同种异体冻干小块骨的临床应用

Clinical application of morselized allogeneic bone processed by lyophilization and radiation

目的探讨临床应用辐照冻干同种异体小块骨移植的成骨效果、并发症及影响因素.方法自1995年12月～2000年12月使用同种异体小块骨移植治疗患者778例,男590例,女188例;年龄7～76岁,平均37.2岁.其中骨肿瘤84例,骨折551例,骨关节融合143例.植入前用自体新鲜血液或温生理盐水充分浸泡,根据病种及骨缺损情况,将其植入骨缺损处或需融合的关节周围.术后引流2～3d,常规应用抗生素预防感染.植骨量为4～64 g,平均24 g.结果术后随访36～96个月,平均59.7个月.术后早期体温、引流量、肢体肿胀等一般情况与自体骨移植同类手术相比差异无显著性.722例(92.80%)在3～8个月达到骨性愈合,平均4.5个月.并发症中伤口渗出44例,占5.65%;伤口延期愈合29例,占3.72%;伤口大量积液2例,占0.26%;骨折不愈合43例,占5.52%;肿瘤复发4例,占0.51%;关节融合失败9例,占1.15%;再骨折6例,占0.77%.全组按Mankin及Komender标准评定,满意688例,占88.44%;不满意90例,占11.56%.结论冻干同种异体小块骨具有良好的组织相容性及成骨作用,是骨移植术中良好的植骨材料,植骨区的稳定性、局部血运情况及外科操作技术是影响骨愈合的重要因素,骨折不愈合、晚期感染及再骨折是其主要并发症.

Objective To investigate the clinical result, complication and influential factors of lyophilized and radiation-sterilized morselized allogeneic bone. Methods Between December 1995 and December 2000, 778 cases with implantation of bone allograft were performed. There were 188 females and 590 males with an average age of 37.2 years (range, 6-76 years). The lyophilized morselized allogeneic bone was processed according to American Association of Tissue Bank (AATB) standards and was sterilized by radiation. The bone allograft was rehydrated in fresh blood or in physiologic saline before implantation. The morselized allograft was used to fill defects attributable to various causes such as 84 bone tumors (10.8%), 551 fractures (70.8%), 143 joint fusions (18.4%). After implantation of the bone allograft, drainage was carried out for 2~3 days and antibiotics were used to prevent infection. The average amount of the allograft implanted was 24 g (range, 4-64 g). Results All patients were followed up clinically and radiographically. The minimum length of follow-up was 3 years with an average follow-up period of 59.7 months (range, 36-96 months), 722 allograft unions occurred at a mean of 4.5 months postoperatively (range, 3-8 months). There were 137 complications, included 44 of wound effusion (5.65%), 29 of delayed wound healing (3.72%), 2 of profuse liquid accumulation (0.26%), 43 of fracture non-union (5.52%), 4 of tumor recurrence (0.51%), 9 of fusion failure (1.15%) and 6 of fracture (0.77%). Estimated by the combined Mankin and Komender standards, 688 (88.44%) patients were satisfied with their outcomes while the other 90 (11.56%) patients were dissatisfied. Conclusion The lyophilized and radiation-sterilized morselized allograft is of good tissue compatibility and able to promote bone formation, it can be considered as a convenient, safe, and available material for bone transplantation. The important factors affecting allograft healing are the mechanical stability in the recipient region, local blood supply for the site of grafting and the surgical technology. The major complications of allograft are late infection and re-fracture.