自体髂骨移植联合BMP治疗四肢长骨干骨折不愈合  

Treatment of Nonunion of Limbs Long Bone Fracture with Autogenous Bone and BMP Composite Materials Grafting

作　　者：俞旭东[1] 邵增务[1] 

机构地区：[1]武汉协和医院骨科,湖北武汉430022

出　　处：《实用骨科杂志》2008年第12期716-718,721,共4页Journal of Practical Orthopaedics

摘　　要：目的分析骨折不愈合的原因，探讨骨折不愈合的治疗方法。方法选取2006年4月至2007年10月45例长骨干骨折不愈合病例，手术取出原内固定．重新复位，选用坚强合适内固定材料固定骨折断端，植人骨形态发生蛋白复合材料及自体髂骨，对于骨质缺损较多者同时植入同种异体骨。结果术后随访5～20个月，伤口均一期愈合，至随访时43例达骨性愈合，未发现内固定钢板及髓内钉松动、折弯。其中2例患者活动时肘关节疼痛，1例活动范围在0°～120°之间，1例活动范围在0°～90°之间；1例肩关节活动受限，肩关节外展范围0°～80°；1例患者活动时膝关节疼痛，活动范围在0°～60°之间。结论内固定不牢固、骨质缺损是长骨干骨折不愈合的重要原因，提高四肢长骨干骨折愈合的关键是选择合适坚强的内固定，术中充分植骨及植入成骨活性物质，促进骨折的愈合。Objective To analyze the reasons of nonunion in order to improve the treatment of nonunion of limbs long bone diaphysis fracture. Methods From April 2006 to October 2007,45 patients with nonunion limbs long bone fracture were treated. Internal fixators were removed and the fracture of long bone were reduced again and fixed with suitable and stable fixator ;autogenous iliac bone and bone morphogenetic protein composite materials grafting were utilized. If the the bone loss was too much,enough allogenic bone would be imbedded. Results Postoperative follow-up ranged from 5 to 20 months in all patients. All patientsr wounds were primary healing. Fractures of 43 patients achieved osseous healing. No internal fixator or intramedullary pin was cinched or distorted. However,two patients felt painful when their elbow joints bended or extended excessively. One of the activity range was 0°-120°,the other＇ s was 0°-90°;One patient＇s shoulder joint was limited in 0°-80°When abdueted：and one patient felt algesic if his knee joint bended large than 60°. Conclusion The important risk factors for the nonunion of long bone fractures were the unstable fixation and too much bone lost. The key of improving in the rate of curing nonunion of long bone fracture were choosing the suitable internal fixtor, and strengthening the internal fixation. And transplanting sufficient bone and bone morphogenetic protein composite were also helpful.

关 键 词：长骨干 骨折不愈合 骨形态发生蛋白 

分 类 号：R683[医药卫生—骨科学]