长骨节段性缺损修复重建的理论及应用进展

Repair and reconstruction of segmental long bone defect: Theory and application advances

背景:长骨节段性骨缺损修复重建方法众多,各有优缺点,限制了其广泛应用,仍是一个未完美解决的骨科难题。目的:综述近年国内外长骨节段性缺损的修复重建进展研究。方法:第一作者应用计算机检索1990年1月至2012年12月PubMed数据库、中国期刊全文数据库、维普数据库有关长骨节段性缺损修复重建的文章,英文检索词"bone defect,long bone reconstruction,tissue engineering of bone,scaffolds,bone reconstruction,bone graft,bone tumor;tumor resection,musculoskeletal tumors,regeneration,autografts";中文检索词"大段,骨缺损,骨肿瘤,软组织肿瘤,瘤段切除,组织工程,骨移植"。共检索到104篇相关文献,纳入52篇文献进一步研究。结果与结论:传统长骨节段性骨缺损的修复方法包括自体骨移植、异体骨移植、骨延长、人工假体置换等。研制适用于儿童保肢需要,符合儿童生长发育特点的假体成为儿童保肢的一个挑战课题。为了解决这一问题,人们研制出可以不断延长的假体,用于儿童骨肿瘤的保肢重建。随着医疗技术的进步,各种人工骨,尤其是骨组织工程和基因治疗在骨缺损修复中的逐步应用将进一步提高骨缺损的修复效果,是未来的研究方向。

ACKGROUND：Various methods have been reported for the repair and reconstruction of long bone segmental defect, but al of them have different advantages and disadvantages which limit their wide application. And this stil presents as a huge problem for many orthopaedics. OBJECTIVE：To review the latest research on reconstruction and repair of long bone segmental defects at national and international level. METHODS：A computer-based retrieval was conducted in PubMed database, CNKI database and VIP database by the first author for the articles published from January 1990 to December 2012, on the repair and reconstruction of long bone segmental defect with the key words of“bone defect, long bone reconstruction, tissue engineering of bone, scaffolds, bone reconstruction, bone graft, bone tumor, tumor resection, musculoskeletal tumors, regeneration, autografts”in English and“large segment, bone defects, bone tumors, soft tissue tumors, tumor resection, tissue engineering, bone graft”in Chinese. A total of 104 articles were screened out, and final y, 52 articles were included for further research. RESULTS AND CONCLUSION：Traditional method for the repair of long bone segmental defect includes autologous or al ogeneic bone graft, bone lengthening and artificial prosthesis replacement. The development of prosthesis that was suitable for child limb salvage and consistent with the child growth characteristics has become the chal enge to child limb salvage. In order to solve the problem, we designed the prosthesis that can continuously extent, and applied for the limb salvage reconstruction of tumor. With the development of medical technology, al kinds of artificial bone, especial y bone tissue engineering and gene treatment are being gradual y used to repair bone defect, which wil further enhance the clinical evaluation of bone defect repair, and that is the direction of further research.