Xenograft and calcium sulphate in treating benign bone tumor

doi:10.3969/j.issn.2095-4344.2014.16.002

Abstract

Abstract:

BACKGROUND: Autologous bone graft is the best method to repair bone defects after tumor curettage, but its shortcomings are as follows: increased surgical trauma, sequelae at bone graft site such as infection and pain, and a limited amount of autologous bone.

OBJECTIVE: To analyze the effectiveness of xenograft and calcium sulphate artificial bone in treating bone defects after benign bone tumor removed.

METHODS: Totally 26 cases of benign bone tumor were selected, including 8 cases of giant cell tumor, 5 of enchondroma, 4 of fibrous histiocytoma, 3 of bone fibrous dysplasia, 2 of non-ossifying fibroma, 2 cases of bone cysts, 1 of aneurysmal bone cyst and 1 of aneurysmal bone cyst and 1 case of chondroblastoma. Of the 26 cases, 12 cases underwent calcium sulphate pellets alone to fill bone defects after benign bone tumor removed, 6 cases were subjected to xenograft alone, and 8 cases were treated with calcium sulphate pellets combined with xenograft. The X-rays were taken at 1 week, 3 months, and 1 year after the operation in all patients to assess the bone healing process.

RESULTS AND CONCLUSION: All the patients were followed up for 36-72 months. The absorption of calcium sulphate appeared to be absorbed earlier, the earlier absorption appearance could be observed as earlier as 1 month after the implantation, and most calcium sulphate was absolved and replaced by new bone at 3 months after the operation. The xenograft bone was degraded at 3 months post implantation and new bone formed. Osseo integration of the graft was observed at the periphery of the implant at 6 months post implantation. One year post implantation, trabecular bone was observed at the site with uniform bone density. In the combined group, thecalcium sulphate pellets were absorbed earlier and new bone formed earlier than the calcium sulphate alone group, and the xenograft absorbed later than the calcium sulphate pellets. Generally, bony union was detectable 1 year after operation. These findings indicate that xenograft and calcium sulphate in treating benign bone tumor have acquired good results, which can be used as a substitute of autologous bone.

Key words: biocompatible materials, bone neoplasms, calcium sulfate, bone transplantation

CLC Number:

R318

Fang Zhi-wei, Li Shu, Fan Zheng-fu, Bai Chu-jie, Liu Jia-yong, Xue Rui-feng, Zhang Lu. Xenograft and calcium sulphate in treating benign bone tumor[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(16): 2468-2473.

Figures/Tables 2

2.1 参与者数量分析按意向性分析处理，26例患者均进入结果分析。 2.2 术后伤口情况 26例中14例未放置伤口引流，骨粒植骨者有9例未放置引流，骨条植骨2例未放置引流，混合植骨者3例未放置引流。是否放置引流的原则是病灶较小、手术切口较小的，比如手的掌骨、小腿的腓骨，不放置引流；病灶大的、切口较大的放置引流。12例放置伤口引流者一般3-5 d拔出引流，引流量30-100 mL者为多，最多者5 d引流量总计230 mL，引流较多者多为股骨和胫骨伤口较大部位。 26例中只有1例骨粒植骨位于指骨病灶未放引流者伤口有淡黄色渗出液，经换药后愈合；另外1例胫骨近端骨粒植骨者出现排异反应，术后1个月伤口破溃，经过再清创换药后伤口愈合；其余24例均为Ⅰ期愈合。有8例患者发生伤口周围肿胀，多是未放置引流患者，其中骨粒植骨者3例，骨条植骨者1例，混合植骨者4例。 2.3 术后血象和体温变化术后1周内查血象有7例中性粒细胞增高，2例白细胞增高，是骨条植骨者。术后有6例出现体温升高，一般3-5 d内降至正常，有1例术后体温升高至术后第8天。一般体温在37-38 ℃之间，只有1例最高达到39 ℃。发生体温增高者多见于骨粒+骨条混合植入，6例中混合植骨者4例术后发热，单独骨粒植骨和单独骨条植骨术后发烧各1例。给予对症退热治疗，预防性给予抗生素及加强伤口换药等处理。 2.4 植骨愈合情况术后1周内、1个月、3个月、6个月、1年、2年拍X射线片观察发现，骨粒的降解发生较早，一般术后4周就开始出现骨粒降解(图1A，B)，术后3个月就可以看到大部分已经降解完毕并被新骨替代(图1C，D)。骨条3个月后可以看到骨降解和骨替代发生，植骨填充物边缘模糊(图2A，B)，术后1年骨缺损内密度均匀，骨小梁形成明显，骨修复良好(图2C)，术后2年塑型良好(图2D)。骨粒+骨条混合植骨者介于单纯骨粒和单纯骨条之间，出现骨粒部分先降解先修复、骨条部分后降解后修复(图3)。24例患者术后1年均达到骨性愈合。 26例患者术后肿瘤复发2例，肿瘤病理类型是骨巨细胞瘤，平均复发时间术后16个月。1例75岁患者术后因其他部位恶性肿瘤死亡。"

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