Abstract

BACKGROUND:Bone defects forming after resection of bone tumor and tumor-like lesion are often packed with autogeneic bone. But sample amount cannot completely meet the clinical demand and different degrees of complications are often left in the bone graft donor region. All these problems remarkably limit the application of autogeneic bone. Allogenic bone is increasingly widely used in the clinical practice due to its structure and biological characteristics similar to autogeneic bone, rich sources, long-term preservation, easy to use and other advantages.

OBJECTIVE: To investigate the biocompatibility and clinical application effects of allogeneic bone in filling and repairing benign bone tumor and tumor-like lesion after resection and curettage.

DESIGN: A retrospective analysis.

SETTING: Department of Pelvis Surgery, Second Affiliated Hospital of Inner Mongolia Medical College.

PARTICIPANTS: Totally 230 patients (156 males and 74 females, with age of 5-56 years) were admitted to Department of Bone Tumor, Second Affiliated Hospital of Inner Mongolia Medical College from December 1999 to December 2005 to undergo curettage and hyperthermia inactivation due to benign bone tumor and tumor-like lesion and to receive the treatment by filling and repairing bone defects with lyophilized small-segment allogeneic bone, and were recruited for this study. Written informed consents of treatment were obtained from all the patients. The protocol was approved by the Hospital’s Ethics Committee.

METHODS: Allogeneic bone grafts (Shanxi Aorui Biomedical Co.,Ltd /Shanxi Provincial Medical Tissue Banking) were used to fill and repair bone defects. Patients who had benign bone tumor, bone cyst or osteofibrous dysplasia underwent cyst curretage. Allogeneic bones were used to pack empty cavity. Therapeutic effects were assessed according to the scoring criteria of allogeneic bone transplantation from Mankin et al, consisting of satisfactory and unsatisfactory two levels. X-ray plain films of surgery sites were taken at postoperative 3, 6 and 12 months. The patients were followed up for 38 months on average in order to observe the therapeutic effects.

MAIN OUTCOME MEASURES: Histocompatibility of allogeneic bone in filling and repairing bone tumor defects.

RESULTS: All 230 patients participated in the final analysis. ① Biocompatibility of allogeneic bone: Postoperatively, minority of patients had mild immunological rejections. Such allogeneic bone grafts had a good biocompatibility. They could directly fuse with bone tissue in the implantation location of patients, but not inhibit the normal activity of osteocytes on the allogeneic bone grafts or interfere the natural substitution of autogeneic osteocytes, i.e. there were no or less immunological rejections. Bone union was obtained in all the patients at postoperative 6-18 months (6.5 months on average). Thirty-four patients presented exudation of light yellow liquid from incision. Incisions healed in 30 (14.8%) patients at postoperative 2 weeks and in 4 (1.7%) in later time. Altogether 196 (85.2%) patients obtained satisfactory therapeutic effects, but 34 (14.8%) obtained unsatisfactory therapeutic effects.

CONCLUSION: Small-segment allogeneic bones have good histocompatibility and osteogenesis, and they are good bone grafts in the bone transplantation.

Department of Pelvis Surgery, Second Affiliated Hospital of Inner Mongolia Medical College, Huhhot 010030, Inner Mongolia Autonomous Region, China

Jia Yan-fei, Associate chief physician, Department of Pelvis Surgery, Second Affiliated Hospital of Inner Mongolia Medical College, Huhhot 010030, Inner Mongolia Autonomous Region, China
guoshibing2006@ sina.com

Received:2007-10-15 Accepted:2007-11-29 (07-50-10-5558/H)

Jia YF, Guo SB, Feng W. Allogeneic bone for repairing bone defects after resection of benign bone tumor and tumor-like lesions.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(7): 1368-1371(China)

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摘要
背景：骨肿瘤及瘤样病变切刮后骨缺损取自体骨填充，由于取材量不能完全满足临床需要，且供骨区常遗有不同程度并发症，使其在临床应用中受到明显限制。异体骨以其结构及生物特性与自体骨相似、来源丰富、可以长期保存及使用方便等特点日益广泛地应用于临床。
目的：观察同种异体骨用于填充修复良性骨肿瘤及瘤样病变切、刮除术后骨缺损后的生物相容性表现及临床应用效果。
设计：回顾性分析。
单位：内蒙古医学院第二附属医院骨肿瘤科、骨盆外科。
对象：选择1999-12/2005-12在内蒙古医学院第二附属医院骨肿瘤科因良性骨肿瘤及瘤样病变行病灶刮除、高温灭活，冻干同种异体小块骨填充修复骨缺损的患者230例，男156例，女74例；年龄5~56岁。患者同意使用异体骨，并签订植入异体骨协议书；实验经医院伦理委员会批准。
方法：①使用由由山西奥瑞生物材料有限公司/山西省医用组织库提供的同种异体骨填充修复骨缺损。对良性骨肿瘤及骨囊肿和骨纤维结构不良等行囊内刮除术，用同种异体骨填塞空腔。②根据Mankin等对同种骨移植结果的评分标准评估疗效，分为满意和不满意两个层次。于术后3，6和12个月对手术部位拍摄X射线平片，并平均随访38个月以观察疗效。
主要观察指标：异体骨填充修复骨肿瘤骨缺损的组织相容性。
结果：患者230例全部进入主要结果分析。①同种骨生物相容性：少数患者术后有轻度排异反应。该植入材料生物相容性好，可与植入部位患者骨组织直接进行融合，不阻止骨细胞在其表面的正常活性或干扰自体骨细胞的自然替代过程，即无免疫排斥反应或很小。所有病例在术后6~18个月达到骨性愈合，平均6.5个月。并发症：34例切口渗出淡黄色液体，其中30例于2周后切口愈合（14.8%）；切口延期愈合4例（1.7%）。②疗效：满意196例（85.2%），不满意34例（14.8%）。
结论：同种异体小块骨具有良好的组织相容性及成骨作用，是骨移植术中良好的植骨材料。
关键词：同种异体骨；骨肿瘤；瘤样病变；骨缺损

内蒙古医学院第二附属医院骨盆外科，内蒙古自治区呼和浩特市 010030
贾燕飞，男，1962年生，内蒙古自治区呼和浩特市人，蒙古族，1985年白求恩医科大学毕业，副主任医师，主要从事骨科疾病的外科治疗研究。


中图分类号: R551.3 文献标识码: A 文章编号: 1673-8225(2008)07-01368-04
贾燕飞，郭世炳，冯卫. 同种异体骨修复良性骨肿瘤及瘤样病变骨缺损[J].中国组织工程研究与临床康复,2008,12(7):1368-1371
[www.zglckf.com/zglckf/ejournal/upfiles/08-7/7k-1368(ps).pdf]
(Edited by Yu XP/Ji H/Wang L)