Provoked Repetitive Healing of Mature Bone Tissue Following Irradiation a Quantitative Investigation

A titanium implant, the bone harvest chamber (BHC), was used to investigate the regenerative capacity of mature bone after irradiation. One BHC was inserted in each proximal tibial metaphysis of a rabbit. One of these implant sites was irradiated (⁶⁰Co single dose) to either 15 or 25 Gy while the other served as control. Newly formed bone grew through a canal that penetrated the implant. This newly formed bone was harvested from the implant every three weeks following irradiation and then quantified by microradiography and computer-assisted densitometry. In this way a ratio between bone formed on the irradiated side in comparison with the control could be established. An immediate depression in bone formation compared with the non-irradiated controls, was seen at both dose levels. A recovery in bone regenerative capacity was seen at 15 weeks after 15 Gy while the decrease in bone formation remained constant after 25 Gy during the 30 week follow-up period.     

Tolerance of autologous and allogeneic bone grafts to therapeutic radiation in humans

Purpose: To examine the effect of perioperative irradiation on bone graft healing and functional integrity.

Methods and Materials: Fifty-five bone grafts (10 autologus and 45 allogeneic) performed between 1978 and 1995 were evaluated retrospectively. Sixteen received preoperative radiation, 11 received postoperative, and 13 were treated with a combination of pre- and postoperative radiation. Fifteen nonirradiated grafts were randomly selected to serve as controls. Twenty-three of the grafts were placed in patients who received chemotherapy in the perioperative period. Functional graft survival and radiographic healing quality were evaluated.

Results: Overall rates of graft survival at 1 year were 89% for autografts and 79% for allografts. Graft survival rates were 86% and 68% at 1 and 5 years for the irradiated group, and 67% and 58% for the control group. No significant difference was seen in the Kaplan-Meier graft survival curves of the two groups. There was a nonsignificant trend toward improved radiographic healing quality in the control group. No significant differences in outcome based on treatment chronology were found with survival rates of 88% for preoperative treatment and 100% for postoperative treatment. No relation between outcome and bone dose (preoperative + postoperative dose), graft dose (postoperative dose), or mean dose/day was found. There was a trend (p = 0.0525) toward worse outcome seen in the Kaplan-Meier curves of patients who received chemotherapy. This difference, however, was not seen in the 1-year survival rates or healing quality. Tobacco use tended toward predicting failure, with 63% graft survival compared to 85% in nonsmokers (p = 0.09). Healing quality was significantly lower in the smoking group.

Conclusion: The low failure rate of grafts in irradiated sites, overall and compared to controls from this study and relevant literature, as well as the lack of dose and time effects, does not support significant deviation from the indicated treatment regimen for patients who have received or are expected to receive a graft. The trend toward decreased quality of radiographic bone healing, and data published in relevant literature indicating improved healing when radiation is withheld until 3–4 weeks postoperatively suggest this delay should be attempted when not expected to otherwise compromise patient outcome. A nonsignificant trend only for the effect of chemotherapy on bone grafts was seen, thus we do not recommend changes in its use as appropriate for disease management other than a preference against use during the immediate perioperative period.     

鹿瓜多肽促进磷酸钙人工骨对兔下颌骨缺损的修复作用

目的研究注射鹿瓜多肽注射液结合自固化磷酸钙人工骨(calcium phosphate cement,CPC)对兔下颌骨缺损修复作用的影响。方法 36只新西兰大白兔制成下颌骨双侧10 mm×4 mm×4 mm缺损的模型,实验组(18只)植入CPC,并每日给予0.2 ml/kg鹿瓜多肽注射液肌注;对照组(18只)植入自固化人工骨,每日给予等量生理盐水肌注。在分别于2、4、6、8 w处死,进行锥形束CT(cone beam CT,CBCT)及免疫组织化学观察。结果 CBCT观察:2、4、6、8 w时实验组骨缺损处的愈合情况优于对照组骨缺损处骨愈合的情况,第8 w时,实验组骨缺损处边缘连续,骨痂形成且密度基本与正常骨组织密度一致;免疫组织化学观察:在2、4、6 w时实验组的BMP-2的表达量早且高于对照组,在第6 w时实验组的BMP-2的表达量达到最高峰,8 w时,实验组BMP-2染色细胞阳性数目低于对照组。结论鹿瓜多肽注射液对植入CPC材料的骨缺损愈合具有良好的促进作用。     

带血管骨移植在四肢骨肿瘤治疗中的临床应用价值

目的 探讨带血管骨移植在四肢骨肿瘤治疗中的临床应用价值.方法 选取90例四肢骨肿瘤患者,按住院单双号分为2组,对照组(44例)给予瘤段切除后无血管骨移植,观察组(46例)给予瘤段切除后带血管骨移植.通过观察并记录患者术后肢体功能情况、骨愈合情况及随访期间并发症发生率,评价带血管骨移植在四肢骨肿瘤治疗中的临床应用价值.结果 术后12个月,观察组肢体功能总的优良率明显高于对照组(P＜0.05),但2组骨愈合率差异无统计学意义(P＞0.05).观察组患者平均骨愈合时间明显短于对照组(P＜0.05).随访期间,观察组并发症发生率4.3％,对照组并发症发生率25.0％,观察组术后并发症发生率明显低于对照组(P＜0.05);2组均未发生伤口感染、下肢深静脉血栓、内固定物松动等并发症.结论 带血管骨移植可以明显提高四肢骨肿瘤的治疗效果,骨愈合时间短,术后并发症较少,值得临床推广使用.     

Dose-response for bone regeneration after single doses of 60Co irradiation

The Bone Growth Chamber (BGC) methodology was used to establish a dose-response relationship for regeneration of mature bone tissue after irradiation of 5, 8, 11, 15 and 25 Gy single dose ⁶⁰Co. The BGC, which is a titanium implant, was inserted in the proximal tibial metaphyses, bilaterally, of a rabbit immediately following local irradiation to one tibia. Each animal thus served as its own control. During a healing period of 4 weeks, the two canals penetrating the implant became filled with more or less newly formed bone. At the end of the healing period, the implants were removed and taken apart and the newly formed bone was collected and its volume measured by microradiography and microdensitometry. It was found that in the dose range of 5 to 8 Gy bone regeneration was reduced by about 20% as compared to non-irradiated controls. Between 8 and 11 Gy, there was a critical range in that a small increase in dose resulted in a greatly reduced bone formation. At 11 Gy and above, the depression in bone formation, as compared to non-irradiated controls, was about 65 to 75%.     

黄芪注射液对兔下颌骨骨折愈合的影响

目的研究黄芪注射液在兔下颌骨骨折愈合过程的影响。方法健康新西兰大耳白兔24只,平均体重（2.1±0.1）kg,随机分成实验组A与对照组B,每组12只（雌雄不限）。在其左侧下颌骨体部均造成1.5 mm×5.0 mm的部分骨折模型。A组从术后第2 d开始,每天1次腹腔注射黄芪注射液（220 mg/Kg.d）,B组不做任何处理。分别于术后1 w、3 w、4 w切取兔左侧下颌骨,行X线片、骨密度、HE染色和骨形态发生蛋白-2{BMP-2}免疫组织化学染色观察免疫组织化学染色观察,并测定血清钙素水平。结果术后1 w、3 w、4 w,A组骨折线评分较B组高（P〈0.05）;术后4 w时,各组骨密度达峰值,A组骨密度高于B组（P〈0.05）;在术后3 w、4 w时,A组的BMP-2的表达水平均高于B组（P〈0.05）;术后1 w、3 w、4 w,A组血清骨钙素水平均较B组明显增高（P〈0.05）。结论黄芪注射液加快成骨细胞的生成,使骨密度增加,从而促进骨折的愈合。     

同种异体骨复合带血管自体骨移植修复大段骨缺损的实验研究

目的研究同种异体骨与带血管自体骨镶嵌式复合骨移植修复骨肿瘤切除后大段骨缺损的疗效。方法采用健康6月龄山羊12只于尺桡骨中段建立尺桡骨双缺损动物模型。实验组6只：将自体截取的带血管蒂尺骨与同种异体骨镶嵌后,嵌插入桡骨缺损处,用外固定架加石膏固定。对照组6只：仅将同种异体骨植入骨缺损区,同法固定。术后12、24周分别行X线片、Micro CT及组织学观察。结果X线示实验组较同时期对照组新骨形成明显,第24周实验组骨缺损愈合率达100％,对照组骨缺损未愈合或愈合不良。Micro CT重建后显示,实验组可见骨缺损区远近端已完全修复,骨性连接,植入异体骨与带血管自体骨间形成大量新生骨,与异体骨形成新的管状骨和髓腔,对照组缺损区异体骨骨密度下降,吸收明显。组织学观察：实验组较同期对照组成骨活动显著,实验组骨缺损远近端及中间部均有不同程度的新骨爬行替代,对照组异体骨吸收明显,新骨形成很少。结论大段同种异体骨复合带血管自体骨移植修复骨缺损效果良好,带血管自体骨在快速愈合的同时能促进大段同种异体骨的爬行替代过程,加快骨折愈合。此方法有望应用于骨肿瘤切除后遗留大段骨缺损的修复。     

放射性骨损伤愈合能力降低机制的实验研究

 目的　探讨放射性骨损伤 (RBI)愈合能力降低的机制。方法　6 0 Coγ射线 15Gy单次照射并致兔右胫骨骨折 ,以半环槽氏外固定器固定 ,未照射组为对照组。术后 3d、1、3、6、12、2 4周通过组织学、血流量测定及免疫组化 (BMP与TGF β1)观察骨折愈合情况。结果　实验组骨折愈合较对照组晚 12～ 16周 ,且骨折端血流量明显降低 ;BMP与TGF β1的表达亦低于对照组。结论　RBI愈合能力下降的原因是骨组织血运障碍与抑制BMP与TGF \| β1的综合作用。     

显微CT多阈值分析评价骨折愈合效果

目的研究显微CT多阈值分析对骨折愈合过程中不同类型骨组织表达的可靠性,为采用显微CT影像学方法有效评价骨折愈合奠定实验基础。方法制备大鼠股骨中段闭合性骨折模型,5 w后采用显微CT对骨折部位进行扫描,分别于225～700(代表全骨组织),225～330(代表钙化软骨和骨痂)和331～700(代表成熟骨组织)3个阈值范围内,测量和分析骨折标本的骨体积(bonevolume,BV)、组织体积(tissue volume,TV)和骨体积分数(BV/TV)。然后,对标本进行四点弯曲生物力学测试,分别测量和计算标本的刚度(stiffness,S)和弹性模量(elastic modulus,E)。最后,制作上述标本的不脱钙组织切片,分别行苏木精-伊红(H&E)和Von Kossa(VK)染色,并采用Osteomea-sure软件对切片的骨体积分数(bone volume/tissue volume,BV/TV)进行测量和分析。上述实验均以正常大鼠股骨作为对照。结果显微CT重建:实验组骨折已完全连接,髓腔再通。显微CT测量结果示:在225～700阈值内,实验组BV值与正常对照组无显著差异(P>0.05),其BV/TV也略低于正常对照组(P=0.054);在225～330阈值内,实验组BV和BV/TV均明显高于正常对照组(P<0.05);在331～700阈值内,实验组BV和BV/TV明显低于正常对照组(P<0.05)。生物力学测量示:实验组S和E均明显低于正常对照组(P<0.05)。H&E染色示:实验组骨折已完全被新生组织桥接修复,但修复组织多为软骨样或编织骨组织。VK染色示:实验组骨折部位填充组织钙盐含量较低,部分组织VK染色阴性。采用Osteomeasure软件对VK染色阳性区域进行测量和统计学分析示:实验组BV/TV明显低于正常对照组(P<0.05)。结论①采用显微CT单阈值分析会将部分不成熟的骨组织成分当做正常骨组织进行评价,造成对骨修复效果和骨强度误判。②通过显微CT多阈值分析可以明确表示不同的骨质成分,相关结果与组织学和生物力学检测存在较好的依从性。③采用显微CT多阈值分析技术能够有效评价骨折愈合效果。     

锁定接骨板联合同种异体骨治疗四肢长骨良性骨肿瘤伴病理性骨折的60例疗效分析

目的 探讨锁定接骨板联合同种异体骨治疗四肢长骨良性骨肿瘤伴病理性骨折的的疗效.方法 选取了60例良性骨肿瘤患者,按住院单双号随机分为两组,研究组(31例)行锁定接骨板联合同种异体骨,对照组(29例)行锁定接骨板.观察并记录患者术后12个月的患肢功能,血清骨折愈合相关因子,VAS评分,2年内的排斥反应率,病灶复发率和骨折愈合时间,以评价两种手术方式的疗效.结果 术后12个月,研究组优良率明显高于对照组(P<0.05),随访2年期间,研究组排斥反应率、骨折愈合时间、病灶复发率均少于或低于对照组(P<0.05);术后12个月,两组骨钙素(BGP)、骨保护素(OPG)、碱性磷酸酶(ALP)、神经生长因子(NGF)水平均明显升高(P<0.05),且研究组上述指标明显高于对照组(P<0.05);术后6,12个月,两组痛觉感受评分均明显降低(P<0.05),但组间比较差异无统计学意义(P>0.05).结论 锁定接骨板联合同种异体骨对四肢长骨良性骨肿瘤伴病理性骨折具有较好的治疗效果,术后提高患肢功能,减轻疼痛,促进骨折愈合,降低肿瘤复发率,值得临床推广使用.     

雌激素对骨质疏松性骨折愈合影响的实验研究

目的研究雌激素对大鼠骨质疏松性骨折愈合的影响。方法选择6月龄雌性SD大鼠60只,随机分为雌激素组、对照组（骨质疏松组）及假手术组,每组20只,前二组建立去卵巢大鼠骨质疏松性骨折模型,假手术组暴露卵巢而不切除,术后3个月行右侧股骨中段骨折内固定术。前二组术后分别皮下注射苯甲酸雌二醇及等量生理盐水,进行骨密度、X线片、组织病理学和生物力学检测,观察骨折愈合的情况。结果雌激素组骨折局部骨密度、生物力学性能明显高于对照组,差异有统计学意义（P〈0．05）;雌激素组比同时期的对照组骨痂生成量多。结论雌激素在促进骨质疏松性骨折愈合时能增加骨量,同时能提高骨生物力学特性和抗骨折能力。     

异体骨和羟基磷灰石及硫酸钙在良性骨肿瘤重建与修复中的应用对比

目的探讨异体骨、羟基磷灰石及硫酸钙在良性骨肿瘤重建与修复中的应用效果。方法选取2018年1月至2019年12月间陕西省友谊医院收治的108例良性骨肿瘤患者,均接受植骨重建术,采用随机数字表法分为异体骨组、羟基磷灰石组和硫酸钙组,每组36例。比较三组患者术后愈合情况、植骨材料降解率、肢体功能评分(MSTS)和生活质量评分(KPS)。结果术后12个月,三组患者愈合率比较,差异无统计学意义(P>0.05)。异体骨组平均初步愈合时间短于羟基磷灰石组和硫酸钙组,差异均有统计学意义(均P <0.05);羟基磷灰石组和硫酸钙组比较,差异无统计学意义(P>0.05)。术后4周、8周、12周,三组患者植骨材料的降解率比较,差异均无统计学意义(P>0.05)。术后3、6、12个月,三组患者KPS评分均较术前升高,差异均有统计学意义(均P <0.05)。术后3个月,三组患者KPS评分比较,差异无统计学意义(P> 0.05)。术后6、12个月,异体骨组患者KPS评分高于羟基磷灰石组和硫酸钙组,差异均有统计学意义(均P <0.05)。术后12个月,异体骨组患者MSTS评分为(28.95±1.45)分,羟基磷灰石组患者为(28.13±1.63)分,硫酸钙组患者为(28.48±1.71)分,组间比较,差异无统计学意义(P> 0.05)。异体骨组患者手术费用为(1.25±0.37)万元,羟基磷灰石组患者为(1.22±0.41)万元,硫酸钙组患者为(1.18±0.40)万元,组间比较,差异无统计学意义(P>0.05)。结论良性骨肿瘤患者使用羟基磷灰石和硫酸钙人工骨植入的愈合情况、降解率与异体骨植入相似,均可获得较好的肢体功能,手术费用无明显差异,异体骨植入初步愈合时间更短,患者生活质量更高。     

A microradiographic investigation of cancellous bone healing after irradiation and hyperbaric oxygenation: a rabbit study

PURPOSE: To analyze the effect of irradiation on cancellous bone healing at different times after irradiation and to study if hyperbaric oxygen therapy (HBO) would affect the bone healing capacity, when delivered directly after irradiation. METHODS AND MATERIALS: Rabbits were given a single dose of 15 Gy (60)Co radiation to one hind leg, the other hind leg serving as control. A standardized defect through the femoral metaphysis of the rabbits was created by a trephine drill biopsy at different times after irradiation. New bone formation in the defect was evaluated by a new biopsy through the previous defect after a healing time of 8 weeks. The mineral contents of the biopsies were analyzed by microradiography and microdensitometry. RESULTS: There was a large variation in the bone-forming capacity expressed as bone mineral content between the animals. No statistically significant differences could be detected regarding the effect of irradiation, HBO, or delayed surgery. Qualitative histology revealed more pronounced inflammation, fibrosis, and bone resorption in the irradiated bone. CONCLUSIONS: No definite conclusions can be drawn from the results of this study, however it might be hypothesized that cancellous bone recovers faster than cortical bone from radiation trauma.     

同种异体移植骨材料修复良性骨缺损的临床研究

目的探讨同种异体骨移植治疗良性骨缺损的临床应用价值。方法对2010年1月至2011年1月收治的良性骨缺损50例患者的临床资料进行回顾性分析,并随机分为治疗组（25例）及对照组（25例）。治疗组行同种异体移植骨材料修复,对照组行常规的自体髂骨骨材料修复。结果治疗组患者无骨不连接、肿瘤复发及骨缺损等不良反应,功能恢复表现为优20例,良2例,中0例,差0例,优良率为88．0％;对照组25例患者发现骨不连接者2例,骨缺损复发3例,其功能恢复表现为优13例,良2例,中2例,差1例,优良率为60．0％。治疗组骨缺损愈合程度及功能恢复明显高于对照组,差异有统计学意义（P（0．05）。结论同种异体骨材料生物相容性良好,无明显排斥反应和非特异炎症反应,在移植治疗良性骨缺损方面具有显著促进骨愈合促进新骨形成及功能恢复的功效,在临床上与传统的移植骨材料相比,具有应用方便、植骨疗效确切及并发症少等优点。     

硫酸钙人工骨填充骨肿瘤刮除后骨缺损的愈合情况

目的:观察硫酸钙人工骨填充骨肿瘤刮除后骨缺损的愈合情况。方法:临床纳入行Osteo Set硫酸钙人工骨移植治疗的原发良性骨肿瘤患者47例,根据术后影像学检查对人工骨降解、吸收以及骨愈合生长情况等进行评估,评估38例含脱钙骨基质（DBM）以及9例未含DBM硫酸钙人工骨的愈合情况,研究植骨量对愈合情况的影响。另外,采用MSTS功能评分对关节功能进行评估。结果:47例患者经4~56个月的临床随访,平均随访时间为16.5个月。所有患者均发生人工骨颗粒与宿主骨间隙变模糊以及颗粒间变模糊,平均用时为3.2（1～6）个月;有37例患者重新塑形,平均用时为7.4（3～18）个月;人工骨愈合良好39例（82.98%）,未发生不愈合病例。含DBM硫酸钙与不含DBM硫酸钙人工骨植入患者的愈合率分别为89.47%、77.78%。植骨量≤5ml组愈合率为95.65%,平均用时为6.7（3～12）个月;植骨量＞5ml组愈合率为79.17%,平均用时为5.7（4～18）个月。两组患者愈合率以及愈合时间等无显著性差异（P＞0.05）;MSTS功能评分平均为29.0分。术后有2例出现伤口不愈合情况。结论:对于良性骨肿瘤切除后骨缺损的重建,硫酸钙人工骨的临床愈合效果较好,属于一种安全、有效的移植材料,值得推广。     

Adequacy evaluation of fine-needle aspiration biopsy in the breast health clinic setting

BACKGROUND: Breast health clinics (BHC) are an unfamiliar source of fine-needle aspiration biopsies (FNABs) in the U.S. and create challenges for adequacy evaluation. The current study described the experience with breast FNAB adequacy evaluation over a 2-year period, the issues that emerged, and the problem-solving employed to mitigate these issues. METHODS: The rate of unsatisfactory FNABs and core biopsies was determined for pathologists, BHC providers, and other clinicians and compared for two different periods. Adequacy criteria during both periods required correlation of the cytologic findings with the clinical and breast imaging findings, and did not require identification of a specific number of ductal epithelial cells. RESULTS: During the first time period, 25% of breast FNABs performed in the BHC received an inadequate evaluation versus 6% performed by pathologists and 14% performed by other clinicians. The BHC adequacy rate exceeded the 20% upper threshold recommended by the National Cancer Institute (NCI), and did not decrease after additional FNAB training. During the first time period, 24% of core biopsies received an adequacy evaluation of unsatisfactory. During the second time interval, the core biopsy volume increased and 12% received an unsatisfactory adequacy evaluation. CONCLUSIONS: It is appropriate to use noncellular features such as clinical and imaging findings as adequacy criteria for breast FNABs rather than identification of a minimal number of ductal epithelial cells. However, the 20% upper threshold for unsatisfactory breast FNABs recommended by the NCI was not appropriate for the BHC setting because the nature of the lesions seen in this type of practice can lead to an increase in inadequate specimens and cause unnecessary concern regarding quality. The authors recommended that laboratories receiving a large number of clinician-performed FNABs from a community population, especially a BHC, define their own unsatisfactory threshold above which they will investigate for technical or other problems.     

Influence of direct referrals on time to diagnosis after an abnormal breast screening result

This study examined the influence of a direct referral process implemented by a population-based provincial breast screening program on the time from screening to first procedure, first procedure to diagnosis, and screening to diagnosis following an abnormal breast screening result. The direct referral process shifted the responsibility for the coordination of diagnostic follow-up procedures from the family physician to the screening program. Three cohorts of women were included: a control cohort (screened prior to the initiation of a direct referral process, n = 1347), a usual care cohort (screened after the initiation of a direct referral process but for whom permission to refer was denied by the family physician, n = 1225), and a direct referral cohort (screened after the initiation of the direct referral process and for whom permission to refer was given by the family physician, n = 1232). The direct referral cohort was subdivided into women referred to a breast health centre (BHC group) (n = 606) and women referred to a diagnostic facility (diagnostic group) (n = 626). The direct referral cohort completed all three time intervals significantly faster than the other two cohorts (P < 0.0001). The diagnostic group experienced a significantly lower time from screening to the first procedure than the other cohorts or the BHC group (P < 0.0001). However, the BHC group had a significantly lower time from first procedure to diagnosis than the other cohorts or the diagnostic group (P < 0.0001). The control and the usual care cohorts were not significantly different from each other (P = 0.6250). The direct referral process significantly reduced the time to diagnosis after an abnormal screening result.     

锁定加压接骨板联合同种异体骨在四肢长骨良性骨肿瘤病理骨折中的修复与重建作用研究

目的探讨锁定加压接骨板联合同种异体骨在四肢长骨良性骨肿瘤病理骨折中的修复与重建作用。方法选取2009年7月至2012年7月间收治的采用锁定加压接骨板联合同种异体骨治疗的21例四肢长骨良性骨肿瘤病理骨折患者为观察组,并将同期采用外固定支架进行治疗的21例患者设为对照组,然后将两组患者的Johner—wruh评分结果和治疗前、治疗后不同时间的血清骨折愈合相关因子进行比较。结果观察组的Johner—Wruh评分结果显著优于对照组,而治疗后1周、4周的血清骨钙索（BGP）、骨保护素（OPG）、碱性磷酸酶（ALP）和神经生长因子（NGF）水平均明显高于对照组,且治疗后4周高于治疗前和治疗后1周,两组之间差异均有统计学意义（P〈0．05）。结论锁定加压接骨板联合同种异体骨在四肢长骨良性骨肿瘤病理骨折中的修复效果相对更佳,且患者的血清骨折愈合相关因子的高表达也为其重建提供了必要的前提。     

两种移植材料治疗肿瘤刮除后骨缺损的临床研究

目的 比较观察脱蛋白牛松质骨复合自体红骨髓和自体髂骨移植修复骨肿瘤或瘤样病变引起的腔洞性骨缺损的临床疗效。方法 按随机数字表分为实验组和对照组,实验组接受脱蛋白牛松质骨复合自体红骨髓移植治疗,对照组接受自体髂骨移植治疗。结果 实验组有６３例,对照组有６２例,接受了骨移植术治疗,经平均随访２０个月,两组腔洞性骨缺损的愈合率及各种并发症均无显著性差异（Ｐ〉０．０５）,但自体骨移植组手术时间明显长于牛松     

深低温冷藏异体骨治疗骨肿瘤术后骨缺损

目的：探讨深低温冷藏异体骨在骨肿瘤术后骨缺损中的应用价值。方法：对58例骨肿瘤术后骨缺损患植入深低温冷藏异体骨，术后随访观察机体对异体骨的免疫反应，植入骨愈合情况，有无并发症。结果：58例均获得随访，其中，带关节软骨面的大块异体骨移植平均随访22．5个月，除1例外，其余未出现排异反应和感染。骨粒移植，平均随访21．5个月，全部骨性愈合，无一例出现排异反应及感染。结论：深低温冷藏异体骨可以降低机体对异体骨的免疫反应，并可以获得与患的形态和大小相匹配的缺损骨组织，而且保留一定程度的关节功能，它不仅作为生物力学的支持结构，而且还同时具有诱导骨生成的作用。当异体骨移入宿主后，能逐步被血管化，进而爬行替代，一旦移植成功，它将成为永久植入物，并且有自身的塑形、再生和修复功能，这一点是除自体骨以外的所有替代物不能比拟的。