吻合血管同种异体肱骨干移植20年随访结果

ALLOGENEIC HUMERAL SHAFT TRANSPLANTATION WITH VASCULAR ANASTOMOSIS: T WENTY YEARS FOLLOW-UP

目的 回顾总结吻合血管同种异体肱骨干移植的临床效果 ,并评价其临床意义。方法 1979年9月～ 11月 ,采用吻合血管的同种异体肱骨干移植修复 1例肱骨干 10 cm缺损 ,2例胫骨干 12 cm缺损 ,术后使用硫唑嘌呤、强地松等免疫抑制剂 3个月 ,进行连续 2 0年随访。结果 例 1修复肱骨干骨折术后恢复顺利 ,骨愈合 ,重塑良好 ,能胜任原工作。例 2术后 3年内发生 5次慢性排斥反应 ,经治疗好转 ;术后 2年发生移植骨骨折 ,经取自体髂骨植骨愈合 ,能胜任原工作。例 3术后 3年 10个月发生骨折 ,取自体髂骨植骨愈合 ;术后 2 0年随访 ,移植骨中段不愈合 ,仍能从事农业劳动。结论 用现代移植免疫学原理 ,进行良好的组织配型 ,在一段时间内使用有效免疫抑制剂 ,有可能提高同种异体长管状骨移植的临床效果。

Objective To sum up the clinical results o f allogeneic humera l transplantation with vascular anastomosis, and evaluate the clinical significa nce. Methods From September to November 1979, 1 case with humeral shaft def ect of 10 cm in length and 2 cases with tibia shaft defect of 12 cm in length we r e repaired by allogeneic humeral transplantation with vascular anastomosis. Azat hiopurine and prednisone were applied for 3 months postoperatively. All cases we re followed up for 20 years. Results Case 1 recovered well with good bone un ion and reconstruction after operation, and could work normally. In case 2, five chronic rejections were occurred during 3 years after operation, and recovered after treatment, the allograft bone was fractured after 2 years of operation, an d unioned by autogeneous iliac bone transplantation. In case 3, the distal part of allograft bone was fractured after 46 months, and unioned by autogeneous ilia c bone transplantation. The middle part of allograft bone was non-unioned after 20 years follow-up in case 3, but the patient could still work normally. Conclusion The clinical results of allogeneic long bone transplantation can be impr oved by rational tissue matching test, application of effective immunosuppressiv e drugs in a certain period according to the principles of modern transplantatio n immunology.