小儿脊柱矫形应用同种异体骨移植的免疫学观察

Oberservation of clinical and immune changes after children＇s spine fusion using homelogous bone allograft.

目的研究同种异体骨移植在小儿脊柱矫形术中的应用及免疫学改变。方法选取1999～2004年123例脊柱矫形患儿，按照融合材料不同分为3组：第1组48例，为自体骨植骨患儿；第2组64例，为以自体骨为主、同种异体骨混合植骨融合的患儿，其中自体骨量大于60％；第3组21例，为以同种异体骨为主、自体骨混合植骨融合的患儿，其中异体骨量大于60％。观察和分析术后临床体征、实验室检查、免疫学检测、放射及同位素检查结果。结果第1组、第2组无明显排异反应；第3组3例出现早期排异反应（经病理学检查及免疫学检测证实），包括高热、局部无菌性渗出、C-反应蛋白（CRP）持续升高，病理检查见局部大量淋巴细胞浸润，未见新骨形成，骨膜反应不明显，免疫学检测显示CD^4＋明显升高，CD^4＋／CD^8＋明显升高。3组骨痂形成无明显差异。结论大量同种异体骨移植可引起早期免疫排斥反应，将同种异体骨与自体骨混合应用可减少排斥反应，并能得到较牢固的融合结果。

Objective To study clinical responses and immune changes after children＇s spine fusion using homologous bone allograft. Methods From 1999 to 2004 123 spine correction cases were got following up.According to the differences of fusion materials,we divided them into three groups：first group was 48 cases,the fusion material was self-bone,second group was 64 cases,the fusion material was mixiture of self-bone and honelogous bone （self-bone 〉 60%）,third group was 21 cases,the fusion material was mixture self- bone and homologous bone （homologous bone 〉 60%）.Observeded and recorded the results of clinical signs; laboratory examinations;immune cheching;radiology and istopic examinations,analysed and compared the observated results. Results We did not find obvious immune reactions in the first and second groups,but there were three eases in the third group were found earlier immune reactions.Included： after operation temperatures kept in higher;aseptic exudates in wounds;CRP kept higher;large amount lymphocytes were found in pathologic sections;no new bone performed and no reactions of periosteam.We examinated obviously increased of CD^4＋and CD^4＋/CD^8＋through immune examination.By long time following up,we did not find out obviously differences about the callus perform bettewen three groups. Conclusions Although there caller immune reactiuns after large amount homologous bone allograft,but if put self-bone with homologous bone mixided to finish spine fusion ,the immune reactions will be decreased and can get same solid fusion results.