同种异体骨材料复合自体浓缩红骨髓移植治疗良性骨肿瘤和瘤样病变

背景：同种异体骨是临床常用的骨移植材料，但缺乏诱导成骨能力是最大的问题。 目的：评价良性骨肿瘤及瘤样病变刮除或切除后应用同种异体骨复合自体红骨髓修复骨缺损的效果。 设计、时间及地点：回顾性病例对比分析，于2004-05/2006-05在华中科技大学同济医学院附属同济医院骨科进行。 对象：选择良性骨肿瘤及瘤样病变108例患者，男 58例，女 50例；年龄10~58岁，平均32岁。其中采用异体骨复合自体浓缩红骨髓植骨52例(复合红骨髓植骨组)；单纯异体骨植骨56例(单纯植骨组)。 方法：复合红骨髓植骨组患者根据预计植骨量从每位患者两侧的髂前上棘或髂后上棘抽取红骨髓40~100 mL，在植骨前将同种异体骨与红骨髓充分混匀。肿瘤刮除或切除后，用电刀烧灼骨缺损腔，将同种异体骨剪成细小的短棒状或修成2 mm见方的块状，植入骨缺损区内。单纯植骨组将相同比例的生理盐水与同种异体骨充分混匀后植入骨缺损区内。 主要观察指标：术后定期进行植骨区X射线检查及骨密度检测，比较两组间移植骨颗粒界限模糊、消失的时间及不同时间骨密度的情况。同时观察术后并发症如免疫排斥反应、感染等发生情况。 结果：100例患者达骨性融合(复合红骨髓植骨组49例，单纯植骨组51例)，并获得24个月随访，数据进入结果分析。复合红骨髓植骨组移植骨界限模糊时间和消失时间均短于单纯植骨组(P < 0.05~0.01)。术后3，6，12个月时复合红骨髓植骨组骨密度高于单纯植骨组(P < 0.05~0.01)。复合红骨髓植骨组2例，单纯植骨组3例出现排异反应，使用免疫抑制剂治疗两三周后痊愈。 结论：同种异体骨复合自体红骨髓来源相对丰富，抗原性减弱，能明显促进骨融合和骨缺损的愈合。

Allogeneic bone combined with autologous concentrated red bone marrow graft for treatment of benign bone tumors and tumor-like lesions

BACKGROUND: Allogeneic bone is a common material used for bone transplantation. But the lack of capability to induce bone formation is the most important problem. OBJECTIVE: To evaluate the efficacy of allogeneic bone combined with autologous red bone marrow graft on repairing bone defect for treatment benign bone tumors and tumor-like lesions after resection. DESIGN, TIME AND SETTING: A retrospective case controlled analysis performed at Department of Orthopaedics, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2004 to May 2006. PARTICIPANTS: A total of 108 patients (58 males and 50 females), aged 10-58 years old (averaged 32 years), with benign bone tumors and tumor-like lesions, were enrolled. Fifty-two patients treated with allogeneic bone transplantation combined with autologous red bone marrow graft were assigned as combined with autologous red bone marrow group; fifty-six patients treated with allogeneic bone transplantation were assigned as simple allogeneic bone group. METHODS: According to the prediction 40-100 mL of autologous red bone marrow was taken from bilateral posterior or anterior superior iliac spine of patients in the combined autologous red bone marrow group. Allogeneic bone was mixed with autologous red bone marrow before bone graft thoroughly. In the simple allogeneic bone group, allogeneic bone was mixed with the same proportional normal saline. After patients underwent cyst resection and curettage, allogeneic bone sheared to rod-shape or clump, 2 mm3 in cubic capacity was used to pack empty cavity which had been cauterized with electro scalpel. MAIN OUTCOME MEASURES: X-ray examinations and bone mineral density tests were performed regularly after operation. The time of vagueness and disappearance of the interface between the grafts and host bones as well as the changes of bone mineral density were compared between the two groups. The postoperative complications, such as immunological rejection and infection, were observed at the same time. RESULTS: At the follow-up of 24 months, 100 patients achieved bony fusion, 49 in the combined autologous red bone marrow group and 51 in the simple allogeneic bone group. The time of vagueness and disappearance of the limits between the grafts and hosts bone in the combined autologous red bone marrow group were both significantly shorter than that in the simple allogeneic bone group (P < 0.05-0.01). At 3, 6 and 12 months after transplantation, the bone mineral density of patients in the combined autologous red bone marrow group were significantly higher than that in the simple allogeneic bone group (P < 0.05-0.01). Rejection reactions occurred in 2 patients in the combined autologous red bone marrow group and 3 in the simple allogeneic bone group. The patients were recovery after 2-3 weeks immune inhibitor treatment. CONCLUSION: The source of allogeneic bones combined with autologous red bone marrow which had weak antigenicity is abundant. They are effective to improve the bone fusion and bone defect healing.