Shinjo K
Department of Orthopaedic Surgery, Nagoya National Hospital, Aichi, Japan.
Nihon Seikeigeka Gakkai Zasshi. 1993 Jan;67(1):22-33.
Malignant bone tumors excluding joints of six patients were resected. The resultant bone defects were reconstructed with a synthetic fabric-enveloped hydroxyapatite spacer in five cases and a filler in one. Dacron fabric was used in four cases and each of Marlex mesh and Dexon mesh were used in one. The grafting and reconstruction processes were studied clinically and roentgenographically. CT scan was used in one case. The synthetic fabrics were helpful in repairing released supporting soft tissue by serving as a scaffold for the formation of new connective tissue. The spacer to the supporting soft tissues was biologically fixed. The synthetic fabrics were capable of inducing and supporting of the ingrowth of vascular connective tissue. The anchor of reconstructed supporting soft tissue became increasingly strong as time passed. For lasting and stable reconstruction, the spacer must be made uniform with the remaining bone by making an extracortical bone bridge using an autogenous bone graft. In two cases, autogenous bone grafts were taken from the ilium to bridge the remaining bone. The autogenous bone grafts were fixed to the spacer by enveloping the bone graft and the spacer with Marlex mesh and Dexon mesh. In the Marlex case roentgenographic findings showed that extracortical bone bridging was completed within six months after the operation. In the Dexon mesh case, extracortical bone bridging was not completed at one year after the operation, however the repair of the released supporting soft tissues was satisfactory. In order to avoid complications, a fabric must be absorbed fully after completion of the biologic fixation and extracortical bone bridging. Yet, further investigations are required to determine which of the synthetic fabrics and mesh sizes to enhance incorporation of the bone graft.
对6例患者的非关节恶性骨肿瘤进行了切除。5例患者用合成织物包裹的羟基磷灰石间隔物重建了由此产生的骨缺损，1例用填充物进行了重建。4例使用了涤纶织物，1例分别使用了Marlex网和Dexon网。对移植和重建过程进行了临床和X线研究。1例使用了CT扫描。合成织物有助于修复松解的支持性软组织，为新结缔组织的形成提供支架。间隔物与支持性软组织实现了生物固定。合成织物能够诱导并支持血管结缔组织向内生长。随着时间的推移，重建的支持性软组织的锚定变得越来越牢固。为了实现持久稳定的重建，必须通过使用自体骨移植构建骨皮质外骨桥，使间隔物与剩余骨均匀一致。2例取自髂骨的自体骨移植用于连接剩余骨。自体骨移植通过用Marlex网和Dexon网包裹骨移植和间隔物而固定在间隔物上。在使用Marlex网的病例中，X线检查结果显示术后6个月内完成了骨皮质外骨桥的构建。在使用Dexon网的病例中，术后1年骨皮质外骨桥未完成构建，然而松解的支持性软组织的修复效果令人满意。为了避免并发症，在生物固定和骨皮质外骨桥构建完成后，织物必须完全吸收。然而，还需要进一步研究以确定哪种合成织物和网眼尺寸能增强骨移植的融合。
