同种异体骨移植修复骨纤维异样增殖症术后骨缺损

Allogeneic Cortical Bone Transplantation with Absorbable Nail Fixation to Repair the Cortical Bone Defect of Fibrous Dysplasia of Bone after Resection

目的观察同种异体皮质骨移植可吸收钉固定修复骨纤维异样增殖症刮除术后皮质骨缺损的疗效。方法自2004年3月至2007年4月我科共收治骨纤维异样增殖症24例,其中股骨11例,肱骨5例,合并桡骨2例,股骨颈及转子间1例,胫骨6例(合并腓骨1例),单纯腓骨1例。24例中6例出现病理骨折并骨愈合。所有患者入院后行病灶刮除,松质骨打压植骨后运用同种异体皮质骨移植可吸收螺钉固定修复皮质骨缺损。术后1、2、3、6、9、12个月对患者进行门诊随访,此后每年随访一次,观察患者的移植骨愈合、并发症及患肢功能恢复情况。结果术后患者切口均Ⅰ/甲级愈合。术后1年,24例患者植入的骨粒及皮质骨块与正常骨质均基本融合;术后1年3例失访,随访的21例术后2～5年移植骨吸收重建,骨缺损修复,病灶消失,其中14例骨干病灶中有6例髓腔再通。3例残留手术区域隐痛,与天气变化有关。所有患者截止随访末期功能均良好,无复发。1例患者术后3年邻近腓骨出现新病灶,5年后因摔伤导致腓骨病理性骨折,但胫骨无骨折。结论同种异体皮质骨移植可吸收钉固定修复骨纤维异样增殖症刮除术后皮质骨缺损疗效可靠。

Objective To observe the effect of cortical bone graft with absorbable screw fixation for repairing the cortical bone defects of fibrous dysplasia of bone after resection.Methods From march 2004 to April 2007,24 cases fibrous dysplasia of bone locating on humerus,radius,femur stem,femur neck,tibia and fibula were treated with cancellous bone transplantation and cortical bone graft transplantation with absorbable nail fixation after tumor curettage.The patients were followed up respectively in 1,2,3,6,9,12 months after operation,then followed up once a year.The healing of transplanted bone,complications and function recovery of limb were observed.Results All surgical wound healed by Grade one and Class A.One year after operation,24 patients all got fusion between implantation of bone and cortical bone with normal bone;during the period of follow up for 2.0 to 5.0 years,three cases lost;the remaining 21 cases had good bone union and good physical function;no nonunion,re-fracture and recurrence was found.Conclusion Allogeneic cortical bone graft with absorbable nail fixation is an effective and reliable procedure for repair the cortical bone defect of fibrous dysplasia of bone after resection.