同种异体冷冻骨移植结合外固定架支撑修复大段骨缺损

背景:各种低温、细胞、免疫和灭菌去抗原技术的进步,使得大量的同种异体骨进入临床应用,给各类大段骨缺损的患者带来了希望。目的:评价临床应用同种异体冷冻骨移植结合外固定架支撑治疗大段骨缺损的效果。方法:利用同种异体冷冻骨移植治疗大段骨缺损36例,同时应用外固定架加压固定,提供力学支撑,在固定后定期回访。结果与结论:随访1～24个月,失访1例,其余35例骨移植区骨质生长良好,9～20个月植骨骨化,无骨不连发生,各关节活动及肢体负重良好。部分患者肢体轻度肿胀,其中3例切口周围轻微红肿疼痛,4例患者伤口渗出较多,细菌培养阴性,涂片染色检查有浆细胞及淋巴细胞,中性粒细胞少,考虑为慢性免疫排斥反应所致,经过换药及应用泼尼松3d后分泌物减少,所有患者切口均一期愈合。结果可见同种异体冷冻骨移植结合外固定架加压固定是治疗大段骨缺损的有效治疗方法之一。

Application of allogeneic frozen bone graft with external fixator to repair massive bone defects

BACKGROUND:A large number of allogeneic bones have been applied in the clinical treatment due to the development of low temperature,cells,immune,and sterilization technology which brings hope to patients with all kinds of large bone defects.OBJECTIVE:To investigate the effect of allogeneic frozen bone graft with external fixator on repair of massive bone defect.METHODS:Large bone defects in 36 patients were repaired by allogeneic frozen bone graft and external fixator.The mechanical support and fixation were provided and the regular return visits were preformed.RESULTS AND CONCLUSION:The patients were followed-up for 1-24 months.Among these 36 cases,one case was lost and all the other 35 cases showed primary bone healing.The mean healing time was 9-20 months.No obvious immune rejection to the grafts was observed in most of the patients in early operation.The joint activity and body weight was good.Some patients showed mild limb swelling,three cases of slight swelling and pain were appeared around the incision,four cases of patients with more wound exudates and the bacterial culture was negative.Smear staining showed that there were plasma cells,lymphocytes and few neutrophils which may due to the chronic immune rejection.After dressing and application of prednisone for 3 days,the secretions were reduced and all the incisions were healed.Allogeneic frozen bone graft with external fixator is a useful and reliable reconstructive method for the treatment of large bone defect.