胎骨移植在治疗骨肿瘤及瘤样病变中的应用：附39例报告

应用胎骨游离移植治疗骨肿瘤术后骨缺损３９例。除２例骨巨细胞瘤切除后植入胎骨发热（３８℃）一周外，余例于植骨后至骨性愈合期间无任何免疫反应。经临床检查和Ｘ线片证实，均获骨性愈合。本文对胎骨的选择、切取、移植方法和注意事项均作了描述。此法不需特殊设备，简单易行。     

小块异体骨移植在骨肿瘤切除术后骨缺损中的应用

目的探讨小块冷冻异体骨治疗良性骨肿瘤切除术后骨缺损中的临床应用及疗效.方法自2000年11月至2004年11月应用打压植骨技术对小块异体骨进行打压植骨来治疗四肢长骨良性骨肿瘤手术切除后残留骨缺损病例22例.结果本组随访6～80个月,平均31个月.因肿瘤复发行肿瘤再切除植骨术1例,3例患者因术后未行有效固定,外伤后出现植骨区骨折,二次手术行内固定术.X线片显示,其余病例的骨缺损腔隙均有骨小梁通过,无感染病例.结论用小块异体骨移植充填肿瘤切除后的骨缺损具有良好的临床效果.彻底切除肿物、正确使用同种异体冷干骨、熟练掌握打压植骨技术、适当固定、应用抗生素及恰当的负重时机是手术成功的关键.     

应用Pyramesh钛网融合器植骨加Orion钛板内固定治疗颈椎椎体肿瘤

目的：探讨经颈前路切除颈椎椎体肿瘤后，利用Pyramesh钛网融合器（简称钛网）植骨修复骨缺损，Orion钛板内固定的方法治疗颈椎肿瘤的临床价值。方法：对9例颈椎肿瘤患行经颈前路椎体肿瘤切除，骨缺损处置入钛网支撑、植骨融合，椎前Orion钛板内固定。结果：9例患经过6-24个月的随访，无内固定物断裂、松动、脱出，植骨融合满意，无严重颈肩痛及颈椎不稳，无因肿瘤复发造成继发的颈椎骨折及脊髓压迫等并发症。结论：钛网植骨加Orion钛板内固定治疗颈椎椎体肿瘤，可充分保证固定节段的稳定性，植骨融合好，并可防止因肿瘤复发造成继发的颈椎骨折及脊髓压迫。     

同种异体胎儿骨移植治疗良胜骨肿瘤(附31例报告)

为了填充和修复良性骨肿瘤及瘤样病变刮除或切除术后遗留的骨缺损，作者自1990年5月～1996年5月采用经75％酒精浸泡贮存的同种异体胎儿骨移植治疗良性骨肿瘤及瘤样病变31例，取得了良好的效果。术后除5例发生体温变化，平均7天恢复正常体温，1例刀口浅表感染外，其余病例无明显不良反应。术后3周胎儿骨开始吸收，5周腔壁处有新骨生长影象，平均9个月肿瘤腔完全由新生骨代替。因此，作者认为胎儿骨具有制做及贮存方法简易、“爬行替代”作用快、骨诱导能力强、免疫排斥反应小等优点，是一种良好的植骨材料。     

同种异体移植骨材料修复良性骨缺损的临床研究

目的探讨同种异体骨移植治疗良性骨缺损的临床应用价值。方法对2010年1月至2011年1月收治的良性骨缺损50例患者的临床资料进行回顾性分析,并随机分为治疗组（25例）及对照组（25例）。治疗组行同种异体移植骨材料修复,对照组行常规的自体髂骨骨材料修复。结果治疗组患者无骨不连接、肿瘤复发及骨缺损等不良反应,功能恢复表现为优20例,良2例,中0例,差0例,优良率为88．0％;对照组25例患者发现骨不连接者2例,骨缺损复发3例,其功能恢复表现为优13例,良2例,中2例,差1例,优良率为60．0％。治疗组骨缺损愈合程度及功能恢复明显高于对照组,差异有统计学意义（P（0．05）。结论同种异体骨材料生物相容性良好,无明显排斥反应和非特异炎症反应,在移植治疗良性骨缺损方面具有显著促进骨愈合促进新骨形成及功能恢复的功效,在临床上与传统的移植骨材料相比,具有应用方便、植骨疗效确切及并发症少等优点。     

近交系猪皮质骨复合骨髓基质干细胞及BMP修复兔大段骨缺损

目的探讨及观察近交系版纳小耳猪皮质骨复合骨髓基质干细胞（MSCs）及骨形态发生蛋白（BMP）在修复日本大耳兔大段骨缺损中的疗效及可行性。方法将35只日本大耳兔，双上肢桡骨中段制造长约1．5cm的骨缺损模型。左侧作为实验组，将版纳猪皮质骨脱脂、脱蛋白处理，消毒后与MSCs在体外联合培养，并加入BMP后植入骨缺损区，右侧作为对照组，骨缺损区单纯用脱脂、脱蛋白处理后的皮质骨植入。另5只兔骨缺损区不植入任何材料，作为空白对照组。术后4，8，12周各时间点行标本大体观察，X线观察，组织学观察，骨密度测试，比较其骨缺损区修复愈合情况。结果术后第12周，实验组骨缺损区完全修复，骨矿密度接近正常，实验后4、8、12周各移植区骨矿密度实验组明显高于对照组（BMC：P〈0.05，BMDIP〈0．01）；对照组骨缺损区修复缓慢，新骨形成量少；空白对照组骨缺损区未修复。结论近交系小耳猪皮质骨复合MSCs及BMP治疗骨缺损效果满意，经处理的近交系小耳猪皮质骨是良好的骨组织工程支架材料，为大段骨缺损提供了一种新的可靠的治疗方法。     

重视老年骨质疏松性骨折骨修复问题

正随着社会老龄化趋势加剧,骨质疏松症发病率逐年上升。老年骨质疏松症患者骨折后具有合并症复杂、骨折类型多变、骨缺损严重、内固定稳定性差及致残、致死率高等特点,受到临床医生的广泛关注。受患者骨量低下、新骨生成潜力受损等因素影响,骨质疏松性骨折的骨修复办法是颇为棘手的难题。近年来,全身抗骨质疏松治疗、手术植骨或骨替代作为针对骨质疏松性骨缺损的主要手段在系统治疗中越来越受国内外学者的关注。     

骨植入材料复合抗生素缓释系统的研究进展

外伤、战伤等各种原因引起的开放性骨折，由于存在感染的可能，往往不能进行一期骨移植，需彻底清创，待感染因素消除、伤口愈合、血管重建后进行二期植骨修复骨缺损，否则常因感染而导致手术失败。传统治疗方法既增加了患者的痛苦及治疗时间，同时也增加了医疗费用。1980年Klemm应用抗生素骨水泥防治骨软组织感染获得成功后,     

立柱式植骨修复胫骨上端骨巨细胞瘤致大块骨缺损

目的 探讨立柱式植骨对胫骨上端大块骨缺损修复的治疗效果.方法 本组胫骨上端立柱式植骨患者23例,按Enneeking外科分期,1期2例,2期16例,3期5例.当胫骨平台关节而下能保留一层骨质时,残腔切刮后用髂骨块或腓骨支撑;当肿瘤位于一侧髁侵犯关节软骨或软骨下骨质较薄时,行包括肿瘤在内的一侧髁切除后.用游离髌骨移植修复骨缺损;当肿瘤较大,胫骨平台无法保留时,将胫骨两髁连同髁间部切除后,用髂骨代替两侧胫骨平台,下方用两腓骨支撑,行立柱式植骨修复和重建膝关节部骨缺损.结果 随访3个月至9年,平均4.7年,根据国际保肢学会功能评分标准,本组优9例,良13例,可1例.主要并发症为关节轻度疼痛,活动范围减小.结论 胫骨上端骨巨细胞瘤切除后的大块骨缺损行它柱式植骨后能获得良好的关节功能.     

重组合异种骨及同种异体骨移植修复良性肿瘤术后骨缺损

 目的 探讨重组合异种骨及同种异体骨移植修复良性肿瘤术后骨缺损的临床应用价值，选择骨移植的最佳材料。方法 对重组合异种骨修复良性肿瘤术后骨缺损11例，异体骨移植修复良性肿瘤术后骨缺损18例，观察患者全身及局部切口，X线检查，随访11 ~ 14个月。结果 重组合异种骨组全部患者未见明显全身反应，有1例局部切口出现无菌性炎症反应，X线检查骨修复基本完成；异体骨移植组， 感染2例，骨不愈合1例。结论 重组合异种骨移植应用并发症少，临床使用安全可靠，是目前可供临床使用的较为理想的植骨材料。     

骨形态发生蛋白与骨肿瘤

骨形态发生蛋白与多种骨疾患有着直接或间接的关系 ,如骨发育异常、某些骨肿瘤和异位骨化等 ,明确他们之间的关系 ,有助于进一步了解此类疾病的发生、发展和预后 ,为选择合适的治疗方案提供指导。就骨形态发生蛋白与骨肿瘤的关系做一综述     

Role of Hepatocyte Growth Factor in Hemopoiesis

Hepatocyte growth factor (HGF) is a polypeptide that stimulates proliferation, motility, and morphogenesis of various cells, particularly epithelial cells. There is considerable evidence that HGF is a regulator in hemopoiesis not only in mice but also in humans. In mice, HGF and c-met (its receptor) mRNA are coexpressed in the fetal liver in the middle and late stages, when hemopoiesis is most active. HGF and c-met mRNA are also expressed in the stromal cells of both fetal liver and bone marrow. Human HGF (2 to 20 ng/ml) enhances colony-forming units in culture (CFU-C) counts and cobblestone colony counts in the long-term cultures of the fetal liver and bone marrow, although HGF has no effect on freshly isolated bone marrow or fetal liver cells in the CFU-C assay. However, when the bone marrow or fetal liver cells are cocultured with HGF in the presence of IL-3, CFU-C counts increase. In humans, it has also been shown that HGF in the presence of erythropoietin induces the formation of erythroid burst-forming unit (BFU-E) colonies from CD34⁺ cells purified from the bone marrow, peripheral blood, or cord blood. This review discusses the role of HGF as a regulator in hemopoiesis.     

Long-Term Bone Marrow Cultures Established from Bone Marrow Transplant Recipients

Following bone marrow transplantation (BMT), the stroma remains host-derived, and has therefore been exposed to the high doses of chemoradiotherapy used in BMT conditioning. We have used long term bone marrow culture (LTBMC) to study the effect of this conditioning therapy on the stroma. Twenty-five BMT recipients were studied, comprising 13 allografts and 12 autografts. Marrow was aspirated prior to transplant (6 cases) and at 3, 6 or 12 months post-BMT. Fifteen haematologically normal subjects were studied in parallel. The stromal layer of LTBMC was visually assessed at weekly intervals and supernatant cells counted and assayed for colony forming unit-granulocyte/macrophage (CFU-GM).

Five of the six cases studied both before and after BMT formed less confluent stroma following the procedure. A successive improvement in the proportion of patients forming good stroma was observed with increasing time from BMT. Supernatant cell and CFU-GM counts were not significantly different from normal following BMT. No clear relationship was observed between stromal confluence and any of the following: supernatant cell and CFU-GM counts, transplant type, underlying disease, conditioning regime or time to engraftment. These data support the view that BMT conditioning regimes cause stromal damage, and that this damage gradually improves with time.     

锁定接骨板联合同种异体骨治疗四肢长骨良性骨肿瘤伴病理性骨折的60例疗效分析

目的 探讨锁定接骨板联合同种异体骨治疗四肢长骨良性骨肿瘤伴病理性骨折的的疗效.方法 选取了60例良性骨肿瘤患者,按住院单双号随机分为两组,研究组(31例)行锁定接骨板联合同种异体骨,对照组(29例)行锁定接骨板.观察并记录患者术后12个月的患肢功能,血清骨折愈合相关因子,VAS评分,2年内的排斥反应率,病灶复发率和骨折愈合时间,以评价两种手术方式的疗效.结果 术后12个月,研究组优良率明显高于对照组(P<0.05),随访2年期间,研究组排斥反应率、骨折愈合时间、病灶复发率均少于或低于对照组(P<0.05);术后12个月,两组骨钙素(BGP)、骨保护素(OPG)、碱性磷酸酶(ALP)、神经生长因子(NGF)水平均明显升高(P<0.05),且研究组上述指标明显高于对照组(P<0.05);术后6,12个月,两组痛觉感受评分均明显降低(P<0.05),但组间比较差异无统计学意义(P>0.05).结论 锁定接骨板联合同种异体骨对四肢长骨良性骨肿瘤伴病理性骨折具有较好的治疗效果,术后提高患肢功能,减轻疼痛,促进骨折愈合,降低肿瘤复发率,值得临床推广使用.     

同种异体骨与自体骨混合移植治疗良性骨肿瘤疗效观察

目的 探讨同种异体骨与自体骨混合移植治疗良性骨肿瘤的临床疗效.方法 采用同种异体骨与自体骨混合移植的方式治疗良性骨肿瘤患者32例,并进行疗效评价.结果 全组患者患肢功能良好恢复,未发生肿瘤复发、骨缺损及骨不连接等并发症,优良率达到了87.5%.结论 同种异体骨与自体骨混合移植治疗良性骨肿瘤疗效较好.     

应用激活骨髓净化肿瘤细胞的研究

应用国产白介素２（ＩＬ－２）与骨髓细胞共同孵育１或３天，产生激活骨髓（分别记为ＡＢＭ１或ＡＢＭ３）。用３Ｈ－ＴｄＲ释放法测定，表明ＡＢＭ对肿瘤细胞株ＡＧＺＹ－８３ａ和ＣＥＭ具有明显杀伤活性。ＡＢＭ３抗瘤活性明显高于ＡＢＭ１，而新鲜骨髓或单用ＩＬ－２不具有明显抗肿瘤活性。ＡＢＭ可以净化自身骨髓中的ＣＥＭ细胞（效／靶为５０／１），而ＡＢＭ与对照组骨髓比较粒单集落形成率无统计学差别，提示ＡＢＭ仍然保持其造血活性。本文结果初步提示ＡＢＭ可用于净化骨髓中肿瘤细胞之目的。     

Bone Healing Following Irradiation During Tourniquet Ischaemia

The bone harvest chamber (BHC) methodology, a titanium implant for quantitative evaluations of bone healing, was used in order to investigate the radioprotective function of anoxia, in healing bone tissue. After incorporation of one BHC in each proximal tibial metaphysis of a rabbit it was possible to collect newly formed bone specimens in 3-week-periods without animal sacrifice. The amount of bone was determined by microradiography and densitometry. Ten animals divided into 2 groups were used. One group receiving a single dose of 25 Gy during tourniquet ischaemia was compared with another receiving the same dose during normal blood perfusion. A significantly improved bone healing response was seen in the ischaemic group, with a tendency to further improvement with increasing time after irradiation.     

负瘤骨截除后煮沸灭活再植治疗恶性骨肿瘤的临床研究（附16例报告）

用煮沸灭活的方法治疗恶性骨肿瘤１６例，即将截除的瘤段煮沸灭活，然后再植回原位达到保肢的目的。随访１年至４年４个月，健在８例。煮沸灭活之骨都已成活并和主骨愈合。局部感染２例，骨折３例，复发３例，保留后的肢体功能较好。同其它保肢方法如假体、异体骨置换，酒精灭活等比较，此方法具有经济、安全、简单易行等优点，值得推广。     

Bone marrow metastasis in astrocytic gliomata

With the increasing survival time of many pediatric patients with malignancies, unexpected symptoms or signs require diligent search for rare complications or second cancers related to the disease or treatment. We recently encountered a patient with extensive glioblastoma multiforme who developed pancytopenia six months after completion of treatment with craniospinal radiation and chemotherapy with etoposide and cyclophosphamide. Bone marrow aspirate and biopsy confirmed bone marrow metastasis from the brain tumor. He showed good partial remission with chemotherapy with carmustine and cis-platinum as demonstrated by serial bone marrow aspirate for cytology and cytogenetics and enjoyed good quality of life for eight months. 14 other patients with astrocytic glioma, two of whom are children, are reported in the literature to have diffuse bone marrow metastasis. Therefore, in patients with malignant astrocytic tumor, bone marrow metastasis, though not common, should be considered when bone pain or cytopenias occur, especially when prolonged.     

Bone marrow micrometastases in 109 breast cancer patients: Correlations with clinical and pathological features and prognosis

Background: The presence in bone marrow of cells which react with monoclonal antibodies against tumor-associated antigens has been proposed over the last few years as a new prognostic factor in breast cancer patients. Patients and methods: Bone marrow aspirates were obtained from 109 stage I and II breast cancer patients during or 2–4 weeks after primary surgery. The samples were processed for leukocyte separation on a Ficoll-Hypaque gradient and then used to prepare cytospin slides for immunocytochemical analysis. The slides were stained with a pool of monoclonal antibodies (MoAbs) which recognize tumor associated antigens, using the alkaline phosphatase anti-alkaline phosphatase method. The median follow-up was 36 months (range 15–62); 22 patients relapsed and 7 died. Results: Thirty-four of the 109 patients (31.1%) had MoAb positive bone marrow cells. The bone marrow was positive in 28/74 (37.9%) patients who had the aspirate taken during surgery and in 6/35 (17.1%) who had it taken after surgery (p = 0.055). No association was found between bone marrow positivity and tumour size, nodal status, menopausal status, estrogen receptor positivity or the proliferative index. No association was found between bone marrow and prognosis: the log-rank test was 0.291 (p > 0.5) for OS and 0.023 for DFS; the hazard ratio (positive vs negative) was 1.51 for OS (95% CI: 0.33–6.86) and 0.93 for DFS (95% CI: 0.35–2.45). Conclusions: In our series, bone marrow positivity did not correlate with prognostic parameters or prognosis. Of interest is the relative excess of positivity when the bone marrow was obtained during surgery.