Aarhus University Hospital, Palle Juul-Jensens Blvd, 8200 Aarhus N, Denmark.
Injury. 2021 Jun;52 Suppl 2:S23-S28. doi: 10.1016/j.injury.2020.11.013. Epub 2020 Nov 11.
In fracture surgery, large bone defects and non-unions often require bone transplantation, and alternatives to autograft bone substitutes in the form of allografts from bone banks and the derivate demineralised bone matrix (DBM) are widely used. With a focus on efficacy, clinical evidence, safety, cost, and patient acceptance, this review evaluated the difference between allogeneic allograft or DBM as a bone substitute in trauma surgery. The efficacy in supporting bone healing from allograft and DBM is highly influenced by donor characteristics and graft processing. Mechanical stability is achieved from a structural graft. Based on the existing literature it is difficult to identify where DBM is useful in trauma surgery, and the level of evidence for the relevant use of allograft bone in trauma is low. The risk of transmitting diseases is negligible, and the lowest risk is from DBM due to the extensive processing procedures. A cost comparison showed that DBM is significantly more expensive. The experiences of dental patients have shown that many patients do not want to receive allografts as a bone substitute. It is not possible to definitively conclude whether it makes a difference if allograft or DBM is used in trauma surgery. It is ultimately the surgeon's individual choice, but this article may be useful in providing considerations before a decision is made.
在骨折手术中，大的骨缺损和骨不连通常需要进行骨移植，异体骨移植物（来自骨库的同种异体移植物）和脱矿骨基质（DBM）等自体骨替代品被广泛应用。本研究重点关注疗效、临床证据、安全性、成本和患者接受度，评估了创伤外科中同种异体移植物或 DBM 作为骨替代物的差异。同种异体移植物和 DBM 促进骨愈合的效果高度取决于供体特征和移植物处理。结构移植物可实现机械稳定性。基于现有文献，很难确定 DBM 在创伤外科中的哪些情况下有用，而相关的同种异体骨在创伤中的应用证据水平较低。传播疾病的风险可以忽略不计，由于 DBM 经过了广泛的处理程序，因此风险最低。成本比较表明，DBM 明显更昂贵。牙科患者的经验表明，许多患者不想接受同种异体移植物作为骨替代品。因此，不能确定在创伤外科中使用同种异体移植物还是 DBM 是否有区别。这最终是外科医生的个人选择，但在做出决定之前，本文可能有助于提供一些考虑因素。
