双膦酸盐在骨科相关疾病治疗中的地位及再认识

 双膦酸盐是目前临床上治疗骨质疏松症的首选药物, 它能够靶向性地沉积在骨骼中,紧密吸附在骨的羟基磷灰石表面,与之结合并选择性聚积在破骨细胞周围;同时能够有效抑制破骨细胞活性及对骨质的吸收,通过预防骨丢失、提高骨质量以降低骨折风险。迄今为止,双膦酸盐类药物已经研究发展到第三代。第一代双膦酸盐为不含氮的双膦酸盐, 代表药物为羟乙膦酸钠,其分子结构中侧链是直链烃,药物活性和结合力相对较弱,有抑制骨钙化,干扰骨形成,导致骨 软化或诱发骨折的可能,且胃肠道不良反应大。第二代双膦 酸盐药物结构中的侧链引入了氨基称为氨基双膦酸盐,代表药物为帕米膦酸钠和阿仑膦酸钠,其药物活性和结合力比羟乙膦酸钠增加10～100倍,对骨的钙化作用干扰小,选择性强。而第三代双膦酸盐为具有杂环结构的含氮双膦酸盐,如利塞膦酸钠、唑来膦酸等,鉴于其强效、低剂量、使用方便等特点,被认为是具有更强的临床疗效且适应证更加广泛的抗骨吸收药物。目前,双膦酸盐已经广泛用于原发性骨质疏松症、继发性骨质疏松症(如糖皮质激素引起的骨质疏松)以及骨质疏松性骨折的预防及治疗。随着临床应用的深入推广, 越来越多的临床医生和研究人员发现,双膦酸盐除适用于上述疾病外,在关节置换术、脊柱融合术、骨坏死、骨关节炎、软骨损伤的治疗,以及乳腺癌、食管癌、结肠及直肠癌等重大疾病的预防中,扮演着十分重要的角色。为此,本文就双膦酸 盐在骨科相关疾病治疗中的重要作用及新进展做一阐述。     

纤维多孔钛微球复合纳米锶磷灰石修复骨缺损的实验研究

Objective To evaluate the effect of titanium fiber mesh microballoons combined with nano-Sr-HAP on repair of bone defects in vivo. Methods The experimental model was set up by creating drill defects in the bilateral femoral condyle of 24 SD rats [6 months, with the mean weight of (545±22 g)]. The left femoral defects were filled with titanium fiber mesh microballoons combined with nano-Sr-HAP, and the right with pure metal scaffolds. At the 1st, 2nd, 4th, and 8th week after surgery, the specimens were killed and taken the X-ray, histology, and histomorphology observation. The results were contrasted and ana-lyzed. Results X-ray observation showed that the bone defects in both sides were repaired. Histological re-sults showed that the titanium fiber mesh microballoons allowed the new bones growing inside, and more new bones in the left implants compared with those in the right sides. The results of histomorphometrical analysis confirmed that neo-bones in the left sides gradually increased as time passed. There were statistic differences in neo-bones at the 2nd, 4th, and 8th week, and the differences between the two sides were statistically sig-nificant at the 4th and 8th week. Conclusion As titanium fiber mesh microballoons used in this experiment have good biocompatibility and osteoconduction ability, they can be used as scaffold for bone defect repair; and Nano-Sr-HAP can enhance the repair ability of titanium fiber mesh.     

纤维多孔钛微球复合纳米锶磷灰石修复骨缺损的实验研究

Objective To evaluate the effect of titanium fiber mesh microballoons combined with nano-Sr-HAP on repair of bone defects in vivo. Methods The experimental model was set up by creating drill defects in the bilateral femoral condyle of 24 SD rats [6 months, with the mean weight of (545±22 g)]. The left femoral defects were filled with titanium fiber mesh microballoons combined with nano-Sr-HAP, and the right with pure metal scaffolds. At the 1st, 2nd, 4th, and 8th week after surgery, the specimens were killed and taken the X-ray, histology, and histomorphology observation. The results were contrasted and ana-lyzed. Results X-ray observation showed that the bone defects in both sides were repaired. Histological re-sults showed that the titanium fiber mesh microballoons allowed the new bones growing inside, and more new bones in the left implants compared with those in the right sides. The results of histomorphometrical analysis confirmed that neo-bones in the left sides gradually increased as time passed. There were statistic differences in neo-bones at the 2nd, 4th, and 8th week, and the differences between the two sides were statistically sig-nificant at the 4th and 8th week. Conclusion As titanium fiber mesh microballoons used in this experiment have good biocompatibility and osteoconduction ability, they can be used as scaffold for bone defect repair; and Nano-Sr-HAP can enhance the repair ability of titanium fiber mesh.     

Notch信号通路与骨发生和骨重建

Notch信号通路对调节胚胎细胞和成体细胞增生、分化、凋亡以及前体细胞的自我更新具有重要意义。它可通过协调胚胎期生长板内软骨细胞分化和生长,控制骨组织正常发生。骨重建是对病损骨组织的再生和修复,主要由成骨细胞和破骨细胞参与,Notch信号除可对上述2种细胞增生、分化、成熟等进行调控外,也可介导依赖于成骨细胞的破骨细胞生成。本文试以Notch信号对软骨细胞、成骨细胞、破骨细胞等细胞学行为改变为主线,探讨Notch信号对上述2种骨生物学行为调节的作用机制。     

双膦酸盐治疗不良反应的研究进展

双膦酸盐类药物具有强大的抗骨吸收作用,可有效减低骨质疏松性骨折的发生率,是用于骨质疏松治疗的首选药物[1]。其临床适应证也包括Paget’s骨病、高钙血症以及由恶性肿瘤骨转移所带来的骨痛、病理性骨折等症状[1]。患者对长期服用该类药物的依从性较好,许多患者甚至服用该类药物达5—10年之久[2]。过去,关于双膦酸盐类长期服用后的安全性的临床研究较少,不良反应报道多来自药物售后监察。这些因素导致人们缺乏对该类药物使用安全问题应有重视。近年来,随着双膦酸盐类药物使用数量的增多,以及大量药效更强、服用方便的新剂型不断开发和推出,也出现了越来越多的不良反应报道。     

大鼠局部肌肉萎缩实验模型的设计与建立

背景:目前研究肌肉与骨骼关系的常用动物模型均存在不足.已经有研究表明A型肉毒素可以使局部肌肉萎缩,而不影响周围其他的肌肉.目的:尝试是否可以用局部肌肉注射A型肉毒素的方法建立一种较为理想的肌肉萎缩的动物实验模型.方法:4月龄雄性Wistar大鼠25只,采用氯胺酮(0.2 mL/kg)和速眠新(0.2 mL/kg)肌注麻醉,在股骨背侧中部做-0.5 cm切口,暴露股四头肌,右侧股四头肌肌注2 U(0.2 mL)注射用A型肉毒毒素,左侧股四头肌注射等量生理盐水作为对照.分别于模型建立后的1,2,4,6和8周各取5只做肌肉大体、组织学观察.结果与结论:肌肉大体观察发现:与生理盐水侧对照组相比,注射A型肉毒素侧股四头肌体积明显缩小、质量明显降低(P＜0.01);肌肉组织学观察发现:注射A型肉毒素侧股四头肌较生理盐水侧明显萎缩、肌纤维变细、肌纤维细胞核聚集、肌纤维与肌纤维之间间距变小.肉毒素侧1周和2周出现肌肉质量突降,4,6,8周之间肌肉质量增加缓慢,而各时间点生理盐水侧肌肉质量呈显著增加的趋势.通过对局部肌肉注射A型肉毒素可以理想地建立单个目的肌肉萎缩的实验模型,此模型操作性强、重复性好、特异性高,可应用于肌肉与骨骼关系的相关研究.     

实验性动力平衡失调对颈椎退变影响的X线观察

目的：探明颈椎动力平衡失调对颈椎退变的影响。方法：选择２０只ＳＤ大鼠,随枘发为３组实验模型组与１组对照组。通过手术切除大鼠颈背部伸肌群浅层、深层与全层,建立了颈椎不同程度动力平衡失调实验模型,６月后在钼靶Ｘ线机下拍摄颈椎正侧位片,并对Ｘ线片进行评分,各组评分结果相互比较分比较分析。结果：颈椎动力平衡失调可加速加重颈椎Ｘ线的退变表现。结论：颈椎动力平衡失调因素在颈椎退变与颈椎病发病中意义重大。     

脑中风偏瘫患者股骨颈骨折治疗方法探讨

目的 探讨中风偏瘫患股骨颈骨折治疗方法。方法 回顾分析25例患治疗方法及结果。结果 23例股骨颈骨折发生在偏瘫同侧，24例接受人工股骨头置换手术，10例双动股骨头，其余患为单极股骨头；23例接受随访，时间为4周至1年，Harris评分均在80分以上。结论 人工股骨头置换是中风偏瘫患股骨颈骨折治疗的有效方法。     

肋尖综合征误诊原因分析

肋尖综合征 ( Rib- tip syndrome)是第 10～ 12肋尖软骨的无菌性炎症 ,病因不甚清楚。该症发病率较日常所见的真肋肋软骨炎低 ,教科书及一般文献很少提及 ,且常不为人们注意 ,误诊率较高。作者自 1985年 9月以来共诊治外院误诊的肋尖综合征 14例 ,报告如下。1　临床资料1.1　一     

双膦酸盐与骨折愈合和非典型性骨折

典型的骨折愈合过程包括血肿和炎症反应、原始软骨痂形成、成熟板层骨形成以及骨板重建和塑形等四个时期。骨重建包括骨吸收和骨形成两个方面。软骨痂和硬骨痂重建对骨折愈合具有重要意义。双膦酸盐类药理基础在于抑制破骨细胞活性和骨转化水平,通过干预骨重建对骨折愈合产生影响。长期使用双膦酸盐不利于骨折愈合,有引起股骨非典型性骨折发生的危险。