[Objective]To develop macroporous calcium phosphate cements(CPCs) by incorporating the gelatin microspheres(GMs) and to evaluate the performance of the composite as a bone substitute in vitro and in vivo. [Methods]GMs were prepared by improved emulsified cold-condensation method and macroporous CPCs were developed using GMs with three different weight ratios (0%,2.5% and 5%). The porosity and the compression strength of the three composites were measured to determine the proper weight ratio of GMs. The morphologic changes of osteoblasts were examined with scanning electron microscope at two days after the cells were seeded on the CPCs and GMs/CPCs. The cells were also cultured with different leaching liquor of three kinds of materials (0%,2.5% GMs/CPCs and polystyrene).Cell viability analysis was performed by MTT assay,and alkaline phosphatase was measured with alkaline phosphatase kit. At six months after implanted in the goat vertebre ,the samples with CPCs or GMs/CPCs were obtained and evaluated by X-ray image and histological anatomy.[Results]Porosity of the GMs/CPCs increased with the increase of GMs,but compression strength decreased. The proliferation and differentiation of the osteoblasts were enhanced with the 2.5% GMs/CPCs compared to the CPCs. In vivo study showed that the degradation of GMs/CPCs was improved.[Conclusion]Macroporous calcium phosphate cements can be developed by incorporating gelatin microspheres,and biocompatibility and degradability of the composite can be enhanced. The composite can be used as a bone substitute under non-loaded circumstances.

[Objective]To explore the treatment method of Spinal tuberculosis with focus-healed kyphosis and compression of spinal cord in thoracolumbar region.[Method]Seventeen cases were treated surgerically by single stage procedure,including posterior fusion,posterior instrumentation,decompression of spinal canal and interbody autografting.[Result]All patients were followed up from 9 months to 7 years postoperatively.The solid fusion was showed radiologically in 2.8 months at posterior autografting and in 3.3 months at interbody autografting on the average.The anteriolateral decompression of spinal canal was performed on 6 cases,completely recovered in 1 case,partially recovered in 3 cases and bad result in 2 cases.[Conclusion]Spinal tuberculosis with focus-healed kyphosis and compression of spinal cord in thoracolumbar region may show little spinal symptom clinically.The purpose of treatment is to provide rigid fixation and good stability of spine.

[Objective] To study the mechanism and clinic characteristic to the serious spinal cord compression from vertebral tuberculosis in the absence of nenrologic deficits.[Method]A total of 15 patients with serious spinal cord compression from vertebral tuberculosis in the absence of neurologic deficits were treated by one-stage debridement,lilac grafting and internal fixation.The clinical characters were retrospectively analyzed.[Result]All these patients had no sinus formation and no recurrence of spinal tuberculosis during average the follow-up of 3.8 years(range:6 months to 7 years).In 5 cases with incomplete paraplegia,3 cases improved 2 grades,1 case was no change and 1 case became serious.[Conclusion]The serious spinal cord compression from vertebral tuberculosis in the absence of neurologic deficits has a long history in illness,the spinal cord is in crisis condition even it can get adjustment by itself.The early one-stage treatment of debridement,iliac grafting and internal fixation can guarantee the restore the spinal cord and spine stability.

[Objective]To study various surgical approaches to the treatment of scapular neck and body fratures,and evaluate the clinical results.[Method]From January 1996 to December 2006,thirty-two cases with scapular neck and body fratures including 21 males and 11 females with age range from 18-56 years (mean 29 years) that had been admitted to the author's hospital were retrospectively analyzed.On the basis of the fracture patterns,straight incision along lateral border of the scapula,posterior approach,Judet approach were performed with plates or lag screws for open reduction and internal fixation.[Result]All cases were followed up for a period of 8-22 months.The mean time of bone union was 6-8 weeks.According to Hardegger's evaluation,22 cases showed excellent results,7 good,2 fair,1 poor.[Conclusion]Open reduction and internal fixation are emphasized to the severe separated scapular neck and body fractures.Straight incision along lateral border of the scapula,posterior approach or Judet approach can be chosen on the basis of the fracture patterns.Most scapular neck and body fractures can be treated by straight incision approach along lateral border of the scapula.This surgical approach can provide exposure of the fratures directly with saved surgical time and attain perfect reduction and fixtion with less trauma.

[Objective]To repair segmental bone defect with the composite of deproteinised cancellous bone,bone morphogenetic protein(BMP) and fibrin.[Method] Bone defects were created in 36 New Zealand rabbits on the bilateral radii and treated with three kinds of implantations:A,composite of deproteinised cancellous bone,BMP and fibrin;B,of deproteinised cancellous bone;C,blank control.The defects were observed by entgenography,optical microscopy,and electron-microscopy at 2,4,8,12,16 weeks.[Result] The defects treated with A implantation regenerated much more new bone and bridged earlier than the defects treated with B implantation and got completely repaired 16 weeks after operation.The defects with B and C implantation couldn't get osseous tissue healing.[Conclusion]The composite of deproteinised cancellous bone,bone morphogenetic protein(BMP) and fibrin can be effectively used to repair segmental bone defect.

[Objective]To investigate the effect of an effervescent-sucrose on the properties of calcium phosphate cement. [Method]The sucrose particles were mixed with CPC powder at sucrose/(sucrose+CPC powder) mass percentage of 0%,10%,20%,30%,40%.The samples were characterized by compressive strength,X-ray diffraction,SEM techniques and degradation in vivo.[Result]The samples decreased on the mechanical properties and increased on the rate of macropore and total porosity,they were effected significantly among groups by added effervescent(P

[Objective]To explore the outcome of repairing nerve defects with nerve allografts stored in green tea polyphenol solution.[Method]Forth-eight male mice were randomly divided into 4 groups of nerve grafting,with 12 rats in each group.A 1.0 cm sciatic nerve segment,5 mm away from infrapiriform foramen,was removed and repaired by 4 kinds of nerve allografts.Group A:autografts.Group B:allografts.Group C:cryopreserved nerve allografts.Group D:nerve allografts stored in green tea polyphenol solution.At 6 weeks and 12 weeks,a series of examinations were performed,including the gross appearance,electrophysiological test,histological observation,electron microscopic study and quantitative analysis with image analysis system.[Result]All the parameters of groups A and D were better than those in groups B and C(P

Objective To probe the repair effect of bone defect after getting rid of free bone in chronic osteomyelitis patients. Method Eighteen chronic osteomyelitis patients were reconstructed with vascularized fibula graft at one stage after getting rid of free bone and 2 cases were reconstructed with regional transplantation of pedic fibula after inflammable bone segment were exsected. Result Twenty chronic osteomyelitis patients who were treated with vascularized fibula graft or regional transplantation of pedic fibula after getting rid of free bone were followed up 3 - 6 months (mean 3. 5 months). The reconstructed bone unioned well,the inflammation of all bones near to joints were controlled; the repaired limbs achieved satisfactory function and outline. Conclusion The operation to reconstruct bone defect after getting rid of free bone in chronic osteomyelitis patients with vascularized fibula graft or regional transplantation of pedic fibula primerally is a good method' The advantage lies in avoiding the long alteration period of free bone, bettering the blood circulation of receipt region, controlling inflammation, shortening the resident period,times and operation times,and so. The method is a good attempt to repair inflammatory bone defect using vascularized bone graft.

Objective To investingate the expression method of bcl-2 and it's significance in osteogenic tumor and tumor-like diseases.Method The protein of PCNA, p53, Fas and bcl-2 were examined immunohistologically in osteosarcoma, ossifying fibroma, fibeous dysplasia of bone and normal bone callus. The results were analysed combing with the information of metastasis and hisomorphology.Results PCNA and p53 were highly expressed in low-differentiated osteosarcoma, bcl-2 were highly expressed at high-differentiated osteocoma and ossifying fibroma. When PCNA, p53 and bcl-2 were all expressed at high level, the metastasis rate was high, when only bcl-2 was expressed at high level, the progmosis was better. Conclusion The mechanism for benign and malignant tumor are different, the benign and low-degree malignant tumor may be caused by over accumulated mutation cells sipported by high level of bcl-2, while malignant tumor may be the result of multi-gene cooperation abnormally.

Objective To analyze the magnetic resonance imaging(MRI) appearance and pathological changes of pig thigh of soft tissues after been shot by rifle,so as to offer a theoretical foundation for wound management in early stage of gunshot injuries.Methods Seventeen adult pigs were intravenously anesthetized and suspended in supine position,the pigs were shot in 10 meters away by domestic-made rifle of 95 type.The wound limb were undergone 1.5T MRI scans and histological observation at 2h,6h,12h,24h,48h,9day,and 18day after shot injury.Results The wounded tissues included four areas of different pathological changes:primary ballistic cavity,coagulative necrosis area,tissue disruption area and tissue distortion area.The thickness of coagulative necrosis area was about 1 to 3 millimeters,which showed double-hypointense signal phenomenon in both T2 weighted image and enhanced T1 weighted image.The tissue disruption area and part of tissue distortion area showed double-hyperintense signal phenomenon in both T2 weight image and enhanced T1 weighted image.Conclusion Penetrating gunshot wound in soft tissues of hind limb can be divided into four areas:primary ballistic cavity,coagulative necrosis area,tissue disruption area and tissue distortion area.MRI can clearly show primary ballistic cavity and coagulative necrosis area.Tissue disruption area and tissue distortion area are hyperintense signal areas on the outside of the primary ballistic cavity,which can be distinguished clearly by pathalogical observation,but tissue disruption area and part of tissue distortion area are undistinguishable by MRI.