复合骨形态发生蛋白-2纳米人工骨辅助锁定支撑钢板手术治疗骨质疏松性桡骨远端C型骨折  

Application of composite bone morphogenetic protein nano artificial bone and locking plate in osteoporosis patients with unstable distal C-style radial fractures

作　　者：汤永华 马玉海 曹烈虎[2] 苏佳灿[2] 

机构地区：[1]嘉兴市武警总队医院骨科,浙江314000 [2]第二军医大学附属长海医院骨科

出　　处：《上海医学》2012年第3期235-237,共3页Shanghai Medical Journal

基　　金：上海市科学技术委员会基础重点项目(11JC1416302);上海市卫生系统新优青计划(XYQ2011032);中国博士后科研基金(20100470756)资助项目

摘　　要：目的观察复合骨形态发生蛋白(BMP)-2纳米人工骨辅助锁定支撑钢板手术治疗骨质疏松性AO-C型桡骨远端骨折的疗效。方法采用复合BMP-2纳米人工骨辅助锁定支撑钢板手术治疗骨质疏松性桡骨远端骨折患者18例。全部患者在术前均行X线正侧位摄片,以明确骨折的塌陷和粉碎程度以及骨折碎片翻转的方向。按照骨折AO分型标准,C型骨折作为该手术方法的适应证。结果术后X线片示,所有骨折均达到解剖复位或接近解剖复位。按照Gartland和Werley评分,优14例,良4例,优良率为100%。上肢功能评分为0～30分,平均为(6±1)分。所有患者随访6个月～2年,平均随访(12±6)个月。随访时X线片显示,在术后8～18周后均获骨性愈合,完全骨代替。平均愈合时间为(12±3)周。植入骨被完全吸收,被新生骨替代,骨缺损处均得到满意修复,达到临床愈合,人工骨与周围骨组织接触良好,无骨溶解、骨折延期愈合或不愈合,无异物、免疫排斥反应发生。所有患者术后均未出现高热、皮疹等过敏反应。伤口全部愈合,无红肿、渗液等不良反应,心电图及生化指标未因植入物而发生异常变化。结论复合BMP-2纳米人工骨辅助支撑钢板手术治疗骨质疏松性桡骨远端骨折可有效避免复位后骨量再丢失,改善远期疗效;复合BMP-2纳米人工骨作为骨移植替代材料,具有良好的临床应用前景。Objective To observe the effect of composite bone morphogenetic protein （BMP）-2 nano artificial bone combined with locking plate on the unstable distal radial fractures （AO-C style）. Methods All patients in this study underwent anteroposterior and lateral radiography in order to accurately find the bone collapse and the flipping direction of the fracture fragments. According to AO fracture classification criteria, C-style fractures were taken as the indication of the surgical treatment. Results X-ray showed that all fractures got anatomical reposition or close to anatomical reposition. According to the Gartland and Werley scores, the clinical outcome was ＂good＂ in 14 cases and ＂fair＂ in 4. The success rate was 100%. The average scores of upper limb function were （6± 1 ） points （ranging 0 to 30 points）. All the patients were followed up for 6 months to 2 years with an average time of （12- 6） months. X-ray showed that all the patients achieved bone union 8 to 18 weeks postoperatively with an average healing time of （ 12 ± 3） weeks. The grafts were completely absorbed and replaced by new bones. Bone defects were perfectly repaired. The artificial bone had good contact with the surrounding bone tissue. There were no osteolysis, delayed healing, disunion, immunological rejection or allergic reaction （such as high fever and rash） in the patients. And all incisions healed. There were no red swelling of the skin, effusion and abnormal changes of electrocardiogram or biochemical index. Conclusion The application of composite BMP-2 nano artificial bone combined with locking plate can effectively avoid further loss of reposition and improve the long-term efficacy in the patients with unstable fractures of distal radius. Nano artificial bone will have extensive clinical application as a substitute material of bone graft. （Shanghai Med J, 2012, 35： 235-327）

关 键 词：纳米 桡骨远端 人工骨 骨折 

分 类 号：R687.3[医药卫生—骨科学]