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Evaluation of damage to trabecular bone of the osteoporotic human acetabulum at small strains using nonlinear micro-finite element analyses

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Chinese Medical Journal 2009年第17期122卷 2041-2047页

作者： DING Hai ZHU Zhen-an dai ke-rong Department of Orthopaedics Ninth People's Hospital ShanghaiJiao Tong University School of Medicine Shanghai 200011 China

Background With advance of age, alterations in bone quality, quantity and microarchitecture render osteoporotic trabecular bone become more sensitive to local failure. The aims of the present study were to clarify the extent to which the distribution of tissue-level stresses and strains was affected by structural changes and the extent to which osteoporotic acetabular trabecular bone was damaged at small strains. Methods Using a DAWING 4000A supercomputer, nonlinear micro-finite element （μFE） analyses were performed to calculate the tissue-level strains and stresses for each element in the trabecular bone of one osteoporotic acetabulum at small strains to quantify the tissue-level damage accumulation and mechanical properties. Results In contour plots of the tissue, maximum principal logarithmic strains, high tissue-level strains, both compressive and tensile, were observed in the osteoporotic trabecular bone at small apparent strains from 0.2% to 0.5% strain. The compressive apparent stress-strain curve showed typical nonlinear behavior and tangent modulus reduction with increasing strains. The microdamage curve suggested that microdamage began at 0.2% apparent strain in the osteoporotic trabecular bone and increased sharply, although very few microfractures occurred. The quartiles of the maximum principal logarithmic strains, minimum principal logarithmic strains and Von Mises stresses increased nonlinearly. For the inter-quartile range of the Von Mises stresses, a leap occurred at small strains ranging from 0.2% to 0.3% while microdamage commenced. Conclusions Extensive microdamage was primarily responsible for the large loss in apparent mechanical properties that occurred in the trabecular bone of the osteoporotic acetabulum at small strains. With increasing apparent strains, continuous nonlinear increments of tissue-level strains and stresses resulted in microdamage that propagated throughout the specimen with very few microfractures. Chin Med J 2009; 122（17）：

关键词： mechanical property trabecular bone nonlinear micro-finite element analysis acetabulum osteoporosis

Simultaneous double dislocation of the interphalangeal joint in one finger

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Chinese Medical Journal 2013年第5期126卷 974-975页

作者： FU Ling-jie dai ke-rong Department of Orthopaedic Surgery Ninth People's HospitalShanghai Jiaotong University School of Medicine Shanghai200011 China

Isolated traumatic dislocation of the distal and proximal interphalangeal .joints of fingers is a common occurrence. However, simultaneous double dislocation of the interphalangeal ,joints in one finger is rare. Here we report one case of simultaneous dorsal dislocation of both interphalangeal .joints in the little finger with a review of the literature.

关键词： distal and proximal interphalangeal joints simultaneous dislocation

Effects of sex and lower extremity alignment on orientation of the knee joint line in knee surgery

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Chinese Medical Journal 2012年第12期125卷 2126-2131页

作者： ZENG Yi-ming WANG You ZHU Zhen-an dai ke-rong Department of Orthopedic Surgery Shanghai Ninth People'sHospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200011China

Background Determination of the proper orientation of the knee articular surface is required both for correction of knee malalignment by osteotomy and for correct component alignment in knee arthroplasty. We sought to determine whether the patients＇ sex and lower extremity alignment （hip-knee-ankle angle） affects proper knee realignment in osteotomy or component alignment in total knee arthroplasty. Methods We examined 199 healthy adult knees with malalignment of 〈5°to determine the mechanical medial distal femoral angle, mechanical medial proximal tibial angle, surgical transepicondylar axis angle, and discrepancies between bone-cut orientations of osteotomy or total knee arthroplasty and the joint line of the distal femoral condyles, posterior femoral condyles and proximal tibial plateaus, using a three-dimensional computed tomography model. Results The mean mechanical medial distal femoral angle and mean mechanical medial proximal tibial angle were （94.4±1.9）° and （87.6±1.8）° respectively for women and （93.8±2.0）° and （87.1±1.4）° respectively for men. The surgical transepicondylar axis angle was （2.9±1.6）° for women and （3.2±1.7）° for men. Independent of sex, the hip-knee-ankle angle was closely related to the mechanical medial distal femoral angle and mechanical medial proximal tibial angle, but not to the surgical transepicondylar axis angle. A slightly more valgus alignment of the knee and a more valgus angulation of the distal femoral joint line were found in women, whereas a more varus angulation of the proximal tibial joint line was found in men. Sex had the greatest effect on knee joint line orientation when the lower extremity was valgus in alignment. Conclusions A more valgus femoral joint line can be expected in women and in persons with valgus lower extremity aliqnment; a more varus tibial joint line can be found in men and in persons with varus lower extremity alignment.

关键词： knee joint sex lower extremity orientation

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非扩增性干细胞治疗理念的形成及其应用前景

上海交通大学学报（医学版） 2020年第10期40卷 1318-1320页

作者：戴尅戎上海交通大学医学院附属第九人民医院骨科上海200011

20世纪干细胞的研究为临床细胞治疗打开了神奇的大门,但从20世纪下叶至今,始终只有血液疾病的干细胞治疗获得了推广,其他领域的干细胞治疗始终处于缓慢发展的阶段。其中一个重要原因,是干细胞的临床应用往往需要进行体外扩增。但扩增培... 详细信息

20世纪干细胞的研究为临床细胞治疗打开了神奇的大门,但从20世纪下叶至今,始终只有血液疾病的干细胞治疗获得了推广,其他领域的干细胞治疗始终处于缓慢发展的阶段。其中一个重要原因,是干细胞的临床应用往往需要进行体外扩增。但扩增培养的过程长、易污染、成本高,理化因素影响大,在一定程度上增加了治疗前后的风险。如使用胚胎干细胞,其获取、培养扩增时动物血清的使用和干细胞体外扩增后可能出现的非二倍体不稳定细胞,也使其受到伦理学的限制。由此,离心技术、免疫磁珠技术、干细胞筛选-富集-复合循环系统等非扩增性干细胞治疗技术逐步受到重视,形成了系统理念,并不断发展。上述技术无需体外培养,即可获取足够治疗剂量的干细胞,直接用于移植治疗。这种技术在临床应用和推广中已逐步展现出良好的应用前景。

关键词：干细胞非扩增技术细胞治疗

New variables for measuring joint space width to evaluate knee osteoarthritis

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Chinese Medical Journal 2011年第23期124卷 3886-3890页

作者： AN Bing-chen FANG Kai WANG You ZENG Yi-ming dai ke-rong Department of Orthopaedics Shanghai Ninth People＇s Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200011 China

Assessing the radiographic features of knee osteoarthritis （OA）, especially joint space narrowing, is important for evaluating disease progression. The purpose of this study was to quantitatively analyze joint space narrowing by measuring 2 new variables： the average joint space width （aJSW） and the articulate angle （AA） on X-ray films, and to evaluate the relationship between the 2 variables, knee function and OA symptoms. Methods Using the web-based radiology viewer （Cedara I-ReachTM 4.1.1）, we measured the 2 variables in 50 knees of 41 patients with knee OA participating in the Shanghai OA Study. We also evaluated the kellgren-Lawrence （K-L） grade, the Western Ontario and McMaster Universities OA Index （WOMAC）, and additional questionnaire in OA knees. The study was approved by the ethics committee of Shanghai Ninth People＇s Hospital （No. 2009-28）. Results The aJSW correlated with the K-L grade （r=-0.57, P 〈0.001）, kneeling （r=-0.29, P=0.04）, sitting cross-legged on the floor （r=-0.31, P=0.03）, WOMAC pain （r=-0.31, P=0.03）, WOMAC disability （r=-0.35, P=0.01）, pain while squatting （r=-0.37, P=0.01）, and defecating in a squatting position （r=-0.39, P= 0.01）. The AA correlated with defecating in a squatting position （r=0.29, P=0.05）, WOMAC disability （r=0.30, P=0.04） and K-L grade （r=0.44, P=0.003）. The K-L grade also correlated with pain while squatting （r=-0.40, P=0.005） and defecating in a squatting position （r=-0.34, P=0.02）, WOMAC pain （r=0.30, P=0.04）, and WOMAC disability （r=0.30, P=0.04）. Conclusions The aJSW closely correlated with knee OA symptoms and function scores, and was more sensitive to knee OA related disabilities than K-L grade and the AA. The aJSW could be used as a new variable for knee OA evaluation.

关键词： knee osteoarthritis X-rays joint space kellgren-Lawrence grade

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骨科个体化治疗与3D打印技术

医用生物力学 2014年第3期29卷 193-199页

作者：王燎戴尅戎上海市骨科内植物重点实验室上海交通大学医学院附属第九人民医院骨科上海200011

个体化治疗是骨科发展的一个重要方向,无论是个体化假体的应用还是常规假体的个体化植入,理论上均可改善骨关节假体与邻近骨性结构的匹配,从而改善病患功能状态。个体化治疗理论上的优越性无法代偿其在术前规划、设计、制造等方面程序... 详细信息

个体化治疗是骨科发展的一个重要方向,无论是个体化假体的应用还是常规假体的个体化植入,理论上均可改善骨关节假体与邻近骨性结构的匹配,从而改善病患功能状态。个体化治疗理论上的优越性无法代偿其在术前规划、设计、制造等方面程序上复杂及时限上滞后的缺陷,因而,个体化治疗常常停留在一种曲高和寡的概念。伴随图像技术的发展及3D打印技术的成熟,个体化设计及制造的生产效率有望显著提高,从而弥补传统个体化治疗效率上的不足,将个体化从概念落地为治疗理念。

关键词：骨科个体化治疗 3D打印假体

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评估肌肉疲劳的中枢和外周起源

医用生物力学 2015年第2期30卷 192-196页

作者：蔡斌戴尅戎上海市骨科内植物重点实验室上海交通大学医学院附属第九人民医院骨科上海200011

疲劳是很多内科及神经疾患的常见表现,理解这些疾病肌肉疲劳的中枢或者外周起源对制定针对性的肌肉疲劳治疗措施具有重要指导意义。综述肌肉疲劳发生的中枢因素(包括脊髓水平和激素上水平所有可以导致运动神经元兴奋性下降的因素)、外... 详细信息

疲劳是很多内科及神经疾患的常见表现,理解这些疾病肌肉疲劳的中枢或者外周起源对制定针对性的肌肉疲劳治疗措施具有重要指导意义。综述肌肉疲劳发生的中枢因素(包括脊髓水平和激素上水平所有可以导致运动神经元兴奋性下降的因素)、外周因素(包括神经肌肉的传播、肌肉动作电位的扩散、兴奋-收缩偶联),并讨论采用直接(最大自主收缩、抽搐力)和间接(抽搐叠加、肌电图、运动皮质刺激)的检测方法评估肌肉疲劳的中枢和外周起源。

关键词：肌肉疲劳中枢神经系统外周神经系统最大自主收缩抽搐力肌电图

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加强创伤领域的转化性研究

中华创伤杂志 2010年第3期26卷 193-194页

作者：戴尅戎殷宁上海交通大学医学院附属第九人民医院骨科 200011

创伤救治是人类最早医疗活动的主要内容之一。仅以敷料为例，从人类将泥土、炭末、干草等当做伤口敷料到现代各种动物、植物、矿物敷料、各种合成或药物性敷料，以及近代生长因子、基因类药物敷料和持续负压封闭引流技术等的广泛应用。... 详细信息

创伤救治是人类最早医疗活动的主要内容之一。仅以敷料为例，从人类将泥土、炭末、干草等当做伤口敷料到现代各种动物、植物、矿物敷料、各种合成或药物性敷料，以及近代生长因子、基因类药物敷料和持续负压封闭引流技术等的广泛应用。创伤科学经历的漫长发展过程，源于人们自古至今在各种创伤救治实践中的经验积累和科学技术的不断进步。

关键词：创伤救治转化性负压封闭引流技术伤口敷料医疗活动生长因子药物敷料科学技术

Bone morphogenetic protein 2 promotes transforming growth factor β3-induced chondrogenesis of human osteoarthritic synovium-derived stem cells

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Chinese Medical Journal 2010年第21期123卷 3040-3048页

作者： RUI Yun-feng DU Lin WANG You WANG Yang LUI Pauline po-yee TANG Ting-ting CHAN Kai-ming dai ke-rong Department of Orthopaedics Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200011 China Shanghai key Laboratory of Orthopaedic Implant Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200011 China Department of Orthopaedics and Traumatology Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China Program of Stern Cell and Regeneration School of Biomedical Science The Chinese University of Hong Kong Hong Kong SAR China

Background Synovium-derived stem cells （SDSCs） with higher chondrogenic potential are attracting considerable attention as a cell source for cartilage regeneration. We investigated the effect of bone morphogenetic protein 2 （BMP-2） on transforming growth factor beta3 （TGF-β3）-induced chondrogenesis of SDSCs isolated from human osteoarthritic synovium in a pellet culture system. Methods The clonogenicity, stem cell marker expression and multi-differentiation potential of isolated SDSCs were determined by colony forming unit assay, flow cytometry and specific staining including alizarin red S, Oil red O and alcian blue staining, respectively. SDSCs pellet was cultured in chondrogenic medium with or without TGF-β3 or/and BMP-2. At day 21, the diameter and the weight of the pellets were measured. Chondrogenic differentiation of SDSCs was evaluated by Safranin O staining, immunohistochemical staining of collagen type Ⅱ, sulfated glycosaminoglycan （sGAG） synthesis and mRNA expression of collagen type Ⅱ, aggrecan, SOX9, link-protein, collagen type X and BMP receptor Ⅱ. Results Cells isolated under the optimized culturing density （104/60 cm2） showed clonogenicity and multi-differentiation potential. These cells were positive （〉99%） for CD44, CD90, CD105 and negative （〈10%） for CD34 and CD71. SDSCs differentiated to a chondrocytic phenotype in chondrogenic medium containing TGF-β3 with or without BMP-2. Safranin O staining of the extracellular matrix was positive and the expression of collagen type Ⅱ was detected. Cell pellets treated with TGF-β3 and BMP-2 were larger in diameter and weight, produced more sGAGs, and expressed higher levels of collagen type Ⅱ and other chondrogenic markers, except COL10A1, than medium with TGF-β3 alone. Conclusions SDSCs could be isolated from human osteoarthritic synovium. Supplementation with BMP-2 significantly promoted the in vitro TGF-β3-induced chondrogenic differentiation of SDSCs.

关键词： chondrogenesis synovial membrane mesenchymal stem cell osteoarthritis bone morphogenetic protein 2 transforming growth factor beta3