酒精灭活再植术对膝关节功能影响的临床与实验研究

Influence of alcoholic devitalization and replantation with inactivated bone on knee function: Clinical and experimental study

目的 探讨酒精灭活再植术对关节功能的影响及临床应用的价值。方法 回顾分析所治疗并获得随访的 2 0例患者 ,总结临床治疗结果和关节功能评价结果。对 1 8只兔股骨远端行酒精灭活再植术 ,通过大体标本、影像学、组织学和电镜 ,观察酒精灭活再植术对关节软骨的影响。结果 2 0例获得随访的患者中 ,复发 2例 ;灭活骨骨折 3例 ;切口延迟愈合 3例 ;迟发性切口感染 1例。并发症发生率为 45 %。肺转移 5例 ,死亡 4例。影像学观察发现灭活骨与截骨断端处可以愈合 ,随着时间的延长 ,关节出现退行性改变。关节功能评价优良率仅为 1 0 %。实验研究发现术后 8周时 ,灭活骨与截骨断端处已有大量骨痂形成 ;术后 1 2周时 ,骨断端处愈合。组织学和电镜观察发现关节软骨逐步失去正常结构。结论 从保留肢体的功能角度而言 ,酒精灭活再植术是一种并非理想的保肢重建方式。

Objective To study the value of clinical application and the influence on joint function for alcoholic devitalization and replantation.Methods Clinical aspect: Twenty patients underwent limb-salvage operation in which the tumor bone was devitalized by alcohol and replanted to the site of bone defect,all patients were reviewed and followed up. The clinical results and the assessments of joint function of these patients were analyzed. Research aspect: The inactivated bone that devitalized by alcohol replanted on the distal femur of 18 rabbits, the influence of this operation on the joint cartilage were observed by the naked eye, radiology, pathology and scanning electron microscope.Results Clinically, among 20 followed-up patients, tumor recurrence found in 2 case, inactivated bone fracture in 3, abnormal heal of incision in 3, late infection of incision in 1, lung metastasis in 5, and death in 4. The complication rate was 45%. On the X-ray plain films, it was found that the inactivated bone healed well and the degenerative change of joint gradually occurred as the time went by. The excellent-good rate of joint function was only 10% according to the Enneking standard. Experimentally, the results showed that a lot callus existed between the femur and inactivated bone at 8 weeks postoperatively and the bone healing existed at 12 weeks postoperatively. The abnormal cartilage structure was found by the pathology and the scanning electron microscope.Conclusion At the view of the limb function, the inactivated bone devitalized by alcohol and replantation is not an ideal but an alternative operation for limb-salvage.