CAJ | 학술논문

背景:近年来同种异体骨移植技术的发展为各种原因造成的大段骨关节缺损的修复这一难题提供了新的解决方法.目的:探讨四肢骨肿瘤切除后采用大段异体骨移植交锁髓内钉内固定修复骨缺损的疗效.设计:自身前后对照观察.单位:云南省肿瘤医院骨科.对象:选择1998-04/2003-02云南省肿瘤医院骨科进行的骨肿瘤病灶清除、交锁髓内钉内固定加同种异体骨移植术的患者18例(患者均签署知情同意书).其中恶性骨肿瘤15例,瘤样病损3例.干预:同种异体骨处理来源于新鲜尸体骨(由云南省肿瘤医院制备、保存).完整切除肿瘤骨段后,于骨缺损处植入同种异体骨,依次置入远端及近端锁钉,骨接合部植入自体松质骨粒促进骨端愈合,肱骨上端半关节移植,主要行肩袖及三角肌重建;膝关节半关节移植,应重新附丽重要肌肉、韧带.术后外固定4～6周,循序渐进功能锻炼.于术后3,6,12个月及随访时进行疗效评定.术后肢体功能恢复按Mankin评定标准评估(分为优,良,中,差).主要观察指标: ①患者肢体功能恢复结果. ②不良事件和副反应.结果:18例患者,平均随访32个月,均进入结果分析. ①患者肢体功能恢复结果:根据Mankin提出的评定标准,本组优7例,良6例,中4例,差1例.6和12个月检查见骨痂和核素浓集逐渐增多,10～14个月生长骨痂可覆盖骨端,并随时间的延长逐渐完成替代爬行. ②不良事件和副反应:本组患者中无瘤存活16例,2例分别于术后12个月和18个月死于原发病变和肺转移.其余患者患肢均无感染、骨不连接、内固定松动或断裂.无一例肢体短缩.半关节移植者关节活动稍受限,关节稳定.结论:此手术方法使固定节段具有高度的内在稳定性,可早期进行功能锻炼,防止影响肩、膝等关节的负重功能,适合于四肢骨肿瘤切除后骨缺损的修复.
배경:근년래동충이체골이식기술적발전위각충원인조성적대단골관절결손적수복저일난제제공료신적해결방법.목적:탐토사지골종류절제후채용대단이체골이식교쇄수내정내고정수복골결손적료효.설계:자신전후대조관찰.단위:운남성종류의원골과.대상:선택1998-04/2003-02운남성종류의원골과진행적골종류병조청제、교쇄수내정내고정가동충이체골이식술적환자18례(환자균첨서지정동의서).기중악성골종류15례,류양병손3례.간예:동충이체골처리래원우신선시체골(유운남성종류의원제비、보존).완정절제종류골단후,우골결손처식입동충이체골,의차치입원단급근단쇄정,골접합부식입자체송질골립촉진골단유합,굉골상단반관절이식,주요행견수급삼각기중건;슬관절반관절이식,응중신부려중요기육、인대.술후외고정4～6주,순서점진공능단련.우술후3,6,12개월급수방시진행료효평정.술후지체공능회복안Mankin평정표준평고(분위우,량,중,차).주요관찰지표: ①환자지체공능회복결과. ②불량사건화부반응.결과:18례환자,평균수방32개월,균진입결과분석. ①환자지체공능회복결과:근거Mankin제출적평정표준,본조우7례,량6례,중4례,차1례.6화12개월검사견골가화핵소농집축점증다,10～14개월생장골가가복개골단,병수시간적연장축점완성체대파행. ②불량사건화부반응:본조환자중무류존활16례,2례분별우술후12개월화18개월사우원발병변화폐전이.기여환자환지균무감염、골불련접、내고정송동혹단렬.무일례지체단축.반관절이식자관절활동초수한,관절은정.결론:차수술방법사고정절단구유고도적내재은정성,가조기진행공능단련,방지영향견、슬등관절적부중공능,괄합우사지골종류절제후골결손적수복.
BACKGROUND: In recent years, the progression of transplantation of allografts has put forward to a new way to repair massive bone and joint defect caused by various reasons, which was a difficult subject in the past.OBJECTIVE: To probe into the effect of massive allograft and interlocking intramedullary nail on rebuilding bone and joint after bone tumor resection.DESIGN: Self-control observation SETTING: Department of Orthopaedics, Yunnan Provincial Tumor Hospital PARTICIPANTS: From April 1998 to January 2003, totally 18 patients with 15 cases of malignant bone tumor and 3 of osteoma-like disease, accepted bone tumor focus removal followed by intrmedullary nailing and allogenic bone transplantation, consented to join the study, were recruited.INTERVENTIONS: Allografts were taken from fresh cadaveric bone (Prepared and stored in Yunnan Provincial Tumor). The bone segment of osteoma was cut completely and the allografts were transplanted at the bone defects. The proximal and distal intrmedullary nailing were inserted in order. Auto cancellous bone particles were transplanted at the bone joint to promote the healing at bone end. The upper part of shoulder bone was transplanted to perform reconstruct of retotar and triangular muscle; half knee joint was transplanted to attach important muscle and ligament. After external fixation of 4 to 6 weeks following operation, the functional exercise was conducted in order sequence. Evaluating the curative effect of functional recovery of the limbs at postoperative 3,6 and 12 months as well as follow-up was carried out according to the criteria of Mankin(excellent ,good , moderate , unsatisfied).MAIN OUTCOME MEASURES: ①Functional recovery of limb of the patients. ② Adverse and side effectRESULTS: Date of totally 18 patients was entered result analysis. ①Functional recovery result of the limbs: According to evaluated criteria put forward by Mankin. In this group, 7 cases of excellent, 6 of good, 4 of moderate and 1 of unsatisfied. Bony callus and the concentration of nuclide were increased gradually in the examination at month 6 and 12. About 10-14 months after operation, the osteotylus would cover the end of allograft, substituted the allograft gradually. ② Adverse events and side effect:In this group, no tumor was survived in 16 cases, two cases died of primary lesion and pulmonary metastasis at postoperative 12 months and 18 months respectively. No infection, bone nonunion, flexible internal fixation or ruptures were found in the limbs of other patients. No one was found with shortened limbs. The patient with part joint transplantation has limitation in joint move, but the joint was stable.CONCLUSION: This operation has the highest stabilization .The patients can do exercise earlier to recover function, and injury arthritis could be prevented. It is suitable to rebuild the bone after bone tumor resection.