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。

Comparison of bone allograft,hydroxyapatite and calcium sulfate for reconstruction and repair in benign bone tumors

Objective To explore the efficacy of bone allograft,hydroxyapatite and calcium sulfate for reconstruction and repair in benign bone tumors. Methods A total of 108 patients with benign bone tumors admitted to Shaanxi Provincial Friendship Hospital from January 2018 to December 2019 were selected.They underwent bone grafting and reconstruction. The patients were categorized into three groups,bone allograft group,hydroxyapatite group and calcium sulfate group with 36 patients in each group. The postoperative healing,degradation rate of bone grafts,score of musculoskeletal tumor society( MSTS) for limb function and Karnofsky performance score( KPS) for quality of life were compared among the three groups.Results At 12 months after the surgery,there was no significant difference in the healing rates among the three groups( P > 0. 05). The average time to healing was shorter in the bone allograft group than in the rest two groups( all P < 0. 05). However,there was no significant difference in the average time to healing between hydroxyapatite group and calcium sulfate group( P > 0. 05). Moreover,there was no significant difference in the degradation rate of bone grafts among the three groups at 4 weeks,8 weeks and 12 weeks after the surgery( P > 0. 05). At 3 months,6 months and 12 months after the surgery,KPS score increased in the three groups compared with before the surgery( P < 0. 05). At 3 months after the surgery,no significant difference was observed in KPS score among the three groups( P > 0. 05). At 6 months and 12 months after the surgery,KPS score was higher in the bone allograft group than in the other two groups( all P <0. 05). At 12 months after the surgery,MSTS score was 28. 95 ± 1. 45 in the bone allograft group,28. 13 ±1. 63 in the hydroxyapatite group and 28. 48 ± 1. 71 in the calcium sulfate group( P > 0. 05). The cost of surgery was 12500 ± 3700 CNY in the bone allograft group,12200 ± 4100 CNY in the hydroxyapatite group and 11800 ± 4000 in the calcium sulfate group( P > 0. 05). Conclusion The healing and degradation rate were comparable among hydroxyapatite,calcium sulfate and bone allograft in patients with benign bone tumors. All of them can lead to good limb function. There is no significant difference in the cost surgery.However,bone allograft is associated with short time to initial healing and good quality of life compared with the other two methods.