The regeneration of bone tissue depends on the harmonious interaction between blood vessels and nerve fibers, both essential for various physiological and pathological functions in the skeletal system. The key to mimicking the structure and function of natural bone lies in integrating angiogenesis and neurogenesis processes to prepare vascular-nerve-tissue-engineered bone (TEB). Unlike traditional strategies for constructing vascular nerve TEB (such as adding growth factors or cells to scaffolds or preparing composite scaffolds), this study employs a bottom-up approach, using modular microtissue units to construct novel vascular nerve TEB. Initially, vascular-nerve-bone microtissues composed of bone marrow mesenchymal stem cells, endothelial progenitor cells (EPCs), and Schwann cells (SCs) were generated through three-dimensional coculture in microporous array plates. These vascular-neural-bone microtissues were then encapsulated as modular building blocks within gelatin methacrylate (GelMA) hydrogels to construct large-scale vascular-neural TEB. The microtissue-based vascular-neural-TEB construction protocol demonstrated feasibility at the molecular, cellular, and tissue/organ levels. Research findings indicate that the GelMA/MSC/EPC/SC vascular-neural-TEB possesses concurrent capabilities for angiogenesis, neurogenesis, and osteogenesis during bone repair. These findings provide novel insights for the construction of multifunctional bone grafts and lay the foundation for the clinical treatment of bone defects.

Epigallocatechin-3-gallate (EGCG) is the most effective active ingredient in tea polyphenols and belongs to the category of catechins. EGCG has excellent antioxidant activity, anti-inflammatory, osteogenesis-promoting, and antibacterial properties, and has been widely studied in orthopedic diseases such as osteoporosis. To reach the lesion site, achieve sustained release, promote osteogenesis, regulate macrophage polarization, and improve the physical properties of materials, EGCG needs to be cross-linked or incorporated in bone regeneration materials. This article reviews the application of bone regeneration materials combined with EGCG, including natural polymer bone regeneration materials, synthetic polymer bone regeneration materials, bioceramic bone regeneration materials, metal bone regeneration materials, hydrogel bone regeneration materials and metal-EGCG networks. In addition, the fabrication methods for the regenerated scaffolds are also elaborated in the text. To sum up, it reveals the excellent development potential of materials containing EGCG and the shortcomings of current research, which will provide important reference for the future exploration of bone regeneration materials containing EGCG.

Background To explore the surgical technique and clinical outcomes of cementless total hip arthroplasty (THA) combined with impacted bone grafting for the treatment of moderate and severe acetabular protrusion with rheumatoid arthritis (RA). Methods From January 2010 to October 2020, 45 patients (56 hips), including 17 men (22 hips) and 28 women (34 hips) with acetabular impingement secondary to RA, were treated with bioprosthetic THA combined with autologous bone grafting at our hospital. According to the Sotello-Garza and Charnley classification criteria, there were 40 cases (49 hips) of type II (protrusio acetabuli 6–15 mm) and 5 cases (7 hips) of type III (protrusio acetabuli > 15 mm). At the postoperative follow-up, the ROM of the hip joint, the VAS score, and the Harris score were evaluated. The healing of the bone graft, the restoration of the hip rotation center, and the prosthesis loosening were assessed by plain anteroposterior radiographs. Results The average operation time was 95.53 ± 22.45 min, and the mean blood loss was 156.16 ± 69.25 mL. There were no neurovascular complications during the operation. The mean follow-up duration was 5.20 ± 1.20 years. The horizontal distance of the hip rotation center increased from preoperative 10.40 ± 2.50 mm to postoperative 24.03 ± 1.77 mm, and the vertical distance increased from preoperative 72.36 ± 3.10 mm to postoperative 92.48 ± 5.31 mm. The range of flexion motion of the hip joint increased from 39.48 ± 8.36° preoperatively to 103.07 ± 7.64° postoperatively, and the range of abduction motion increased from 10.86 ± 4.34° preoperatively to 36.75 ± 3.99° postoperatively. At the last follow-up, the Harris score increased from 37.84 ± 4.74 to 89.55 ± 4.05. All patients were able to move independently without assistance. Conclusions Cementless THA combined with impacted grafting granule bone of the autogenous femoral head and biological acetabular cup can reconstruct the acetabulum, restore the rotation center of the hip joint, and achieve good medium-term outcomes in the treatment of moderate to severe acetabular herniation secondary to RA.

In conventional bone tissue engineering, cells are seeded onto scaffolds to create three-dimensional (3D) tissues, but the cells on the scaffolds are unable to effectively perform their physiological functions due to their low density and viability. Cell sheet (CS) engineering is expected to be free from this limitation. CS engineering uses the principles of self-assembly and self-organization of endothelial and mesenchymal stem cells to prepare CSs as building blocks for engineering bone grafts. This process recapitulates the native tissue development, thus attracting significant attention in the field of bone regeneration. However, the method is still in the prebasic experimental stage in bone defect repair. To make the method clinically applicable and valuable in personalized and precision medicine, current research is focused on the preparation of multifunctionalized building blocks using CS technologies, such as 3D layered CSs containing microvascular structures. Considering the great potential of CS engineering in repairing bone defects, in this review, the types of cell technologies are first outlined. We then summarize the various types of CSs as building blocks for engineering bone grafts. Furthermore, the specific applications of CSs in bone repair are discussed. Finally, we present specific suggestions for accelerating the application of CS engineering in the clinical treatment of bone defects.

Abstract Purpose The aim of this study was to compare the clinical outcomes of culture-negative periprosthetic joint infection (CN PJI) with those of culture-positive periprosthetic joint infection (CP PJI). Methods Data were obtained from Embase, Web of Science and EBSCO for all available studies comparing the clinical outcomes of CN PJI with those of CP PJI. The quality of the studies was scored using the Newcastle–Ottawa scale (NOS). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess clinical outcomes. Subgroup analyses were performed to explain heterogeneity among the included studies. Publication bias was estimated using Begg’s funnel plot. Sensitivity analysis was performed to test the stability of pooled results. Results Thirty studies with 1630 (38.7%) CN PJI and 2577 (61.3%) CP PJI were included in this meta-analysis. The pooled results of the included studies showed that overall failure rate in CN PJI group (19.0%, 309/1630) was significantly lower than that in CP PJI group (23.4%, 604/2577) (OR 0.63, 95% CI 0.47–0.84, P = 0.002). We performed the subgroup analysis based on the surgical strategies, the pooled results of nine studies for patients undergoing debridement, antibiotics and implant retention (DAIR) revealed that failure rate in CN PJI group (22.2%, 53/239) was significantly lower than that in CP PJI group (29.3%, 227/775) (OR 0.62, 95% CI 0.43–0.90, P = 0.01), the pooled results of four studies for patients undergoing one-stage revision revealed that failure rate between CN PJI group (11.5%, 11/96) and CP PJI group (7.6%, 27/355) had no significant difference (OR 1.57, 95% CI 0.75–3.26, P = 0.23), and the pooled results of 19 studies for patients undergoing two-stage revision revealed that failure rate in CN PJI group (16.1%, 171/1062) was significantly lower than that in CP PJI group (20.4%, 206/1010) (OR 0.52, 95% CI 0.34–0.79, P = 0.002). Conclusions CN PJI group had similar or better survival rate when compared with CP PJI group for patients who underwent DAIR, one-stage or two-stage revision. Negative culture was not a worse prognostic factor for PJI.

骨巨细胞瘤是一种临床上常见的良性的、局部侵袭性的肿瘤,好发于长骨的干骺端,发生于骨盆的骨巨细胞瘤较为少见.恶性骨巨细胞瘤在临床极少见,相关文献报道也较少.骨盆的恶性骨巨细胞瘤的治疗一直是临床治疗的难点.完整切除肿瘤及有效的骨盆重建是治疗骨盆恶性骨巨细胞瘤最关键的问题之一.笔者通过1例坐骨巨大骨巨细胞瘤复发患者,并结合国内外相关文献,对骨盆恶性骨巨细胞瘤进行综述.

In the process of repairing of bone defects, bone scaffold materials need to be implanted to restore the corresponding tissue structure at the injury. At present, the repair materials used for bone defects mainly include autogenous bone, allogeneic bone, metal materials, bioceramics, polymer materials and various composite materials. Different materials have demonstrated strong reconstruction ability in bone repair, but the ideal bone implants in the clinic are still yet to be established. Except for autogenous bone, other materials used in bone defect repair are unable to perfectly balance biocompatibility, bone formation, bone conduction and osteoinduction. Combining the latest advances in materials sciences and clinical application, we believe that composite materials supplementedwith Chinese medicine, tissue cells, cytokines, trace elements, etc. and manufactured using advanced technologies such as additive manufacturing technology may have ideal bone repair performance, and may have profound significance in clinical repair of bone defects of special type. This article reviewed to the domestic and foreign literature in recent years, and elaborates the current status of bone defect repair materials in clinical application and basic research in regard to the advantages, clinical options, shortcomings, and how to improve the autogenous bone, allogeneic bone and artificial bone materials, in order to provide a theoretical basis for clinical management of bone defects.

患者,男,21岁,因"无明显诱因出现左小腿下段间歇性疼痛4年余"入院。患者于4年前长时间站立后出现左小腿下段疼痛,当时未行治疗,后症状逐渐加重,就诊于当地医院,行X线、MRI等检查,当时考虑病变较小,建议定期复查。2018年2月26日患者在剧烈运动后疼痛加重就诊我院。入院查体:左小腿远端前内侧压痛阳性,未触及肿块,局部皮肤无红肿、发热、破溃等异常,肢体远端足趾颜色红润、毛细血管反应良好,足背动脉可扪及。

Bone injury is the most common type of war wound, and different from ordinary open bone injury. The war wound bone injury caused by high-energy weapons has the characteristics of deep bleeding site, coagulation dysfunction, multi bacteria infection and large bone defect area, so it is difficult to be treated in battlefield. Mesoporous silica is a new type of inorganic nano biomaterial, which is widely used in bleeding treatment and bone tissue engineering due to its high specific surface area, large porosity and easy modification. Compared with the traditional materials for the treatment of traumatic bone injury, mesoporous silica has the advantages of local sustained hemostasis, broad-spectrum, sustained-release and strong mechanical support. Its main research direction is the composite and multifunctional materials. The surface functionalized mesoporous silica has the functions of hemostasis and infectious bone defect repair. However, there are still some problems such as unclear biological distribution in vivo and hepatorenal toxicity in large doses of mesoporous silica materials; in terms of preparation technology, there are still some problems such as unclear selection of pore size and shape of materials for promoting bone formation. Based on the actual needs of the treatment of war-induced bone injuries, the multifunctional, easy-to-use and portable properties of new mesoporous silica materials are reviewed in this paper. DOI: 10.11855/j.issn.0577-7402.2021.02.11

Osteoarthritis (OA) is a common disease of the elderly, posing a major personal and socioeconomic burden. OA is characterized by painful degeneration of articular cartilage, and its prevention, diagnosis and treatment remain problematic. Circular RNAs (circRNAs) constitute a large family of non-coding RNAs that are widely distributed, stable, conserved and tissue-specific. circRNAs have been found to be closely associated with OA development and progression, and they may serve as targets for disease prevention and treatment. The aim of the present article was to review the roles of circRNAs in OA and discuss possible treatment strategies.

[目的]探讨β-磷酸三钙填充载药微球对兔感染性骨缺损的治疗作用.[方法]采用复乳化溶剂挥发法制备缓释微球,3D打印制备多孔β-TCP支架,采用离心震荡法制备复合支架.取75只新西兰兔,随机分为5组,每组15只.其中15只设为正常对照组,其余4组制备股骨下段慢性骨髓炎模型,造模成功后,15只给予单纯清创(清创组);15只给予清创后,骨缺损处植入利福平/异烟肼/PLGA缓释微球(药物组);15只给予清创后,骨缺损处置入多孔β-TCP支架(支架组);15只给予清创后,骨缺损处植入利福平/异烟肼/PLGA缓释微球/多孔β-TCP支架(复合组).分别于术后4、8、12周取材进行观测.[结果]扫描电镜观察微球填充于复合支架之间的孔隙内,生物力学测量示复合支架符合松质骨压缩强度的要求.X线片和组织学检查显示,复合组能有效控制慢性骨髓炎,并且有较好成骨作用;Micro-CT检测表明,各时间点,BV、BVF、BS、Tb.Th和Tb.N由高至低均依次为:正常对照组＞复合组＞支架组＞药物组＞清创组,差异均有统计学意义(P＜0.05).细菌培养发现,术后4周,清创组实验动物耐甲氧西林金黄色葡萄球菌培养均阳性;药物组2只动物培养阳性;支架组动物全部培养阳性;复合组1只动物培养阳性.术后8周,清创组1只培养阳性;其余3组培养结果均阳性.[结论]β-磷酸三钙填充载药微球治疗兔慢性骨髓炎效果优良.

Traumatic arthritis (TA) is a kind of osteoarthritis secondary to joint trauma, and its pathogenesis is not clear at present. It is mainly related to the apoptosis of chondrocytes involved in a variety of cytokines and related signal pathways. Curcumin has anti-inflammatory, anti-oxidant and anti-apoptotic effects. Curcumin is used to treat TA mainly by inhibiting oxidase, scavenging free radicals' antioxidant effects, inhibiting the anti-inflammatory effects of cyclooxygenase, lipoxygenase and various inflammatory mediators, and acting on various signal transduction pathways to inhibit apoptosis of chondrocytes. This paper describes some of the biological functions of curcumin, and introduces its related mechanism of action in the treatment of TA. DOI: 10.11855/j.issn.0577-7402.2021.01.13

人工关节置换术已经作为骨科的一种标准治疗手段,用于治疗累及关节的骨折、重度骨关节炎、骨肿瘤和先天性关节发育不良等疾病,术后效果较好,但并发症也不容忽视.其中术后假体无菌性松动成为影响患者恢复的最大问题之一.本文主要从机械性因素(假体微动、应力遮挡、高液压等)及生物学因素(磨损颗粒、细胞、分子等)两方面全面阐述了关节置换术后假体发生无菌性松动的影响因素及发生机制.

患儿,女,14岁,摔倒致右膝疼痛剧烈,摔伤后4 h 就诊.门诊 CT 检查显示:右髌骨病理性骨折.骨科门诊遂以"右髌骨病理性骨折"收住入院.膝关节X线检查:右侧髌骨骨质改变,考虑良性肿瘤合并病理性骨折,见图1A.

疼痛和抑郁是对许多有害刺激最常见的神经反应,两者互为彼此的危险因素,疼痛与抑郁的共病关系增加了临床治疗难度.寻求一种兼具镇痛、抗抑郁的药物是当前临床管理疼痛与抑郁的迫切目标.松果腺分泌的褪黑素(N-乙酰基-5-甲氧基色胺)具有多种功能,包括抗炎、抗氧化、免疫调节、镇静和镇痛.褪黑素作为一种止痛剂和抗抑郁药的高效性、安全性以及基本无毒副作用已经在各种疼痛动物模型中得到证实,这使得褪黑素在不同的病理条件下以及在手术患者中得到了临床应用.褪黑素介导的镇痛、抗抑郁作用可能涉及炎性因子、星形胶质细胞、蛋白激酶C(PKC)/N-甲基-D-天冬氨酸(NM-DA)通路.然而,目前国内关于褪黑素在疼痛综合征与抑郁中的作用机制报道较少,故笔者通过查阅国内外文献,归纳分析了褪黑素镇痛、抗抑郁的作用机理,为推广褪黑素在临床治疗相关疾病提供理论依据.

假体周围感染(PJI)是人工关节置换术后灾难性的并发症,其诊疗一直是关节外科领域的研究热点和难点.目前,PJI的治疗策略包括抗生素治疗、保留假体清创灌洗术、Ⅰ期翻修术、Ⅱ期翻修术、关节融合术、截肢以及生物治疗等.常规治疗不能取得满意的疗效,而生物治疗作为一种新兴的治疗模式,在PJI治疗中具有独特的优势.该文就PJI的危险因素和感染源、诊断和分型,以及治疗策略进行综述,为临床PJI治疗方式的选择提供参考.

Traumatic arthritis (TA) is one of the common diseases of bone and joint caused by trauma. The main pathological changes are degeneration of articular cartilage and secondary hyperplasia and ossification of cartilage. The main clinical manifestations are joint pain and dysfunction of movement. Its pathogenesis is still unclear. At present, the treatment of TA is based mainly on symptoms rather than etiology, including physical therapy, drug treatment, surgical treatment, etc. Conservative treatment (physical therapy, drug treatment) can only alleviate short-term pain, and the long-term effect is not satisfactory. Thus, patients with middle and late TA tend to choose surgical treatment. At present, the surgical treatment of TA includes arthroscopic debridement, arthrodesis, cartilage repair, osteotomy, artificial joint replacement, 3D printing technology, etc. There are differences in the postoperative efficacy. This article reviews the current situation of surgical treatment for TA. DOI: 10.11855/j.issn.0577-7402.2020.05.17

骨肉瘤是目前儿童和青少年中病死率很高的恶性肿瘤[1].对于儿童和青少年股骨下端、胫骨上段的骨肉瘤,在新辅助化疗基础上行定制肿瘤型假体全膝关节置换术使保肢成为可能,但是长期化疗导致患儿免疫力持续降低,加上手术时间长、创伤大、软组织切除较多等因素,大大增加了术后发生感染的概率,患儿需面对假体取出旷置、再次翻修甚至截肢等严重后果[1-3].因此,在术前化疗和定制肿瘤型假体全膝关节置换的条件下进行保肢治疗仍是儿童胫骨近端骨肉瘤治疗的难题[3-4].笔者回顾性分析于2019-06采用化疗联合定制肿瘤型假体全膝关节置换术治疗的1例青少年胫骨近端骨肉瘤,术后发生感染并截肢,然后对相关文献进行复习总结,报道如下.

通过分析甘肃省中医院脑病科收住的1例以脑梗死为临床表现伴术后癫痫的烟雾病(moyamoya disease,MMD)患者的临床表现、影像学检查、治疗及预后探讨MMD的诊断及其术后并发症的防治,指出数字减影血管造影虽然为MMD诊断的金标准,但需结合临床症状、影像学表现进行诊断,一旦确诊应早期治疗、长期服用药物者需定期复查,预防并发症,外科手术是目前公认的治疗MMD的首选方法,同时通过中西医结合治疗相关并发症具有一定优势.

骨巨细胞瘤(giant cell tumor of bone,GCT)是一种良性肿瘤,但易发生局部侵袭、有复发倾向,对骨质侵蚀破坏性大[1,2].GCT除好发于股骨远端和胫骨近端外,也常累及桡骨远端[1,3].GCT诊断主要依靠临床表现、影像学及病理学检查等.桡骨远端骨巨细胞瘤的治疗大多采用自体骨移植重建腕关节[4],随着人工假体材料及其设计的不断改进,使肿瘤性人工假体重建腕关节成为可能[5],然而桡骨远端骨巨细胞瘤局部解剖复杂、瘤体不易切除、病损组织切除范围大以及假体远端不易固定等原因易造成术后局部炎症,对肿瘤性假体置换治疗桡骨远端骨巨细胞瘤提出挑战.笔者回顾分析诊治的1例使用人工假体置换治疗桡骨远端骨巨细胞瘤术后切口感染患者的资料,并对相关文献进行复习,报道如下.