活性多孔纳米复合人工颗粒骨修复下肢承重骨大块良性肿瘤性骨缺损疗效观察

Clinical Effect of n-HA/PA66 in Repairing Bone Defect Due to Benign Bone Tumors

目的观察和评估活性多孔纳米复合人工颗粒骨纳米羟基磷灰石聚酰胺66(n-HA/PA66)骨修复下肢承重骨大块良性肿瘤性骨缺损的临床疗效。方法选取2007年12月-2011年5月,良性骨肿瘤行股骨和胫骨手术术后骨缺损较大,需植骨填充且植骨量>20 g的患者67例。其中骨巨细胞瘤26例,纤维结构不良18例,骨囊肿10例,其他良性骨肿瘤13例。肿瘤刮除后瘤腔大小为3.0 cm×2.0 cm×1.5 cm～7.0 cm×3.0 cm×3.0 cm。全部患者行病灶刮除、瘤腔灭活、大量打压式植入n-HA/PA66人工骨,根据患者情况加用同种异体松质骨、含DBM人工骨,并根据皮质受累范围及厚度选择适当内固定。定期随访观察伤口愈合情况、患者肝肾功能、免疫指标、关节活动度及植骨处愈合情况。结果 67例患者全部获得随访,随访时间7～45个月,平均31.3个月。所有患者伤口均I/甲愈合,术后无肝、肾功能损害,无免疫相关疾病发生。患者植骨愈合时间为术后3～9个月,平均4.6个月,愈合率95.2%。术后骨巨细胞瘤患者局部复发3例,均经再次手术,随访未再复发。结论 n-HA/PA66颗粒骨可作为下肢承重骨大块良性肿瘤性骨缺损的植骨填充材料。

Objective To evaluate the clinical effect of nano-hydroxyapatite polyamide 66 （n-HA/PA66） in repairing benign large bone defects of legs. Methods We retrospectively analyzed the clinical data of 67 patients with large bone defects of legs due to benign bone tumors and the patients were treated with more than 20 g n-HA/PA66 between December 2007 and May 2011. Of these patients, 26 had giant cell tumor, 18 had fibrous dysplasia aneurism, 10 had bone cysts, and 13 had other bone tumors. The defect of bone after bone tumor resection was ranged in size from 3.0 cm×2.0 cm×1.5 cm to 7.0 cm× 3.0 cm×3.0 cm. All patients underwent focus erosion, n-HA/PA66 Medpor, spongy allograft or BMP bone grafting with the appropriate fixation or no fixation. We observed the status and time of bone healing in the graft. Results All patients were followed up for a mean time of 31.3 months （ranged from 7 to 45 months）. All the incisions healed by the first intention. No patients had obvious liver or kidney functional lesion. All patients had bone healing three to nine months after surgery （4.6 months on average）. Bone healing rate was 95.2%. Three patients with giants cell tumor suffered tumor recurrence, and non-recurrence after second surgery occurred. Conclusion The n-HA/PA66 has good clinical effect for repairing the large defects of legs due to benign bone tumors.