深低温骨库建立及同种体骨与关系移植的临床应用

冷冻保同种异体骨和骨关节在修补大块骨缺损及关节移植的应用中具有重要意义,采用深低温冷冻法和辐照灭菌法保存的异体骨,临床应用异体骨时,根据患者的需要和骨库的记录资料合理选择,临床应用同种异体骨和骨软骨移植手术4例,未见明显排斥反应,疗效满意。     

同种异体移植骨的组织生物学

自1880年苏格兰人Willian.Macewen完成人类历史上的首例同种异体骨移植手术以来,同种异体骨移植逐渐应用于临床,但发展缓慢.直到1941年,Inclan提出了骨库的概念,解决了异体骨的储存问题,同种异体骨的临床应用出现飞速发展.目前临床应用的异体移植骨均为库存骨.异体移植骨作为一种移植组织,生物学行为复杂,受多种因素的影响,表现出不同的特性.     

临床应用同种异体骨及甲基强地松龙治疗骨囊肿11例分析

目的:评价同种异体骨及甲基强的松龙治疗骨囊肿的临床效果.方法:应用同种异体骨及甲基强的松龙治疗骨囊肿,术后随访,了解骨折愈合情况.结果:骨囊肿手术刮除后骨缺损部植入甲基强的松龙浸泡过的同种异体骨后愈合良好,排异反应小,避免了取自体髂骨对患者造成的痛苦.结论:同种异体骨联合甲基强的松龙治疗骨囊肿效果满意,与自体骨移植无显著区别,值得推广.     

同种异体骨螺钉治疗髋臼骨折的比较研究

目的：探讨同种异体骨螺钉、可吸收螺钉和普通金属螺钉治疗髋臼骨折的疗效。方法：应用同种异体骨螺钉、可吸收螺钉和普通金属螺钉治疗髋臼骨折患者共129例,并对其在功能恢复、临床愈合时间等方面进行比较。结果：同种异体骨螺钉内固定组和可吸收螺钉内固定组的髋关节功能恢复优于普通金属螺钉内固定组。同种异体骨螺钉内固定组的功能恢复优于可吸收螺钉内固定组。同种异体骨螺钉内固定组和可吸收螺钉内固定组的临床愈合时间短于普通螺钉内固定组。结论：同种异体骨螺钉治疗髋臼骨折的疗效优于可吸收螺钉和普通金属螺钉。     

大段同种异体骨移植对四肢创伤性骨缺损的重建

目的:探讨大段煮沸异体骨在治疗四肢创伤性骨缺损中的临床应用.方法:本组11例为创伤导致骨缺损均在6cm以上,均采用煮沸法同种异体骨 自体髂骨移植重建骨缺损.结果本组11例术后无感染,伤口一期愈合,随访1.5年～4年,移植之同种异体骨与宿主骨愈合良好,肢体功能恢复.结论利用煮沸的同种异体骨 自体髂骨移植重建骨缺损,仍不失为一种可靠、经济、疗效满意的简便方法.     

同种异体骨移植修复骨肿瘤切除术后骨缺损

目的 探讨冷冻保存大段同种异体骨和关节移植治疗骨肿瘤的临床疗效.方法 1998年6月～2008年1月,应用冷冻保存大段同种异体骨关节移植治疗骨肿瘤切除术后巨大骨缺损;随访资料完整的25例.应用异体半关节移植12例,骨段移植10例,人工关节复合异体骨3例,螺丝钉固定6例,重建钢板固定2例,普通髓内钉固定5例,交锁髓内钉固定9例.结果 该组24例骨愈合,1例骨不连,愈合时间3～10个月.按Mankin功能评分标准:优12例,良7例,优良率为76%.结论 冷冻保存大段同种异体骨关节移植修复骨肿瘤切除术后骨缺损可获得满意疗效.     

同种异体深冻骨移植临床应用54例

同种异体深冻骨移植用于临床上骨与关节缺损的修复与重建５４例。大块骨移植１７例，小块骨充填植骨３７例。同种异体深冻骨移植，极大的降低了同种异体新鲜骨移植的排斥反应。与其它方法相比，最大限度地保存了骨移植的骨诱导能力和骨传导能力。同种异体深冻骨是理想的骨移植材料。小块同种异体深冻骨移植在临床上比大块移植效果好。     

同种异体深冻骨移植临床应用54傲

同种异体深冻骨移植用于临床上骨与关节缺损的修复与重建５４例。大块骨移植１７例，小块骨充填植骨３７例。同种异体深冻骨移植，极大的降低了同种异体新鲜骨移植的排斥反应。与其它方法相比，最大限度地保存了骨移植的骨诱导能力和骨传导能力。同种异体深冻骨是理想的骨移植材料，小块同种异体深冻骨移植在临床上比大块移植效果好。     

用重组合异种骨修复良性肿瘤术后骨缺损

良性骨肿瘤切除术后往往遗留较大的骨缺损,传统的修复方法是采用自体骨或冷冻同种异体骨作为植骨来源.自体骨和冷冻同种异体骨来源十分有限,并且有增加患者的损伤及并发症的缺点,其临床应用受到限制.2001年10月～2003年9月,对41例良性骨肿瘤切除术后骨缺损采用重组合异种骨植骨治疗,获得较好疗效,总结如下.     

应用自、异体骨整复颌面骨缺损畸形212例分析

作者采用自体骨及同种异体骨为212例颌面骨缺损畸形患者进行整复手术,其中新鲜自体骨147例,冷冻自体骨2例,煮沸自体骨1例,同种异体骨62例.经临床观察,效果良好.本文还分别对自体游离骨、带血管复合骨、带衬里组织的骨移植、同种异体骨移植的适应症,以及移植骨失败原因等进行了讨论分析.     

Selection of allografts for impaction bone grafting for bone defect reconstruction on the acetabular side

Objective To review the choices of allografts for bone defect reconstruction in acetabular revision surgery using the technique of impaction bone grafting.Data sources The data cited in this review were mainly obtained from articles listed in PubMed that were published from January 1993 to July 2009. The search terms were ＂impaction bone grafting＂, ＂particle size＂, ＂mechanical property＂and ＂biological behavior＂.Study selection Articles relevant to the choices of allografts and their results for bone defect reconstruction on the acetabular side were selected.Results Different choices of allografts, including the particle size, process of irradiation or fat reduction, composition and particle grade, are made to improve the survival rate of a prosthesis in acetabular revision surgery. This review,which compares both mechanical and biological factors, summarizes the experimental and clinical results for different techniques.Conclusions Fresh frozen cancellous allografts with particle sizes ranging from 7 to 10 mm are a favorable choice for reconstruction of bone defects of American Academy of Orthopedic Surgeons （AAOS） types Ⅱ （cavitary defect） and Ⅲ（combined cavitary and segmental defect） on the acetabular side. A fat-reducing procedure with saline or solvent/detergent is controversial. Adding autologous marrow into irradiated allografts, which provides reliable mechanical stability and biological safety, may be a substitute for fresh frozen allografts. Cortical bone can be a supplementary material in cases of insufficiency of cancellous allografts. Cartilage should be excluded from the graft material. Further research is required to demonstrate the best particle grade, and randomized controlled trials in clinical practice are required to obtain more information about the selection of allografts.     

酒精储骨移植在脊柱外科的应用

102例脊柱外科手术应用酒精储骨移植取得满意效果。酒精储骨方法简单,不要特殊设备,灭菌效果可靠,异物免疫排斥反应小。脊柱外科应用储骨移植可大大缩短手术时间,减少术中出血及并发症的发生,保证足够的植骨量,减少假关节的形成。本文介绍了酒精储骨的方法及临床应用经验。对不同储骨方法的优缺点进行了讨论,并初步探讨了假关节形成的原因及诊断体会。     

骨库现状

同种异体冷冻骨和软骨在修补大块骨缺损和骨关节重建的应用中具有重要的意义,作为一种移植材料,骨组织可以通过一定的方法长期保存,本文回顾了国内外骨库发展的历史和现状,对当今骨库如供体的筛选、移植骨的获取,加工、保存、灭菌以及资料管理和费用等主要的运用过程进行了探讨。     

同种异体皮质骨板移植重建股骨骨折的实验研究

目的 研究深低温冷冻与环氧乙烷处理同种异体皮质骨板移植重建山羊股骨骨折的治疗效果。方法 将16只山羊造成右侧股骨骨折．双侧股骨分别进行深低温冷冻与环氧乙烷处理同种异体皮质骨板移植,在术后3、6、12、24周处死动物取材,通过X线片,血管墨汁灌注．四环素荧光标记,组织学检查观察骨折愈合以及骨板存活情况。结果 未骨折一侧术后3周,骨折一侧术后6周移植骨板出现再血管化。术后3～6周,骨折一侧移植骨板四环素荧光标记比未骨折一侧弱;而6周以后骨折一侧明显增强。术后12周骨折愈合,移植骨板与宿主骨骨性连接。术后24周移植骨板和宿主骨融为一体．骨折一侧移植骨板再塑性能力强,股骨皮质厚度增加明显。结论 同种异体皮质骨板移植具有促进骨折愈合作用,移植骨板与宿主骨整合后能增加局部骨量储备,增强股骨强度。     

Structural bone allografts with intramedullary vascularized fibular autografts for the treatment of massive bone defects in extremities

Objective：To report the clinical outcome of repairing massive bone defects biologically in limbs by homeochronous using structural bone allografts with intramedullary vascularized fibular autografts. Methods： From January 2001 to December 2005, large bone defects in 19 patients （11 men and 8 women, aged 6 to 35 years） were repaired by structural bone allografts with intramedullary vascularized fibular autografts in the homeochronous period. The range of the length of bone defects was 11 to 25 cm （mean 17.6 cm）, length of vascularized free fibular was 15 to 29 cm （mean 19.2 cm）, length of massive bone allografts was 11 to 24 cm （mean 17.1 cm）. Location of massive bone defects was in humerus（n=1）, in femur（n=9） and in tibia（n=9）, respectively. Results： After 9 to 69 months （mean 38.2 months） follow-up, wounds of donor and recipient sites were healed inⅠstage, monitoring-flaps were alive, eject reaction of massive bone allografts were slight, no complications in donor limbs. Fifteen patients had the evidence of radiographic union 3 to 6 months after surgery, 3 cases united 8 months later, and the remained one case of malignant synovioma in distal femur recurred and amputated the leg 2.5 months, postoperatively. Five patients had been removed internal fixation, complete bone unions were found one year postoperatively. None of massive bone allografts were absorbed or collapsed at last follow-up. Conclusion： The homeochronous usage of structural bone allograft with an intramedullary vascularized fibular autograft can biologically obtain a structure with the immediate mechanical strength of the allograft, a potential result of revascularization through the vascularized fibula, and accelerate bone union not only between fibular autograft and the host but also between massive bone allograft and the host.     

Effect of impaction on gene-modified cells seeded on granular bone allografts in vitro and in vivo

Background While attempting to restore bone stock, impaction bone grafting employed during revision joint surgery may result in slow and limited allograft incorporation into host bone. A new approach including gene-modified bone marrow stromal cells （BMSCs） in combination with impaction bone grafting may effectively restore bone stock and improve allograft incorporation. This study aimed to investigate the effect of impaction on gene-modified BMSCs seeded on granular bone allografts in vitro and in vivo.Methods Deep-frozen, granular, cancellous bone allografts from canines were prepared to serve as cell delivery scaffolds and were seeded with green fluorescent protein （GFP） genetically-modified BMSCs to construct cell-allograft composites. The composites were impacted in a simulative, in vitro impaction model and cultured for further analysis under standard conditions. Four Beagle dogs, treated with bilateral, uncemented proximal tibial joint hemiarthroplasty with a prosthesis, were implanted with autologous GFP gene-modified cell-allograft composites to repair the bone cavity around each prosthesis.Results A significant reduction in cell viability was observed after impaction by fluorescence microscopy in vitro.However, there remained a proportion of GFP-positive cells that were viable and functionally active, as evidenced by the secretion of GFP protein in vitro and in vivo.Conclusions Gene-modified BMSCs seeded on granular allografts were able to withstand the impaction forces and to maintain their normal functions in vitro and in vivo, in spite of a partial loss in cell viability.     

Intraosseous lipoma: a report of two cases with use of tricalcium phosphate bone void filler

Intraosseous lipoma is a rare bone tumor that may be encountered in clinical practice. It is benign and is described as a well-defined, radiolucent lesion that must be differentiated from other lytic lesions. Most of these lesions may be treated without surgery; however, when surgery is needed, the classic approach involves curettage and packing using autologous bone grafts, allografts, or synthetic bone substitutes. This article reports two cases using a synthetic bone substitute, TheriLok, to fill the void made from surgical curettage of the intraosseous lipoma. Both patients tolerated the TheriLok bone substitute without developing adverse reactions and precluded the need for a secondary donor site.     

同种异体冻干骨加自体骨移植治疗骨缺损

目的报道采用同种异体冻干骨和自体骨混合一起移植治疗骨质缺损的治疗结果.方法自1995年～2000年对20例大块骨质缺损因自体骨源不足而采用同种异体冻干骨和自体骨按一定比例混合一起进行植骨修复.年龄9岁～65岁,平均32.3岁.骨缺损范围30cm3～90cm3.随访1年～5年,平均1年7个月.结果术后平均5.5个月移植骨和宿主骨骨性愈合.3月～6个月功能恢复正常,无不良反应.结论对治疗大块骨质缺损,应用同种异体冻干骨和自体骨按一定比例混合一起进行植骨治疗是一种有效的方法,可得到类似于自体骨移植的治疗效果.     

人工关节置换术中骨移植的研究进展

总结了人工关节置换术中骨移植基础研究及临床应用研究进展,对近5年研究自体和异体骨移植的生物学、免疫学及其骨移植在人工膝、髋关节置换术中应用的主要文献进行了总结。骨移植的生物学及其免疫学已趋明确。骨移植,特别是异体骨移植已广泛应用于人工关节置换术。在人工关节置换术中,自体骨应用的疗效及其结果优于异体骨。但在自体骨缺乏的情况下,特别是在人工关节翻修术中,应用经合适处理的异体骨同样能取得满意效果。     

同种异体骨移植后骨愈合的实验研究

目的：通过有关的动物实验来探讨有关异体骨移植骨愈合的规律，以达到加速异体骨移植骨愈合的目的。方法：24只新西兰大白兔为实验动物，随机分为实验组和对照组。实验组用梯度降温、深低温保存的股骨外侧髁植入，在接触的骨面置入骨形态发生蛋白(BMP)骨基质，以金属螺钉固定；对照组用取下的自体股骨外侧髁原位植入，用与实验组相同的内固定方法固定；术后4、8和12周行大体标本观察，并行苏木精-伊红(H-E)染色及BMP免疫组化染色，观察异体骨愈合的情况。结果：深低温保存的同种异体骨移植愈合与自体骨相似。BMP染色在新生骨及其周围类基质表达阳性。其愈合是从宿主骨向移植骨，从周围向中央，从哈佛管向其四周逐渐进行爬行替代的过程。结论：同种异体骨移植愈合过程主要通过骨传导实现成骨，骨诱导亦发挥积极作用。使用BMP、合适的内固定、大小适合的移植物，可以使异体骨愈合的过程与自体骨相似。