个体化组织工程骨与同种异体骨修复骨纤维异常增殖症术后骨缺损的对比研究

Individualized tissue engineering bone vs allograft in treatment of repairing bone defect of fibrous dysplasia

目的对比分析个体化组织工程骨和同种异体骨修复骨纤维异常增殖症术后骨缺损的长期临床疗效和生物安全性。方法回顾性分析10例个体化组织工程骨病例(组织工程骨组)和10例同种异体骨病例(异体骨组)移植修复重建骨纤维异常增殖症刮除术后骨缺损的临床资料。比较两种方法的愈合时间、骨性愈合评分、并发症发生率及植骨失败率,评价组织工程骨治疗骨纤维异常增殖症的临床疗效及其长期生物安全性。结果组织工程骨组随访(63.6±19.6)个月,1例术后2年出现病理骨折再次手术,其余9例术后骨缺损获得良好修复,愈合时间为(3.3±1.6)个月,骨性愈合评分为(2.6±0.5)分。异体骨组随访(55.1±15.4)个月,1例术后2年出现复发,3例出现骨移植区疼痛、局部肿胀等并发症,骨缺损均获得良好修复,愈合时间为(6.0±2.4)个月,骨性愈合评分为(2.4±0.8)分。2组之间在并发症发生率以及愈合评分方面差异无统计学意义(P>0.05);在愈合时间方面的差异有统计学意义(P<0.05)。结论个体化组织工程骨治疗骨纤维异常增殖症能获得优于同种异体骨的疗效且具有较高的生物安全性,是治疗骨纤维异常增殖症的一种新选择。

Objective To evaluate the clinical efficacy and bio-safety of individualized tissue engineered bone in repairing bone defect of fibrous dysplasia compared with allo-grafting. Methods A retrospective analysis was performed in 20 patients with bone defects cause by fibrous dysplasia who underwent bone reconstruction in our department from September 2004 to September 2009. Ten of them receive the bone reconstruction with tissue engineered bone, and the other 10 patients used the allograft. The healing time, bone healing score （according to Jorgenson standard）, and incidence of complications were compared in 2 groups to analyze the clinical efficacy and long-term bio-safety. Results In bone tissue engineered bone group, the average duration of follow-up was 63.6±19.6 months. Only 1 patient suffered from pathologic fracture in 2 years after surgery and was re-operated, while the other 9 patients achieved satisfactory effects with an average healing time of 3.3±1.6 months, and score of bone healing of 2.6±0.5. In allo-graft group, the average duration of follow-up was 55.1±15.4 months. Receiver site complications such as pain, local swelling and others were observed in 3 cases, recurrence was seen in 1 patient in 2 years after surgery, and 9 patients of reconstruction of the bone defects cause by fibrous dysplasia achieved satisfactory effect. The average healing time was 6.0±2.4 months, and the bone healing score was 2.4±0.8. There was no significant difference between the groups in bone healing score and incidence of complications （P〉0.05）, while significant difference was seen in the healing time （P〈0.05）. Conclusion Individualized tissue engineered bone is superior to allograft in clinical curative effect in repairing bone defect of fibrous dysplasia, and has high biological safety. It is an alternative choice for fibrous dysplasia treatment.