冷冻异体手指骨与关节移植后长期的X线影像学表现

The long-term roentgenogrophic demonstration after transplantation of allogenic frozen phalanx and joint at hand

目的 研究冷冻同种异体手指骨与关节移植后远期随访的X线影像学表现。方法 用冷冻同种异体手指骨 关节 肌腱 腱鞘复合组织移植加自体甲皮瓣再造拇、手指 2 76例。术后分 2～ 6个月、7～ 1 2个月、1 3～ 2 4个月、3～ 5年、6～ 1 0年、大于 1 0年 6个时间组随访 ,每组病例数均超过 2 0例 ,共 2 0 8例。每组摄X线片并进行影像学对比分析。结果 术后 6个月组供受体骨性愈合者占 76 .92 % ,1 2个月组骨性愈合者 94.2 9% ,1 0年组达 98.2 1 %。与供受体骨相连接部愈合的同时 ,异体关节下区及关节面出现变性与骨吸收的现象则逐年加剧 ,6个月组到 1 0年组的骨吸收发生率从 7.69%增加到 64 .2 9% ,关节变性从 3 .85 %到 85 .71 %。 1 0年以上组骨吸收与关节变性减少。 2 0 8例的骨愈合率为 94.2 3 % ,关节下区与指端骨吸收发生率为 39.42 % ,关节变性率为 51 .44%。结论 冷冻异体骨关节移植能与自体骨相连接 ,愈合过程与自体骨移植的X线片表现基本相同 ;但异体软骨失活、变性坏死 ,累及关节下区骨的吸收 ,并随术后时间增加而加重。

Objective To investigate the long term X ray photography manifestation after transplantation of frozen allogenic phalanx and joint. Methods 276 cases of thumb and finger reconstruction were performed using composite tissue transplantation of frozen allogenic phalanx joint tendon sheath ,combined with wraparound flap transfer. 208 cases were involved in the study and they were randomly divided into 6 subgroups: 2 6 months,7 12 months,13 24 months,3 5 years,6 10 years and over 10 years, with each group greater than 20 cases .Comparison of X ray manifestation was performed. Results Bone union between the allograft and autograft occurred 76.92% at postoperative 6 month group, 94.29% at 12 months group, 98.21% at 10 years group, respectively . However, there was gradual deterioration of degeneration and bone absorption around sub joint area and joint surface, with bone absorption rate from 7.69% at 6 months group to 64.29% at 10 years group, and with joint degeneration from 3.85% to 85.71% . Bone absorption and joint degeneration decreased at over 10 years group. The overall bone union rate was 94.23% in 208 cases, while bone absorption in sub joint area and the finger tip was 39.42%, and joint degeneration rate 51.44%. Conclusions Transplantation of frozen allogenic phalax and joint can make union with autogenous bone, with an identical healing process of roentogenographic demonstration comparing with autogenous bone transplantation. However, gradual deterioration of allo cartilage degeneration and necrosis, as well as sub joint bone absorption occurred with aggravation at an increasing rate after operation.