Czitrom A A, Gross A E, Langer F, Sim F H
Instr Course Lect. 1988;37:13-24.
The increasing volume of orthopaedic reconstructive procedures requiring replacement of bone stock justifies the initiation of programs of bone banking in community hospitals. Provided that strict criteria are followed to assure rigorous screening of donor bone and the reliable preservation of bone graft material, community banking is safe and cost-effective. Banked allograft bone can be used successfully in a wide variety of orthopaedic procedures performed in community hospitals. In general, the best uses are filling bone cavities, buttressing, and augmenting the quantity of autograft bone. In revision reconstructive surgery of the hip, bank bone is used to replace bone stock in protrusio, acetabular dysplasia, and proximal femoral deficiency. The best and most common indication for the use of bank bone in tumor surgery is after curettage or excision of benign lesions. Allografts may be used to reconstruct bony defects after excision of malignant tumors and in the surgical treatment of metastatic disease. These instances require larger bone bank facilities than those commonly available in a community hospital setting. Medicolegal considerations related to bone banking and the use of allografts in community practice include the regulatory requirements outlined in the UAGA, questions concerning negligence liability, and theories of strict product liability. Overall, good medical practice and obtaining informed consents will minimize legal risks related to bone banking and transplantation in a community setting.
需要补充骨量的骨科重建手术数量不断增加，这使得社区医院启动骨库项目变得合理。只要遵循严格的标准以确保对供体骨进行严格筛选并可靠保存骨移植材料，社区骨库就是安全且具有成本效益的。库存同种异体骨可成功用于社区医院开展的各种骨科手术。一般来说，其最佳用途是填充骨腔、支撑以及增加自体骨的数量。在髋关节翻修重建手术中，库存骨用于替代髋臼前突、髋臼发育不良和股骨近端缺损中的骨量。在肿瘤手术中使用库存骨的最佳且最常见的指征是在刮除或切除良性病变之后。同种异体骨可用于在切除恶性肿瘤后重建骨缺损以及在转移性疾病的外科治疗中。这些情况需要比社区医院通常具备的更大的骨库设施。与社区实践中的骨库和同种异体骨使用相关的法医学考量包括《统一人体器官捐赠法》（UAGA）中概述的监管要求、有关过失责任的问题以及严格产品责任理论。总体而言，良好的医疗实践和获得知情同意将使社区环境中与骨库和移植相关的法律风险降至最低。
