CAJ | 학술논문

背景:大块骨缺损的修复是骨科面临的难题之一,自体骨移植疗效最佳,但来源有限,目前尚缺乏自体骨理想的替代材料.目的:探讨表面脱钙骨基质明胶修复大块骨缺损的疗效及替代自体骨的可能性.设计:实验研究设计应用完全随机设计的对照实验.临床研究设计应用以诊断为依据的前后对照研究.单位:解放军广州军区武汉总医院骨科.对象:实验在解放军广州军区武汉总医院实验室及武汉理工大学测试中心完成.实验材料为32只本地产健康雄性成年家兔,体质量2.5 kg,购自湖北省医学科学院.临床研究对象为1991-01/2001-05解放军广州军区武汉总医院骨科收治的大块骨缺损患者31例,男25例,女6例;平均年龄9岁.方法:将32只家兔随机分成A,B两组,两组双侧桡骨制成1 cm骨缺损,两组左侧植入表面脱钙骨基质明胶(surface-demineralized bone matrix gelatin,SDBMG),A组右侧植入全脱钙骨基质明胶(wholly demineralized bone matrix gelatin,WDBMG),B组右侧植入自体骨.临床采用人SDBMG治疗大块骨缺损31例.主要观察指标:①动物术后定期进行X射线、组织学检查(A组)及生物力学测定(B组).②术后定期进行X射线检查.结果:SDBMG呈由表及里的"渐进"诱导成骨过程;SDBMG的骨修复作用与自体骨相近,抗压强度与自体骨侧的差异无显著性意义;临床随访示除1例因适应证选择不当而失败外,其他30例均治愈.结论:SDBMG具有良好的成骨作用和可靠的力学性能,可作为自体骨理想的替代材料修复大块骨缺损,但对活动期感染性骨缺损慎用.
배경:대괴골결손적수복시골과면림적난제지일,자체골이식료효최가,단래원유한,목전상결핍자체골이상적체대재료.목적:탐토표면탈개골기질명효수복대괴골결손적료효급체대자체골적가능성.설계:실험연구설계응용완전수궤설계적대조실험.림상연구설계응용이진단위의거적전후대조연구.단위:해방군엄주군구무한총의원골과.대상:실험재해방군엄주군구무한총의원실험실급무한리공대학측시중심완성.실험재료위32지본지산건강웅성성년가토,체질량2.5 kg,구자호북성의학과학원.림상연구대상위1991-01/2001-05해방군엄주군구무한총의원골과수치적대괴골결손환자31례,남25례,녀6례;평균년령9세.방법:장32지가토수궤분성A,B량조,량조쌍측뇨골제성1 cm골결손,량조좌측식입표면탈개골기질명효(surface-demineralized bone matrix gelatin,SDBMG),A조우측식입전탈개골기질명효(wholly demineralized bone matrix gelatin,WDBMG),B조우측식입자체골.림상채용인SDBMG치료대괴골결손31례.주요관찰지표:①동물술후정기진행X사선、조직학검사(A조)급생물역학측정(B조).②술후정기진행X사선검사.결과:SDBMG정유표급리적"점진"유도성골과정;SDBMG적골수복작용여자체골상근,항압강도여자체골측적차이무현저성의의;림상수방시제1례인괄응증선택불당이실패외,기타30례균치유.결론:SDBMG구유량호적성골작용화가고적역학성능,가작위자체골이상적체대재료수복대괴골결손,단대활동기감염성골결손신용.
BACKGROUND: Repair of segmental bone defects is one of the difficult problems in orthopaedics. Although the therapeutic effect on bone autograft is the best, the source is limited and there is lack of suitable substitutive materials for autologous bone.OBJECTIVE: To probe into the therapeutic effects of surface-decalcified bone matrix gelation(SDBMG) and the substitutive possibility of autologous bone on repair of segmental bone defects.DESIGN: The research was designed as completely randomized controlled experiment. The clinical research was designed as pre- and post-controlled study on the basis of diagnosis.SEETING: Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command.MATERLALS and PARTICIPANTS: The experiment was accomplished in Laboratory of Wuhan General Hospital of Guangzhou Military Area Command, and Testing Center of Wuhan University of Technology. Thirty-two local healthy adult male rabbits were employed as the materials in the experiment, 2.5 kg in body mass, bought from Hubei Academy of Medical Sciences. The clinical subjects were 31 patients(male 25 and female 6, a meanage of 9 years old) with segmental bone defects hospitalized in the Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command during January 1991 to May 2001.METHODS: The 32 rabbits were randomized into group A and group B. The bilateral radial bones were prepared into 1-cm bone defect in both groups. In both groups, SDBMG was grafted on the left side; in Group A, wholly-decalcffied bone matrix gelatin(WDBMG) was grafted on the right side;and in Group B, the autologous bone was grafted on the right side. Human SDBMG was provided to treat 31 cases of segmental bone defects.MAIN OUTCOME MEASURES: ① Regular X-ray and histological examinations after operation in animals(Group A) and biomechanical deterruination (Group B ). ② Regular X-ray examinations after operation.RESULTS: SDBMG induced osteogenesis process "gradually" from exterior to interior. The bone repair with SDBMG was similar to that with autologous bone, and there was no significant difference in compressive strength compared with autologous bone. After clinical follow-up, except failure in 1 case due to improper selection of indication, the other 30 cases were all cured.CONCLUSION: SDBMG provides satisfactory osteogenesis and reliable mechanical property. It can be taken as the suitable substitutive material for autologons bone in the repair of segmental bone defects. But it is cautious for the application of SDBMG to infective bone defect in the active phase.