Schweiberer L, Stützle H, Mandelkow H K
Chirurgische Klinik Innenstadt der Universität München, Federal Republic of Germany.
Arch Orthop Trauma Surg. 1990;109(1):1-8. doi: 10.1007/BF00441902.
According to one principle of surgery, the transplantation of vital tissue is the best method of reconstructing a defect. Because of absent immunologic reactions, high osteogenic potency, and preserved stability, transplantation of autogenous bone shows the best results. Necrosis of transplanted bone, leading inevitably to absorption and remodeling of the graft, can be avoided if microsurgically vascularized autogenous bone segments are transferred. Disadvantages are the low availability and the necessity of additional operations. As an alternative, deep-frozen allogeneic bone is used. However, this kind of bone shows delayed incorporation based on cellular and humoral immune reactions, and it is also installed into the host bed after overcoming the immune barrier. The risk of microbiological contamination or transmission of unrecognized germs such as HIV is a cause of great expense in bone banking techniques. If one succeeds in reducing (a) the immunologic defense reaction and (b) the risk of infection by sterilization or disinfection without damaging the osteoinductive proteins of bone matrix, the rate of complications can be lowered. Demineralized bone matrix can be used if biomechanical stability is not required. Its ability to induce osteogenesis without a major immune reaction or the risk of transmitting diseases justifies its clinical application. Further intensive research in these areas is unavoidable.
根据一项外科手术原则，重要组织的移植是修复缺损的最佳方法。由于不存在免疫反应、具有高成骨能力且稳定性良好，自体骨移植显示出最佳效果。如果采用显微外科血管化自体骨段移植，可避免移植骨坏死，而移植骨坏死不可避免地会导致移植物的吸收和重塑。缺点是可用性低且需要额外手术。作为替代方案，可使用深冻同种异体骨。然而，这种骨由于细胞和体液免疫反应会出现延迟整合，并且在克服免疫屏障后才植入宿主床。微生物污染风险或诸如艾滋病毒等未识别病原体的传播是骨库技术成本高昂的一个原因。如果能够成功降低（a）免疫防御反应以及（b）通过灭菌或消毒降低感染风险而又不损害骨基质的骨诱导蛋白，并发症发生率就可以降低。如果不需要生物力学稳定性，可使用脱矿骨基质。其诱导成骨而无重大免疫反应或传播疾病风险的能力证明了其临床应用的合理性。在这些领域进行进一步深入研究是不可避免的。
