【摘要】 目的观察运用新鲜及冷冻异体关节移植修复关节毁损的效果。方法1977年3月～1993年9月,对13例16个关节创伤性毁损患者进行异体关节移植修复手术。男9例,女4例;年龄17～55岁。其中掌指关节5例5个关节,指间关节6例9个关节,共11例14个关节;肘关节2例,共2个关节。指间关节及掌指关节均为机器挤压伤,2例肘关节为车祸伤,所有患者均为创伤致关节毁损。临床随机分为两组,A组7例8个关节于关节畸形愈合后行新鲜异体关节移植,B组6例8个关节伤后即时行冷冻处理后异体关节移植。于伤后即时至6个月行异体关节移植术。术后对移植关节的活动度、X线片表现及术后8周行免疫学检测。结果A组骨性愈合时间为5～8个月,B组骨性愈合时间为4～6个月。A组术后2年,掌指关节屈曲度为30～40°,指间关节屈曲度为20～30°;术后6～7年,屈曲度仅有10～20°;新鲜肘关节移植1例术后屈肘60°,伸肘0°,前臂旋前30°,旋后30°。B组术后2年,掌指关节屈曲度为60～70°,指间关节屈曲度为40～50°;术后6～7年,屈曲度仍有40～50°;冷冻异体肘关节移植1例术后屈肘90°,伸肘0°,前臂旋前45°,旋后45°。B组关节活动度、X线片表现明显优于A组。两组免疫学比较:A组IL-2为21.64±3.99,CD4/CD8为3.88±0.82。B组IL-2为16.63±3.11,CD4/CD8为2.53±0.23。A组与B组比较差异有统计学意义(P<0.01)。结论以恢复关节的外形、运动及综合性活动而言,冷冻异体骨修复骨关节缺损为一种较好的方法。更多还原

【Abstract】 Objective To evaluate the long-term function of the traumatically-damaged joint after its repair with transplantation of a fresh or a frozen allogenic joint.Methods From March 1977 to September 1993,13 patients(9 males,4 females;age,17-55 years) with traumatically-damaged joints underwent transplantation of the fresh or the frozen allogenic joints.Five patients had 5 damaged metacarpophalangeal joints,6 patients had 9 damaged interphalangeal joints,and 2 patients had 2 damaged elbow joints.So,the traumatic damage involved 13 patients and 16 joints.All the metacarpophalangeal joints and the interphalangeal joints were injured by machines and the 2 elbow joints were injured by road accidents.The patients were randomly divided into 2 groups:Group A(n=7) and Group B(n=6).The 7 patients with 8 joints in Group A underwent transplantation of fresh allogenic joints;the 6 patients with 8 joints in Group B underwent transplantation of frozen allogenic joints.The allogenic joint transplants were performed in the period from immediately after the injuries to 6 months after the injuries.The motion ranges of the transplanted joints and the X-ray films were examined after operation,and the immunological examination was performed at 8 weeks after operation.Results The time for synostosis was 5-8 months in Group A,but 4-6 months in Group B.In Group A,at 2 years after operation the metacarpophalangeal flexion was 30-40° and the interphalangeal flexion was 20-30°;however,at 6 or 7 years after operation the interphalangeal flexion was only 10-20°.The patients undergoing the transplantation with fresh elbow joints had the elbow flexion of 60° and the elbow extension of 0°,and had the forearm pronation of 30°and the forearm supination of 30°.But in Group B,at 2 years after operation the metacarpophalangeal flexion was 60-70° and the interphalangeal flexion was 40-50°;at 6 or 7 years after operation the interphalangeal flexion was still 40-50°.However,the patients undergoing the transplantation with frozen elbow joints had the elbow flexion of 90° and the elbow extension of 0°,and had the forearm pronation of 45° and a forearm supination of 45°.The joint motion ranges,the X-ray findings,and the immunological results in the patients undergoing the transplantation of the frozen allogenic joints were significantly better than those in the patients undergoing the transplantation of fresh allogenic joints.There was a significant difference in the immunological examination between Group A and Group B(IL-2,21.64±3.99;CD4/CD8,3.88±0.82 vs.IL-2,16.63±3.11;CD4/CD8,2.53±0.23,P<0.01).Conclusion Repairing the traumatically-damaged joints with frozen allogenic joints is a better method of regaining the contour,movement,and complex motion of the hands.更多还原