自体与同种异体骨移植修复四肢长骨骨缺损的对比研究

A comparative study on bone defect reconstruction in long bones using bone autograft and allograft

目的比较自体与同种异体骨移植修复四肢长骨骨缺损的临床效果。方法回顾性分析132例异体骨和97例自体骨修复重建四肢长骨骨缺损患者的临床治疗资料,比较两种方法愈合时间、骨性愈合评分(按Jorgenson标准)、并发症发生率及植骨失败率。结果异体骨重建组132例,4例因感染致植骨失败需行病灶清除灌洗加自体骨移植,10例发生局部排斥反应,其余118例患者术后骨缺损获得良好修复,愈合时间(17.6±1.9)周。骨性愈合评分2.7±0.5。自体骨重建组97例,9例出现供区疼痛、切口感染及局部皮肤麻木等供区并发症,骨缺损均获得良好修复,愈合时间(17.4±2.3)周,骨性愈合评分2.8±0.3。两组之间在愈合时间、并发症发生率以及愈合评分方面的差异无统计学意义(P>0.05);在植骨失败率方面的差异有统计学意义(P<0.05)。结论运用同种异体骨和自体骨移植重建四肢长骨骨缺损,均能获得满意结果且疗效相似。异体骨移植术后感染致植骨失败以及排斥反应发生率较高,而自体骨移植则多表现为供区的并发症。

To compare the clinical results of reconstruction with bone autograft and allograft for bone defect in long bones. Methods A retrospective analysis was performed in 229 patients with long bone defects who underwent bone reconstruction, with the use of bone autograft in 97 patients, or bone allograft in 132 patients. The healing time, bone healing score （according to Jorgenson standard）, incidence rate of complications and bone graft failure in two groups were compared with each other. Results In bone allograft group, graft failure due to infection occurred in 4 patients who underwent debridement of the wound, 10 cases got local rejection, and satisfactory effects were achieved in other 118 patients. The average healing time was （17.6 ~ 1.9） weeks. The bone healing score was 2.7 ~ 0.5. In bone autograft group, donor site complications such as pain, incision infection or numbness of skin occurred in 9 cases, All of reconstruction of long bone defects with autogenous bone graft achieved satisfactory effect. The average healing time was （17.4 ± 2.3） weeks, and the bone healing score was 2.8 ± 0.3. Differences between the groups were no statistically significant among healing time, bone healing score, and incidence rate of complication （P 〉0.05）, while the incidence rate of graft failure in bone allograft group was higher than one in bone autografl, the difference was statistically significant （P 〈 0.05）. Conclusions The reconstruction using bone autograft and allograft for long bone defects have the similarclinical curative effect. There were high incidence rate of bone graft failure and rejection in bone allograft group, and obviously donor complications in bone autografl group.