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胸骨骨性重建热点问题讨论

Discussion on hot topics of skeletal sternal reconstruction

摘要:

胸骨是胸廓的重要组成部分,也是前胸壁的枢纽组分.大范围的胸骨切除后,为保护深部器官,恢复胸廓解剖结构和生理机能,需要行胸骨重建.胸骨重建包括骨性重建和软组织重建.骨性重建可采用的材料包括:自体或同种异体骨组织、金属修补材料、“三明治”修补材料、非刚性修补材料、生物合成修补材料和三维打印重建假体等.目前可用的重建方法各有利弊,如自体骨移植取材受限,创伤大;同种异体骨移植供体保存要求高,易发生感染;钛合金板修补材料难以交叉、重叠使用;“三明治”修补材料存在局部积液感染的风险;非刚性修补材料不能提供足够的机械支撑;三维打印假体制作复杂,且当术中需要改变切除范围时无法应用等.在钛合金板修补材料基础上设计出的模块化组合式假体制作方便,可根据术中需要临时更换模块,有一定的临床应用价值.目前尚未找到能够完全模拟自体胸骨组织解剖结构与生理功能的重建方法和材料.而软组织重建则是大范围骨性重建成功的必要条件.

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abstracts:

Sternum is an important constituent of the thoracic cage,and a pivotal part of the anterior chest wall.When a considerable portion of the sternum needs to be resected,in order to protect the vital organs beneath,restore the anatomical structure and physiological function,reconstruction is unavoidable.Sternal reconstruction consists of two related parts:skeletal and soft tissue reconstruction.Skeletal reconstruction uses materials such as autograft or allograft of bones,metallic plates,sandwich patch,nonrigid patches,bio-synthetic patches and three-dimensional printing prosthesis.Each has its advantages and disadvantages.For example,autogenous bone transplantation is limited by the source of donor bones and surgical trauma;allograft bone transplantation demands cryopreservation and is susceptible to infection;titanium plate cannot be placed overlapped;"sandwich" patch is susceptible to local fluid accumulation and infection;non-rigid patches cannot provide enough mechanical support;the design and manufacture of three-dimensional printing prosthesis is complicated,time consuming and expensive,and cannot be adjusted due to change of extent of resection during operation.The modularized prosthesis system is a promising new technique developed on the basis of titanium plate.It is divided into standard components of different sizes that can be selected according to operational requirement and easily assembled.Until now,no perfect method or material has been found to imitate the autogenous sternum.Soft tissue reconstruction is a prerequisite to the success of large scale skeletal reconstruction of the sternum.

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作者: 王海峰 [1] 姜格宁 [1]
第一作者: 王海峰
期刊: 《中华外科杂志》2018年56卷9期 661-664页 MEDLINEISTICPKUCSCD
栏目名称: 专家论坛
DOI: 10.3760/cma.j.issn.0529-5815.2018.09.005
发布时间: 2018-09-25
基金项目:
上海市科委西医引导项目(15411965400)Western Medicine Guidance Project of Shanghai Science and Technology Commission
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