同种异体松质骨复合自体红骨髓移植治疗创伤性骨缺损  

TREATMENT OF TRAUMATIC BONE DEFECT WITH GRAFT MATERIAL OF ALLOGENIC CANCELLUS COMBINED WITH AUTOLOGOUS RED MARROW

作　　者：孔志刚[1] 田德虎[1] 于海泉[1] 冯文岭[1] 刘长城[1] 

机构地区：[1]河北医科大学第三医院骨伤科,石家庄050051

出　　处：《中国修复重建外科杂志》2008年第10期1251-1254,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河北省卫生厅科研基金资助项目(07080)~~

摘　　要：目的探讨同种异体松质骨复合自体红骨髓移植治疗创伤性骨缺损的临床效果。方法2002年2月-2006年4月,应用同种异体松质骨复合自体红骨髓移植治疗创伤性骨缺损38例。男25例,女13例;年龄21～68岁,平均38岁。内固定失败骨不愈合11例,严重粉碎性骨折13例,开放性骨折或感染性骨缺损9例,陈旧性骨折需矫形植骨5例。肱骨干骨折8例,肱骨髁上髁间粉碎性骨折4例,股骨髁间髁上粉碎性骨折8例,股骨干骨折5例,胫骨开放(GustiloⅠ、Ⅱ型)粉碎性骨折4例,胫骨平台骨折9例。新鲜骨折17例,陈旧性骨折21例。局限性骨缺损23例,范围3cm×3cm×2cm～7cm×4cm×3cm,整段骨缺损15例,范围在3cm以内。骨折按AO/ASIF分类,B2型5例,B3型10例,C2型16例,C3型7例。新鲜骨折伤后至手术时间5～17d,平均8d;陈旧性骨折伤后至手术时间5～13个月,平均7.5个月。术中植入同种异体松质骨与自体红骨髓复合体20～50g,平均28g。结果38例切口均Ⅰ期愈合。患者均获随访,随访时间8个月～4年,平均3.2年。复查X线片示36例达骨性愈合,其中新鲜骨折愈合时间2～6个月,平均4个月;陈旧性骨折愈合时间3～10个月,平均7个月。同种异体松质骨6～8周开始与自体骨融合爬行替代。1例感染性骨缺损移植后迟发性感染,去除内固定及同种异体骨,置管冲洗、局部稳定后再次植骨愈合,随访2年1个月骨感染未复发;1例钢板松动致骨折未愈合,再次行内固定、自体骨移植后骨折愈合。根据Mankin等和Komender等标准评定,满意36例,不满意2例。结论同种异体松质骨复合自体红骨髓移植安全、有效,是修复骨折和骨缺损的较好材料。Objective To study clinical effects of the graft material of allogenic cancellus combined with autologous red marrow in the treatment of traumatic bone defect. Methods From February 2002 to April 2006, 38 patients of traumatic bone defect, 25 males and 13 females, aged 21-68 years old （38 on average）, were treated with allogenic cancellus combined with autologous red marrow. Among them, there were 11 cases of bone nonunion caused by failure of internal fixation, 13 of serious comminuted fracture, 9 of bone defect caused by open fractures or bone infection, 5 of old fracture in need of graft. Of these fractures, there were 8 cases of shaft of humerus, 4 of intercondylar comminuted fracture of humerus, 8 of intercondylar comminuted fracture of femur, 5 of shaft of femur, 4 of open tibia fracture （Gustilo Ⅰ、Ⅱtype） and 9 of tibial plateau fracture. They included 17 cases of fresh fracture and 21 of old fracture. There were 23 cases of limitations of bone defect, and the range was 3 cm × 3 cm × 2 cm - 7 cm×4 cm ×3 cm; and the range of the large bone defect was less than 3 cm in 15 cases. According to AO/ASIF classification, there were 5 cases of type B2, 10 of type B3, 16 of type C2 and 7 of type C3. The time from fresh fracture to operation was 5-17 days （8 days on average）, and the time from old fracture to operation was 5-13 months （7.5 months on average）. The amount of the allograft implantation was 20-50 g （28 g on average）. Results The wounds in all 38 cases obtained healing by first intention. All the patients were followed up for 8 months to 4 years （3.2 years on average）. The X-ray films at reexamination showed that 36 patients had bone healing, with fresh fracture healing time of 2-6 months （4 months on average） and old fracture healing time of 3-10 months （7 months on average）. The allogenic cancellus particles began to be fused with autogenous bone through creeping substitution 6-8 weeks after operation. One case, which had delayed infection, had bone union by remo

关 键 词：同种异体松质骨 自体红骨髓 复合移植 骨缺损 

分 类 号：R687.3[医药卫生—骨科学] R683.4[医药卫生—外科学]