钛网打压植骨重建四肢长骨节段骨缺损
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摘要
背景:四肢长骨节段骨缺损临床上常见,一直以来是骨科修复领域的难题。目的:介绍钛网打压植骨重建四肢长骨节段骨缺损新方法的实验研究和临床用用。方法:第一作者应用计算机检索1990至2011年PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed),CNKI数据库(www.cnki.net/index.htm),和维普数据库(http//www.cqvip.com)有关钛网打压植骨重建四肢长骨节段骨缺方面的文献,英文检索词为"segmental bone defect,titanium mesh or titanium cage";中文检索词为"四肢或长骨,骨缺损,钛网"。排除重复性研究、非四肢长骨和Meta分析类文献。根据纳入标准,共检索到30篇文献进行归纳总结。结果与结论:钛网打压植骨重建四肢长骨节段骨缺损无论在大动物或是小动物的实验中均取得较好的成骨效果,优于非钛网的游离植骨和大块皮质骨游离植骨;自体骨、异体骨和人工骨均是可行的填充植骨材料,以自体松质骨为主的植骨材料的成骨效果相对较好,具有生物活性钛网较普通钛网的成骨效果更好。临床上,在四肢长骨各个部位的节段骨缺损中均取得很好的治疗效果,包括骨缺损长达十余厘米的病例。钛网打压植骨重建四肢长骨节段骨缺损新方法,改变了以往认为大于6cm以上长段骨缺损只适宜带血运的骨移植、而不适宜无血运游离植骨的传统观点。该方法较简单、安全、有效,是一种较理想的替代治疗长骨骨干部节段骨缺损的无血运游离植骨法。
BACKGROUND:Segmental defect of limb long bone is common in clinic,which has long been a problem in the field of reconstruction and repair of bone.OBJECTIVE:To introduce a new method of impacted bone graft in a titanium mesh for reconstructing segmental defect of limb long bone,including its experimental research and clinical applications.METHODS:The PubMed database(http://www.ncbi.nlm.nih.gov/PubMed),CNKI database(www.cnki.net/index.htm),VIP database(http//www.cqvip.com/) between 1990 and 2011 were searched by the first author for the articles relate to impacted bone graft in a titanium mesh for reconstructing segmental defect of limb long bone.The English key words were "segmental bone defect,titanium mesh or titanium cage" and the Chinese key words were "limbs or lone bone,segmental bone defect,titanium mesh or titanium cage".The repetitive studies,non-limb long bone and Meta-analysis articles were excluded.According to the inclusion and exclusion criteria,a total of 30 literatures were included to review. RESULTS AND CONCLUSION:Impacted bone graft in a titanium mesh for reconstructing segmental defect of limb long bone have achieved good results for bone formation in both large and small animal experiments,which was superior to free bone graft without titanium mesh and free large cortical bone graft.Autologous bone,allograft bone and artificial bone are feasible materials for bone graft,but autogenous cancellous bone is relatively better and bioactive titanium mesh of the autogenous cancellous bone is better than general titanium mesh.Clinically,it has achieved good therapeutic effect in all parts of long bone segmental bone defects,including long bone defect cases that more than 10 cm.The impacted bone graft in a titanium mesh for reconstructing segmental defect of limb long bone is a new method,which changed the old view of more than 6 cm long bone defect is only suitable for vascularized bone graft,not suitable for non-vascularized free bone graft.It is relatively simple,safe and effective,and it is an ideal non-vascularized free bone graft for the treatment of segmental long bone defects.
BACKGROUND:Segmental defect of limb long bone is common in clinic,which has long been a problem in the field of reconstruction and repair of bone.OBJECTIVE:To introduce a new method of impacted bone graft in a titanium mesh for reconstructing segmental defect of limb long bone,including its experimental research and clinical applications.METHODS:The PubMed database(http://www.ncbi.nlm.nih.gov/PubMed),CNKI database(www.cnki.net/index.htm),VIP database(http//www.cqvip.com/) between 1990 and 2011 were searched by the first author for the articles relate to impacted bone graft in a titanium mesh for reconstructing segmental defect of limb long bone.The English key words were "segmental bone defect,titanium mesh or titanium cage" and the Chinese key words were "limbs or lone bone,segmental bone defect,titanium mesh or titanium cage".The repetitive studies,non-limb long bone and Meta-analysis articles were excluded.According to the inclusion and exclusion criteria,a total of 30 literatures were included to review. RESULTS AND CONCLUSION:Impacted bone graft in a titanium mesh for reconstructing segmental defect of limb long bone have achieved good results for bone formation in both large and small animal experiments,which was superior to free bone graft without titanium mesh and free large cortical bone graft.Autologous bone,allograft bone and artificial bone are feasible materials for bone graft,but autogenous cancellous bone is relatively better and bioactive titanium mesh of the autogenous cancellous bone is better than general titanium mesh.Clinically,it has achieved good therapeutic effect in all parts of long bone segmental bone defects,including long bone defect cases that more than 10 cm.The impacted bone graft in a titanium mesh for reconstructing segmental defect of limb long bone is a new method,which changed the old view of more than 6 cm long bone defect is only suitable for vascularized bone graft,not suitable for non-vascularized free bone graft.It is relatively simple,safe and effective,and it is an ideal non-vascularized free bone graft for the treatment of segmental long bone defects.
引文
[1]郝定均,温世明,何思敏,等.前路Ⅰ期病灶清除植骨内固定治疗胸腰椎结核的疗效观察[J].中国脊柱脊髓杂志,2003,13(11):652-654.
[2]李展春,董英海,董宇启,等.自行设计微创植骨器修复骨缺损的疗效观察[J].中国临床康复,2005,8(34):72-73.
[3]周宁峰,王金武,刘昌胜,等.负载rhBMP-2的CPC活性人工骨修复骨缺损的临床应用[J].中国修复重建外科杂志,2009,23(3):257-今259.
[4]李伦昊,肖彩雯,范先群.钛合金材料在眼眶骨缺损修复中的应用[J].中国实用眼科杂志,2011,29(5):67-69.
[5]李国臣,王林,桑宏勋,等.可控微结构电子束熔化成形钛合金支架作为成骨细胞载体修复兔骨缺损的研究[J].中华创伤骨科杂志,2010,12(6):557-561.
[6]Cobos JA,Lindsey RW,Gugala Z.The cylindrical titanium mesh cage for treatment of a long bone segmental defect:description of a new technique and report of two cases.J Orthop Trauma.2000;14(1):54-59.
[7]Lindsey RW,Gugala Z,Milne E,et al.The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect.J Orthop Res.2006;24(7):1438-1453.
[8]Bullens PH,Bart Schreuder HW,de Waal Malefijt MC,et al.Is an impacted morselized graft in a cage an alternative for reconstructing segmental diaphyseal defects?Clin Orthop Relat Res.2009;467(3):783-791.
[9]Segal U,Shani J.Surgical management of large segmental femoral and radial bone defects in a dog:through use of a cylindrical titanium mesh cage and a cancellous bone graft.Vet Comp Orthop Traumatol.2010;23(1):66-70.
[10]Teixeira CR,Rahal SC,Volpi RS,et al.Tibial segmental bone defect treated with bone plate and cage filled with either xenogeneic composite or autologous cortical bone graft.An experimental study in sheep.Vet Comp Orthop Traumatol.2007,20(4):269-276.
[11]张开放,闫宏伟,刘凯,等.仿生骨植入钛网管固定修复兔骨缺损[J].西安交通大学学报(医学版).2007,28(1):89-92.
[12]张云坤,郁忠杰,贾晓钧,等.钛网植骨修复四肢长骨干骨缺损的实验研[J].江苏大学学报(医学版),2006,16(4):288-290.
[13]Fujibayashi S,Kim HM,Neo M,Uchida M,et al.Repair of segmental long bone defect in rabbit femur using bioactive titanium cylindrical mesh cage.Biomaterials.2003,24(20):3445-3451.
[14]Ostermann PA,Haase N,Rübberdt A,et al.Management of a long segmental defect at the proximal meta-diaphyseal junction of the tibia using a cylindrical titanium mesh cage.J Orthop Trauma.2002,16(8):597-601.
[15]Attias N,Lindsey RW.Case reports:management of large segmental tibial defects using a cylindrical mesh cage.Clin Orthop Relat Res.2006,450:259-266.
[16]Attias N,Lehman RE,Bodell LS,et al.Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates:a case report.J Orthop Trauma.2005,19(3):211-216.
[17]Bullens PH,Schreuder BH,de Waal Malefijt MC,et al.The stability of impacted morsellized bone grafts in a metal cage under dynamic loaded conditions:an in vitro reconstruction of a segmental diaphyseal bone defect.Arch Orthop Trauma Surg.2009,129(5):575-581.
[18]Bullens PH,Hannink G,Verdonschot N,et al.No effect of dynamic loading on bone graft healing in femoral segmental defect reconstructions in the goat.Injury.2010,41(12):1284-1291.
[19]宁漱岩,乔伟松,刘建国.金属钛网支撑颗粒骨植骨处理人工全髋关节翻修中的髋臼骨缺损[J].中国组织工程研究与临床康复,2009,13(43):8475-8479.
[20]尹东芳,黄一飞.医用钛合金的生物相容性研究[J].医学研究杂志,2008,37(10):96-97.
[21]张德宝,谷贵山.钛网结合自体骨重建TKA中T3级非包容性胫骨内侧平台骨缺损中华医学会第十二届骨科学术会议暨第五届COA国际学术大会[C],2010.
[22]赵建宁,周利武,郭亭,等.金属钛网联合颗粒骨打压植骨治疗髋臼骨缺损[J].中国矫形外科杂志,2004,12(20):1529-1532.
[23]Su JC,Liu XW,Yu BQ,et al.Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion.Int Orthop.2010;34(3):369-375.
[24]Zhang Q.Treatment of intra-articular calcaneal fracture by bone grafting and plastic ti-alloy plate internal fixation.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi.2009;23(6):648-650.
[25]Michiardi A,Hélary G,Nguyen PC,et al.Bioactive polymer grafting onto titanium alloy surfaces.Acta Biomater.2010;6(2):667-675.
[26]Gross AE,Wong P,Saleh KJ.Don't throw away the ring:indications and use.J Arthroplasty.2002;17(4Suppl1):162-166.
[27]Brammer KS,Frandsen CJ,Jin S.TiO(2)nanotubes for bone regeneration.Trends Biotechnol.2012.
[28]Wu X,Liu X,Wei J,et al.19.Nano-TiO(2)/PEEK bioactive composite as a bone substitute material:in vitro and in vivo studies.Int J Nanomedicine.2012;7:1215-1225.
[29]Secchi AG,Grigoriou V,Shapiro IM,et al.RGDS peptides immobilized on titanium alloy stimulate bone cell attachment,differentiation and confer resistance to apoptosis.J Biomed Mater Res A.2007;83(3):577-584.
[30]Clements JR,Carpenter BB,Pourciau JK.Treating segmental bone defects:a new technique.J Foot Ankle Surg.2008;47(4):350-356.
[2]李展春,董英海,董宇启,等.自行设计微创植骨器修复骨缺损的疗效观察[J].中国临床康复,2005,8(34):72-73.
[3]周宁峰,王金武,刘昌胜,等.负载rhBMP-2的CPC活性人工骨修复骨缺损的临床应用[J].中国修复重建外科杂志,2009,23(3):257-今259.
[4]李伦昊,肖彩雯,范先群.钛合金材料在眼眶骨缺损修复中的应用[J].中国实用眼科杂志,2011,29(5):67-69.
[5]李国臣,王林,桑宏勋,等.可控微结构电子束熔化成形钛合金支架作为成骨细胞载体修复兔骨缺损的研究[J].中华创伤骨科杂志,2010,12(6):557-561.
[6]Cobos JA,Lindsey RW,Gugala Z.The cylindrical titanium mesh cage for treatment of a long bone segmental defect:description of a new technique and report of two cases.J Orthop Trauma.2000;14(1):54-59.
[7]Lindsey RW,Gugala Z,Milne E,et al.The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect.J Orthop Res.2006;24(7):1438-1453.
[8]Bullens PH,Bart Schreuder HW,de Waal Malefijt MC,et al.Is an impacted morselized graft in a cage an alternative for reconstructing segmental diaphyseal defects?Clin Orthop Relat Res.2009;467(3):783-791.
[9]Segal U,Shani J.Surgical management of large segmental femoral and radial bone defects in a dog:through use of a cylindrical titanium mesh cage and a cancellous bone graft.Vet Comp Orthop Traumatol.2010;23(1):66-70.
[10]Teixeira CR,Rahal SC,Volpi RS,et al.Tibial segmental bone defect treated with bone plate and cage filled with either xenogeneic composite or autologous cortical bone graft.An experimental study in sheep.Vet Comp Orthop Traumatol.2007,20(4):269-276.
[11]张开放,闫宏伟,刘凯,等.仿生骨植入钛网管固定修复兔骨缺损[J].西安交通大学学报(医学版).2007,28(1):89-92.
[12]张云坤,郁忠杰,贾晓钧,等.钛网植骨修复四肢长骨干骨缺损的实验研[J].江苏大学学报(医学版),2006,16(4):288-290.
[13]Fujibayashi S,Kim HM,Neo M,Uchida M,et al.Repair of segmental long bone defect in rabbit femur using bioactive titanium cylindrical mesh cage.Biomaterials.2003,24(20):3445-3451.
[14]Ostermann PA,Haase N,Rübberdt A,et al.Management of a long segmental defect at the proximal meta-diaphyseal junction of the tibia using a cylindrical titanium mesh cage.J Orthop Trauma.2002,16(8):597-601.
[15]Attias N,Lindsey RW.Case reports:management of large segmental tibial defects using a cylindrical mesh cage.Clin Orthop Relat Res.2006,450:259-266.
[16]Attias N,Lehman RE,Bodell LS,et al.Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates:a case report.J Orthop Trauma.2005,19(3):211-216.
[17]Bullens PH,Schreuder BH,de Waal Malefijt MC,et al.The stability of impacted morsellized bone grafts in a metal cage under dynamic loaded conditions:an in vitro reconstruction of a segmental diaphyseal bone defect.Arch Orthop Trauma Surg.2009,129(5):575-581.
[18]Bullens PH,Hannink G,Verdonschot N,et al.No effect of dynamic loading on bone graft healing in femoral segmental defect reconstructions in the goat.Injury.2010,41(12):1284-1291.
[19]宁漱岩,乔伟松,刘建国.金属钛网支撑颗粒骨植骨处理人工全髋关节翻修中的髋臼骨缺损[J].中国组织工程研究与临床康复,2009,13(43):8475-8479.
[20]尹东芳,黄一飞.医用钛合金的生物相容性研究[J].医学研究杂志,2008,37(10):96-97.
[21]张德宝,谷贵山.钛网结合自体骨重建TKA中T3级非包容性胫骨内侧平台骨缺损中华医学会第十二届骨科学术会议暨第五届COA国际学术大会[C],2010.
[22]赵建宁,周利武,郭亭,等.金属钛网联合颗粒骨打压植骨治疗髋臼骨缺损[J].中国矫形外科杂志,2004,12(20):1529-1532.
[23]Su JC,Liu XW,Yu BQ,et al.Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion.Int Orthop.2010;34(3):369-375.
[24]Zhang Q.Treatment of intra-articular calcaneal fracture by bone grafting and plastic ti-alloy plate internal fixation.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi.2009;23(6):648-650.
[25]Michiardi A,Hélary G,Nguyen PC,et al.Bioactive polymer grafting onto titanium alloy surfaces.Acta Biomater.2010;6(2):667-675.
[26]Gross AE,Wong P,Saleh KJ.Don't throw away the ring:indications and use.J Arthroplasty.2002;17(4Suppl1):162-166.
[27]Brammer KS,Frandsen CJ,Jin S.TiO(2)nanotubes for bone regeneration.Trends Biotechnol.2012.
[28]Wu X,Liu X,Wei J,et al.19.Nano-TiO(2)/PEEK bioactive composite as a bone substitute material:in vitro and in vivo studies.Int J Nanomedicine.2012;7:1215-1225.
[29]Secchi AG,Grigoriou V,Shapiro IM,et al.RGDS peptides immobilized on titanium alloy stimulate bone cell attachment,differentiation and confer resistance to apoptosis.J Biomed Mater Res A.2007;83(3):577-584.
[30]Clements JR,Carpenter BB,Pourciau JK.Treating segmental bone defects:a new technique.J Foot Ankle Surg.2008;47(4):350-356.