结构性骨移植的并发症

Complications of the structural allograft

目的:综合分析结构性骨移植主要并发症的产生机制、预防和治疗措施。资料来源:应用计算机检索Pubmed1990-01/2006-04有关同种异体骨移植、结构性骨移植的文献,检索词为“allograft,massive bone allograft,structural allograft”,限定文章语言种类为English。同时检索清华同方CNKI中国期刊全文数据库1990-01/2006-04有关大段结构性骨移植的文献,检索词为“同种异体骨移植,大段同种异体骨移植,结构性骨移植”,并限定文章语言种类为中文。资料选择:对所有资料进行初审,选择与结构性骨移植并发症有关的文献。纳入标准:①同种异体骨移植相关基础研究。②大段同种异体骨移植临床应用研究。③结构性骨移植的并发症。资料提炼:共收集到45篇外文文献和107篇中文文献,其中113篇关于同种异体骨移植,39篇关于大段骨移植。排除122篇,选择其中30篇进行综述。资料综合:大段同种异体骨是重要的骨替代材料,但移植骨段存在愈合缓慢、生物学性能下降等不足,临床并发症众多,主要包括异体骨骨折、骨不连、感染、肿瘤复发及关节不稳定。预防并发症的方法包括:①移植骨在活体随时间延长骨强度逐渐下降,加速新骨生成可提高移植骨的生物学性能,减少骨折。②提高骨掺入能力可减少骨不连。③感染可能与免疫排斥反应有关,预防感染最好的措施是选择MHC相同的配体,广泛的手术干预,长时间手术暴露,输血量,肌肉皮肤散失,放疗化疗等均与感染有关。④严格掌握保肢指征,术前应用新辅助化疗方案,术中严格按界线切除,术后严密随访等都是减少肿瘤复发的重要措施。⑤异体骨的匹配程度,固定方法,周围软组织重建效果是决定早期稳定性的重要因素;软组织重建失败,异体骨骨折,软骨变性坏死关节面塌陷,骨性关节炎是晚期关节不稳定的原因。结论:要提高结构性骨移植的成功率,必须努力减少并发症。如何预防和减少结构性骨移植并发症必将成为今后的研究重点。

OBJECTIVE： To explore the causes, prevention and therapeutic measures for the main complications of structural allograft. DATA SOURCES： A computer-based online search of was Pubmed database was undertaken to identify the articles about allograft and structural allograft published in English from January 1990 to April 2006 with the key words of ＂allograft, massive bone allograft, structural allograft＂. Meanwhile, we searched the Chinese articles in Tsinghua Tongfang CNKI joumal full-text database for the Chinese articles about massive bone allograft published from January 1990 to Apnl 2006 with the same key words in Chinese. STUDY SELECTION： After the first selection, the literatures on the complications of structural allograft were selected and the full texts were looked for. Inclusive criteria： （1）related basic research about allograft; （2）clinical application research about massive bone allograft; （3）omplications of structural allograft. DATA EXTRACTION： A total of 45 English articles and 107 Chinese articles were collected including 113 articles about allograft and 39 articles about massive bone allograft. 122 articles were excluded, and 30 articles were reviewed. DATA SYNTHESIS： Massive allograft bone is the pnmary source of graft matenals, but allograft bone is poorly healed with decreased mechanical matedal properties. A lot of complications have been reported include fracture, nonunion, infection, tumor recurrence and instability. There are some ways to prevent complications： （1）The bone strength of grafted bone is decreased in vivo with time, so to accelerate the bone regeneration could improve the biological properties and minimize fracture; （2）The improvement in bone incorporation could reduce nonunion; （3）lnfection is likely the result of immunologic rejection. The best measure to prevent infection is to select better MHC matching honor and host. Extensive operative procedure, long duration of exposure, volume of transfusions, loss of muscle and skin, and adjuvant chemotherapy and radiation are associated with infection. （4）There are many important measures to reduce tumor recurrence such as strict limb salvage indication, application of new adjuvant chemotherapy before operation, tumor excision by surgical border and following up intensively. （5）The important factors such as matching honor and host, fixation measure and effect of the reconstructions of soft tissue determine early stability. Failure of soft tissue reconstructions, fracture, degenerative necrosis of cartilage, and osteoarthritis result in late joint instability. CONCLUSION：The success rate of massive bone allograft is improved by decreasing complications. How to prevent and decrease these complications may be the important themes in future.