中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (14): 2284-2289.doi: 10.3969/j.issn.2095-4344.0744

• 生物材料综述 biomaterial review • 上一篇    下一篇

扩髓-灌洗-吸引器的研究现状与应用特点

李海峰,顾三军,殷渠东   

  1. 无锡市第九人民医院骨科,江苏省无锡市 214062
  • 收稿日期:2017-12-22 出版日期:2018-05-18 发布日期:2018-05-18
  • 通讯作者: 殷渠东,主任医师,无锡市第九人民医院骨科,江苏省无锡市 214062
  • 作者简介:李海峰,男,1980年生,江苏省无锡市人,汉族,硕士,主治医师,主要从事创伤和关节外科研究。

Research and application of the reamer-irrigator-aspirator

Li Hai-feng, Gu San-jun, Yin Qu-dong   

  1. Department of Orthopaedics, the Ninth People’s Hospital of Wuxi, Wuxi 214062, Jiangsu Province, China
  • Received:2017-12-22 Online:2018-05-18 Published:2018-05-18
  • Contact: Yin Qu-dong, Chief physician, Department of Orthopaedics, the Ninth People’s Hospital of Wuxi, Wuxi 214062, Jiangsu Province, China
  • About author:Li Hai-feng, Master, Attending physician, Department of Orthopaedics, the Ninth People’s Hospital of Wuxi, Wuxi 214062, Jiangsu Province, China

摘要:

文章快速阅读:

  

文题释义:
扩髓-灌洗-吸引器:前方为直径12-19 mm的空心多孔锥形金属钻头,中央部分的内层为长度360-520 mm的空心钻体,外层为塑料收集管,后方有锁夹盖和和钻体封口。收集管后部有进水口、引流口,钻体封口位于钻体最后方,防止灌洗液从空心的钻体后方溢出,钻体后方与电钻连接后用可滑动的锁夹盖套住并锁定。
扩髓-灌洗-吸引器应用技术被认为是骨科领域近10年的一项重要新技术,由最初的特殊扩髓方法发展成获取较多自体骨的微创取骨技术。与传统髂骨取骨相比,扩髓-灌洗-吸引器取骨的成骨效果不亚于髂骨,取骨量较多、并发症较少,在需要大量非结构性自体骨移植患者可取代髂骨取骨。其次,扩髓-灌洗-吸引器可清除髓腔病灶,用于治疗髓腔感染、骨髓炎、骨肿瘤和清除长骨髓腔内骨水泥。
 
 
背景:扩髓-灌洗-吸引器所取骨量较多,还含有较多基质干细胞和多种成骨因子,故可用来作为获取大量自体骨移植方法。
目的:介绍扩髓-灌洗-吸引器的应用研究和进展。
方法:由第一作者检索PubMed数据库(2000年1月至2017年5月)有关扩髓-灌洗-吸引器的文献,以“Reamer-irrigator-aspirator”为检索词,共查阅文献87篇,其中38篇符合纳入标准。

结果与结论:与髂骨取骨相比,利用高速钻头扩髓器可获取更多数量的自体骨和骨髓基质干细胞,其成骨效果不亚于髂骨,而并发症更少,作为非结构性自体骨移植的一种方法得到较为广泛应用。利用高速钻头扩髓器清除髓腔内病变,用于治疗长骨骨感染、骨髓炎和骨肿瘤,以及用于清除髓腔骨水泥。高速钻头扩髓最初作为股骨干骨折髓内钉固定特殊扩髓方法,具有降压和降温作用,减少扩髓高压致脂肪栓塞和高温致骨热坏死风险。总体上,高速钻头扩髓并发症较少,治疗效果满意,但也存在费用大、透视较多、出血多、适应证有限和医源性骨折或穿孔等风险。

ORCID: 0000-0003-2812-5860(李海峰)

中国组织工程研究杂志出版内容重点:生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程

关键词: 扩髓-灌洗-吸引器, 扩髓, 生物材料, 骨移植, 骨髓炎, 骨肿瘤

Abstract:

 BACKGROUND: Large volume of bone can be harvested by the reamer-irrigation-aspirator (RIA), which can be used for autologous bone graft, because there are many stromal stem cells and a variety of osteogenesis factors in the harvested bone.

OBJECTIVE: To introduce the application progress of the RIA.
METHODS: PubMed database was retrieved by the first author for RIA-related articles published from January 2000 to May 2017 using the keyword of “reamer-irrigator-aspirator”. A total of 87 articles were searched initially and finally 38 articles met the inclusion criteria.
RESULTS AND CONCLUSION: Compared with harvesting bone tissues from the iliac bone, the RIA can harvest more autologous bone tissues with more bone marrow stromal stem cells. Moreover, the osteogenic effect of the harvested autologous bone is better and there are fewer complications. Therefore, the RIA has been widely used as a method of harvesting non-structural autologous bone tissues. Removal of intramedullary lesions by the RIA is used in the treatment of long bone infection, osteomyelitis and bone tumors, as well as in the removal of intramedullary cement. RIA was originally used as a special reaming during intramedullary nailing for femoral shaft fractures, which could reduce high pressure and high temperature so as to decrease the risks of fat embolism and osteonecrosis. To conclude, the RIA can achieve satisfactory outcomes and result in few complications, but the clinical use is still limited by high cost, frequent fluoroscopy, bleeding and limited indications, as well as risks for iatrogenic fractures and perforation.

Key words: Osteomyelitis, Bone Transplantation, Tissue Engineering

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