目的对股骨头坏死标本不同区域的骨小梁进行量化分析。方法收集我院2011-2013年非创伤性股骨头坏死病人行全髋关节置换术后的股骨头标本10个以及病人病历和临床影像学资料(男性6例,女性4例)。对标本进行显微CT断层扫描,根据图像结果将...目的对股骨头坏死标本不同区域的骨小梁进行量化分析。方法收集我院2011-2013年非创伤性股骨头坏死病人行全髋关节置换术后的股骨头标本10个以及病人病历和临床影像学资料(男性6例,女性4例)。对标本进行显微CT断层扫描,根据图像结果将标本分为健康区、硬化区和坏死区,分别进行骨计量学分析。分析指标有骨矿密度(bone mineral density,BMD)、骨矿容量(bone mineral content,BMC)、骨表面积与骨骼体积比(bone surface to bone volume ratio,BS/BV);体积分数(bone volume fraction,BVF)、结构模型指数(structure model index,SMI)、骨小梁数目(trabecular plate number,Tb.N)、骨小梁厚度(trabecular plate thickness,Tb.Th)、骨小梁间隙(trabecular spacing,Tb.Sp)。扫描后将标本作病理学处理。结果晚期股骨头坏死区和硬化区的骨小梁空间结构明显改变。与健康区相比,硬化区骨小梁明显增厚,BVF显著增加,两组间BMD、Tb.Th、BMC、BS/BV差异有统计学意义(P<0.05),而Tb.Sp差异无统计学意义(P>0.05);与健康区相比,坏死区的BMD、BMC、BVF、Tb.N明显减少,Tb.Sp较硬化区显著增宽,两组差异有统计学意义(P<0.05),而Tb.Th、BS/BV差异无统计学意义(P>0.05)。结论晚期股骨头坏死标本坏死区的骨小梁连续性破坏,结构散乱;硬化区的骨小梁结构增厚,数目增多,间隙变窄;正常区域骨小梁结构完整,厚度分布均匀。展开更多
目的探讨骨髓间充质干细胞（BM SC ）迁移归巢在骨折愈合中的作用。方法6周龄健康成年雄性清洁级C57／BL小鼠65只，体重17～25 g ，采用外力冲击方法制备闭合性股骨骨折内固定模型，7 d后将小鼠分为3组：间充质干细胞（MSC）组（n＝35...目的探讨骨髓间充质干细胞（BM SC ）迁移归巢在骨折愈合中的作用。方法6周龄健康成年雄性清洁级C57／BL小鼠65只，体重17～25 g ，采用外力冲击方法制备闭合性股骨骨折内固定模型，7 d后将小鼠分为3组：间充质干细胞（MSC）组（n＝35）尾静脉注射生理盐水0．5 mL ，0．5 h后注射内含1＆#215;106个红色荧光蛋白标记的骨髓间充质干细胞（RFP‐BMSC）溶液0．5 mL ；1，4，8，11‐四氮杂环十四烷（AMD3100）组（n＝15）尾静脉注射1 mmol／L AMD3100（CXCR4受体的特异性阻断剂）0．5 mL ，0．5 h后注射内含1＆#215;106个RFP‐BMSC的溶液0．5 mL ；对照（CON）组（n＝15）尾静脉注射生理盐水0．5mL，0．5h后再次注射生理盐水0．5mL。造模成功后14、28、42d采用冰冻切片荧光示踪法观察M SC组小鼠RFP‐BM SC归巢情况，并在28 d后采用免疫荧光法观察BM SC位置和骨桥蛋白（OPN）及骨钙素（OCN）的表达；14、42 d后分别采用HE染色和Masson三色染色观察3组组织切片骨痂形成情况，并进行组织病理学检查及生物力学检查，评价3组骨折愈合情况。结果骨折后28 d MSC组有大量RFP‐BMSC迁移至骨折处聚集，且高度表达OPN与OCN。14 d后病理组织切片染色结果显示，CON组与AMD3100组以软骨成分为主，而 MSC组多已开始形成骨性骨痂；42 d后CON组与AMD3100组处于骨痂塑形期，皮质骨质量差，MSC组骨痂已基本塑形完成。生物力学检测结果显示， MSC组最大负荷、最大桡度、弹性桡度及刚度显著高于另两组（P＜0．05），接近正常骨组织（P＞0．05）。结论 BMSC归巢能促进骨折愈合，基质细胞衍生因子（SDF）‐1／CXCR4通路在其中发挥重要作用。展开更多
Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. T...Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.展开更多
[目的]评估SF-12量表用于评价全髋关节置换术后患者生存质量的适用性。[方法]Harris髋关节功能评分量表(Harris hip score,HHS)、SF-12生存质量量表(MOS 12-item Short Form Health Survey,SF-12)评估接受全髋关节置换术治疗的患者283例...[目的]评估SF-12量表用于评价全髋关节置换术后患者生存质量的适用性。[方法]Harris髋关节功能评分量表(Harris hip score,HHS)、SF-12生存质量量表(MOS 12-item Short Form Health Survey,SF-12)评估接受全髋关节置换术治疗的患者283例381髋,采用内部一致性信度(Cronbach's alpha系数)评估SF-12量表的信度;采用集合效度、区分效度和结构效度评估SF-12量表的效度;Pearson相关分析评估HHS与生理总分、心理总分关联度;单因素方差分析评估生理及心理总分分级的组间差异性。[结果]SF-12量表总的Cronbach's alpha系数为0.879,各维度Cronbach's alpha系数均>0.8;集合效度及区分效度定标实验均为100%;结构效度因子分析产生两个公因子生理及心理总分,累积解释72.229%的总方差,8个维度因子负荷与理论假设基本符合;HHS与生理总分、心理总分均为强相关(r1=0.745,r2=0.703,P<0.01);组间差异F1=85.282,F2=61.377,P<0.01。[结论]SF-12量表具有良好的信度和效度,适用于评价全髋关节置换术后患者的生存质量,评估效果良好。展开更多
文摘目的对股骨头坏死标本不同区域的骨小梁进行量化分析。方法收集我院2011-2013年非创伤性股骨头坏死病人行全髋关节置换术后的股骨头标本10个以及病人病历和临床影像学资料(男性6例,女性4例)。对标本进行显微CT断层扫描,根据图像结果将标本分为健康区、硬化区和坏死区,分别进行骨计量学分析。分析指标有骨矿密度(bone mineral density,BMD)、骨矿容量(bone mineral content,BMC)、骨表面积与骨骼体积比(bone surface to bone volume ratio,BS/BV);体积分数(bone volume fraction,BVF)、结构模型指数(structure model index,SMI)、骨小梁数目(trabecular plate number,Tb.N)、骨小梁厚度(trabecular plate thickness,Tb.Th)、骨小梁间隙(trabecular spacing,Tb.Sp)。扫描后将标本作病理学处理。结果晚期股骨头坏死区和硬化区的骨小梁空间结构明显改变。与健康区相比,硬化区骨小梁明显增厚,BVF显著增加,两组间BMD、Tb.Th、BMC、BS/BV差异有统计学意义(P<0.05),而Tb.Sp差异无统计学意义(P>0.05);与健康区相比,坏死区的BMD、BMC、BVF、Tb.N明显减少,Tb.Sp较硬化区显著增宽,两组差异有统计学意义(P<0.05),而Tb.Th、BS/BV差异无统计学意义(P>0.05)。结论晚期股骨头坏死标本坏死区的骨小梁连续性破坏,结构散乱;硬化区的骨小梁结构增厚,数目增多,间隙变窄;正常区域骨小梁结构完整,厚度分布均匀。
文摘目的探讨骨髓间充质干细胞（BM SC ）迁移归巢在骨折愈合中的作用。方法6周龄健康成年雄性清洁级C57／BL小鼠65只，体重17～25 g ，采用外力冲击方法制备闭合性股骨骨折内固定模型，7 d后将小鼠分为3组：间充质干细胞（MSC）组（n＝35）尾静脉注射生理盐水0．5 mL ，0．5 h后注射内含1＆#215;106个红色荧光蛋白标记的骨髓间充质干细胞（RFP‐BMSC）溶液0．5 mL ；1，4，8，11‐四氮杂环十四烷（AMD3100）组（n＝15）尾静脉注射1 mmol／L AMD3100（CXCR4受体的特异性阻断剂）0．5 mL ，0．5 h后注射内含1＆#215;106个RFP‐BMSC的溶液0．5 mL ；对照（CON）组（n＝15）尾静脉注射生理盐水0．5mL，0．5h后再次注射生理盐水0．5mL。造模成功后14、28、42d采用冰冻切片荧光示踪法观察M SC组小鼠RFP‐BM SC归巢情况，并在28 d后采用免疫荧光法观察BM SC位置和骨桥蛋白（OPN）及骨钙素（OCN）的表达；14、42 d后分别采用HE染色和Masson三色染色观察3组组织切片骨痂形成情况，并进行组织病理学检查及生物力学检查，评价3组骨折愈合情况。结果骨折后28 d MSC组有大量RFP‐BMSC迁移至骨折处聚集，且高度表达OPN与OCN。14 d后病理组织切片染色结果显示，CON组与AMD3100组以软骨成分为主，而 MSC组多已开始形成骨性骨痂；42 d后CON组与AMD3100组处于骨痂塑形期，皮质骨质量差，MSC组骨痂已基本塑形完成。生物力学检测结果显示， MSC组最大负荷、最大桡度、弹性桡度及刚度显著高于另两组（P＜0．05），接近正常骨组织（P＞0．05）。结论 BMSC归巢能促进骨折愈合，基质细胞衍生因子（SDF）‐1／CXCR4通路在其中发挥重要作用。
基金supported by grants from the National Natural Science Foundation of China (No. 81141022)the General Hospital of Chinese Liberation Army (No. 10KMM09)
文摘Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.
文摘[目的]评估SF-12量表用于评价全髋关节置换术后患者生存质量的适用性。[方法]Harris髋关节功能评分量表(Harris hip score,HHS)、SF-12生存质量量表(MOS 12-item Short Form Health Survey,SF-12)评估接受全髋关节置换术治疗的患者283例381髋,采用内部一致性信度(Cronbach's alpha系数)评估SF-12量表的信度;采用集合效度、区分效度和结构效度评估SF-12量表的效度;Pearson相关分析评估HHS与生理总分、心理总分关联度;单因素方差分析评估生理及心理总分分级的组间差异性。[结果]SF-12量表总的Cronbach's alpha系数为0.879,各维度Cronbach's alpha系数均>0.8;集合效度及区分效度定标实验均为100%;结构效度因子分析产生两个公因子生理及心理总分,累积解释72.229%的总方差,8个维度因子负荷与理论假设基本符合;HHS与生理总分、心理总分均为强相关(r1=0.745,r2=0.703,P<0.01);组间差异F1=85.282,F2=61.377,P<0.01。[结论]SF-12量表具有良好的信度和效度,适用于评价全髋关节置换术后患者的生存质量,评估效果良好。
