冷冻异体手指骨与关节移植后长期的X线影像学表现

目的 研究冷冻同种异体手指骨与关节移植后远期随访的X线影像学表现。方法 用冷冻同种异体手指骨－关节－肌腱－腱鞘复合组织移植加自体拇甲皮瓣再造拇，手指276例。术后分2－6个月，7－12个月，13－24个月，3－5年，6－10年，大于10年6个时间组随访，每组病例数均超过20例，共208例。每组摄X线片并进行影像学对比分析。结果 术后6个月组供受体骨性愈合者占76．92％，12个月组骨性愈合者94．29％，10年组达98．21％。与供受体骨相连接部愈合的同时，异体关节下区及关节面出现变性与骨吸收的现象则逐年加剧，6个月组到10年组的骨吸收发生率从7．69％，增加到64．29％。关节变性从3．85％到85．71％。10年以上组骨吸收与关节变性减少。208例的骨愈合率为94．23％，关节下区与指端骨吸收发生率为39．42％，关节变性率为51．44％。结论 冷冻异体骨关节移植能与自体骨相连接，愈合过程与自体骨移植的X线片表现基本相同，但异体软骨失活，变性坏死，累及关节下区骨的吸收，并随术后时间增加而加重。     

指骨压迫性缺损:一种Bunnell滑车重建术后的并发症

目的报告Bunnell滑车重建术后滑车下指骨可有凹陷形缺损。方法9例12指共重建滑车（Bunnell方法）16个：A2滑车11个，A3滑车1个，A4滑车4个。术后随访4-55个月，平均25．22个月；观察重建滑车功能，记录手指关节主动屈、伸运动，拍摄X线平片观察指骨变化。结果重建滑车均顺利愈合，功效确实，指屈肌腱无“弓弦”状现象；关节主动屈、伸运动均有改善；X线平片显示指骨与重建滑车接触部均有凹陷形缺损。部分病例还有髓腔变窄、骨赘增生、皮质变薄等变化。结论Bunnell滑车重建术后其下指骨可有凹陷形缺损，可能是重建滑车收受指屈肌腱牵拉负荷产生压力所致。     

复合自体骨髓的冷冻异体犬足趾关节移植实验研究

目的探讨经过多重钻孔并复合自体骨髓的冷冻异体犬足趾关节移植的疗效. 方法 24只健康成年杂交犬,制备双侧后肢第2足趾近侧趾间关节1.5 cm缺损模型,共48侧,随机分成A、B、C 3组(n=16).分别采用新鲜自体趾间关节(A组)、经钻孔并复合自体新鲜骨髓的冷冻异体趾间关节(B组)及单纯冷冻异体趾间关节(C组)修复缺损.于术后1、3、6和12个月分别行X线摄片和组织病理学检查,了解移植骨关节的成活情况. 结果根据移植关节术后X线片和组织学改变,犬趾骨关节移植后的病变可分为轻度、中度和重度变性3级.A组移植骨关节3～12个月始终表现为轻度变性;B组移植骨关节1～6个月为轻度变性,骨孔中央软骨内成骨现象明显,12个月部分移植骨关节为中度变性;C组从1个月出现移植骨关节中度变性,3个月移植骨关节重度变性. 结论冷冻异体犬足趾关节内多重钻孔并复合自体新鲜骨髓,能有效延缓异体骨关节的早、中期变性,单纯冷冻异体骨关节移植后早期可能发生严重变性.     

同种异体骨关节移植与自体皮瓣转位修复手部骨关节缺损并皮肤缺损

目的；探讨同种异体骨关节移植与自体皮瓣转位修复手部骨关节缺损并皮肤缺损。方法：应用同种异体掌指、指间关节移植，可携带异体肌腱、关节囊，3种自体逆行岛状皮瓣。结果：治疗8例均获得成功。修复后的骨关节对位对线好，关节间隙存在，骨愈合好，术后3个月关节活动接近正常，皮瓣全部成活。结论：术式简单实用，损伤小，骨愈合率高，可利用异体肌腱、关节囊一期修复肌腱、关节囊损伤，并可同时修复多个关节缺损。     

手掌部克氏针前臂皮下滑移一例报告

患者女，２０岁。１９８８年６月，因右２～５指及相应掌骨自腕掌关节处缺如，而拇指存在，要求重建手部功能而入院。我们选用异体中指骨－关节－肌腱－腱鞘复合组织，加甲瓣游离移植再造小指。选择在－３０℃冷冻保存８７１天的异体中指为供指。异体中指近节指骨与受区...     

应用冻干异体手指骨关节肌腱腱鞘复合组织再造拇指

目的：介绍采用冻干异体手指骨关节—肌腱—腱鞘复合组织进行拇手指再造的方法与结果。方法：对异体骨—关节—肌腱—腱鞘进行冷冻干燥处理，再包装密封消毒，临床取出应用，生理盐水水合复原，种植于缺指部位，以自体足母甲皮瓣游离移植包裹营养。为4例缺指患者再造手指。结果：术后随访时间29—33个月，平均31个月，再造手指外型逼真，X线片提示冻干骨和自体骨完全融合，肌腱连接愈合。结论：冻干异体手指复合组织储存携带方便，抗原性微弱，术后不用免疫抑制药，不必牺牲足趾而达到手指再造目的，治疗费用低，便于临床应用。     

Mu甲趾骨片皮瓣与冷冻异体手指再造手指

１９８４年４月￣１９９４年３月，用自体Ｍｕ甲趾骨片皮瓣包裹冷冻异体手指骨－关节－肌腱复合组织，并联第２足趾游离移植再造手指１５例，共再造拇、手指３１指。经１个月￣８年随访，功能及外形良好。认为此法具有多造手指、少切足趾的优点。对造指部位选择、虎口狭小、血管危象及异体关节之变性吸收等问题，提出治疗及预防的方法。冷冻保存尸手指降低异体组织的抗原性，有利于在宿主体内存活。强调急诊截指时应尽量多保留手部活     

冷冻异体手指复合组织移植的免疫耐受5例

目的 探讨冷冻异体手指复合组织移植的免疫耐受性。方法 通过5例移植10～18年病例的随访，供指均被低温冷藏预处理，从指骨的^99mTcMDP检测，感觉与运动功能测定，X片影像学表现及肌腱的病理组织切片检查等判定异体手指复合组织的长期存活。结果 宿主身上异体指骨血供很快建立，供受体骨镶嵌部位完全骨性融合，供受体肌腱连接牢固，异体关节软骨磨损吸收于术后10年以上不再发展，磨损与修复处于平衡状态，新拇指感觉完全恢复，对掌功能优良。结论 经过低温冷藏预处理后，异体手指复合组织可以在宿主身上产生免疫耐受，长期存活。     

应用弹性髓内钉治疗儿童长骨瘤样病变并病理性骨折

目的探讨病灶刮除植骨结合弹性髓内钉（elastic stable intramedullary nailing, ESIN）内固定术治疗儿童长骨部分瘤样病变合并病理性骨折的疗效及特点。方法2010年1月至2013年12月我院共收治长骨部分瘤样病变并病理性骨折患儿16例,均实施病灶刮除植骨并ESIN内固定术,通过术后X线片和临床随访两方面评价治疗效果：通过X线片评估病变骨骨折复位有无丢失及病灶愈合情况;采用肩、肘、髋、膝、踝等关节功能综合评价标准及随访患者的满意度进行临床评估。结果16例患儿平均随访25.6个月。X线片显示病理性骨折均达骨性愈合,愈合时间为4~6个月,平均5个月。在随访过程中,病灶未出现复发或者再次骨折。术后平均12.5个月取钉。至末次随访时病灶完全消失（14例）或部分消失（2例）;患肢无疼痛,关节活动均不受限。结论病灶刮除植骨结合ESIN内固定术可作为治疗儿童长骨部分瘤样病变并病理性骨折的有效方法。     

同种异体骨复合人工关节置换治疗骨肿瘤

目的：探讨分析同种异体同关节复合人工假体移植治疗骨肿瘤的临床应用及疗效。方法：对应用同种异体骨关节复合人工假体移植治疗骨肿瘤12例进行临床回顾分析。其中髋关节周围7例，膝关节周围3例，肩关节周围（肱骨近端）2例，病变性质；骨巨细胞瘤6例，皮质旁骨肉瘤2例，软骨肉瘤2例，转移性腺癌2例，均行肿瘤切除及异体骨关节复合人工假体移植。结果：本组12例病人手术均顺利，肿瘤获彻底切除，平均随访时间2．5年（1－5年），伤口均一期愈合无1例感染，关节功能按Mankin标准评定，优良率为91．6％，结论：同种异体骨关节复合人工假体移植是修复骨肿瘤的有效手段。     

同种异体骨关节移植修复长段骨关节缺损

目的 评价同种异体骨关节移植修复长段骨关节缺损后的临床效果。方法 １９９１年９月￣１９９７年１１月对侵袭性或恶性骨肿瘤瘤段切除后长段骨关节或骨干缺损３６例,创伤性长段骨缺损２例,采用低温冷冻或冻干同种异体骨关节或骨干移植物修复。结果 术后早期３８例均未发生明显的免疫排异反应。随访１年５个月￣７年５个月,平均４．２年,存活３１例,优良率达７４．１９％。结论 低温冷冻或冻干的同种异体骨或骨关节移植物抗     

Survivorship and radiographic analysis of knee osteoarticular allografts

An evaluation of long-term survival and radiographic deterioration of 118 knee osteoarticular allografts in 114 patients was performed. Radiographic analysis was done according to the Musculoskeletal Tumor Society grading system. A failure was defined as when the allograft was removed during a revision procedure or amputation. Ten patients were lost to followup during the first 2 years after surgery. Eighteen patients without allograft failures died of complications related to the tumor. Twenty-six allografts failed because of infection (13 allografts), local recurrence (eight allografts), massive resorptions (three allografts) and fractures (two allografts). Sixty-four allografts still were in place at a mean of 98 months (range, 36-360 months) after implantation. The Kaplan-Meier 5-year survival rate for the knee osteoarticular allografts was 73% and the limb preservation rate was 93%. The mean radiographic score was 83%. Sixty-four percent of the allografts showed no radiologic changes or minor articular deterioration. Fourteen percent had narrowing of the joint space of more than 2 mm, and 22% had some form of subchondral bone collapse. Five patients required joint resurfacing to preserve the original allograft. Most of the allograft failures occurred during the first 4 years, and the allograft survival rate for the current series remained unchanged after 5 years.     

复杂性骨巨细胞瘤的外科治疗初步随访分析

目的提出复杂性骨巨细胞瘤的定义并回顾分析其治疗方法和结果，为减少其术后复发提供临床依据。方法2001年4月～2005年4月共治疗22例复杂性骨巨细胞瘤患者。男11例，女11例。年龄15～60岁。肿瘤位于股骨下段10例，胫骨上段5例，股骨近端2例，肱骨近端2例，髋骨2例和桡骨远端l例。所有患者按Campanicci’s分级，Ⅱ级4例，余均为Ⅲ级。行肿瘤边缘性切除或扩大性切除加大段同种异体骨与关节移植14例，肿瘤型人工关节置换8例。结果将骨巨细胞瘤已穿破骨皮质和／或侵犯至关节软骨下，已发生病理性骨折，瘤组织活检显示肿瘤细胞具有较强的侵袭性和肿瘤已有一次或多次复发定义为复杂性骨巨细胞瘤。所有患者获随访6～48个月，平均23个月。2例患者分别于术后8个月和11个月复发，分别经截肢和放射治疗后好转，复发率为9％。人工关节置换的关节功能优于同种异体骨移植；不带关节的同种异体骨移植的关节功能优于带关节的同种异体骨移植。所有移植的同种异体骨均获得不同程度的骨愈合。结论对定义为复杂性骨巨细胞瘤患者采用上述方法进行治疗，可获得较低的肿瘤复发率和一定范围的关节功能，是临床上治疗复杂性骨巨细胞瘤可采用的一种方法。     

Unicondylar osteoarticular allografts of the knee

BACKGROUND: In the management of a resected distal femoral or proximal tibial condyle as the result of tumor or trauma, a unicondylar osteoarticular allograft is currently the only reconstructive option that avoids the sacrifice of the unaffected condyle. The purposes of this study were to perform a survival analysis of unicondylar osteoarticular allografts of the knee and to evaluate the complications. METHODS: We retrospectively reviewed the results of forty large unicondylar osteoarticular allograft procedures in thirty-eight patients who were followed for a mean of eleven years. Twenty-nine allografts were femoral transplants and included eleven medial and eighteen lateral femoral condyles. Eleven allografts were tibial transplants, including four medial and seven lateral tibial condyles. The procedure was performed after a tumor resection in thirty-six patients and to replace condylar loss after a severe open fracture in the remaining two patients. Complications were analyzed, and allograft survival from the date of implantation to the date of revision or the time of the latest follow-up was determined. Functional and radiographic results were documented according to the Musculoskeletal Tumor Society scoring system at the time of the latest follow-up. RESULTS: One patient died of tumor-related causes without allograft failure before the two-year follow-up evaluation. The global rate of allograft survival at both five and ten years was 85%, with a mean follow-up of 148 months. In six patients, the allografts were removed at an average of twenty-six months (range, six to forty-eight months) and these were considered failures. All six patients underwent a second allograft procedure including two new unicondylar and four bicondylar reconstructions. The mean radiographic score for the thirty-three surviving allografts evaluated was 89%, with an average functional score of 27 of a possible 30 points. CONCLUSIONS: Unicondylar osteoarticular allografts of the knee appear to be a reliable alternative for patients in whom reconstruction of massive osteoarticular bone loss is limited to one condyle of the femur or the tibia.     

Rückfußkorrekturarthrodese am sog. Charcot-Fuß

THE PROBLEM: First patient: neuropathic osteoarthropathy with severely deformed foot, plantar ulceration and recurrent purulent infections. Second patient: diabetic osteoarthropathy with pathologic fracture. CLINICAL FINDINGS: First patient: 50-year-old man with hereditary sensory and motor neuropathy, plantar ulceration, equinus of the hindfoot, and extensive destruction of all bones of the foot. Recurrent infections necessitated repeated surgical interventions during the last 7 years. At the time of admission purulent infection of the foot. Healing after debridement including a resection of metatarsal bones and part of sequestrated bones of the foot. Patient was left with a severe equinus of the hindfoot. TREATMENT OPTIONS: Orthopedic shoes with or without below-knee orthesis. Lengthening of the Achilles tendon and plantar alignment of the calcaneus. Arthrodesis of the hindfoot. Below-knee amputation, if necessary as a primary procedure to combat infection. THE SOLUTION: Arthrodesis of the hindfoot after realignment; an amputation of the foot was refused. SURGICAL TECHNIQUE: Two-stage procedure: treatment of infection followed by astragalectomy and tibiocalcaneal arthrodesis achieved with cancellous lag screws. Bridging of the area of resection with a segment of the fibula. RESULT: Bony fusion and full load bearing in an orthopedic shoe after 3 months. Recurrence of ulcerations after 20 and 27 months due to wear of ill-fitting shoes. The accompanying purulent process forced the authors to resort to a below-knee amputation and fitting of a prosthesis. Second patient: of this patient only radiographs with a retrograde introduced intramedullary nail are shown.     

肢体大块骨缺损的大段同种异种骨关节移植

作者为３５例四肢恶性肿瘤切除后的骨缺损患者进行了大段同种异体骨移植重建，其中男性２３例，女性１２例。股骨下端和胫骨上端占６８．５％。骨肉瘤占４０％。所有病例均经术前、术后化疗。植骨材料来源于该院综合骨库。作者强调充分的术前准备，仔细选择匹配移植骨段，手术中注意设计骨膜油套和软组织袖套以利于骨愈合。本组病例随访５个月￣１０年，平均３年，其中无病存活者２５例，死亡６例，带病存活４例。部分患者于术后２年     

Distal femur osteoarticular allograft reconstruction after grade III open fractures in pediatric patients

Even though massive osteoarticular allografts have been reported to restore function successfully after tumor resection, little has been published about this procedure in post-traumatic joint reconstruction. We report two pediatric patients who sustained a grade III open fracture of the distal femur and were treated with osteoarticular allografts as a salvage procedure. In each patient, a femoral condyle was inserted to treat the bone and cartilage defect, and a 4.5 dynamic compressive plate was applied to fix the graft to the host bone. There were no complications after the reconstructive procedure. At 2 and 10 years of follow-up, both patients showed a favorable functional and radiographic outcome using the scoring instruments of the Musculo-skeletal Tumor Society and the International Symposium on Limb Salvage.     

Survival of 25 osteoarticular allografts followed more than 10 years

An evaluation of the long-term survival rate of 25 osteoarticular allografts was made. Clinical analysis was based on the Mankin scale and the Musculoskeletal Tumor Society (MSTS) Grading system. After a mean follow-up time of 15 years 76% of the osteoarticular allografts had good or excellent rating. The MSTS scale revealed a mean score of 89% for those 20 grafts still functioning according to their primary purpose. Allograft related complications occurred in 32% of the cases being most common among malignant cases. Due to the rather good long-term results, osteoarticular allografts can still be recommended for hemicondylar allograft reconstruction in benign lesions.     

The use of 'hybrid' allografts in the treatment of fractures of the thoracolumbar spine: first experience

Harvesting autogenous bone grafts of the iliac crest carries complications and lengthens operative times. Allografts are preferred to avoid these problems. Fusion after using allogenic bone grafts has been well studied, by examining trabeculations and remodelling on anteroposterior and lateral radiographs. However, the question remains whether one can rely on radiographs alone to determine fusion. 'Hybrid' fresh-frozen allografts from the femur or tibia were used in 11 adult patients with a mean age of 56.4 years (range: 30-78 years) to stabilize the thoracolumbar spine after anterior decompression for trauma. In one case two adjacent levels were fractured, in another case two fractures occurred at different levels. Fresh-frozen allografts of the femur (in ten cases) and tibia (one case), filled with autogenous cancellous bone graft or pieces of rib, were used to reconstruct the anterior column of the spine. Stabilization was performed by means of a Kaneda device. Anteroposterior and lateral radiographs and, additionally, computed tomography (CT) examinations with reconstructions were used to study fusion. One patient died 1 month after surgery. At follow-up in ten patients, after a mean time of 30.2 months (range: 18-42 months), ten allografts showed a grade I fusion and one a grade III fusion. Additional data from the CT examination with reconstructions, however, showed cross-trabeculations in all cases, and a partially united allograft in the patient with a grade III fusion. Cross-trabeculations between the allograft and vertebral body was observed at 6 months, with remodelling occurring at approximately 2 years. Mean loss of correction was minimal, at 3.6 degrees (range 0 degree-16 degrees). Fresh-frozen femoral or tibial allografts worked effectively to maintain correction after trauma when combined with anterior instrumentation. CT examinations with sagittal and coronal reconstructions were more effective for evaluation of fusion compared with anteroposterior and lateral radiographs. The high fusion rate and the low morbidity achieved using allografts in this way supports the exclusive use of allografts in the anterior thoracic and lumbar spine in the future.