同种异体贴花骨移植:临床骨科的可行选择

S. Tuli
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摘要

人们不得不求助于同种异体骨移植物,特别是在填充大的或多个可控制的空洞病变,大的周向骨骨膜缺损的结构重建,严重畸形的广泛脊柱融合,或全关节置换术后的广泛手术重建。这些手术需要大量的骨材料,如果没有显著的发病率和风险,患者(受体)的身体无法提供这些材料。目前大多数同种异体骨库采用深度冷冻、冷冻干燥或辐射等方法进行长期保存。该技术保持无菌性,降低免疫原性,并提供足够的结构完整性;然而,这种方法降低了骨形成的生物活性,而且价格昂贵。我们曾为乌里斯特元帅(1965-1994)进行的基础研究的临床翻译工作。经过广泛的实验观察,自1978年以来,我们一直在临床病例中使用部分脱钙的同种异体骨作为移植物。在良性囊性病变、宽间隙移植和脊柱融合中观察到良好的结果。宣布手术“成功”或“失败”的最低随访时间为植入后2年。
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Allogenic Decal-Bone Grafts: A Viable Option in Clinical Orthopedics
One has to resort to allogenic source of bone grafts especially in filling up of large or multiple containable cavitary lesions, structural reconstruction of large circumferential osteoperiosteal defects, extensive spinal fusions for gross deformities, or extensive operative reconstruction after total joint replacements. These procedures demand an abundant quantity of bone material in which a patient’s (recipient’s) body cannot supply without significant morbidity and risks. At present most of the allogenic bone banks use deep-freezing or freeze-drying or radiation for long-term preservation. The techniques maintain sterility, reduce immunogenicity, and provide adequate structural integrity; however, such procedures reduce the bone-forming biological activity and are expen- sive. We have worked for clinical translation of the basic research performed by Marshal Urist (1965–1994). After extensive experimental observations, we have been using partially decalcified allogenic bone as grafts in clinical cases since 1978. Favorable out come has been observed in benign cystic lesions, wide-gap grafting, and spinal fusions. Minimum follow-up for declaring “success” or “failure” of the procedure was 2 years after implantation.
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