Deutsches Institut für Zell- und Gewebeersatz gGmbH, Berlin.
Transfus Med Hemother. 2012 Dec;39(6):395-404. doi: 10.1159/000345269. Epub 2012 Nov 13.
Patients requiring knee and hip revision arthroplasty often present with difficult anatomical situations that limit options for surgery. Customised mega-implants may be one of few remaining treatment options. However, extensive damage to residual bone stock may also be present, and in such cases even customised prosthetics may be difficult to implant. Small quantities of lost bone can be replaced with standard allografts or autologous bone. Larger defects may require structural macro-allografts, sometimes in combination with implants (allograft-prosthesis composites).
Herein, we describe a process for manufacturing lesion-specific large structural allografts according to a 3D, full-scale, lithographically generated defect model. These macro-allografts deliver the volume and the mechanical stability necessary for certain complex revisions. They are patient-and implant-matched, negate some requirements for additional implants and biomaterials and save time in the operating theatre by eliminating the requirement for intra-operative sizing and shaping of standard allografts.
While a robust data set from long-term follow-up of patients receiving customised macro-allografts is not yet available, initial clinical experience and results suggest that lesion-matched macro-allografts can be an important component of revision joint surgery.
需要进行膝关节和髋关节翻修手术的患者通常存在解剖结构复杂的情况，这限制了手术选择。定制的大型植入物可能是为数不多的治疗选择之一。然而，残余骨量的广泛损伤也可能存在，在这种情况下，即使是定制的假体也可能难以植入。少量丢失的骨可以用标准同种异体移植物或自体骨替代。较大的缺损可能需要结构性大的同种异体移植物，有时还需要与植入物结合（同种异体-假体复合材料）。
本文描述了一种根据 3D 全尺寸光刻生成的缺陷模型制造特定病变的大型结构性同种异体移植物的方法。这些大型同种异体移植物提供了某些复杂翻修所需的体积和机械稳定性。它们与患者和植入物匹配，消除了对额外植入物和生物材料的一些要求，并通过消除对标准同种异体移植物术中尺寸和形状的要求，在手术室中节省了时间。
虽然尚未获得接受定制大型同种异体移植物患者的长期随访的可靠数据集，但初步临床经验和结果表明，病变匹配的大型同种异体移植物可以成为关节翻修手术的重要组成部分。
