保留骨骺灭活再植术的实验与临床研究

Inactivated bone replantation with preservation of the epiphysis:Clinical and experimental study

目的探讨保留骨骺灭活再植术的可行性。方法在有效大剂量化疗保护下对2例儿童骨肉瘤患者行保留骨骺的灭活再植术。以18只新西兰大白兔为实验对象,行保留骨骺灭活再植术,于术后4、8、12周处死动物,行大体标本、影像学、病理组织学、扫描电镜观察及软骨各层厚度的测量。结果2例患者分别随访36个月和40个月,无复发转移,膝关节屈曲100°和110°。患肢较对侧短1.0cm和1.2cm。实验研究发现保留骨骺灭活再植术的灭活骨与保留的骨骺、灭活骨与截骨断端间术后8周即愈合;保留骨骺软骨钙化层的厚度随时间逐渐增厚,较正常薄;关节软骨面基本保持了正常的形态和结构。结论保留骨骺的灭活再植术为儿童骨肉瘤提供了一种新的保肢手术方法。

Objective To evaluate the value of inactivated bone replantation with preservation of the epiphysis by clinical and experimental study.Methods Two children(aged5and10years,1male and1female)with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy;18New Zealand rabbits underwent the inactivated bone replantation with preservation of the epiphysis.The animals were killed later4weeks,8weeks and12weeks after operation,respectively.The specimens from animals were observed with naked eye,radiology,pathology and scanning electron microscope,and the measure ment of each cartilage layer thickness were also done.Results In two the patients,no evidence was seen in metastasis and recurrence within postoperative36and40months.The affected limbs were shorter1.0cm and1.2cm than limb of the control sides.Functions of the affected limbs were satisfactory.The results of the experimental study showed that healing between the inactivated bone and preserved epiphysis,the inactivated bone and bone end were well late8weeks after operation;the thickness of calcified cartilage increased along with the change of time,and was thiner than that of the normal;the normal form and structure of joint cartilage were kept.Conclusion Inactivated bone replantation with preserving epiphysis is a viable option for salvage-limb in children osteosarcoma.