珊瑚羟基磷灰石人工骨移植修复良性骨肿瘤骨缺损32例

Coralline hydroxyapatite for repair of bone defects in 32 cases of benign bone tumor

背景:作为一种植骨替代材料,珊瑚羟基磷灰石具有均匀一致且相互连通的孔隙结构,植入骨缺损区其孔隙适合于血管再生、骨再生和骨沉积,生物相容性好,且无免疫原性。目的:评估珊瑚羟基磷灰石人工骨移植修复良性溶骨性骨缺损的临床效果。设计、时间及地点:回顾性病例分析,于1996-05/2007-05在海南医学院附属医院骨科完成。对象:选取海南医学院附属医院骨科同期收治的32例良性溶骨性瘤样病变患者,病理诊断骨缺损原因:骨囊肿18例,骨纤维异样增殖症9例,动脉瘤样骨囊肿4例,骨软骨瘤1例;合并骨折5例,其中2例股骨、1例肱骨为完全骨折,2例肱骨为不完全骨折。珊瑚羟基磷灰石由海南医学院生物材料实验室制备。方法:32例患者均行常规手术入路,彻底刮除病灶内瘤组织至正常变薄的骨皮质,选用大小不一的块状珊瑚羟基磷灰石充填,并用颗粒状珊瑚羟基磷灰石尽量将腔隙填满压实,缝合骨膜。完全骨折的3例患者作内固定,其余患者未作内固定,均不采用石膏外固定。主要观察指标:人工骨移植修复后不同时间X射线摄片检查骨折愈合情况。结果:32例患者均获随访,随访时间6~24个月,无全身性异常反应,伤口均在2周内一期愈合。移植前骨缺损病变范围为3cm×2cm×2cm^12cm×4cm×4cm;移植修复后1~3个月人工骨植入区与缺损周围的骨组织之间界限模糊;3~6个月人工骨与周围骨组织融为一体,骨缺损基本修复;6~24个月植入人工骨塑形改建,逐渐为自体新骨替代。结论:应用珊瑚羟基磷灰石人工骨移植修复良性溶骨性骨缺损效果满意,且并发症少,验证了其为一种比较理想的移植骨替代物。

BACKGROUND： As a bone graft, coralline hydroxyapatite （CHA） has uniform and interacted pore structure, which is suitable for vascular regeneration, bone regeneration and bone deposition. It displays good biocompatibility and no immunogenicity. OBJECTIVE： To explore the clinical results of CHA in the treatment of benign osteolytic bone defects. DESIGN, TIME AND SETTING： A retrospective analysis was performed in the Department of Orthopaedics, Affiliated Hospital of Hainan Medical College from May 1996 to May 2007. PARTICIPANTS： A total of 32 cases of benign osteolytic bone defects were enrolled from Department of Orthopaedics, Affiliated Hospital of Hainan Medical College. Pathological diagnosis showed that the cause of bone defect included bone cyst for 8 cases, fibrous hyperplasia of bone for 9 cases, aneurysmal bone cyst for 4 cases, osteoenchondroma for 1 case; fracture complication for 5 cases consisting of femoral complete fracture for 2 cases and humeral complete fracture for 1 case, and humeral incomplete fracture for 2 cases. CHA was prepared by the Biomaterials Laboratory of Hainan Medical College. METHODS： According to routine approach of the operation, 32 cases of benign osteolytic bone defects were implant with CHA granules, chips or blocks after deleting tumor tissue and thinning cortical bone. Then the periosteum was sutured. Three cases with complete fracture received internal fixation, while other cases were untreated. None was fixed with plaster for external fixation. MAIN OUTCOME MEASURES： The X-ray films were observed to evaluate the bone healing at different time. RESULTS： All cases were followed up for average 6-24 months. No general abnormal reactions were found. The incisions were healed in two weeks. The lesion range of bone defect was from 3 cm×2 cm×2 cm to 12 cm×4 cm×4 cm before operation; At 1-3 months after operation, bone graft began to fuse with bone tissue around defects and fused completely at 3-6 months, which indicated the bone defect was almost repaired; At 6-24 months, bone graft was moulded and rebuilt, gradually substituted by newly formed born. CONCLUSION： The CHA is an idea bone graft substitute material for its good results in the treatment of benign osteolytic bone defects, shorter operating time and fewer complications.