纳米晶胶原基骨材料在骨科疾病中的应用  

Application of nano-hydroxyapatite/collagen in orthopaedics

作　　者：沈铁城[1] 夏青[1] 黄永辉[1] 徐晓峰[1] 崔福斋[2] 田进[1] 

机构地区：[1]江苏大学附属医院骨科,江苏省镇江市212001 [2]清华大学材料科学与工程系,北京市100000

出　　处：《中国组织工程研究与临床康复》2007年第1期48-51,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:观察纳米晶胶原基骨材料(简称人工骨)植入后骨愈合的时间和骨修复效果,探讨人工骨在骨科临床的应用范围。方法:于2003-03/2005-03选择江苏大学附属医院骨科收治的骨折后骨缺损患者32例,骨不连患者5例,骨肿瘤患者4例,腰椎峡部裂患者4例。均符合本临床试验所制定的诊断标准,并经X射线片确诊,患者均知情同意。①骨折后骨缺损患者:均为四肢各部位粉碎性骨折,经切开复位后有骨缺损,采用人工骨植入骨缺损处。②骨不连患者:将骨折端瘢痕及硬化骨切除、髓腔打通后,植入人工骨。③良性骨肿瘤患者:将病骨刮除后植入人工骨。④腰椎峡部裂患者:在减压,RF复位、内固定后有2例行自体骨与人工骨混合植入,1例左侧行自体骨、右侧行人工骨植入,另1例在原来行自体骨植骨基础上因愈合欠牢固,而在原植骨处加植人工骨。结果:42例患者获得随访。①骨折后骨缺损患者29例,25例在术后2～7个月先后达临床愈合。另4例中,1例尺骨缺损植人工骨处术后2年尚无骨痂形成,术后2年9个月骨缺损处愈合;1例胫骨中上段粉碎骨折于术后15个月见原骨缺损植人工骨处骨痂形成不多。其余2例为术后过早负重,发生钢板断裂,给予重新手术复位、固定。②骨不连患者5例,有2例于术后9个月愈合,3例单纯植人工骨者未愈,其中2例再手术行自体骨移植,术后1年愈合。③良性骨肿瘤患者4例,骨囊肿2例术后未见复发。骨纤维结构不良2例,术后再次手术,改行自体骨移植。④腰椎峡部裂患者4例,3例术前腰腿痛症状消失,复查X射线片见原峡部断裂影消失。1例仍感下肢麻痛,复查X射线片见植骨愈合欠佳。结论:纳米晶胶原基骨材料具有良好的生物相容性及生物可降解性能,植入体内具有良好的骨传导作用,可用于四肢粉碎性骨折所致的骨缺损;因其不具备骨诱导成分,对于骨不连、良性骨肿瘤�AIM： To observe the healing time and the repairing effects of bone after nano-hydroxyapatite/collagen （NHAC） implantation and study its clinical application in orthopaedics. METHODS From March 2003 to March 2005, there were 32 cases with bone defects enrolled from Affiliated Hospital of Jiangsu University, and they all underwent surgical procedure but had bone defects, as well as 5 cases with nonunion, 4 cases with benign bone tumor and 4 cases with spondylolysis. All of them were diagnosed by X ray according to self-designed standard of this clinical experiment, and knew the treatment scheme and agreed. ① In the bone defects after bone fracture, it was comminuted fracture in all parts of four limbs, after operation and reduction it presented bone defects. So NHAC was implanted. ② In the nonunion of bone, we excised the scar and ossified tissue in fracture, and reamed the medullary cavity, and then implanted the NHAC. ③In the benign bone tumor, NHAC was implanted after excision of diseased bone. ④In the spondylolysis, NHAC together with autograft were implanted in 2 cases after decompression, RF reduction and intemal fixation. In one case, autologous bone was implanted in his left side while NHAC was implanted in the right side. Another one case received the operation of autologous bone implantation, but the healing isthmus was not solid, so NHAC was implanted. RESULTS ： Totally 42 cases were followed up. ①Among the 29 cases of bone defects, 25 cases got clinical healing from 2 to 7 months after operation. As for other 4 cases, one case of ulnar bone defect showed nonunion after NHAC had been implanted for 2 years, and got healing effect at 2 years and 9 months after implantation; In one case of comminuted bone fracture in upper and middle tibial bone, a few of bone scars were observed at 15 months after implantation. The other two were reoperated for restoration and internal fixation, because of broken fixator as the patients exerted a heavy burden on the suffering broken limb. ②Among those

关 键 词：纳米羟基磷灰石/胶原复合材料 骨缺损 骨移植 

分 类 号：R318.08[医药卫生—生物医学工程]