目的：（1）报告本院全膝关节初次表面置换术治疗骨关节病的临床特点和疗效。（2）探讨影响本院全膝关节初次表面置换术治疗骨关节病疗效的因素，为今后的临床工作提供经验与教训。方法：对52例全膝关节初次表面置换术进行随访，并用Hss评分系统进行分析，随访3～110个月，平均28。3个月。结果：手术优良率88.5%。病人术后在疼痛、功能及活动度等方面均有改善，尤其在缓解疼痛方面效果明显，但在关节活动度方面改善最少，有些甚至下降。结论：全膝关节初次表面置换术是治疗严重膝关节骨关节病的有效手段；局部早期的并发症是影响本院全膝关节初次表面置换术近期疗效的主要因素。

目的 了解以Gross治疗原则和第一代骨水泥技术的骨水泥治疗人工全髋关节翻修骨缺损的疗效。方法 选取1995年2月-2001年10月因人工髋关节松动而行翻修术的23例，了解按Gross治疗原则翻修者与以骨水泥填充骨缺损者Harris评分、影像学差异。结果 ①术中所见与术前Gross分型相符。②翻修术后患者Harris评分平均为82.7±8.3分，较术前增加18.9分。③X线片复查按Gross治疗原则翻修者假体无松动或移位，未见植骨块吸收或塌陷，未见骨溶解；以骨水泥填充骨缺损者有2例3处出现骨溶解加重或新的骨溶解。结论 ①Gross治疗原则对轻中度假体周围骨溶解的术前评估、全髋翻修术式提供很好的指导意义。②单纯以第一代骨水泥技术的骨水泥填充骨缺损者疗效欠佳。③随诊时Harris评分与X线片相结合，有助于发现早期骨溶解。

目的：探讨脊髓型颈椎病非手术治疗的效果及其影响因素。方法：随访1991-01/2002-01在中山大学附属第一医院行非手术治疗的脊髓型颈椎病病例。通过治疗前后的日本矫形外科协会（JOA）评分来分析疗效。并将疗效与多种可能的相关因素进行多重线性回归分析。结果：37例获得1年以上随访。治疗前平均JOA评分为（12.28±1.54）分，随访平均JOA评分为（14.82±2.19）分。治疗前后平均改善率为58.54%±33.97%。经回归分析，治疗前评分和疗效呈正相关，相关系数为0.19±0.06，并得出了回归方程。结论：颈髓功能较好的脊髓型颈椎病患者经非手术治疗的疗效较好；而颈髓功能较差的患者非手术治疗的疗效较不理想。治疗前的颈髓功能情况是影响脊髓型颈椎病非手术治疗的效果的唯一因素。

Background Mutation and expression change of p21WAF1/CIPI may play a role in the growth of osteosarcoma. This study was to investigate the expression of the p21WAF1/CIPI gene in human osteosarcoma, p21WAFl/CIPI gene DNA sequence change and their relationships with the phenotype and clinical prognosis. Methods p21WAF1/CIPI gene in 10 normal people and the tumours of 45 osteosarcoma patients were examined using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) with silver staining. The PCR product with an abnormal strand was sequenced directly. The p21WAF1/CIPI gene mRNA and P21 protein of 45 cases of osteosarcoma were investigated by using in situ hybridization and mmunohistochemistry, respectively. Results The occurrence of P21 protein in osteosarcoma was 17.78% (8/45), and p21WAFl/CIPI mRNA expression in osteosarcoma was 42.22% (19/45). The p21WAFl/CIPI gene DNA sequencing of amplified production showed that in p21WAF1/CIPI gene exon 3 of 36 cases of human osteosarcoma, there were 17 cases (47.22%) with C→T at position 609; 10 normal blood samples' DNA sequence analysis yielded 8 cases (80.00%) with C→T at the same position. Conclusions Along with the increase of malignancy, the expression of p21WAF1/CIPI mRNA and P21 protein in osteosarcoma tends to decrease. It is uncommon for the p21WAF1/CIPI gene mutation to occur in human osteosarcoma. As a result, the possible existence of tumour subtypes of p21WAF1/CIPI gene mutation should be investigated. Our research leads to the location of p21WAF1/CIPI gene polymorphism of Chinese osteosarcoma patients, which can provide a basis for further research.

目的 探讨复合重组人骨形态发生蛋白（rhBMP）的羟基磷灰石（HA）梯度涂层植入体的界面骨结合性能。方法 6只健康成年杂交犬股骨内、外髁关节面各垂直植入1个种植体，共植入钛合金圆柱体（Ti组）、HA涂层钛合金圆柱体（HA组）、复合rhBMP的HA涂层钛合金圆柱体（BMP组）各8个。12周时取材进行界面组织学观察、顶出试验和扫描电镜检查。结果 界面组织学和扫描电镜观察显示HA 组和BMP组界面骨结合良好。Ti组、HA 组和BMP组骨结合率分别为（11.53±10.79）%、（81.51±4.53）%、（92.71±5.30）% （P<0.01）；抗剪切力强度分别为（2.36±1.04）、（21.65±1.48）、（30.95±3.67）Mpa（P<0.01）。结论 复合BMP的HA梯度涂层在负重情况下界面骨结合好。结合强度高，已具备应用于新型涂层假体研制的生物学性能。