摘要
目的 :为避免同种异体移植骨的污染 ,减少感染及交叉感染的危险 ,总结了全军骨科研究所综合骨库移植骨制备情况 ,特别对植骨污染情况进行了调查。方法与结果 :自 1991年 9月～ 1997年 12月共得到 2 8例供体 ,经系列筛选 5例不合格 ,占 18% ,以HBV感染者为主。经无菌取骨的大段骨关节细菌污染率仍高达 3 0 % ,主要为软组织、骨膜及骨干表面污染 ,而髓腔内污染少。所染细菌主要为非致病菌或条件致病菌 ,包括枯草杆菌、表皮葡萄球菌及类白喉杆菌等。共制备各种骨移植材料 75 3份 ,在我院应用 410例病人 ,6例术后感染 ,其中大段骨关节移植 72例中 3例发生深部感染。结论 :( 1)要加强对供体的筛选 ,特别对HIV、HBV及HCV的筛选 ,建议开展PCR检测。 ( 2 )大段骨关节移植物应尽量去净骨膜、骨髓等有形成份 ,并于包装前抗生素生理盐水反复冲洗浸泡 ;对骨段、骨板及骨粒等推荐应用环氧乙烷消毒。 ( 3 )建立一整套骨库质量管理体系 ,摒弃医院内酒精贮骨等“临时性骨库 ,”才能保证移植骨的无菌、无毒 ,实现骨库三级网络管理。
Objective: To avoid the potential danger of infection and cross-infection of the bone allograft transplantation, the experience of banking bone allografts was introduced in this paper. Method and Results: From September, 1991 to December, 1997, 28 cases of donors were selected with 5 cases (18%) unsatisfied, mainly HBV testing positive. Though the massive osteoarticular grafts were harvested under aseptic condition, its contamination rate remained 30%, mainly in the area of soft tissue, periosteum and the osteoarticular surface, rarely in the bone marrow. The bacteria contaminated mostly were gram-positive organisms such as Bacillus species, Staphylococcus epidermidis and Bacterium diphtheroid. Totally 753 bone grafts were obtained in our bone bank and transplanted to 410 patients in our hospital with 6 cases infection, which including 3 cases infection among the 72 cases of massive osteoarticular transplantations. Conclusions: 1. Donor selection takes the first step in bone banking, especially the selecting for HIV, HBV and HCV. 2.To massive osteoarticular grafts, the soft tissue, periosteum and bone marrow are removed completely, followed by antibiotic saline washing. To diaphyses and bone chips, sterilizing with ethylene oxide gases are recommanded. 3.For providing safe and efficacious bone grafts, a set of banking processes, bone banking methodology, are desirable pertaining to donor selection, tissue recovery, preservation techniques, record keeping and quality control. It is suggested that small individual “bone bank” might be discontinued, and the establishment of bone bank networking and co-operations would appear to be reasonable.
出处
《中国矫形外科杂志》
CAS
CSCD
2000年第2期109-111,共3页
Orthopedic Journal of China
