de Peretti F, Trojani C, Cambas P M, Loubière R, Argenson C
Service d'Orthopédie et de Traumatologie, Hôpital Saint-Roch, Nice.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(3):234-40.
Infection risk makes the management of a bone bank more and more difficult. On the other hand, realizing an autologous graft is not always without consequences. That is why we estimated the mechanical quality, the osteo-integration and the biocompatability of a coral graft.
Between 1988 and 1992, two of us systematically used coral graft as "support" after lifting of some articular depression in fractures of inferior limb. Osteosynthesis was systematically associated. In this way, we operated 13 fractures of the lateral tibial plateau, 8 thalamic fractures of the calcaneus and 2 fractures of the inferior extremity of the tibia. Average follow-up is 20 months, with extremes of 68 and 12 months. Material ablation was realized 13 times and coral graft biopsy 4 times. Bone integration was estimated radiologically in 3 stages: stage 1: non union = "margin" around the coral, stage 2: possible integration = the coral is perfectly visible, but its borders grow indistinct, stage 3: certain integration = peripheral disparition of the coral weft, radiological interpenetration between coral and bone framework. We systematically searched for secondary displacements and complications.
Mechanical conditions were respected, there was no secondary displacement. "Possible integration" (stage 2) was found in 8 cases at an average follow-up of 20 months. In 9 cases, we found "certain integration" (stage 3), at an average follow-up of 28 months. It is possible that a more important follow-up time would allow to find more integration cases. Biocompatibility is debatable under the operating conditions of the authors. We counted 5 aseptic serous flows which continued to be aseptic (1 tibial plateau, 1 inferior extremity of the tibia, 3 calcaneum). Three coral grafts were removed to obtain healing.
When biocompatibility is satisfactory the integration is certain. The longer the follow-up time, the more stage 3 cases can be observed. Nevertheless, this integration runs out with time. We did not find any explication to aseptic serous flows. It may result from some impurities. On the other hand, use of the coralin hydroxyapatite does not seem to drive to allergic complications.
In accordance with this study, we use the coral graft only in case of tibial plateau fracture. Our experience with coral graft in the other fields of bone surgery is not sufficient to express an opinion.
感染风险使得骨库的管理愈发困难。另一方面，实现自体移植并非总是毫无影响。这就是我们评估珊瑚移植物的力学性能、骨整合及生物相容性的原因。
1988年至1992年间，我们中的两人在治疗下肢骨折的某些关节凹陷复位后，系统性地使用珊瑚移植物作为“支撑物”。均系统性地进行了骨接合术。通过这种方式，我们治疗了13例胫骨外侧平台骨折、8例跟骨丘部骨折和2例胫骨下端骨折。平均随访时间为20个月，最短12个月，最长68个月。进行了13次材料消融和4次珊瑚移植物活检。通过放射学分三个阶段评估骨整合情况：第1阶段：未愈合 = 珊瑚周围出现“边缘”；第2阶段：可能整合 = 珊瑚清晰可见，但其边界模糊；第3阶段：确定整合 = 珊瑚纹理周边消失，珊瑚与骨结构之间出现放射学相互渗透。我们系统性地检查了二次移位和并发症情况。
力学条件得到满足，未出现二次移位。平均随访20个月时，8例出现“可能整合”（第2阶段）。平均随访28个月时，9例出现“确定整合”（第3阶段）。更长的随访时间可能会发现更多的整合病例。在作者的手术条件下，生物相容性存在争议。我们记录到5例无菌性浆液渗出，且持续无菌（1例胫骨平台、1例胫骨下端、3例跟骨）。为实现愈合，取出了3块珊瑚移植物。
当生物相容性令人满意时，整合是确定无疑的。随访时间越长，观察到的第3阶段病例越多。然而，这种整合会随时间推移而消失。我们未找到无菌性浆液渗出的任何解释。这可能是由某些杂质导致的。另一方面，使用珊瑚羟基磷灰石似乎不会引发过敏并发症。
根据本研究，我们仅在胫骨平台骨折的情况下使用珊瑚移植物。我们在骨外科其他领域使用珊瑚移植物的经验不足以发表意见。
