasculogenesis and limb development during embryogenesis. Some in vitro and animal studies has already proven its potential for bone regeneration. However, no data on the role of SHH in the human fracture healing have been published so far.

Methods

Seventy-five patients with long bone fractures were included into the study and divided in 2 groups. First group contained 69 patients with normal fracture healing. Four patients with impaired fracture healing formed the second group. 34 volunteers donated blood samples as control. Serum samples were collected over a period of 1 year following a standardized time schedule. In addition, SHH levels were measured in fracture haematoma and serum of 16 patients with bone fractures.

Results

Fracture haematoma and patients serum both contained lower SHH concentrations compared to control serum. The comparison between the patients'' serum SHH level and the control serum revealed lower levels for the patients at all measurement time points. Significantly lower concentrations were observed at weeks 1 and 2 after fracture. SHH levels were slightly decreased in patients with impaired fracture healing without statistical significance.

Conclusion

This is the first study to report local and systemic concentration of SHH in human fracture healing and SHH serum levels in healthy adults. A significant reduction of the SHH levels during the inflammatory phase of fracture healing was found. SHH concentrations in fracture haematoma and serum were lower than the concentration in control serum for the rest of the healing period. Our findings indicate that there is no relevant involvement of SHH in human fracture healing. Fracture repair process seem to reduce the SHH level in human. Further studies are definitely needed to clarify the underlying mechanisms.