骨囊肿刮除术后骨缺损修复的新方法

目的 介绍一种骨囊肿刮除术后修复骨缺损的新方法,并总结其治疗效果。方法 对8例骨囊肿,经手术彻底刮除病灶后所形成的包容性骨缺损,在其骨缺损区的血肿内,植入自体骨膜碎片,通过术前、术后影像学对比和临床功能进行评价。结果 经2－11年随访,X线片显示成骨良好,骨缺损修复,病变未复发,肢体功能正常。结论 病灶彻底刮, 在 骨缺损区血肿内植入自体骨膜碎片,是治疗孤立性骨囊肿的有效新方法。     

非骨化性纤维瘤的诊断与治疗

目的：探讨非骨化性纤维瘤的本质和属性、临床特点及诊治方法。方法：总结１９９３～１９９９年收治的非骨化性纤维瘤２４例。其中男１６例，女８例，平均１５．６岁。多发性２例，合并其他良性肿瘤２例。病灶多发生于四肢长骨的干骺端，以膝关节周转最常见。全部病例均行手术治疗，术式包括单纯病灶刮除术、病灶刮除自体髂骨或加异体骨移植术。结果：全部病例均经病理证实为非骨化性纤维瘤，随访最长６ａ ３个月，无一例复发。结论     

自体骨泥混入骨膜碎片修复肿瘤及瘤样病变骨缺损

目的探讨自体骨泥混入骨膜碎片修复肿瘤及瘤样病变骨缺损的疗效方法对18例骨肿瘤及瘤样病变患者行病灶刮除,自体骨泥混入骨膜碎片修复骨缺损。结果经8～38个月随访,X线片显示成骨良好,骨缺损完全修复,肢体无畸形,功能基本恢复正常。结论自体骨泥混入骨膜碎片修复肿瘤及瘤样病变骨缺损效果满意,是一种值得研究的新方法     

原发性股骨近端溶骨性骨缺失的修复重建

目的总结和分析股骨近端原发性溶骨性骨缺损的手术修复方法。方法自1997～2003年我科共收治股骨近端原发性溶骨性骨缺损36例。根据肿瘤的性质及大小分别采用病灶刮除 自体(异体)皮松质骨植入8例；病灶刮除 自体(异体)皮松质骨 自体缝匠肌髂骨瓣复合植入 内固定术22例；病灶刮除 骨水泥填充 内固定5例；瘤段切除 人工双动股骨头置换1例。结果术后随访12～54个月，平均24个月，仅1例骨巨细胞瘤复发，关节功能评分33例优，3例良。结论根据肿瘤的性质和股骨近端骨缺损大小采取不同手术方式进行了病灶清除及功能重建，是一套有效的重建股骨近端骨缺损的方案。     

骨基质明胶复合自体红骨髓及同种异体骨修复骨缺损

目的：评价骨基质明胶复合自体红骨髓及同种异体骨联合移植修复骨缺损的疗效。方法：76例良性骨肿瘤和瘤样病损患者，彻底刮除病灶或作肿瘤骨段切除，并对瘤壁作灭活处理，以同种异体骨作支架，周围填充骨基质明胶和自体红骨髓复合物，术后观察机体反应及骨缺损修复情况。结果：术后机体无明显免疫排斥反应，无1例发生感染，所有病例随访时间为5-16个月，X线显示新骨形成时间为术后1.5-4月，完全骨化的时间为术后5-9月，骨缺损骨性愈合74例，并获得较好的关节功能，肿瘤复发2例。结论：骨基质明胶、自体红骨髓、同种异体骨复合物能有效恢复骨缺损，有广泛的临床应用前景。     

骨膜移植修复骨缺损的实验研究及临床应用

为探寻大块骨缺损修复方法的新途径，进行了自体骨膜游离移植修复骨缺损的实验及临床研究。实验用４２只兔，于双侧胫骨作人工骨缺损模型（６ｍｍ×１８ｍｍ×５ｍｍ）。一侧随机植入自体游离骨膜片，另一侧不植入，作为对照。以组织学、Ｘ线和放射性同位素为观察指标，研究成骨过程。结果表明，骨膜植入侧骨缺损的愈合比对照侧缺损的愈合快一倍。原因可能是骨膜提供了大量成骨细胞并直接呈膜内成骨而非软骨内化骨。在此基础上，为２１例骨缺损患者应用自体胫骨骨膜片植入治疗骨缺损，面积最大１０．５ｃｍ×４ｃｍ×４ｃｍ，最小２ｃｍ×２ｃｍ×２ｃｍ；其中１７例为良性骨肿瘤，４例为骨慢性感染。骨缺损均得到修复，关节功能恢复满意。为腔洞性骨缺损的修复提供了一种新方法。     

自体骨膜骨髓复合移植修复肿瘤性骨缺损

目的 介绍自体骨膜骨髓复合移植修复少儿委性骨肿瘤切除后骨缺损的方法。方法 抽取自体髂骨骨髓，自然形成凝块后植入骨缺损处，自体胫前骨膜切片１～２ｍｍ＾２邮票状，均匀植入骨髓凝块中。结果 随访４～１０个月，术后１个月新生骨形成，术后３～４个月１４例骨缺损处新生骨骨密度与周围组织一致，术后４个月恢复正常的关节功能和肢体负重功能。结论 自体游离骨膜骨髓复合移植，成骨能力强，方法简便，是治疗骨肿瘤切除后骨缺     

自体骨膜碎片血肿内植入修复骨缺损的实验研究与临床应用

为探讨骨膜移植的成骨性能和不同血肿对其成骨的影响，作者在家兔双侧桡骨中段制成１．５ｃｍ长的骨缺损模型，并在缺损区内分别填以自体外周血块和骨髓血块。然后将自体骨膜碎片分别植入一侧血肿内，另一侧不植骨膜以作对照。通过Ｘ线、组织学、缺损区新生骨钙磷含量测定、骨组织形态测量和计算机图像分析等手段检测，结果证实自体骨膜碎片有成骨作用；自体骨髓血也有成骨潜能，但成骨能力弱于骨膜成骨；单纯外周血不能成骨；若以骨髓血为载体可使成骨作用提高。自体骨膜碎片血肿内植入临床应用１２例，平均随访２年，临床效果满意。     

天然型无机骨修复良性溶骨性骨缺损的临床观察

为寻找良性骨缺损理想的充填材料，特别是修复儿童良性溶骨性较大的骨缺损，采用天然型无机骨（ＮＮＢ）充填良性溶骨性骨缺损５例，其中骨囊肿３例，纤维异样增殖症１例，非骨化性纤维瘤１例。病变位于股骨中上段１例，股骨下段３例，肱骨上段１例。５例均行病灶开窗刮除，彻底清除内膜及瘤样病变。充填方块状ＮＮＢ，术后伤口均Ⅰ期愈合。术后３个月～６个月活动正常。术后Ｘ线片复查见方块状ＮＮＢ间及其内的间隙影消失，新生骨与周围骨壳融合，显示病灶愈合。经７个月～２年随访，病变区无复发。认为，ＮＮＢ是修复良性溶骨性骨缺损理想的充填材料。     

通过注射脱钙骨和自体骨髓治疗动脉瘤样骨囊肿

背景：在假设动脉瘤样骨囊肿通过内部骨化存在自愈潜能的基础上，发展出一种新的、微创的治疗动脉瘤样骨囊肿方法。即用脱矿物质骨粉混合自体骨髓注入骨囊肿内，从而使病变停止进展，并自行骨化。我们提出假设，即为了诱导骨质愈合。骨囊肿细胞只需要对诱导材料的作用产生反应，而囊肿刮除术或扩大的外科手术是不必要的。此项研究的目的在于评估这种新方法对于骨囊肿的治愈情况，及其治疗本病的复发率的因素。方法：对13例经活检确诊为动脉瘤样骨囊肿的患者，经小切口向病灶内注入脱矿物质骨和自体骨髓混合骨泥。研究组中男3例，女10例，平均年龄16．6岁。病灶部位位于长骨者6例，骨盆5例，位于肩关节盂和跟骨者各1例。其中5例患者既往未经任何治疗，1例经术前栓塞，其余7例患者为治疗后复发者。结果：经过平均3．9年的随访，其中11例患者获得治愈。结论：该微创方法能够促进原发性动脉瘤样骨囊肿自愈。采用该治疗方法不再需要进行刮除术。能够避免过大的外科手术及失血，并且对于位于类似骨盆这样不容易暴露部位的病灶，可以使操作更为便捷。     

Autogenous bone marrow graft to non-ossifying fibroma with a pathologic fracture

Non-ossifying fibroma with a pathological fracture of the radius in a 10-year-old girl was successfully treated by curettage and autogenous bone marrow graft. The lesion was completely replaced by normal bone at 1 year after the operation. Autogenous bone-marrow graft was considered to be a useful method for the treatment of non-ossifying fibroma with minimal morbidity of the graft-harvesting site. Received: 18 February 1999     

Spontaneous regeneration after juvenile ossifying fibroma resection: a case report.

A case of unusual bone regeneration after resection of a juvenile ossifying fibroma (JOF) is presented. Secondary mandibular reconstruction with autogenous grafts was delayed due to the rapid bone formation. To the best of our knowledge there are no reports of this unusual response following JOF resection.     

带血运骨膜管移植和骨充填物修复桡骨长段缺损的研究

目的：探讨联合应用带血运骨膜管移植和骨充填物治疗兔桡骨长段缺损的效果。方法：实验分两部分，分别选用幼兔和成年兔各40只，根据填充物的不同分为4组，将兔双侧桡骨干中段切除3cm制成骨长段缺损模型，保留切骨段骨膜，重新重原缝合后作带血运骨膜管移植模型，左侧分别用自体骨，同种异体脱钙骨，磷酸三钙陶瓷和羟基磷灰石进行填充，右侧不行任何填作为对照。观察3个月。通过X线片，髓强度，骨密度和组织学检查等方法，了解骨缺损的修复效果。结果：幼兔术后6周，所有实验组双侧的骨缺损均得到修复，术后12周，磷酸三钙陶瓷和羟基磷灰石组桡骨抗弯曲强度较差与自体骨组、同种异体脱钙骨组和对照侧比较具有统计学意义（P＜0．05）；骨愈合为膜内成骨和软骨成骨，以膜内成骨为主，成年兔；各组实验侧骨缺损修复率分别为：自体骨组50％；同种异体脱钙骨组40％；磷酸三钙陶瓷和羟基磷灰石组为30％。对照侧骨缺损修复率为42．5％，结论：幼兔单行单血运骨管移植或结合应用骨充填物均可有效修复骨长段缺损，但置换较慢的骨充填物不利于再生骨强度的恢复，成年兔带血运骨膜移植联合应用骨填充物不能有效修复骨长段缺损。     

活骨移植治疗四肢骨肿瘤切除后长段骨与关节缺损

目的:探讨四肢骨肿瘤的广泛或边缘切除后,长段骨关节缺损的修复方法及其疗效。方法:四肢骨肿瘤切除术后骨缺损14例,男10例,女4例;年龄4~37岁。骨巨细胞瘤4例,骨化性纤维瘤1例,非骨化性纤维瘤2例,韧带样纤维瘤1例,骨纤维结构不良3例,侵袭性骨母细胞瘤1例,软骨母细胞瘤1例,瘤样病损致骨溶解1例。14例四肢侵袭性良性骨肿瘤行肿瘤广泛或边缘切除,应用吻合血管的腓骨、带腓骨头腓骨近端和带旋髂深血管的髂骨瓣移植修复骨缺损、重建桡腕关节和重建肩关节。移植体行简单内固定加外固定。术后定期复查X线片、多普勒血管超声,其中3例行ECT核素骨扫描,并作关节功能评定。结果:随访3个月~5年,13例均于手术后3个月后达Ⅰ期愈合,其中1例因内固定松动再次手术而愈合。1例肿瘤局部复发,再次行肿瘤切刮与植骨术后愈合;2例畸形愈合行截骨矫形后愈合。关节功能评定:优9例,良3例,差2例。结论:骨肿瘤切除后行骨移植修复骨缺损、重建关节,手术切除彻底,复发率低,植骨愈合可靠,重建后的关节功能良好。     

Treatment of giant-cell tumors of long bones with curettage and bone-grafting.

BACKGROUND: The use of curettage, phenol, and cement is accepted by most experts as the best treatment for giant-cell tumor of bone. The present study was performed to evaluate whether equivalent results could be obtained with curettage with use of a high-speed burr and reconstruction of the resulting defect with autogenous bone graft with or without allograft bone. METHODS: The prospectively collected records of patients who had a giant-cell tumor of a long bone were reviewed to determine the rate of local recurrence after treatment with curettage with use of a high-speed burr and reconstruction with autogenous bone graft with or without allograft bone. All of the patients were followed clinically and radiographically, and a biopsy was performed if there were any suspicious changes. RESULTS: Fifty-nine patients met the criteria for inclusion in the study. According to the grading system of Campanacci et al., two patients (3 percent) had a grade-I tumor, twenty-nine (49 percent) had a grade-II tumor, and twenty-eight (47 percent) had a grade-III tumor. Seventeen patients (29 percent) had a pathological fracture at the time of presentation. The mean duration of follow-up was eighty months (range, twenty-eight to 132 months). Seven patients (12 percent) had a local recurrence. Six of these seven were disease-free at the latest follow-up examination after at least one additional treatment with curettage or soft-tissue resection (one patient). One patient had resection and reconstruction with a prosthesis after a massive local recurrence and pulmonary metastases. CONCLUSIONS: Despite the high rates of recurrence reported in the literature after treatment of giant-cell tumor with curettage and bone-grafting, the results of the present study suggest that the risk of local recurrence after curettage with a high-speed burr and reconstruction with autogenous graft with or without allograft bone is similar to that observed after use of cement and other adjuvant treatment. It is likely that the adequacy of the removal of the tumor rather than the use of adjuvant modalities is what determines the risk of recurrence.     

Integration of periosteum covered autogenous bone grafts with and without autologous chondrocytes. An animal experiment using the Göttinger minipig

Autologous osteochondral transplantation has the major disadvantage of significant damage to a healthy joint surface at the donor site.The purpose of this study was to examine the effect of autogenous chondrocytes injected into the periosteum of autologous bone grafts in order to provide an alternative method for cartilagerepair. A total of 22 Göttinger minipigs were operated twice on both knees.The first operation served for cartilage biopsy for the chondrocyte culture.During the second operation an osteochondral defect was created in the medial facet of the trochlear groove.The defect was treated differently with an autologous cortico-cancellous bone cylinder,harvested from the proximal tibia.Group A: untreated defect (control);B: bone-graft;C: bone-graft covered with periosteum; D: bone-graft with periosteum and injected autologous chondrocytes.The animals were killed after 6,12,26 and 52weeks.The regenerated areas were evaluated macroscopically, tested biomechanically (long-term specimens; indentation-test) and a histological, blind evaluation was carried out according to a semi-quantitative scoring system. The periosteum covered bone cylinders in Groups C and D showed good repair of the bone and cartilage defect.The repaired tissue consisted predominantly of fibrocartilage with the partial formation of hyalin like tissue.The regenerated areas were integrated with the adjacent cartilage and were biomechanically superior when compared with the other groups. The additional injection of chondrocytes did not produce significantly better results. Our findings suggest that the transplantation of periosteum-covered bone cylinders may provide an alternative method for treating chondral and osteochondral defects and can be recommended for filling large donor site defects in joint surgery.The additional transplantation of chondrocytes does not seem to be justified.     

Surgical reconstruction of fibrous dysplasia of bone in long-term follow-up

PURPOSE: To examine how different operative measures influence the surgical outcome in patients with fibrous dysplasia of bone. METHODS: 118 dysplastic fibrous lesions of bone were surgically treated and reviewed in 70 patients between 1983 to 1993 (eleven years) with a median follow-up of six and a half years. Surgery consisted of intralesional curettage in 93 and marginal en bloc resection in 25 lesions. Bony defects were reconstructed with autogenous iliac crest graft in 55 lesions, with autogenous fibula graft in 9, with homologous bone chips in 28, and 5 times with a homologous fibula graft from the bone bank. In 33 lesions the entire defect was filled with polymethylmethacrylate. Osteosynthesis was performed in 41 patients. RESULTS: Recurrences requiring surgical revision were observed in 26 of 74 primary lesions (= 35% overall recurrence rate) at a mean 123.6 weeks postoperatively. The most frequent primary and recurrence location was the proximal femur (85% revision rate). 69% of all recurrences occurred under the age of 20. After intralesional curettage the reoperation rate was 32% and after marginal resection 8%. After reconstruction with autogenous iliac crest graft recurrence rate was 36%, after autogenous fibula graft 55%, after homologous bone chips 18%, after polymethylmethacrylate 9% and allograft fibula reconstruction showed no recurrences. A combined stable osteosynthesis bridging the fibrous osseous defect significantly reduced the revision rate to 3% (p = 0.01). CONCLUSION: Intralesional curettage and reconstruction with autogenous iliac crest graft in fibrous dysplasia of bone leads to a high recurrence rate. Reconstruction with cortical grafts or bone chips from the bone bank, if necessary in combination with a durable osteosynthesis in mechanically demanding locations, or solely bone cement in mechanically less demanding areas, reduces the revision rate in patients with monoostotic and polyostotic fibrous dysplasia.