Schindler O S, Cannon S R, Briggs T W R, Blunn G W
Droitwich Knee Clinic & Birmingham Arthritis and Sports Injury Clinic, Worcestershire, United Kingdom.
J Orthop Surg (Hong Kong). 2008 Apr;16(1):66-74. doi: 10.1177/230949900801600116.
To report the use of a composite ceramic bone graft substitute containing calcium sulphate and hydroxyapatite (HA) in the treatment of large expansive osteolytic benign bone tumours.
4 women and 9 men aged 8 to 49 (mean, 22) years with aneurysmal bone cysts (n=6) or giant cell tumours (n=7) in the epi- or meta-physeal areas of the lower limbs underwent curettage, phenolisation, and filling with bone graft substitute containing calcium sulphate and HA. The mean tumour size was 38.5 (range, 18-65) ml. The patients were followed up for a mean of 41 (range, 33-52) months. Range of movement, Musculoskeletal Tumor Society Rating Score (MTSRS), and haematological and blood biochemical parameters were measured.
Two patients had recurrence at 7 and 9 months, both progressed to grade-III giant cell tumours. One underwent revision with an iliac crest autograft, whereas the other underwent en bloc excision and prosthetic replacement. The 11 other lesions displayed clinical and radiological consolidation at a mean of 4.6 (range, 3-7) months. No restriction of range of movement was observed, except in the patient undergoing prosthetic replacement. The mean MTSRS was 96% (range, 83-100%) of that expected for normal function. During the follow-up period, haematological and blood biochemical parameters stayed within normal limits.
Composite bioceramic osteoconductive grafts, which combine porous HA with calcium sulphate, provide a framework for human osteogenesis and avoid donor-site morbidity (autologous bone graft harvesting). Tumour recurrence remains a major concern especially in young patients, as revision invariably requires removal of additional bone, potentially compromising joint integrity.
报告使用含硫酸钙和羟基磷灰石（HA）的复合陶瓷骨移植替代物治疗大型膨胀性溶骨性良性骨肿瘤的情况。
4名女性和9名男性，年龄8至49岁（平均22岁），下肢骨骺或干骺端区域患有骨囊肿（n = 6）或骨巨细胞瘤（n = 7），接受了刮除、苯酚处理，并填充含硫酸钙和HA的骨移植替代物。肿瘤平均大小为38.5（范围18 - 65）ml。对患者进行了平均41（范围33 - 52）个月的随访。测量了活动范围、肌肉骨骼肿瘤学会评分（MTSRS）以及血液学和血液生化参数。
2例患者分别在7个月和9个月时复发，均进展为Ⅲ级骨巨细胞瘤。1例接受了髂嵴自体骨移植翻修，另1例接受了整块切除和假体置换。其他11个病灶在平均4.6（范围3 - 7）个月时显示临床和影像学上的骨愈合。除接受假体置换的患者外，未观察到活动范围受限。MTSRS平均为正常功能预期值的96%（范围83 - 100%）。在随访期间，血液学和血液生化参数保持在正常范围内。
将多孔HA与硫酸钙相结合的复合生物陶瓷骨传导性移植物为人体骨生成提供了框架，并避免了供体部位的并发症（自体骨移植取材）。肿瘤复发仍然是一个主要问题，尤其是在年轻患者中，因为翻修往往需要去除额外的骨组织，可能会损害关节完整性。
