骨肉瘤患者同种异体骨移植后的组织学与扫描电镜观察

Histological and scanning electron microscopic observation of retrieved bone allografts

目的分析骨肉瘤患者同种异体骨植骨愈合与吸收的形态学特征及影响因素。方法收集2例骨肉瘤患者临床移植的大段异体骨标本,通过大体、组织学和扫描电镜观察,探讨移植骨愈合和吸收的形态学特点。结果例1观察到新骨的形成,植入骨与宿主骨发生骨性结合,在结合部位观察到骨爬行替代的演变过程。扫描电镜下看到愈合处多为松质骨,有形成面和吸收面及不同阶段的成骨细胞和各种形态的破骨细胞。例2植入骨和宿主骨发生自然离断,两端均吸收破溃,无愈合。宿主骨端有较多的破骨细胞和吸收窝,看不到形成面和成骨细胞。结论植骨方法、对接情况、固定方式、年龄及不同部位的供体骨均影响植骨愈合。

Objective To analyze the morphological characteristics and related factors of bone healing and resorption after bone allograft. Methods Specimens were harvested from two patients with bone tumors. The morphological characteristics of the bone healing and resorption were detected through routine histological and SEM observations. Results In specimen I： Bone union at cortical-cortical junctions was found on hostderived external end where the bone was crawling. Large proportion of cancellous bone was observed at the healing sites where the formation end, resorption end and osteoclasts and osteoblasts of different stages were also seen. In specimen II： No union was found in donor-derived end or host-derived end where the resorption was observed without healing. Large number of osteoclasts and absorption holes were seen with no evidence of osteoblasts and the formation end. Conclusion Grafting technique, bone-to-bone anastomosis, fixation methods, age of patients and characteristics of allogeneic bone play important roles in the healing process of bone transplantation.