内固定对异体骨段移植愈合影响的实验与临床研究

The Experimental Study and Clinic Observation of Internal Fixation on the Healing of Intercalary Bone Allografts

目的 :研究内固定对异体骨段移植愈合影响的实验与临床观察。方法 :采用新西兰大白兔股骨中段切除1.5cm骨干和骨膜实验动物模型。将 3 6只兔随机分成圆形髓内针内固定组和三棱形髓内针内固定组。于术后第 1、2、3个月行ECT检查、HE染色组织学观察异体骨愈合过程。比较普通非交锁髓内针和特制交锁针固定对异体骨修复骨肿瘤保肢术中瘤段切除大段骨缺损的治疗情况。结果 :圆形髓内针内固定组和三棱形髓内针内固定组异体骨移植愈合组织学过程相似 ,但三棱形髓内针内固定组在第 1、2个月时骨代谢活跃 (P <0 .0 5 )。 5 7例异体骨段移植随访 7个月～ 6.5年 ,平均 2 .6年 ,结果异体骨愈合 5 2例 ,不愈合 5例。其中普通非交锁髓内针 12例 ,骨不连 3例 (2 5 % ) ;特制交锁髓内针47例 ,骨不连 2例 (4 .3 % )。普通非交锁形髓内针易发生异体骨移植不愈合 (P <0 .0 5 )。结论 :稳固的髓内针固定有利于异体骨愈合。

Objective:To study effect of internal fixation on the healing of intercalary bone allografts.Methods:The bone intercalary defect animal models were made on New Zealand white rabbits at the middle shaft of the femur in which 1.5cm of diaphysis and periosteum were removed.36 rabbits were randomly divided into two groups.The bone defect was filled by the similar segment from another rabbit which were frozen in bone bank in each group.One group were fixed with 3mm circular-intramedullary nailing,the others were fixed with 3mm triangular-intramedullary nailing.Observations were done with bone scintigraphy and hemaloxylin and eoxin stain histological examinations at the 1,2,3 months postoperative.A retrospective analysis of 69 consecutive clinical cases of large-segment allograft implantations performed from Sep.1991 to Oct.1998 was conducted.All patients had bone tumors.The allogeneic bone healing were observed.Sixty-nine at the time of treatment was 31.4 years (ranged 9～70 years).Sixteen were fixed with common intramedullary and fifty-three were fixed with interlocking intramedullary nails.Results:The frozen bone of allografts being able to produce bone conduction is similar in two groups.ECT showed that bone metabolism were more active in the first and second month postoperative in triangular-intramedullary nailing group( P <0.05) and it is similar in two group at the third month postoperative.Follow-up time ranged from 5 months to 6.5 years (averaged,2.6 years)in 57 cases.52 cases were union and 5 cases were non-union.There was significant difference between the rate of union after fixation with common intramedullary and that after interlocking intramedullary fixation( P <0.05).Conclusions:The satisfactory union are obtained of in with stable interlocking intramedullary nailing.