Bone Transport in Tibial Gap Non-Union—A Series of 25 Cases

Gap non-union of the tibia is frequently associated with deformity, infection and shortening. Ilizarov’s method of bone transport was used in the management of twenty-five cases of gap non-union of the tibia. The mean bone gap was 6.53 cm (range 4 to 12 cm). Union was achieved in all cases within a mean period of 11.12 months. The mean time taken for union, per centimeter of bone gap was found to be 1.7 months/cm. Pin tract infection was the commonest complication, seen in 9 cases (36%). The other complications encountered were neuropraxia (n = 3) deviation of the transported bone segment (n = 7), buckling of skin at the advancing side of bone (n = 4), traumatic corticotomy (n = 3), incomplete corticotomy (n = 1), equinus deformity (n = 4), knee stiffness (n = 4) and curling of toes (n = 4). The bone healing results were excellent in 92% of cases and good in 8% of cases. The functional results were excellent in 84% of cases, good in 12% and fair in 4% of cases. Thus bone transport by Ilizarov’s method manages the bone loss and the associated conditions with good bone healing and functional results.

Evaluation of bone remodeling in regard to the age of scaphoid non-unions

AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions(SNU) with immunohistochemistry.METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The resected material was evaluated histologically after staining with hematoxylin-eosin(HE), tartrate resistant acid phosphatase(TRAP), CD 68, osteocalcin(OC) and osteopontin(OP). Histological examination was performed in a blinded fashion.RESULTS: The number of multinuclear osteoclasts in the TRAP-staining correlated with the age of the SNU and was significantly higher in younger SNU(P = 0.034; r = 0.75). A higher number of OP-immunoreactive osteoblasts significantly correlated with a higher number of OC-immunoreactive osteoblasts(P = 0.001; r = 0.55). Furthermore, a greater number of OP-immunoreactive osteoblasts correlated significantly with a higher number of OP-immunoreactive multinuclear osteoclasts(P = 0.008; r = 0.43). SNU older than 6 mo showed a signifi-cant decrease of the number of fibroblasts(P = 0.04). Smoking and the age of the patients had no influence on bone remodeling in SNU.CONCLUSION: Multinuclear osteoclasts showed a significant decrease in relation to the age of SNU. However, most of the immunhistochemical findings of bone remodeling do not correlate with the age of the SNU. This indicates a permanent imbalance of bone formation and resorption as indicated by a concurrent increase in both osteoblast and osteoclast numbers. A clear histological differentiation into phases of bone remodeling in SNU is not possible.

Use of demineralized bone matrix in the extremities

Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts andbone graft substitutes. Demineralized bone matrix(DBM) is an allograft product with no quantity limitation. It is an osteoconductive material with osteoinductive capabilities, which vary among different products, depending on donor characteristics and differences in processing of the bone. The purpose of the present review is to provide a critical review of the existing literature concerning the use of DBM products in various procedures in the extremities. Clinical studies describing the use of DBM alone or in combination with other grafting material are available for only a few commercial products. The Level of Evidence of these studies and the resulting Grades of Recommendation are very low. In conclusion, further clinical studies of higher quality are required in order to improve the Recommendation Grades for or against the use of DBM products in bone grafting procedures.

Image Findings Following Vertebroplasty in Osteoporotic Vertebral Compression Fractures: Bone Healing and Sagittal Alignment

Purpose: To clarify the effect of percutaneous vertebroplasty for vertebral compression fracture by assessing the changes of radiographic and CT image findings. Materials and Methods: A retrospective radiological analysis comprising 101 vertebrae of 48 patients who underwent percutaneous vertebroplasty for painful osteoporotic vertebral compression fracture was conducted. Whole spine radiographs and CT images were compared in patients preoperatively and 6 months postoperativey. Sagittal Cobb angles in three regions, sagittal vertical axis, and pelvic tilt were measured using whole spine lateral radiographs. CT findings due to the vertebral compression fracture, its healing process, and complications were evaluated. Results: On radiographs, sagittal alignment had an average gain of no more than 2.5° in each region. Sagittal vertical axis and pelvic tilt did not show significant change. Out of 68 vertebrae that demonstrated cortical disruption on preoperative CT, 37 (54%) demonstrated fusion of disrupted cortex on postoperative CT. Conclusion: No significant difference was observed between preoperative and postoperative spinal sagittal alignment on radiographs. However, CT did reveal healing process through fusion of disrupted cortex, intervertebral bridging, and increased density of cancellous bone. It is suggested that cement in the space of fracture may play a role in both mechanical stability and bone union.

Effects of Povidone-Iodine or Ethanol Exposure on Bone Formation at the Osteotomy Site of the Proximal Tibia in Rats

Background: Povidone-iodine (PVI) irrigation is currently used to decrease the frequency of postoperative surgical site infections. Ethanol (EtOH) is sometimes applied to prevent local recurrence after curettage of benign bone tumors. However, the effects of PVI and EtOH on surrounding soft tissue and on bone union are unclear. The purpose of this study was to determine whether PVI or EtOH adversely affects the cancellous bone healing of the osteotomy site at the proximal tibia in rats. Methods: A cancellous bone osteotomy was performed at the right proximal tibia in 4-month-old, female, Sprague Dawley rats. Vehicle, 10% PVI, or 95% EtOH-soaked gauze was inserted into the osteotomy site and maintained for 6 minutes. The rats were euthanized 2 or 4 weeks after the osteotomy. Results: Two weeks after treatment, the bone union rate was significantly higher in the vehicle group than in the PVI group and the EtOH group (p < 0.001). However, the bone union rate was not significantly different between the PVI and EtOH groups. There was no significant difference among the three groups in the bone union rate 4 weeks after treatment. Conclusion: PVI or EtOH delayed bone union of the cancellous bone osteotomy site of the proximal tibia in the early phase (2 weeks), but not at 4 weeks, in rats.

Two-stage surgical treatment for septic non-union of the forearm

AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union.METHODS Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years(19-57 years) and a mean follow-up of 6 years(2-10 years). All patients presented an atrophic nonunion with a mean length of the bone defect of 1.8 cm(1.2-4 cm). Complications and clinical results after surgical treatment were recorded. RESULTS Mean time to resolution of the infectious process was 8.2 wk(range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo(range 2-10 mo) after the second step surgery. Cultures on intraoperative samples werepositive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5(27.8%) patients, satisfactory in 10(55.5%) and unsatisfactory in 3(16.7%) patients. No activities of daily living(ADLs) limitations were reported by 12(66.6%) patients, slight by 3(16.6%) and severe limitation by 3(16.6%) patients. Mean visual analog scale at the last follow-up was 1(0-3).CONCLUSION The two-step technique has proven to be effective to achieve resolution of the infectious process and union with good functional results and low rate of complications.

Bioabsorbable Barrier Membrane Combined with rhBMP-2 Improved Bone Formation in an Experimental Model of Compromised Healing But Was Not Superior to rhBMP-2 Alone

Objective: Bioabsorbable barrier membranes placed over alveolar ridge bone defects are routinely used in dental surgery to promote bone formation. Combining these osteoconductive membranes with osteoinductive Bone Morphogenetic Proteins could prove useful in long bone fracture treatment. The hypothesis was tested in a clinically relevant model of compromised healing. Methods: Four groups of 8 rabbits underwent unilateral mid-tibial osteotomy, excision of periosteum and endosteum, and plate fixation. One group had rhBMP-2 deposited between the bone ends and Membrane wrapped around the osteotomy, the second group had Membrane wrapped around the osteotomy, the third group had rhBMP-2 placed between the bone ends, and the fourth group received no additional treatment. Results: After 7 weeks, callus size and blood flow were significantly higher in the Membrane+rhBMP-2 group than in the rhBMP-2 treated group, but torsion to failure test showed no significant difference. Membrane treatment and no treatment led to non-union. Conclusion: Absorbable barrier membrane combined with rhBMP-2 enhances bone formation, but has no advantage to rhBMP-2 alone. Membrane alone wrapped around the osteotomy was unable to prevent non-union formation.

富血小板血浆联合玻璃酸钠对骨质疏松性骨折大鼠的影响

目的探讨富血小板血浆联合玻璃酸钠对骨质疏松性骨折大鼠骨愈合、血管生成及NFATc1信号通路的影响。方法选取50只SPF级SD雌性大鼠,随机分为正常(NO)组,模型(MO)组,富血小板血浆(PP)组,玻璃酸钠(SH)组,富血小板血浆联合玻璃酸钠(PS)组。通过小动物骨密度仪检测骨密度、生物力学试验机检测骨生物力学、HE染色法检测骨组织病理形态、ELISA法检测血清中血管生成相关因子含量、免疫印迹法检测大鼠骨组织中NFATc1信号通路蛋白表达。结果与NO组相比,MO组骨密度、刚度、最大载荷、最大压强、弹性模量、血管数量及血管面积、VEGF、bFGF、ANG-1含量显著降低(P<0.05),股骨组织NFATc1、OSCAR蛋白表达显著升高(P<0.05),与MO组相比,PP组、SH组、PS组骨密度、刚度、最大载荷、最大压强、弹性模量、血管数量及血管面积、VEGF、bFGF、ANG-1含量明显升高(P<0.05),股骨组织NFATc1、OSCAR蛋白表达显著降低(P<0.05),且SH组与PP组相比无明显差异(P>0.05),PS组比SH组变化显著(P<0.05)。结论富血小板血浆联合玻璃酸钠对骨质疏松性骨折大鼠具有显著疗效,可有效促进骨愈合及血管生成,并抑制NFATc1信号通路。

骨折延迟愈合与骨不连现状与趋势:一项运用Citespace文献计量学及数据可视化研究

目的:使用文献计量学及数据可视化分析技术,对骨折延迟愈合与骨不连的相关文献进行综合分析,总结该领域的研究现状及前沿动态,并推测未来发展趋势。方法:检索Web of Science核心数据库中2002年1月1日至2023年12月31日的骨折延迟愈合与骨不连文献作为研究对象,使用Citespace软件对相关文献发表的国家、研究机构、杂志、作者、关键词等信息进行数据分析及可视化分析。结果:符合检索条件的文献9403篇,符合纳入标准的为9183篇,该领域发文量呈上升趋势,发达国家和相关国家的研究机构在该领域的研究中占据主导地位,但中国及上海交通大学等机构则在该领域发展迅速,处于追赶地位,频次最高的关键词为managemen(t治疗),关键词共形成15个聚类,突现关键词25个。结论:骨折延迟愈合与骨不连研究处于不断发展的状态,逐渐从手术治疗转向对疾病的发病机制及骨修复与再生领域的研究,研究层次不断加深。骨修复与再生将成为该领域未来研究的主要趋势。

先天性胫骨假关节的临床治疗新进展

先天性胫骨假关节是罕见的先天性胫腓骨骨骼畸形,以骨不连、假关节形成、肢体成角短缩等畸形为主要表现,多合并神经纤维瘤病,治疗极其困难。近年来,随着对先天性胫骨假关节发病机制研究的深入,新型手术方法如胫腓骨“4合1融合术”、“Cross-union内固定法”(胫腓骨交叉融合术)的开展,结合新型药物如双膦酸盐、骨形态发生蛋白的综合使用,其骨愈合率逐渐提高,再骨折发生率降低。本文总结了近年来先天性胫骨假关节治疗的现状及进展,以期为临床治疗提供借鉴和思考。

长骨骨不连的发病率及手术治疗研究进展

骨不连是骨折并发症之一,其发病部位及病因多样化,治疗方式也不完全相同。不同因素之间相互作用,使之成为临床骨科医师棘手的难题。多数骨不连发生在长骨骨折后,以锁骨、肱骨、前臂、股骨、胫骨为主。临床治疗中,存在多种手术方式可供选择。笔者就近年来长骨骨不连的发病率及手术治疗现状进行综述,旨在为骨不连手术治疗方法的进一步研究和应用提供参考依据。

参芪补肾活血汤改善兔股骨骨折延迟愈合的机制初探

[目的]初步探讨参芪补肾活血汤对兔股骨骨折延迟愈合的作用效果。[方法]采用外科手术截除30只新西兰大白兔左侧股骨中段10 mm皮质骨的方法构建股骨愈合延迟模型,将模型动物随机分为模型组、参芪补肾活血汤高剂量组(10 mL/kg)、参芪补肾活血汤低剂量组(5 mL/kg),每组10只,另取10只健康动物作为空白组。参芪补肾活血汤组按剂量每天灌胃1次,持续4周,空白组与模型组同法给予生理盐水。动物给药完成后收集血清样本与愈伤处骨组织样本,逆转录实时定量聚合酶链反应(RT-qPCR)法检测血清中骨形态发生蛋白(BMP)-2、BMP-7、转化生长因子-β1(TGF-β1)和血管内皮生长因子(VEGF)基因相对表达水平,苏木精-伊红染色法观察骨组织愈合情况,免疫组织化学法检测愈伤处骨组织中BMP-2、BMP-7、TGF-β1和VEGF蛋白表达水平。[结果]病理学显示,模型组骨组织愈合缓慢,损伤区域明显,参芪补肾活血汤高剂量组则出现明显骨痂与骨组织形成。与空白组比较,模型组血清与组织中BMP-2、BMP-7、TGF-β1和VEGF表达水平均降低(P<0.01),与模型组比较,参芪补肾活血汤高剂量血清与组织中BMP-2、BMP-7、TGF-β1和VEGF表达水平均升高(P<0.05)。[结论]参芪补肾活血汤具有促进兔股骨愈合的效果,其机制可能是促进BMP-2、BMP-7、TGF-β1表达,诱导骨缺损区域血管形成。

万古霉素骨水泥对感染性骨缺损骨折愈合的影响

目的探究万古霉素骨水泥对感染性骨缺损患者骨折愈合及炎症因子水平的影响。方法选取2019年1月至2020年12月贵阳市第四人民医院收治的64例感染性骨缺损患者作为研究对象,按照随机数字表法将其分为对照组(32例)与研究组(32例),对照组接受常规清创引流治疗,研究组在对照组基础上采用万古霉素复合型骨水泥植入治疗,比较两组患者骨折愈合优良率、炎症因子改善情况以及术后肢体功能恢复情况。结果研究组患者的骨折愈合优良率、术后关节功能恢复优良率高于对照组,差异有统计学意义(P<0.05)。术后,两组患者白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞计数(WBC)水平低于本组术前,研究组患者IL-6、TNF-α、ESR、CRP、WBC水平低于对照组,差异有统计学意义(P<0.05)。术后,两组患者平均通过时间(MTT)短于本组术前,血容量(BV)、血流量(BF)水平高于本组术前,研究组患者MTT短于对照组,BV、BF水平高于对照组,差异有统计学意义(P<0.05)。术后,两组患者血管内皮生长因子(VEGF)、转化生长因子β1(TGF-β1)、骨形态发生蛋白2(BMP-2)水平高于本组术前,研究组患者VEGF、TGF-β1、BMP-2水平高于对照组,差异有统计学意义(P<0.05)。结论对感染性骨缺损患者实施万古霉素复合型骨水泥植入治疗可有效降低炎症因子水平,促进患者骨折愈合,改善肢体功能。

T细胞免疫在骨重建和骨再生中的研究进展

骨重建和骨再生对于保持骨骼完整性和维持矿物质稳态至关重要。T淋巴细胞为适应性免疫的关键成员,通过产生一系列细胞因子和生长因子,在骨重建和骨再生过程中起着举足轻重的作用。在生理状态下,T淋巴细胞通过与间充质干细胞、成骨细胞、破骨细胞的交互作用参与骨稳态的维持;在病理状态下,T淋巴细胞通过与雌激素、糖皮质激素、甲状旁腺激素的协作参与不同类型骨质疏松的病理过程;在损伤后修复的骨折愈合过程中,T淋巴细胞在炎症血肿期、骨痂形成期和骨重建期发挥了不同的作用。因此,靶向T淋巴细胞成为调节骨稳态的潜在策略。本文综述了T细胞免疫参与骨重建和骨再生的研究进展及相关机制,以期为靶向T淋巴细胞调控骨重建和骨再生提供科学依据。

补肾活血汤对老年髋部骨折患者术后骨密度及骨折愈合的影响

目的:观察补肾活血汤对老年髋部骨折患者术后骨密度及骨折愈合的影响。方法:选择2023年1月—2023年10月于我院治疗的老年髋部骨折患者150例,按照随机数字表法分为对照组与观察组两组。对照组75例,微创内固定手术治疗后,进行常规康复治疗。观察组75例,在按对照组治疗基础上同时给予补肾活血汤治疗,比较两组临床疗效,治疗前、后两组患者中医证候评分(骨连未坚、肢体萎软、腰膝酸痛、神疲乏力),检测两组患者患肢肿胀程度,评价并比较两组患者6点行为评分法(BRS-6)评分、骨痂评分,检测髋部骨密度值,记录骨折愈合时间,检测两组患者丙二醛(MDA)、晚期糖基化终末产物(AGEs)、生长分化因子15(GDF15)、骨保护素(OPG)、骨碱性磷酸酶(BALP)、血钙水平。结果:观察组总有效率(94.67%)显著高于对照组总有效率(80.00%),差异有统计学意义(P<0.05);观察组骨连未坚、肢体萎软、腰膝酸痛、神疲乏力评分低于对照组(P<0.05);观察组肿胀程度、BRS-6评分低于对照组(P<0.05);观察组骨密度值、骨痂评分高于对照组(P<0.05),观察组骨折愈合时间短于对照组(P<0.05);观察组AGEs、GDF15、MDA、BALP水平低于对照组(P<0.05),观察组OPG水平高于对照组(P<0.05),两组血钙水平比较,差异无统计学意义(P>0.05)。结论:补肾活血汤治疗老年髋部骨折术后患者,可抑制氧化应激及炎症,改善骨代谢及骨密度,缓解疼痛及患肢肿胀,促进骨折愈合,提升临床疗效。

带锁髓内钉内固定术与加压钢板内固定术对四肢创伤性骨折后骨不连患者的治疗效果比较

目的 对比四肢创伤性骨折后骨不连采用带锁髓内钉内固定术、加压钢板内固定术进行治疗的效果。方法 选择66例四肢创伤性骨折后骨不连患者,采用随机数字表法分为对照组与观察组,每组33例。对照组患者行加压钢板内固定术治疗,观察组患者行带锁髓内钉内固定术治疗。比较两组手术疗效、手术指标、术后恢复指标、术后并发症发生情况、运动功能、生活能力和膝关节功能。结果 观察组患者手术优良率90.91%(30/33)高于对照组的63.64%(21/33)(P<0.05)。观察组患者手术用时(131.50±15.50)min、切口长度(15.30±2.50)cm、术后住院时间(10.50±1.50)d、患肢恢复时间(22.05±2.20)周短于对照组的(164.50±16.05)min、(18.30±3.30)cm、(15.50±1.50)d、(35.50±2.50)周,术中出血量(365.50±22.50)ml少于对照组的(453.50±30.60)ml(P<0.05)。观察组患者术后并发症发生率6.06%低于对照组的24.24%(P<0.05)。治疗后,两组患者运动功能、生活能力、膝关节功能评分均高于治疗前,且观察组高于对照组(P<0.05)。结论 带锁髓内钉内固定术治疗四肢创伤性骨折后骨不连具有较高的安全性与有效性,手术损伤小、恢复快,能促进患者运动功能、生活能力、膝关节功能恢复。

体外冲击波疗法与手术治疗骨折延迟愈合和骨不连的有效性与安全性比较:一项基于临床随机对照试验研究的Meta分析

目的采用Meta分析方法评价体外冲击波疗法(ESWT)与手术治疗骨折延迟愈合和骨不连的有效性和安全性。方法计算机检索中国知网、万方数据库、Pubmed、Cochrane Library等中、英文数据库关于ESWT对比手术治疗骨折延迟愈合和骨不连的临床随机对照试验(RCTs),试验组采用ESWT,对照组采用手术治疗。检索时间从建库至2023年10月。结局指标包括愈合率、愈合时间、不良反应发生率、治疗费用。结果共纳入16篇RCTs,Meta分析结果显示,对比对照组,试验组的愈合率更高(OR=1.720,95%CI:1.240~2.380,P=0.001),愈合时间(d)缩短约27 d(MD=-27.110,95%CI:-49.700~-4.510,P=0.020),治疗费用(万元)减少约3.2万元(MD=-3.200,95%CI:-3.850~-2.560,P<0.001),不良反应发生率比较差异无统计学意义(RR=0.520,95%CI:0.100~2.860,P=0.450)。结论对比手术治疗骨折延迟愈合和骨不连,ESWT愈合率更高,愈合时间更短,无严重不良反应,成本-效益优势显著,具有较好的临床应用及推广价值。

创伤性骨折患者血清炎症指标与骨折愈合及骨生化指标的相关性分析

目的探讨分析血清C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体(D-D)以及骨生化指标在创伤性骨折患者骨折愈合中的价值。方法回顾性分析2021年3月至2023年2月本院收治的25例创伤性骨折延迟愈合患者病例资料,并将其纳入延迟组;同时将69例创伤性骨折正常愈合患者纳入对照组。比较2组患者CRP、PCT、D-D水平以及骨生化指标[血钙、血磷、骨碱性磷酸酶(BALP)]差异,采用Pearson相关分析上述指标与骨折延迟愈合的相关性。结果延迟组CRP、PCT、D-D水平均高于对照组(P<0.05),延迟组血钙、血磷、BALP水平均低于对照组(P<0.05);骨折患者血清CRP、PCT、D-D水平均与骨折延迟愈合呈正相关(P<0.05),骨折患者血钙、血磷、BALP水平均与骨折延迟愈合呈负相关(P<0.05)。结论CRP、PCT、D-D与骨生化指标均与创伤性骨折患者骨折延迟愈合密切相关,临床应予以重视。

胰岛素样生长因子1基因转染骨髓间充质干细胞对骨折愈合及血管形成的作用研究

目的探究胰岛素样生长因子1(insulin-like growth factor 1,IGF1)基因转染骨髓间充质干细胞(bone marrow mesenchymal stem cell,BMSC)对大鼠骨折愈合及血管形成的影响。方法建立大鼠股骨骨折模型,采用BMSC、含IGF1基因慢病毒转染的BMSC分别处理模型大鼠。X线影像系统、micro-CT扫描仪观察骨折愈合情况,HE染色观察股骨组织病理学变化,免疫荧光染色观察血管内皮标记物CD31表达,蛋白质印迹检测骨形态发生蛋白2(BMP-2)、骨桥蛋白(OPN)、骨钙素(OCN)与血管内皮生长因子(VEGF)、血管生成素-1(Ang-1)表达。结果与模型组比较,BMSC组与IGF1-BMSC组大鼠的骨折线模糊,有愈合性骨痂形成,BMD、BV/TV升高(P<0.05),Tb.N增加(P<0.05),Tb.Sp降低(P<0.05),CD31荧光表达增强,BMP-2、OPN、OCN及VEGF、Ang-1蛋白相对表达量均上调(P<0.05)。与BMSC组比较,IGF1-BMSC组大鼠骨折线几乎消失,愈合效果更佳,BMD、BV/TV升高(P<0.05),Tb.N增加(P<0.05),Tb.Sp降低(P<0.05),CD31荧光表达更强,BMP-2、OPN、OCN及VEGF、Ang-1蛋白相对表达量也进一步上调(P<0.05)。结论IGF1基因转染BMSC能够有效促进大鼠股骨骨折愈合,加速血管形成,且效果优于BMSC单独作用。

异体骨关节移植后骨愈合的X线形式及影响因素

目的 探讨肢体恶性肿瘤接受大段同种异体骨关节移植后和异体骨愈合在 X线的表现及影响因素 ,以改进手术方法。 方法 1992年 5月～ 1999年 3月 ,对收治的 90例中可纳入统计的 85例骨恶性肿瘤在手术切除长段骨关节后 ,应用不同内固定方式进行异体骨关节移植 ,其中 16例保留髁部关节面的异体骨段移植 ,5 7例异体关节移植 ,9例复合异体骨段人工髋关节置换 ,3例膝关节置换。术后平均随访 2年 9个月 ,以 X线片表现判定骨愈合方式 ,依据Enneking肢体恶性肿瘤保肢术后的肢体功能标准 ,评价手术结果。 结果 85例 10 1处异体骨与自体骨接合部有 91处达到临床骨愈合。根据 X线片表现特征 ,异体骨与自体骨间有 4种愈合方式 ,其中以断端周围形成外骨痂、同时植骨间隙逐渐消失最多见 ;内固定不牢固是引起术后骨不愈合的主要原因 ;异体骨周围软组织覆盖、血供差及大段异体骨移植后诱发的免疫排异反应等可能影响骨愈合 ;远离异体骨与自体骨结合部的肿瘤复发或感染、不同长度的异体骨对骨愈合无肯定的负作用 ;选用牢固的髓内固定、断端周围植骨及采用骨膜袖套技术可减少术后骨不愈合的发生。 结论 大段异体骨关节移植后骨愈合有不同的 X线片表现形式。手术设计应为异体骨提供充足的血液供应。