Johnson E E, Urist M R
Department of Orthopaedic Surgery, University of California at Los Angeles 90095, USA.
Clin Orthop Relat Res. 1998 Feb(347):105-16.
Fifteen patients with posttraumatic shortened atrophic femoral nonunions were treated with one-stage lengthening. The alloimplant was composed of allogeneic antigen extracted autolyzed human bone perfused with partially purified human cortical bone morphogenetic protein associated with noncollagenous protein and used as graft. The composite was lyophilized and sterilized with ethylene oxide. All 15 nonunions were atrophic diaphyseal and were lengthened through intercalary segmental defects bridged with the human bone morphogenetic protein composite alloimplants stabilized to the medial femoral cortex through plate osteosynthesis and lag screw fixation. One lengthened proximal femur had fatigue failure of the plate and was treated successfully by exchange plating. The average increase in length was 2.8 cm (range, 1.5-5 cm) and an average percentage increase in length of 8% (range, 4%-132%) of the residual shortened femur. The human bone morphogenetic protein composite produced an immediate reactive bone formation in the host bone and progressive remodeling of the donor recipient interfaces. There were no infections, allergic reactions, clinical rejection of the human bone morphogenetic protein composite alloimplants, or evidence of malignant disease. One-stage femoral lengthening augmented with human bone morphogenetic protein composite graft bridged the intercalary defect, remodeled the atrophic host bone and restored bone continuity within 1 to 2 years. Human bone morphogenetic protein composite alloimplants are a substitute of autogeneic bone graft and offer an alternative to iliac crest bone without the associated morbidity.
15例创伤后股骨萎缩性短缩骨不连患者接受了一期延长治疗。同种异体植入物由提取自异体抗原的自溶人骨组成，灌注有部分纯化的人皮质骨形态发生蛋白并与非胶原蛋白结合，用作移植物。该复合物经冻干并用环氧乙烷灭菌。所有15例骨不连均为骨干萎缩性，通过节段性间置缺损进行延长，缺损用人类骨形态发生蛋白复合异体植入物桥接，通过钢板接骨术和拉力螺钉固定稳定于股骨内侧皮质。1例延长的股骨近端钢板出现疲劳断裂，通过更换钢板成功治疗。平均延长长度为2.8 cm（范围为1.5 - 5 cm），相对于残留缩短股骨，平均长度增加百分比为8%（范围为4% - 132%）。人类骨形态发生蛋白复合物在宿主骨中立即引起反应性骨形成，并使供体 - 受体界面逐渐重塑。未发生感染、过敏反应、对人类骨形态发生蛋白复合异体植入物的临床排斥反应，也未发现恶性疾病迹象。用人骨形态发生蛋白复合移植物增强的一期股骨延长术在1至2年内桥接了节段性缺损，重塑了萎缩的宿主骨并恢复了骨连续性。人类骨形态发生蛋白复合异体植入物是自体骨移植的替代品，提供了一种替代髂嵴骨且无相关并发症的选择。
