异种骨基质明胶移植治疗骨折不愈合

Treatment of Fracture Nonunion by Implantation of Heterogeneous Bone Matrix Gelatin

目的 :临床观察骨基质明胶植入的成骨效果及生物相溶性。方法 :取健康的猪或小牛的管状皮质骨 ,根据Urist法制备成骨基质明胶 ,包装后环氧乙烷或钴60 消毒备用。 72例四肢长骨折不愈合患者 ,手术内固定治疗 ,并在骨折端植入骨基质明胶。术后观察切口愈合情况及定期拍X线片评价骨折愈合情况。结果 :72例植入骨基质明胶的患者 ,3例出现切口局部轻度红肿、清亮的液体渗出 ,培养无致病菌生长。 66例患者获随诊 1～ 3年 ,全部骨折愈合。其中 3 8例术后 2个月骨愈合 ,2 3例术后 3个月骨愈合 ,5例术后 4个月骨愈合。 5 1例内固定钢板取出时观察植入的骨基质明胶已完全吸收 ,被骨组织取代 ,随诊的患者未发现传播人畜共患疾病。结论 :异种骨基质明胶跨种属应用仍具有诱导成骨作用 ,未见免疫排斥反应 ,可替代自体骨移植治疗骨不愈合。

Objective:To investigate the osteogenesis effects and biocompatibility of the graft of bone matrix gelatin(BMG).Methods:BMG was made of tubal cortical bones of healthy bovine or swine according to the method of Urist and was standby after sterilization of ethylene oxide or Co 60 .Seventy-two cases of nonunion of long bone fractures were treated by internal fixation and implantation of BMG.Postoperative observations of incisions and X-ray evaluations of the circumstance of fracture union were carried out.Results:Of the 72 cases,incision union of the first rate happened in 69 cases and the second rate took place in 3 cases.The latter we could found exudations of clear liquids in 2 to 3 weeks.But no bacteria could be found after cultivations.Sixty-six cases were followed up for 1～3 years and all fractures were found union,of which postoperative union in 2 months in 38 cases,3 months in 23 cases and 4 months in 5 cases.The implanted BMG was observed totally absorbed and replaced by normal bone tissues in 51 cases when the internal fixations were taken out and none of zoonosis was found in the follow-up patients.Conclusions:Heterogeneous BMG still has function of osteoinduction after spanning different genus and species and no severe immuno-rejection was found.It can replace autograft in the treatment of bone non-union.