同种异体皮质骨板移植治疗股骨假体周围骨折

Reconstruction of periprosthetic fractures of hip with cortical bone plates allografts

目的评价同种异体皮质骨板移植治疗髋关节股骨假体周围骨折的临床治疗效果.方法对7例髋关节置换术后股骨假体周围骨折患者应用深低温冷冻和环氧乙烷处理同种异体皮质骨板移植治疗股骨骨折.根据Harris评分,外周血T淋巴细胞亚群、抗体和免疫复合物检测、X线摄片以及核素骨显像评价其治疗效果.结果患者未发生免疫排斥反应和感染,术后3、6、12、24个月Harris评分分别比术前平均增加21、32、40、40分.术后3个月骨折愈合,一部分移植骨板与宿主骨骨性连接,同位素骨显像骨板移植区放射性分布比对侧浓集.术后12个月,85%移植骨板与宿主骨融为一体,宿主股骨皮质厚度增加3～5 mm,平均4.3 mm,骨板放射性浓集进一步加深,15%移植骨板出现吸收现象.术后24个月,80%移植骨板重新塑形后恢复宿主股骨皮质骨密度,10%骨板表面吸收停止,股骨假体无松动.结论深低温冷冻和环氧乙烷处理同种异体皮质骨板移植无菌、抗原性弱、生物相容性好,移植骨板能够维持骨折和假体稳定性,增加股骨局部骨量储备,避免再次手术取出金属内置物,是用来治疗股骨假体周围骨折较理想的方法之一.

Objective To observe clinical results for reconstruction of periprosthetic fractures of hip with cortical bone plates allografts by deep-freezing and ethylene oxide treatment. Methods Seven patients with periprosthetic fractures of hip underwent cortical bone plates allografts by deep-freezing at -70℃ after being treatment of 48℃ ethylene oxide. And evaluate clinical outcome by examinating T lymphocytes, Harris scores, X-rays photograph, and bone scintigraphy. Results There weren't activity of immunal rejection and infection in all patients. Harris scores of patients increased 21, 32, 40, 40 scores at 3,6, 12, 24 months after surgery. T-lymphocytes, antibody and immunocomplex in blood was normal postoperation. X-ray film indicated that fracture was healed at 3 months and there was partially bone conjunction between allograft strut and host bone. There was incorporation of 85% allograft strut to host bone, and 15% allograft strut was partically absorbed at 12 monthes after surgery. The size of femur of host was added 3mm to 5mm, averaged 4. 3 mm at 12 months postoperation. Density of 80% allograft plates was as same as host bone after remodeling and the absorbtion of 10% allograft plates stopped at 24 months after surgery. There was thick of nuclein in the area of allograft cortical bone plates by bone scintigraphy examination at 3 months postoperation, and the thick of nuclein was stronger at 6, and 12 months after surgery. Conclusion Allograft cortical bone plates by deep frozen at -70℃ after being treatment of 48 ℃ ethylene oxide is suitable for mechanical fixation and biological bone transplantation, and it can increase bone reservation, augment strength of femur once the allograft strut incorporates to host bone, and avoid removing metal implant in second operation when being applied into reconstruction femoral fracture in joint replacement.