五种骨移植材料在胫骨平台骨折中运用的疗效比较

A Comparative Study of Five Kinds of Bone Graft Materials in the Treatment of Tibial Plateau Fracture

目的：探讨运用自体髂骨、同种异体骨、异种骨、及两种人工骨治疗胫骨平台骨折骨缺损的方法,分析比较五种植骨材料的成骨效应及免疫原性。方法：通过对2003年1月~2005年12月间行植骨手术的125例胫骨平台骨折病例进行回顾性分析。对平台下骨质塌陷缺损的病例,分别填充入上述5种骨移植物,并采用相应的钢板固定达到坚强内固定。对5组骨移植物病例,通过术后并发症、伤口愈合时间、骨愈合时间、术后平台高度丢失情况及X线表现进行比较。结果：仅从临床X线片上五种植骨材料的骨愈合时间未表现出明显差异,只是X线表现不同。自体髂骨植骨的主要并发症是供骨区的不适和疼痛,同种异体骨、异种骨出现持续伤口渗液,金骨威植骨出现胫骨平台高度丢失的病例较多。结论：骨移植是胫骨平台骨折治疗的重要步骤之一,掌握好它的适应证和方法对胫骨平台骨折的预后至关重要。自体骨是标准的骨移植物,同种异体骨、异种骨有一定的免疫排斥反应,人工骨具有良好的生物相容性、骨传导性和诱导成骨活性,无排斥反应,是良好的骨移植替代物。

Objective：To compare the osteogenesis and immunogenicity of 5 kinds of bone graft materials （autologous iliac bone, allogenic bone, heterogeneous bone and 2 kinds of artificial bone） in treating tibial plateau fracture. Methods： A retrospective study was done in 125 cases of tibial plateau accepted bone graft from January 2003 to December 2005. Once bone collapse or defect occurred under tibial plateau, the above 5 bone graft materials were selected and transplanted into tibial plateau. Postoperative complication, wound healing time, bone healing time, plateau height loss and X--ray appearance were observed. Results： There was no significant difference of bone healing time in five bone grafts. The main complication of autogenous iliac bone transplantation was discomfort and pain in donor area. Persistent effusion occurred from wound in allogenic and heterogeneous transplantation. Plateau height loss mostly occurred in Jinguwei transplantation. Conclusion： Bone graft is one of the most important steps in treating tibial plateau fracture, and indication and therapeutic methods are crucial to prognosis. Autogenous bone was considered as the standard bone graft. Autologous and allogenic bones show immunological rejection in some degree. Artificial bone is fine surrogate of bone transplantation materials with advantages of good biocompatibility, bone conductibility, osteogenesis and no rejection.