兔脊柱结核模型的构建

目的 在兔腰椎椎体钻孔种植人型H37 Rv结核标准菌株构建兔脊柱结核模型.方法 对16只兔腰5椎体上方钻孔,填充明胶海绵,吸附结核菌混悬液0.1 ml(菌量:5g/L)骨蜡封闭钻孔,在术后不同时间段行大体观察、影像学、组织病理学、细菌学等检查.结果 16只大白兔中,其中13只兔腰椎椎体感染结核菌后,局部反应较明显,全身反应较轻,完成实验;3只未感染结核杆菌.在感染的大白兔中,2只出现消瘦、厌食等症状;术后1个月X线阳性4只,术后2个月X线阳性8只、CT阳性12只、MRI阳性13只;感染大白兔的椎体、椎旁软组织切片苏木素-伊红(HE)染色示有脓细胞、类上皮样细胞或坏死灶等形成,对形成的脓肿进行脓液培养显示69.2％结核分枝杆菌生长.建立模型成功率为69.2％.结论 通过在兔脊柱椎体局部进行适当剂量H37 Rv结核标准菌株的种植感染,可构建出与人类脊柱结核病理变化相似的兔脊柱结核.     

构建新西兰兔脊柱结核模型的对比研究

 目的 探讨构建新西兰兔脊柱结核模型的实验方法,并评价此种方法的可行性。方法 62只新西兰兔随机分为致敏造模组（经弗氏完全佐剂致敏后造模）20只、未致敏造模组（造模前未经弗氏完全佐剂致敏）20只、对照组20只、空白组2只。致敏造模组兔经弗氏完全佐剂致敏后,于L4上终板下方钻孔,填入明胶海绵,在其中浸注种植H37Rv人型标准结核杆菌混悬液0.1 ml;未致敏造模组未经弗氏完全佐剂致敏,浸注H37Rv人型标准结核杆菌混悬液0.1ml;对照组浸注液体培养基与生理盐水混悬液0.1 ml;空白组不做任何处理。结果 术后8周兔存活率致敏造模组为89.5%、未致敏造模组60.0%,对照组94.7%、空白组100%;致敏造模组成活兔造模全部成功。致敏造模组造模椎体破坏情况：术后4周X线片为50%、重建CT和MRI均为 83.3%;术后8周X线片为58.8%、CT重建和MRI均为100%。术后8周,肉眼观察全部成活兔造模椎体均出现骨破坏、肉芽及坏死组织形成,腰大肌脓肿发生率为17.6%;组织病理学显示造模椎体均有大量淋巴细胞和类上皮样细胞、骨小梁断裂、凝固性坏死物质;细菌培养阳性率为52.9％。未致敏造模组术后8周有75%成活兔造模椎体出现骨破坏,腰大肌脓肿发生率为100%。对照组与空白组无上述改变。结论 经弗氏完全佐剂致敏后,在新西兰兔腰椎椎体的上终板下钻孔、明胶海绵填塞、种植H37Rv结核杆菌标准菌株的方法,可成功构建兔脊柱结核模型。     

小鼠不同周龄与骨密度的关系

目的　采用pQCT设备 ,以整体小鼠胫骨为检测对象 ,了解不同周龄骨密度含量以及不同组分面积 ,为进行小鼠骨代谢研究提供参考。方法　 4～ 12周龄昆明种小鼠 30只 ,雌性 ,每 6只为 1组。用戊巴比妥钠麻醉后 ,固定于检测台上 ,以右后肢为被测对象 ,采用德国产动物用pOCT设备 ,分别对胫骨近端骨骺线 1 4mm和 4 0mm处进行测定。结果　小鼠 4～ 12周龄 ,体重增长很快 ,周龄与体重的相关性r=0 96 3,P <0 0 0 1;此阶段胫骨总骨密度、皮质骨密度随着周龄的增长而增加 ,呈非常显著的正相关 ;周龄与骨小梁的骨密度无明显相关性 ;8周龄时胫骨小梁面积最大。结论　pQCT能灵敏、精确的测定整体小鼠胫骨 ,有效地区分各个不同组分 ,可以动态的观察骨骼的变化 ,以 8～ 10周龄的小鼠适宜造模型。     

超短程化疗方案及病变椎体部分切除术治疗脊柱结核

目的探讨三种化疗方案及病变椎体部分切除术治疗脊柱结核的临床效果。方法1998年12月至2003年11月,将收治的76例脊柱结核分为三组超短程化疗组38例,化疗方案2SHRZ/2.5H2R2Z2,疗程4.5个月;短程化疗组23例,方案为3SHRZ/5H2R2Z2,疗程8个月;标准化疗组15例,方案为3SHRZ/9H2R2Z2,疗程12个月。术前化疗时间三组基本相同,为15~40d,平均21d。全部病例均采用前路病变椎体部分切除、大块髂骨支撑植骨、前路或后路内固定手术。结果超短程、短程和标准化疗组平均随访时间分别为23、28和45个月。观测指标为(1)临床表现结核病症状消失,一般情况良好,无主诉疼痛,恢复正常工作或生活;体温正常,病变局部无叩击痛;神经功能恢复;术后1个月下地,4~5个月恢复工作。(2)实验室检查ESR、CRP两项或一项正常或接近于正常。(3)影像学检查X线片、CT、MRI见脓肿消失,无新生破坏灶,无植骨床与植骨吸收现象,植骨界面出现骨愈合征象,畸形矫正满意、矫正角度丢失<5°。(4)B超可能出现椎旁脓肿或流注脓肿的部位无液性暗区。(5)药物并发症随访时肝、肾功能正常或基本正常。随访时三组均达到以上标准,为优良效果,并且三组效果相同。结论超短程化疗、短程化疗和标准化疗方案结合前路脊柱结核病变椎体部分切除植骨、前路或后路内固定术治疗脊柱     

脊柱椎体后部结核合并椎管内脓肿的外科治疗

典型的脊柱结核多累及2个以上的椎体前部, 易形成椎前和椎旁脓肿及脊柱后凸畸形。临床上仅局限在椎体后部的脊柱结核较少报道,因本病形成的椎管内脓肿可直接对相邻脊髓产生压迫,故可较早产生脊髓受累的并发症。1999年8月-2004年 7月我院共收治该类椎体结核患者28例,均早期采取外科手术治疗并取得较满意的疗效。     

脊柱结核的外科治疗及康复

[目的]回顾性分析脊柱结核的外科治疗方案。[方法]统计2002～2004年收治1d例患者的临床资料，对其翼妻方案、疗效进行分析。[结果]10例患者均恢复优良，术前症状消失，随访无复发，病灶区融合牢靠。[结论]脊柱结核彻底清创、一期植骨固定后，经正规化疗效果满意。     

病变椎体部分切除、髂骨植骨及内固定术治疗脊柱结核

目的:探讨病变椎体部分切除、植骨、内固定手术治疗脊柱结核的临床效果。方法:对55例脊柱结核患者,术前抗痨治疗9~38d后采用前路病变椎体部分切除、大块髂骨支撑植骨、前路或后路器械内固定手术。融合2个椎间隙以下者行前路固定24例;融合3个椎间隙以上者行后路固定31例,其中前后路同期手术者14例,分两期手术者17例。术后负压引流3~5d。结果:随访24~70个月,平均38个月。24例伴脊柱畸形者后凸Cobb角由术前平均22°矫正至术后平均9°,随访时平均11°。19例伴神经功能障碍者均有不同程度恢复。术后半年87%的患者血沉达到正常,CRP93%达到正常;1例出现并发症,经再次手术治愈。X线片复查见全部患者于术后3~6个月(平均5.5个月)植骨愈合,均恢复了正常生活与工作。结论:病变椎体部分切除、植骨、内固定术病灶清除彻底,病椎骨融合快,复发率低,患者卧床时间短,缩短了脊柱结核的疗程,是治疗脊柱结核的有效术式。     

相隔单椎体跳跃性椎体结核的手术治疗

目的探讨前路病灶清除植骨融合内固定治疗相隔单椎体跳跃性椎体结核的临床疗效。方法2002年3月至2005年3月,对21例相隔一个正常椎体的跳跃性胸腰椎椎体结核患者施行前路病灶清除植骨融合椎体钉棒内固定治疗,植骨采用自体髂骨-肋骨或钛网-肋骨植骨。男14例,女7例;年龄22～67岁,平均43岁。病变范围：T4～L3,胸椎12例,胸腰段6例,腰椎3例。两处跳跃病变破坏2个椎体1例、3个椎体7例、4个椎体10例;三处跳跃病变破坏5个椎体2例,6个椎体1例。病变节段后凸角：胸椎30°～50°,胸腰段15°～30°,腰椎10°～20°。4例伴不完全截瘫。术前强化抗痨2～4周,术后规则抗痨1年。结果21例患者随访2.1～5.1年,平均3.4年。切口均一期愈合,术后早期肺不张2例,腹胀1例,经保守治疗1周内恢复。术后1～3个月红细胞沉降率、C-反应蛋白逐渐恢复正常。手术矫正后凸畸形10°～30°,末次随访畸形矫正角度丢失≤5.1°。植骨于术后3个月开始出现融合,随访期间无植骨块移位和内固定松动、折断。4例不完全截瘫患者术后6个月神经功能基本恢复正常。结论前路病灶清除植骨融合内固定治疗相隔单椎体跳跃性椎体结核可彻底清除病灶、矫正后凸畸形、重建和维持脊柱稳定性。     

关于脊柱结核治疗的讨论

[编者按]在旧社会骨关节结核是骨科常见病.新中国成立后,由于人民健康及卫生状况的根本好转,结核病的发生率曾大幅度下降.近年来随着免疫性疾病的增长,结核病死灰复燃,呈明显的上升趋势.同时由于结核杆菌耐药菌株的不断增多,以及结核病变的变异,也给骨关节结核病的早期诊断与治疗带来新的困难.骨科医生对这一新的变化应给予充分认识和重视.目前我国骨关节结核病的现状如何?在新的条件下,骨关节结核的治疗是否仍要遵循过去的治疗原则?关于脊柱结核外科治疗,特别是内固定应用的适应证,以及微创外科在脊柱结核治疗的应用前景等问题,本期刊登了相关文章,并特邀请了有关专家就上述问题进行论述与讨论,供同道们参考.     

人工椎体置换术治疗脊柱结核（附10例报告）

脊柱结核病人病灶清除后缺损较大,采取植骨等方法不易解决时,可行人工椎体置换1术[1,4]。我院从1987年～1989年对10例脊柱结核病人采用一期切除病灶,并置入人工椎体,平均随访.2年以上。获得满意效果。2临床资料 本组10例中,男4例,女6例;年龄最小者3岁,最大者60岁,平均42岁。农民9例,工人1例。病程最长者2年,最短者5个月。病变部位:胸椎中段3例,下段4例,胸腰段1例,L1～2例。受累椎体均在2个以上。术前合并截瘫者4例,其中完全截瘫者1例。2手术2.1手术入路 本组7例胸椎结核中,采用经胸腔入路4例,肋骨横突切除入路3例。胸腰椎采用肾切口腹膜外…     

Iliac trabecular bone formation predicts radial trabecular bone density changes in type 1 osteoporosis.

In 28 patients with idiopathic or postmenopausal type 1 (spinal crush fracture) osteoporosis, resorption indices and dynamic measurements of trabecular bone formation based on in vivo tetracycline labeling in 7.5 mm transiliac biopsies have been compared with trends in radial cortical and trabecular bone density measured with computed tomography. Positive correlations were observed between trabecular bone density trends in the radius and indices of bone formation in the ilium. These were improved when one of the two resorption indices was included with a formation index in bivariate regressions. Marked interindividual variations in radial bone density trends were also seen in cortical bone. These correlated poorly with trends in trabecular bone. Weak negative relationships between cortical bone trends and indices relating to bone formation and resorption were observed, but a positive association was seen with single-labeled surfaces on iliac trabeculae. If, as has been suggested, there are periodic variations in bone formation, the results suggest that axial and peripheral trabecular bone density trends are synchronized in osteoporosis, perhaps in response to systemic factors, such as circulating hormones.     

Cnaical significance of changes in cortital and trabeular bone density after menopause

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Vertebral shape, trabecular pattern, and spinal bone mineral density in osteoporosis

Vertebral morphometry and trabecular pattern were correlated to the bone mineral density (BMD) of the corresponding vertebra in 82 patients with osteoporosis. With lateral roentgenograms of the lumbar spine, the anterior, middle, and posterior vertebral heights of L2, L3, and L4 were measured, and the wedge index, concavity index, lumbar spine score, and relative central compression were calculated. The trabecular pattern was graded from normal to a disappearance of trabeculae. The BMD of the corresponding vertebrae was measured by dual photon absorptiometry. There were positive correlations between the BMD and the following measurements of biconcavity: the middle height (r=0.182, p=0.0086), concavity index (r=0.202, p=0.0034), lumbar spine score (r=0.147, p=0.0343), and relative central compression (r=0.179, p=0.0099). The trabecular pattern showed a negative correlation with the BMD (r=−0.141, p=0.0428). Although these correlations were statistically significant, the correlation coefficients and the coefficients of determination were small. Therefore, we may be able to use the degree of biconcavity and the trabecular pattern to differentiate severe osteoporosis from mild one, but these parameters are of limited value in the precise assessment of bone loss.     

绝经后骨密度的改变及其临床意义

为指导临床防治绝经后骨质疏松,以单光子吸收法(SPA)测量了435例妇女挠骨皮质骨密度,并以定量计算机层面扫描法(QCT)测其中263例腰椎松质骨密度。435例年龄21～75岁,分5组:正常月经130例,绝经前月经失调81例,自然绝经后172例,人工绝经13例,合并其它疾病39例。挠骨与腰椎单位长度骨矿含量(BMC)峰值分别出现于36～40和31～35岁。月经正常时,从峰值期至50岁,挠骨与腰椎年降率分别为0.94%和0.51%;从峰值期经绝经至75岁,年降率分别为0.89%和1.41%。骨加速丢失从绝经前月经失调时开始。与绝经时间的关系,BMC表现非线性下降,可分为加速丢失、稳定及再次丢失三期。人工绝经与合并疾病者BMC不同程度地提前下降。172例自然绝经后妇女总骨折率为12.8%,骨折组腰椎BMC显著低于未骨折组(P<0.01)。人工绝经组骨折率为15.4%,合并疾病组为25.6%。     

Age-related changes in trabecular bone microdamage initiation

With age, alterations occurring in bone quality, quantity, and microarchitecture affect the resistance of trabecular bone to local failure. The clinical implications of these changes are evident by the observed exponential increase in fracture incidence with age. Although age-related development of skeletal fragility is well established, it is unclear how the local failure properties of bone change with age. We previously reported a specimen-specific technique to assess microstructural stresses and strains associated with microdamage initiation but did not assess age-related changes. In this study, we compared younger (average age 2 years) and older (average age 10 years) bovine trabecular bone to evaluate how alterations in bovine bone quantity and quality with age affect the local mechanical environment associated with microdamage formation. The results show strong positive correlations between microdamage and local stresses and strains for both younger and older bovine trabecular bone. Correlation strength was slightly improved (<8%) for some parameters by incorporating heterogeneous local material properties based on mineral density into the finite element models. Within individual trabeculae, average stresses and strains were significantly higher in microdamaged trabeculae compared to randomly selected undamaged trabeculae, regardless of age. However, damaged trabeculae in older bone were found to have higher stresses and lower strains than those from younger bone. Corresponding differences in mineral density, microarchitecture, and FEM-determined local material properties were also observed between the two groups. Taken together, these data suggest marked age-related changes in the mechanics of microdamage initiation at the trabecular level. The combined experimental, computational, and histochemical approaches used in this study provide an improved understanding of microdamage initiation and bone quality.     

The relationship between spinal trabecular bone mineral content and iliac crest trabecular bone volume

Summary The relationship between spinal trabecular bone mineral density and iliac crest trabecular bone volume has been studied in 84 patients, 23 with primary osteoporosis, 19 with osteoporosis secondary to inflammatory bowel disease, and 42 with nonsteroid-treated rheumatoid arthritis. Spinal trabecular bone mineral density was measured in the first three lumbar vertebrae by quantitative computed tomography, and iliac crest trabecular bone volume was assessed histomorphometrically in sections from trans-iliac biopsies using computerized techniques. In all 84 patients, there was a significant positive correlation between the two measurements (r=0.60,P<0.001). However, when the three patient groups were analyzed separately, a significant correlation was found in the group with secondary osteoporosis (r=0.65,P<0.01) but not in the patients with primary osteoporosis (r=0.07) or rheumatoid arthritis (r=0.19). These results indicate that the relationship between spinal trabecular bone mineral density and iliac crest trabecular bone volume differs according to the underlying disease process, these differences possibly reflecting variations in skeletal patterns of bone loss in different types of osteoporosis.     

Reduced cortical bone density with normal trabecular bone density in girls with Turner syndrome

Summary  

This study of 22 girls with Turner syndrome (TS) demonstrates a reduction in bone mineral apparent density (BMAD) at the femoral neck along with a reduction in cortical bone density at the radius (with sparing of trabecular bone). These findings may account for the increased fracture risk noted in this population.