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

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

【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1～6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 investigate the treatment in the use of allograft bone grains combined with autograft bone grafting in giant cell tumor.［Method］From 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 operation 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 closed up with allograft grains combined with cancellous bone autografts.The knee joints exercise was made for 12 weeks with external orthosis fixation.［Result］No 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 taken off for severe rejection ，one case showed tolerant pathologic fracture.All the transplantations showed ideal appearance in X ray 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, good in 4 cases.［Conclusion］Bone 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; 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17～35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 ℃）