经皮自体骨髓移植在骨缺损瘢痕组织内成组作用的实验研究 …

观察经皮自体骨髓移植在骨缺损瘢痕组织的成骨作用，探索治疗骨不连的新途径。方法选健康家兔１８只，建立双侧桡骨中段骨及骨膜缺损１ｃｍ模型，６周后，实验侧骨缺损区经皮注射自体红骨髓２ｍｌ，对照侧骨缺损区经皮注射自身外周血２ｍｌ。在不同时间内进行Ｘ线片，组织学检查及新和组织钙，磷含量测定。     

经皮自体骨髓移植在骨缺损瘢痕组织内成骨作用的实验研究与临床应用

目的观察经皮自体骨髓移植在骨缺损瘢痕组织内的成骨作用,探索治疗骨不连的新途径。方法选健康家兔１８只,建立双侧桡骨中段骨及骨膜缺损１ｃｍ模型,６周后,实验侧（右）骨缺损区经皮注射自体红骨髓２ｍｌ,对照侧（左）骨缺损区经皮注射自身外周血２ｍｌ。在不同时间内进行Ｘ线片、组织学检查及新生组织钙、磷含量测定。临床应用经皮自体骨髓移植治疗骨不连１５例,其中腕舟骨不连７例,肱骨不连３例,股骨不连２例,胫骨不连３例。骨不连时间为７～４８个月,平均１３个月。结果实验侧骨缺损区在骨髓注射后不同时间的Ｘ线片、组织学检查均显示新骨形成逐渐增多,钙、磷含量均高于对照侧。对照侧无成骨现象。临床应用的１５例中,１３例在５～９个月骨折愈合,２例未愈合。结论经皮自体骨髓移植在骨缺损瘢痕组织内有成骨作用,在临床上可作为治疗骨不连的方法,尤其适用于骨不连部位软组织条件差、不具备开放植骨的病例。     

骨髓基质细胞促进引导性骨再生的研究

目的观察骨髓基质细胞增强引导性骨再生（GBR）修复骨缺损的能力。方法30只兔造成双桡骨干15mm骨缺损，以硅胶管桥接骨断端，实验组在硅胶管内注射自体骨髓基质细胞（MSC）1ml；对照组注射等量生理盐水。在不同时间内作X线片、大体、组织学观察及生化捡测。结果实验组成骨活跃，10周骨缺损完全修复，对照组各时间点骨修复均较实验组差，10周时仍无1只兔骨性愈合。术后4周实验组钙及碱性磷酸酶含量明显高于对照组（P〈0．01），术后8及10周实验组骨缺损区新生骨骨痂密度与相邻尺骨密度比值亦明显高于对照组（P〈0．01）。结论自体骨髓基质细胞可明显增强GBR修复骨缺损的能力。     

引导性骨再生过程的实验研究

本实验用３５只新西兰兔研究长管状骨引导性骨再生。手术的方法造成双侧兔桡骨中段１０ｍｍ骨缺损。实验侧用缝合成管状的硅胶膜来连接。另一侧作对照。６组分别于术后３天，１、２、３、４、１２周处死，标本行Ｘ线片，组织学检查。早期，大量增殖的纤维细胞被硅膜阻挡在骨缺损区之外，而对照侧骨缺损很快为结缔组织占据。新骨自骨端沿硅管内血肿向骨缺损中央生长。１２周时，１０只兔中有７只实验侧骨缺损已修复，２只近愈合，１只     

引导性骨再生的实验研究

将引导性组织再生的概念用于骨再生过程，以促进骨再生。实验用１０只新西兰兔，手术切除双侧桡骨１０ｍｍ，实验侧用硅胶管连接，对侧为对照。术后Ｘ线片观察骨再生过程，标本分别作三点弯曲试验及组织学检查。结果，术后３～４周，实验侧可见新生骨自骨端向骨缺损区生长。６～８周，７只实验侧达到骨性愈合，２只尚有＜１ｍｍ间隙，但髓腔已闭。对照侧无一愈合。实验侧标本抗三点弯曲强度为对照侧１１．７倍，大体标本观察及组织学检查均表明，新生骨位于硅管内，无外骨痂。对照侧骨缺损区为结缔组织占据。本实验证实，长骨存在引导性骨再生现象，这为骨科临床中促进骨再生，骨缺损修复提供了新的思路。关键词     

酸性成纤维细胞生长因子促进引导性骨再生的实验研究

目的　研究酸性成纤维细胞生长因子（α Ｆ Ｇ Ｆ）对引导性骨再生（ Ｇ Ｂ Ｒ）的作用,增强 Ｇ Ｂ Ｒ 修复骨缺损的能力。方法　１６ 只新西兰白兔分为四组,每组 ４ 只,造成兔双侧桡骨干１０ ｍ ｍ 节段性骨缺损,以硅胶管桥接骨缺损,实验侧管内置入人基因重组酸性成纤维细胞生长因子（ｈｒａ Ｆ Ｇ Ｆ）２４ μｇ,对侧管内注入生理盐水作对照。于术后２、４、６ 及８ 周各处死一组兔,作 Ｘ 线、大体、组织学观察。结果　实验侧术后２ 周即在骨断端髓腔、骨内膜及皮质断面处有新骨形成,并长入管内血肿,术后４ 周新骨长入血肿中心,８ 周完全骨愈合。对照侧在各阶段新骨形成均不如实验侧,８ 周时仅出现部分骨愈合。结论　酸性成纤维细胞生长因子（ａ Ｆ Ｇ Ｆ）可促进 Ｇ Ｂ Ｒ,增强其修复骨缺损的能力。     

引导性骨再生模型（GBR）成骨特点及骨髓的作用

目的∶研究引导性骨再生模型（ＧＢＲ）的成骨特点及骨髓的作用。材料与方法∶本实验应用了２４只新西兰兔，兔右侧桡骨为ＧＢＲ侧，左侧为去骨髓侧。ＧＢＲ侧手术过程：于兔右侧桡骨做１０ｍｍ骨缺损，以硅胶管套于缺损两侧；去骨髓侧以骨水泥封堵缺损两端髓腔。动物于３日、１、２、３、４、６、１０、１２周处死，标本做非脱钙骨切片，分析大体观察、Ｘ线及非脱钙骨组织切片结果。结果：（１）骨髓在ＧＢＲ模型膜管内成骨过程中起决定作用；（２）ＧＢＲ模型骨修复方式：于膜管内骨缺损两端分别形成两成骨尖端，两成骨尖端相对生长至愈合；（３）膜管内成骨过程早期为成骨细胞直接成骨过程，后期成骨尖端缺乏成熟皮质骨结构。结论：ＧＢＲ模型基础为隔膜干扰技术，其骨缺损修复为一特殊成骨过程，骨髓对其起决定作用。     

经皮注射自体骨膜细胞修复骨缺损的实验研究

为研究经皮注射自体骨膜细胞能否促进骨缺损的修复，探讨修复骨缺损的新方法。本实验用健康新西兰兔１２只，无菌操作下切取胫骨前内侧骨膜，进行骨膜细胞培养，然后将培养的单层骨膜细胞收集后经皮注射至预制的供体动物一侧的桡骨缺损内，对侧桡骨缺损做对照。     

自体骨膜细胞移植治疗骨不连的实验研究

目的：研究自体骨膜细胞移植能否促进骨修复，探讨治疗骨不连的新方法。方法：用健康新西兰兔１０只，切取胫骨前内侧骨膜，进行骨膜细胞培养，然后将培养的单层骨膜细胞收集后移植至供体动物一侧的桡骨缺损内，对侧桡骨缺损做对照。术后２、４、６和８周进行Ｘ线平片和组织病理学检查。结果：大多数实验侧于术后６～８周发生骨性愈合；而对照侧均未发生骨性愈合。结论：自体骨膜细胞移植具有促进骨修复的作用。     

巯基烷基化壳聚糖介导piRES-hVEGF121cDNA／hBMP-4真核双表达质粒修复兔桡骨缺损的初步研究

IB的研究以巯基烷基化壳聚糖（TACS）介导的双核共表达质粒（pIRES—hVEGF121cDNA／hBMP-4）修复骨缺损的作用。方法以新西兰兔15只（30侧）为实验动物,制作桡骨中段15mm长的骨缺损实验模型,分实验组（左侧桡骨）和对照组（右侧桡骨）,实验组植入明胶海绵＋双基因混悬液,对照组植入明胶海绵＋等量生理盐水,并于术后6周、8周、12周对骨缺损区进行大体观察、X线观察、X线阻射密度测定及组织形态学观察,图像分析骨小梁的生成数量。结果实验组在12周内骨缺损完全修复,且同时期内新生骨的数量和质量显著优于对照组：对照组骨缺损主要由纤维结缔组织填充。结论TACS介导的pIRES—hVEGF121cDNA／hBMP-4真核双表达基因具有良好的促进骨缺损修复的能力。     

自体骨髓促进引导性骨再生

目的　研究自体骨髓增强引导性骨再生 (GBR)修复骨缺损的能力。方法　 18只兔分为 5组 ,每组 3只 (第 5组 6只 ) ,造成双桡骨干 10 mm骨缺损 ,以硅胶管桥接骨断端 ,实验组于 0、2和 4周分别在硅胶管内注射自体骨髓 0 .3ml;对照组于相同时间点注射等量外周静脉血。在不同时间内作 X线片、大体、组织学观察及生化检测。结果　实验组成骨活跃 ,10周骨缺损完全修复 ,对照组各时间点均较实验组差 ,10周时仍无 1只兔骨性愈合。术后 2、4周实验组钙及碱性磷酸酶含量明显高于对照组。结论　自体骨髓可明显增强 GBR修复骨缺损的能力     

三种移植骨材料修复骨缺损能力的比较研究

目的 研究单纯异种无机骨，复合骨髓异种无机骨以及自体皮质骨修复骨缺损的能力。方法 取健康6月龄纯系新西兰大白兔22只，制作兔桡骨节段性骨缺损（1.5cm)模型。根据植入物的不同，随机分为自体皮质骨组（10肢），单纯异种无机骨组（10肢），复合骨髓的异种无机骨组（20肢）和空白对照组（4肢），术后2、4、6、8、12周进行放射线片和组织学观察。结果 单纯异种无机骨植入组，直至12周，仍为缓慢的骨传导过程，周边骨小梁向无机骨内爬行替代，异种无机骨内大部分为纤维组织，只有少数中心区域有新骨形成，而复合骨髓的异种无机骨植入后2周即有新骨形成，8周无机骨基本吸收替代完毕，12周髓腔形成，塑形改造，基本相关于自体皮质骨移植的融合速度，结论 复合骨髓的异种无机骨的成骨能力明显优于单纯异种无机骨，与自体皮质骨相当。     

A study of 23 unicameral bone cysts of the calcaneus: open chip allogeneic bone graft versus percutaneous injection of bone powder with autogenous bone marrow

BACKGROUND: The treatment of unicameral bone cyst varies from percutaneous needle biopsy, aspiration and local injection of steroid, autologous bone marrow, or demineralized bone matrix to curettage and open bone-grafting. The purpose of this study was to compare the results of open chip allogeneic bone graft versus percutaneous injection of demineralized bone powder with autogenous bone marrow in management of calcaneal cysts. MATERIALS AND METHODS: Twenty-three calcaneal unicameral cysts in 20 patients were treated. Lyophilized irradiated chip allogeneic bone (CAB) and autogenous bone marrow were used for treatment of 13 cysts in 11 patients, and 10 cysts in 9 patients were treated with percutaneous injection of irradiated allogeneic demineralized bone powder (DBP) and autogenous bone marrow. There were 11 males and 9 female patients with mean age of 17 years. RESULTS: The patients were followed for an average of 49.4 months. Complete healing was achieved in 9 cysts treated with chip allogeneic bone and in 5 cysts treated with powdered bone. Four cysts treated with CAB and 3 cysts treated with DBP healed with a defect. Two cysts treated with powdered bone and autogenous bone marrow were classified as persistent. No infections or pathological fractures were observed during the followup period. CONCLUSION: Percutaneous injection of a mixture of allogeneic bone powder with autogenous bone marrow is a minimal invasive method and could be an effective alternative in the treatment of unicameral calcaneal bone cysts. The postoperative morbidity was low, the hospital stay was brief, and patient's comfort for unrestricted activity was enhanced.     

Percutaneous transplantation of pulverized bone in rabbits

The effects of percutaneous injection of the pulverized bone on osteogenesis at the site of bone defect were investigated in rabbits. Although the ceramic bone mixed with blood coagula showed the osteogenic capacity in fresh bone defects, it did not show this capacity in old bone defect. Injection of pulverized bone mixed with blood coagula resulted in greater bone formation than did pulverized bone mixed with saline. Three types of pulverized bone were used: ceramic bone, Kiel bone and autologous corticocancellous bone. Ceramic bone showed the greatest capacity in osteogenesis. These results suggest that the percutaneous injection of pulverized ceramic bone is effective in the treatment of fresh bone defects.     

经皮交叉克氏针固定、自体骨髓移植治疗Herbert Ⅰ型腕舟骨骨折的临床研究

目的观察经皮交叉克氏针固定、自体骨髓移植治疗HerbertⅠ型腕舟骨骨折的临床效果。方法随机选择36例新鲜无错位（HerbertⅠ型）腕舟骨骨折患者，采用经皮交叉克氏针固定，抽取自体红骨髓5ml，快速、加压注入舟状骨骨折部位，术后6周开始，每周拍摄计算机X线片（CR-X）1次，至骨折愈合，并记录骨折愈合及恢复工作时间。结果术后随访6周～4年，36例全部愈合，骨折愈合时间为7～12周，平均8．3周。35例腕关节活动度达到健侧腕关节活动标准，活动后无疼痛，均恢复了正常工作。1例腕关节伸屈活动术后较术前有明显改善，但仍未达健侧腕关节活动范围，且活动时疼痛。结论经皮交叉克氏针固定、自体骨髓移植治疗HerbertⅠ型腕舟骨骨折，较传统治疗方法，具有损伤小、操作简单、安全，最大限度地避免了医源性损伤，缩短了骨折愈合时间，提高了治愈率，是一种有效的治疗方法。     

富血小板血浆／人工骨修复兔桡骨骨缺损的实验研究

目的探讨富血小板血浆和羟基磷灰石生物陶瓷复合物修复兔桡骨节段性骨缺损的疗效。方法新西兰大白兔12只,切除兔双前肢桡骨中下段1 cm连同骨膜的骨质造成骨缺损,选择左侧前肢为实验侧,右侧前肢为对照侧。实验侧缺损区植入富血小板血浆加羟基磷灰石生物陶瓷,对照侧缺损区单纯植入羟基磷灰石生物陶瓷。术后第2、4、8和12周分别处死3只实验动物,进行大体观察、X线片、组织学、新生骨面积图像分析和透射电镜等观察两侧桡骨愈合情况。结果术后所有动物无感染、死亡,植入物无脱落。大体标本和X线片显示：术后2周实验侧和对照侧在人工骨与宿主骨交界处均有较多肉芽组织,实验侧略多。第4、8周实验侧人工骨表面及孔隙被新生骨组织包裹填充,人工骨与自体骨吻合好;对照侧骨痂主要限于人工骨两端,与对侧比较相对较幼稚。第12周,实验侧骨缺损修复完全,人工骨表面被皮质骨完全包裹;对照侧在人工骨两端区域有板层骨形成,表面未见连续性骨痂。组织学和透射电镜观察显示：随着术后时间的延长,实验侧骨细胞生长明显优于对照侧,有统计学差异。结论富血小板血浆加人工骨复合对管状骨缺损的修复有明显的加速愈合功能。     

自身骨泥在长管状骨骨折中的应用与实验研究

探讨长管状骨钢板内固定产生的自身骨泥有无骨诱导活性,能否作为植骨材料及其临床应用。采用22只兔桡骨钻孔采集的骨泥股部肌肉内植入,在二周时五只兔做ECT检测,在一、二、三周取材,做组织形态学观察和碱性磷酸酶(ALP)检测。另5只兔桡骨中段骨折模型一侧自身骨泥植骨、对侧对照,二周做ECT检测。研究结果显示:自身骨泥植入兔肌袋内一周软骨生长,三周网织骨形成;ALP二周水平最高;二周ECF检查肌肉植入区出现放射性浓集,放射性计数明显高于对侧正常肌肉(P<0.05)。骨折模型植骨ECT计数比值明显高于对侧(P<0.05)。52例56处长管状骨钢板内固定自身骨泥植骨取得了良好效果,无一侧骨延迟愈合或骨不连。结果表明长管状骨内固定产生的自身骨泥具有诱导成骨活性,可做为植骨材料,应用于长管状骨骨折钢板内固定一期植骨,可望促进骨折愈合。     

Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow

BACKGROUND: The treatment of unicameral bone cysts varies from open bone-grafting procedures to percutaneous injection of corticosteroids or bone marrow. The purpose of this study was to evaluate the feasibility and effectiveness of percutaneous injection of a mixture of demineralized bone matrix and autogenous bone marrow for the treatment of simple bone cysts. METHODS: Twenty-three patients with an active unicameral bone cyst were treated with trephination and injection of allogeneic demineralized bone matrix and autogenous bone marrow. The patients were followed for an average of fifty months (range, thirty to eighty-one months), at which time pain, function, and radiographic signs of resolution of the cyst were assessed. RESULTS: The average time until the patients had pain relief was five weeks, and the average time until the patients returned to full, unrestricted activities was six weeks. Bone-healing at the site of the injection was first seen radiographically at three to six months. No patient had a pathologic fracture during this early bone-healing stage. Cortical remodeling was seen radiographically by six to nine months, and after one year the response was usually complete, changing very little from then on. Five patients required a second injection because of recurrence of the cyst, and all five had a clinically and radiographically quiescent cyst after an average of thirty-six additional months of follow-up. Seven of the twenty-three patients had incomplete healing manifested by small, persistent radiolucent areas within the original cyst. None of these cysts increased in size or resulted in pain or fracture. CONCLUSIONS: Percutaneous injection of allogeneic demineralized bone matrix and autogenous bone marrow is an effective treatment for unicameral bone cysts.     

Clinical and radiographic outcomes of posterolateral lumbar spine fusion in humans using recombinant human bone morphogenetic protein-2: an average five-year follow-up study

The objectives of this study were to determine whether recombinant human bone morphogenetic protein-2 (rhBMP-2) can be used as the sole stimulator of osteogenesis with success equal to an autologous graft in posterolateral lumbar fusion (PLF) at the same level and to describe the progress until bone union. This study included 11 patients who underwent PLF of L4-5. On the right side, only rhBMP-2, for which polylactic/glycolic acid (PLGA) was used as a carrier, was used, whereas, on the left side, autogenous bone was used. The bone union rate was 73 and 82% at 12 and 24 months after surgery, respectively, on the right BMP side, while the rate on the autogenous bone side was 91%. There was no statistically significant difference in the bone union rate. rhBMP-2 can be used as the sole source of osteogenesis with success equivalent to an autologous graft of the PLF.