Objective: To compare the healing process and clinical results of bioactive glass and allogenic bone in the repair of bone defects after benign bone tumor curettage.
Methods: Between November 2011 and December 2012, 20 patients with benign bone tumor received bioactive glass and allogenic bone for repair of bone defects after benign bone tumor curettage. There were 17 males and 3 females, aged 9-68 years (median, 18.5 years). The mean course of disease was 3.3 months (range, 1-9 months). Pathological examination revealed that there were 7 cases of chondroblastoma, 5 cases of bone cyst, 2 cases of non-ossifying fibroma, 2 cases of enchondroma, 1 case of vascular tumor of bone, 1 case of lipoma of bone, 1 case of osteoid osteoma, and 1 case of chondromyxoid fibroma. The lesion located at the femur in 5 cases, at the tibia in 11 cases, at the humerus in 1 case, at the calcaneus in 2 cases, and at the talus in 1 case. The bioactive glass and allogenic cancellous bone were implanted in the cavity at the same time. The Musculoskeletal Tumor Society (MSTS) function evaluation score was used for evaluation of postoperative limb function. According to the imaging and clinical benefit, the healing processes of two kinds of implants were evaluated. The healing rate and healing time were compared. The distribution of the bioactive glass was divided into two layers: the layer close to host bone and the layer close to allogenic bone. The bone ingrowth time and bone resorption time in different layers were evaluated and compared.
Results: All cases were followed up 12-42 months (mean, 34.5 months). All incisions healed by first intention. There were no complications of wound infection or deep infection, rejection, nonunion of bone, fracture at bone graft site, and collapsing of articular surface. There was no tumor recurrence during follow-up. The mean MSTS functional score was 29.5 (range, 28-30) at last follow-up. Complete healing was observed in 11 cases and healing in 9 cases. The healing rates of two kinds of implants were both 100%. The healing time of bioactive glass and allogenic bone was (4.7±1.3) months and (5.2±1.6) months, respectively, showing no significant difference (t=-1.240, P=0.244). The bone ingrowth time and the bone absorption time were (3.6±0.9) months and (3.7±1.0) months in the layer close to host bone and were (4.2±1.3) months and (4.2±1.3) months in the layer close to allogenic bone, all showing no significant difference (t=1.785, P=0.097; t=1.476, P=0.172).
Conclusions: For the repair of bone defects after benign bone tumor curettage, bioactive glass can achieve satisfactory healing result and has good safety.
目的: 比较研究生物活性玻璃与同种异体骨修复良性骨肿瘤刮除后缺损的骨愈合过程和临床效果。.
方法: 2011年11月－2012年12月，收治20例原发良性骨肿瘤患者。男17例，女3例；年龄9～68岁，中位年龄18.5岁。病程1～9个月，平均3.3个月。软骨母细胞瘤7例，骨囊肿5例，非骨化纤维瘤2例，内生软骨瘤2 例，骨血管瘤1 例，骨脂肪瘤1例，骨样骨瘤1例，软骨黏液样纤维瘤1例。病灶部位：股骨5例，胫骨11例，肱骨1 例，跟骨2 例，距骨1例。术中同时植入生物活性玻璃和同种异体松质骨修复肿瘤刮除后缺损。术后采用骨与软组织协会（MSTS）功能评定法评价患者肢体功能；根据影像学和临床获益情况评价两种植入物的骨愈合过程，比较骨愈合率和愈合时间；根据生物活性玻璃的分布分为近宿主骨层和近同种异体骨层，比较不同植骨层的骨长入和植骨吸收时间。.
结果: 术后患者均获随访，随访时间12～42个月，平均34.5个月。所有患者切口均Ⅰ期愈合，未发生切口感染或深部感染、排斥反应、植骨不愈合、植骨部位骨折和关节面塌陷等并发症；随访期间未见肿瘤复发。末次随访时MSTS评分为28～30分，平均29.5分。末次随访时，骨愈合良好11例，愈合9例，两种材料植入后骨愈合率均为100%。生物活性玻璃与同种异体骨诱导的骨愈合时间分别为（4.7±1.3）个月和（5.2±1.6）个月，比较差异无统计学意义（t=-1.240，P=0.244）。生物活性玻璃的近宿主骨层和近同种异体骨层的骨长入时间分别为（3.6±0.9）个月和（4.2±1.3）个月，植骨吸收时间分别为（3.7±1.0）个月和（4.2±1.3）个月，比较差异均无统计学意义（t=1.785，P=0.097；t=1.476，P=0.172）。.
结论: 与同种异体骨相比，采用生物活性玻璃修复良性骨肿瘤刮除后缺损，其诱导的骨愈合效果满意，安全性良好。.
Keywords: Allogenic bone; Benign bone tumor; Bioactive glass; Bone healing; Repair and reconstruction.