Hofmann G O, Kirschner M H, Wagner F D, Brauns L, Gonschorek O, Bühren V
Trauma Centre Murnau, Germany.
Transplant Proc. 1998 Sep;30(6):2754-61. doi: 10.1016/s0041-1345(98)00803-3.
This article has presented the preliminary results of three patients who received vascularized allogeneic femoral diaphyses and three patients having undergone vascularized transplantation of fresh and perfused total human knee joints. The large osseous defects in the femora followed osteomyelitis and chondrosarcoma. The three knee joints were lost due to various trauma mechanisms. All grafts were harvested within 25 hours from multiorgan donors perfused with 4 L of UW solution. All osteosyntheses were performed employing intramedullary nails. Vascular pedicles of the grafts were anastomosed end-to-side to the superficial femoral artery and vein in the adductorial canal of the recipient thigh. Immunosuppression was based mainly on two drugs: CyA and AZA. Perfusion of the grafts was demonstrated by DSA, and bone metabolism in the graft by SPECT scintigraphy. Six months after the operation all osteotomies demonstrated callus formation and osseous consolidation in conventional radiographs. Biopsies of the grafted bone revealed intact osteocytes, and arthroscopy of the transplanted knee joints demonstrated intact synovial, chondral, and ligamentous structures. From the surgical aspect, the vascularized transplantation of the femoral diaphyses and total knee joints is technically feasible. The main problems are immunologic. All transplantations were performed with respect to ABO compatibility, but with a large HLA mismatch. Therefore, acute and chronic rejection crises were observed. In total synovial joints, lifelong immunosuppression of graft recipients seems to be currently unavoidable.
本文介绍了3例接受带血管异体股骨干移植患者以及3例接受新鲜灌注的全人膝关节带血管移植患者的初步结果。股骨的大骨缺损继发于骨髓炎和软骨肉瘤。3个膝关节因各种创伤机制而缺失。所有移植物均在25小时内从用4升UW溶液灌注的多器官供体获取。所有骨合成均采用髓内钉进行。移植物的血管蒂在受者大腿内收肌管内与股浅动脉和静脉进行端侧吻合。免疫抑制主要基于两种药物：环孢素A（CyA）和硫唑嘌呤（AZA）。通过数字减影血管造影（DSA）显示移植物的灌注情况，通过单光子发射计算机断层扫描（SPECT）骨闪烁显像显示移植物中的骨代谢情况。术后6个月，所有截骨部位在传统X线片上均显示有骨痂形成和骨愈合。移植骨活检显示骨细胞完整，移植膝关节的关节镜检查显示滑膜、软骨和韧带结构完整。从手术角度来看，带血管的股骨干和全膝关节移植在技术上是可行的。主要问题是免疫方面的。所有移植均考虑了ABO血型相容性，但存在较大的人类白细胞抗原（HLA）错配。因此，观察到了急性和慢性排斥反应危机。在全滑膜关节中，目前似乎不可避免地要对移植物接受者进行终身免疫抑制。
