硫酸钙人工骨填充良性骨肿瘤刮除后骨缺损愈合情况的临床研究

目的分析硫酸钙人工骨填充良性骨肿瘤刮除后骨缺损的愈合情况,探讨人工骨在骨肿瘤切除重建中的作用。方法自2005年12月至2008年3月,应用Osteo Set硫酸钙人工骨移植治疗72例原发良性骨肿瘤,其中随访资料完整的47例。根据术后随访期X线片所见评估人工骨降解、吸收和骨愈合生长情况,评估38例含脱钙骨基质（demineralized bone matrix,DBM）和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,同时采用肌肉骨骼肿瘤协会（Musculoskeletal Tumor Society,MSTS）功能评分评价关节功能。结果 47例患者获3～55个月随访,平均随访时间16.3个月。均有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3.1（1～6）个月;42例完全吸收,用时4.2（1～12）个月;27例重新塑形,用时7.3（3～17）个月。人工骨愈合良好39例（83.0%）,未出现不愈合病例。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89.5%和77.8%。植骨量≤5mL组愈合率95.6%,用时6.8（3～12）个月;植骨量〉5mL组愈合率79.2%,用时5.5（3～17）个月。对两组愈合率、愈合时间进行比较,差异无统计学意义（Z=-0.100,P=0.920;Z=-0.650,P=0.516）。MSTS功能评分平均28.8分。术后2例出现伤口不愈合。结论对于良性骨肿瘤切除后骨缺损的重建,硫酸钙人工骨愈合效果满意,是一种安全、有效的移植材料。

Clinical study of bone healing results of calcium sulfate artificial bone in the reconstruction of bone defects after benign bone tumor curettage

Objective To analyze the healing process of calcium sulfate graft in the reconstruction of bone defects after benign bone tumor curettage, and to discuss the role of artificial bone in management of bone tumor. Methods From December 2005 to March 2008, 72 patients underwent primary benign bone tumor curettage and calcium sulfate graft reconstruction of bone defects. For 47 cases who obtained complete records during the follow-up, bone graft degradation, absorption and healing conditions were evaluated according to X-ray results, healing results of calcium sulfate bone graft containing demineralized bone matrix （DBM） in 38 cases and the bone graft without DBM in 9 cases were evaluted, the effects of bone graft volume on bone healing were examined. At the same time, joint functions were assessed by Musculoskeletal Tumor Society （MSTS） function scores. Results Forty-seven cases were followed up at an average of 16.3 months after the operation （from 3 to 35 months）. At an average of 3.1 months, the artificial bone granules fused together and with host in all the patients. At an average of 4.2 months, the artificial bone was absorbed in 42 cases. At an average of 7.3 months, the new bone remolding completed in 27 cases. Artiftcial bone complete healed in 39 cases （83.0%） and no patient presented nonunion. The healing rate was 89.5% in patients who implanted calcim sulfate graft containing DBM and 77.8% in cases who implanted calcim sulfate graft without DBMs. The healing rate of group which bone graft volume ≤5 mL was 95.6%, and the healing time was 6.8 （3-12） months; while the healing rate of group which bone graft volume 〉5 mL was 79.2%, and the healing time was 5.5 （3-17） months. There was no statistical difference in the healing rate （Z = --0.100, P = 0.920） and healing time （Z = -- 0.650, P = 0.516） between two groups. The average MSTS functional score was 28.8. The postoperative complications included 2 cases of wound nonunion. Conclusions For the reconstruction of bone defects after benign bone tumor curettage, calcium sulfate artificial bone is a safe and effective graft.