异体冻干小块骨修复良性骨肿瘤及瘤样病变切刮术后骨缺损

目的研究异体小块骨填充修复良性骨肿瘤及瘤样病变切除骚刮术后骨缺损的临床应用价值及其并发症。方法1999年12月～2005年12月,使用异体小块骨对230例良性骨肿瘤及瘤样病变骨缺损填充修复,其中男156例,女74例;年龄5～56岁,平均32.8岁。病程3个月～15年。肿瘤刮除术后囊腔范围为1.0cm×0.8cm～10.0cm×2.0cm,局限性切除后骨缺损长度为1.0～3.5cm。根据骨缺损情况,植入自体髂骨和异体骨0.5～30.0g,术后引流2～3d,常规应用抗生素预防感染,观察术后早期并发症,定期摄X线片了解骨愈合情况。结果术后早期体温、引流量、肢体肿胀等一般情况与自体骨移植同类手术相比无差异。术后196例切口期愈合;切口渗出淡黄色液体34例,其中30例引流2周后切口愈合,占14.78%;切口延期愈合4例,占1.7%(渗液持续3～4周后,经扩创换药期愈合3例,取出植入材料切口愈合1例)。获随访时间6～60个月,平均38个月,所有患者在6～18个月达到骨性愈合,平均6.5个月。骨移植术后肿瘤复发6例,复发率3.0%。按Mankin、Komender和王志强标准评定,满意196例,占85.22%;不满意34例,占14.78%。结论异体小块骨具有良好的组织相容性及成骨作用,是骨移植术中良好的植骨材料。植骨区的稳定性、局部血运情况及骨肿瘤刮除后瘤腔处理方法是影响骨愈合的重要因素。

LYOPHILIZED SMALL-SEGMENT ALLOGENEIC BONE IN REPAIRING BONE DEFECT DUE TO BENIGN BONE TUMOR AND TUMOR-LIKE LESIONS AFTER RESECTION AND CURETTAGE

OBJECTIVE: To investigate the clinical application and complication of the lyophilized small-segment allogeneic bone used in repairing bone defects caused by benign bone tumor and tumor-like lesions after resection and curettage. METHODS: From December 1999 to December 2005, 230 patients (156 males, 74 females; age, 5-56 years, averaged 32. 8 years), who had bone defects caused by benign bone tumors and tumor-like lesions after surgical resection and curettage, were treated by the lyophilized small-segment allogeneic bones. The cavities left by the tumor curettage ranged in size from 1.0 cm x 0.8 cm to 10.0 cm x 2.0 cm, and the bone defects were about 1.0 to 3.5 cm in diameter after the localized resection of the bones. According to the bone defect degrees, the autogenous nonvascular iliac bone and the bone allograft (0.5-30.0 g) were implanted, followed by the drainage for 2-3 days and the use of antibiotics to prevent infection. The postoperative systemic and local reactions were observed, and the regular X-ray examinations were performed to observe the bone union. RESULTS: There was no significant difference in the allergic reactions, such as postoperative temperature, drained amount, and body swelling, between this kind of transplantation and the autogenous bone transplantation. The wounds in 196 patients were healed by the first intension. The wounds in 34 patients had extravasate. Among them, the wound was healed by changing dressing in 30 cases; the wound had delayed healing in 4, including 3 whose wounds were healed by changing dressing for 3-4 weeks,and 1 whose wound was healed by taking out the implants. The follow-up for 6-60 months (average, 38 months) revealed that all the patients had the allograft unions of the bones within 6-18 months after the transplantation, and only 6 patients had recurrence of the tumor (3.0%). Evaluated by the Mankin,Komender and WANG Zhiqiang's standards, 196 (85.22%) patients were satisfied with their outcomes while the other 34 (14. 78%) patients were not satisfied. CONCLUSION: The lyophilized small-segment allogeneic bone has a good compatibility and osteogenesis, when it is used in repairing bone defects caused by benign bone tumor and tumor-like lesions after resection and curettage. So, this kind of bone is a good, convenient and safe material for the bone transplantation. The important factors affecting the allograft union are as follows: the mechanical stability in the recipient region, local blood supply, and management of the bone cavity left by resection and curettage of the bone tumor.