同种异体骨颗粒复合自体骨移植治疗近膝关节骨巨细胞瘤骨缺损

1、同种异体骨颗粒复合自体骨移植治疗近膝关节骨巨细胞瘤骨缺损         08-06-25 10:43:00     作者：田敏    编辑：studa20【摘要】  探讨同种异体骨颗粒和自体骨复合体在近膝关节骨巨细胞瘤骨缺损的疗效。方法自1996年3月2006年3月，24例膝周患者经病理检查证实为骨巨细胞瘤;其中股骨远端骨巨细胞瘤11例，胫骨近端骨巨细胞瘤13例。以机械及化学方法将同种异体骨进行脱抗原处理为骨颗粒,术中将骨巨

2、细胞瘤于外科边缘彻底刮除,将同种异体骨颗粒复合取得的自体骨彻底紧密填塞骨缺损空腔；术后支具外固定辅助活动膝关节12周。结果本组术后早期均未发生严重并发症。24例病例术后随访16年,平均2年8个月。所有病例均未见肿瘤复发，1例发生轻度病理性骨折，经制动2个月治愈。所有骨移植体X线片上显示理想的替代形态。疗效评定采用Mankin评定标准，优：20例，良：4例，优良率达100%。结论同种异体骨颗粒复合自体骨移植能有效治疗近膝关节骨巨细胞瘤造成的骨缺损。 【关键词】  同种异体骨 骨巨细胞瘤 骨缺损 膝关节    Abstract：Objective To in

3、vestigate the treatment in the use of allograft bone grains combined with autograft bone grafting in giant cell tumor.MethodFrom March 1996 to March 2006, 24 cases of giant cell tumor closed to knee were verified by pathology in this department，including 11 on thighbone and others on tibia.Before op

4、eration allografts was sheared to grains after antigen extracted by repeat freeze thawing and mechanical methods.Giant cell tumor of bone was completely erased in surgical fringe and the defect was thoroughly closedup with allograft grains combined with cancellous bone autografts.The knee joints exe

5、rcise was made for 12 weeks with external orthosis fixation.ResultNo severe complication occurred in early stage after operation in the 24 patients.All of them were followed up for 1 to 6 years with an average of 2 years and 8 months.None of them recidivated after the operation , and no insert was t

6、aken off for severe rejection ，one case showed tolerant pathologic fracture.All the transplantations showed ideal appearance in Xray photograph and the motion of joints had no significant difference than before.Curative effects were evaluated by Mankin criteria.The outcome was excellent in 20 cases,

7、 good in 4 cases.ConclusionBone allograft grains combined with autograft is an effective and few rejection in filling of giant bone defect in surgical operation of giant cell tumor near knee joints.    Key words:bone allograft;  giant cell tumor of bone;  bone defect; 

8、knee joints    骨巨细胞瘤主要发生在青壮年，半数以上的肿瘤发生在膝关节周围。传统治疗方法是手术刮除、自体骨移植填塞。自1996年3月2006年3月,作者采用手术刮除病灶+同种异体骨移植治疗膝周骨巨细胞瘤,取得满意疗效。    1  临床资料    1.1  一般资料    临床收治病历24例。男性10例,女性14例；年龄1735岁,平均28岁;其中股骨远端骨巨细胞瘤11例，胫骨近端骨巨细胞瘤13例。按Enneking提出的巨细胞瘤分期标准,1

9、期6例,2期18例。18例因局部肿块或疼痛不适而就诊，6例因疼痛不适合并轻度病理性骨折就诊。囊腔最小2.5 cm×3.0 cm，最大3.5 cm×10.5 cm。所有病例均为第一次手术治疗。    1.2  治疗方法    1.2.1  同种异体骨制备    所有同种异体骨均来自本院骨库。术前将在低温冰箱（-30 ）中保存的同种异体骨取出置于无菌台，剪切成35 mm的骨粒。用50 60 的生理盐水反复洗涤2 h，至洗涤液无油花、无血色，充分去除骨髓及血液组织。再用3

10、双氧水漂洗1 min×2次，生理盐水洗涤，庆大霉素浸泡5 min，最后置于37 庆大霉素生理盐水中贮存备用。    1.2.2  手术方法    刮除植骨术,手术主要是开窗、彻底刮除病灶植骨。根据患者年龄、全身情况选用相应麻醉方式;常规消毒铺巾,根据不同病变部位采取相应手术入路,显露病变区域后,选取关节外皮质最薄弱处开槽,彻底刮除病灶；冲洗后再用5石碳酸和70酒精烧灼腔内骨面。大量盐水冲洗后，取自体髂骨块剪成纵形骨柱植于瘤腔内负重线，将处理好的灭活同种异体骨颗粒复合刮取的松质骨泥,均匀、紧密地填塞于腔内,不留死腔（

11、注意避免损伤关节面软骨）；尽可能缝合骨膜,常规放置引流,关闭切口。    1.2.3  术后处理    患者术后行石膏托或支具外固定，抬高患肢，常规应用抗生素预防感染46 d，口服激素预防免疫排异反应。术后麻醉消除后即行下肢等长肌力训练；无关节面病理骨折者 23 d拔除引流管后即可行床上非负重下膝、踝关节功能锻炼。一般68周后去除外固定，逐步拄拐下地活动。    2  结  果    2.1  术后早期结果    20例体温在37.5 以下，切口无红肿渗出，切口期愈合；4例术后体温搏动在37.5 38.5 之间，有淡黄色渗出液，细菌培养均阴性，经抗生素、激素等治疗后，体温于37 d内恢复至正常，510 d后渗出液消失，切口愈合。    2.2  随访结果