同种异体骨联合自体骨复合骨移植用于瘤样骨病术后治疗

Intermingled transplantation of allochthonous and autogenous bone in the treatment of tumor-like legion

目的:探讨同种异体骨联合自体骨复合骨移植应用于儿童瘤样骨病术后的最佳治疗措施。方法:选择2003-03/2006-03在郑州大学第一附属医院进行瘤样骨病刮除植骨术的患儿40例,患儿监护人均签署知情同意书。根据植骨材料的不同将患者分为两组,即复合移植组和自体移植组,各20例。①复合移植组采用同种异体骨、自体骨和自体骨髓的复合骨移植,同时加入庆大霉素针16万单位、万古霉素针400mg和地塞米松针5mg。同种异体骨均来自山西奥瑞生物材料有限公司(山西省医用组织库)生产的冷冻干燥辐射灭菌骨;自体骨取自患儿髂骨。②自体移植组采用单纯髂骨移植,自体骨取自患儿髂骨,植骨时加入庆大霉素16万单位,不加入地塞米松。③复合移植组患者术中以5mg地塞米松针剂渗入同种异体骨,术后适当剂量的激素静脉滴注;自体移植组患者术中及术后均未应用激素。④术后引流,以24h引流量少于20mL为拔管指标。⑤复合移植组患者中应用去甲万古霉素400mg和庆大霉素16万单位渗入同种异体骨和自体骨中。术后两组均常规应用头孢类或青霉类抗菌素等预防感染。⑥术后观察比较两组患儿体温、白细胞、血沉恢复正常的时间及需要引流管留置的时间,定期随访。结果:40例患儿全部进入结果分析,无脱落。①复合移植组组患儿体温、白细胞、血沉恢复正常的时间和引流管留置时间均较自体移植组长[(10.95±2.63,13.85±2.68,25.90±2.53,13.15±3.01)d;(6.95±1.57,8.80±1.96,15.30±2.27,6.40±1.98)d,P<0.01]。②术后随访1￣3年,两组患者均有大量骨痂形成,但复合移植组患者骨痂形成量明显多于自体移植组。所有病例中均无感染、无延迟愈合或假关节形成。结论:同种异体骨联合自体骨复合骨移植的植骨融合情况优于自体骨移植。瘤样骨病的病灶较大,需要的同种异体骨量较多,因此机体的反应时间明显延长,术后必须延长引流管留置时间、合理应用激素及抗生素,抵制抗免疫反应及其潜在诱发感染的风险,才能真正发挥复合骨移植在儿童瘤样骨病治疗中的优势,确保植骨融合。

AIM： To approach the best therapeutic measures after allochthonous intermingled with autogenous bone transplantation in children with tumor-like legion. METHODS： Forty children received bone transplantation between from March 2003 to March 2006 were selected from First Hospital Affiliated to Zhengzhou University. The guardians of .Children all knew and agreed with the items. Subjects were divided into two groups according to the bone grafts with 20 children in each group： Compound transplantation group and autoplastic transplantation group. ① Subjects in compound transplantation group were transplanted with compound bone of allochthonous bone, autogenous bone and marrow with 160 thousands of gentamicin, 400 mg of vacocin and 5 mg of dexamethasone added. AIIochthonous bone was obtained from dried radiosteriliaed bone, which was made by Shanxi Aorui Biomaterial Co., Ltd. Autogenous bone was gotten from the lilac bone of children. ② Subjects in autoplastic transplantation group were transplanted with simple lilac bone got from subjects. Meanwhile, 16 thousands of gentamycin was adopted in the transplantation without using dexamethasone, ③ 5 mg of dexarnethasone was added in to the allochthonous bone used for the surgery of subjects in compound transplantation group, and intervenous drop infusion of hormone was given to subjects after the surgery at proper dose, while children in autoplastic transplantation group received no hormone during and after the surgery. ④ Post-operation draining was performed, and the draining flow within 24 hours less than 20 mL was taken as the index of extubate. ⑤ The allochthonous bone and autoplastic bone were immersed into 160 thousands of gentamicin and 400 mg of norvancemycin used for patients in the compound transplantation group. Patients in both groups were administrated with antibiotic drugs of blue mold for fear of infection. ⑥ The duration of recovery to normal body temperature, leukocyte count and erythrocyte sedimentation rate （ESR） as well as the time of reservation of drainage tube of patients in both groups were observed after the surgery after operation, and follow-up was conducted regularly. RESULTS： Totally 40 patients were involved in the analysis of results, and no one withdrew from the study. ① The duration of recovery to normal body temperature, leukocyte count and ESR as well as the time of reservation of drainage tube of patients in compound transplantation group were longer than those in autoplastic group [（10.95 ±2.63,13.85 ±2.68,25.90 ±2.53, 13.15±3.01） days ; （6.95±1.57,8.80±1.96,15.30±2.27,6.40± 1.98） days,P 〈 0.01]. ②During 1-3 years follow-up, a great quantity of osteotylus formed in patients of both groups, but those in compound transplantation group was much more than those in the autoplastic transplantation group. There was no infection, late healed or pseudarthrosis occurred. CONCLUSION： It＇s obvious that the organism reaction time prolonged in compound transplantation operations, and a series of correspondent treatment should be done to attenuate immunity reaction and to reduce the risk of latent infection, Only in this way, can we make sure osteocoalesce after the compound transplantation.