体外冲击波联合扩髓骨泥回植对股骨干骨折骨不连的影响  

The effects of extracorporeal shock wave treatment combined with expanding bone marrow autografts in thetreatment of nonunion of femoral shaft fractures with interlocking intrameduilary nails

作　　者：孙英华[1] 陈连旭[2] 李冰[1] 焦兆德[1] 

机构地区：[1]潍坊医学院附属益都中心医院骨外科,潍坊262500 [2]北京大学运动医学研究所

出　　处：《中华物理医学与康复杂志》2013年第2期134-137,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：山东省卫生厅科技发展计划青年基金（373）

摘　　要：目的观察体外冲击波（ESW）联合扩髓骨泥回植对股骨干骨折骨不连的影响。方法选取股骨干骨折骨不连患者30例，按随机数字表法将其分为ESW组、扩髓骨泥组和联合治疗组，每组10例。ESW组丢弃扩髓骨泥，于交锁髓内钉固定术后ldd开始行ESW治疗，扩髓骨泥组则在交锁髓内钉固定术中将扩髓骨泥回植于骨折断端，联合治疗组在扩髓骨泥回植基础上辅以ESW治疗。交锁髓内钉固定术后第4、8、12和16周，采用x线对3组患者的骨痂及骨折线愈合情况进行评定。结果术后第4周，联合治疗组、扩髓骨泥组骨痂及骨折线评分分别为[（1．55±0．52）分和（1．25±1．03）分、（1．50±0．71）分和（1．20±1．01）分]，显著高于ESW组骨痂及骨折线评分[（1．11±0．32）分和（0．21±0．63）分，P〈0．05]；术后第8周，联合治疗组骨痂及骨折线评分增高至[（3．01±0．22）分和（4．00±1．46）分，P〈0．05]，显著高于ESW组和扩髓骨泥组的骨痂及骨折线评分[（2．01±0．67）分和（2．03±1．33）分、（2．10±0．57）分和（2．40±1．14）分，P〈O．05]；术后第12和16周，ESW组骨痂及骨折线评分分别为[（3．99±0．67）分和（5．81±1．33）分、（4．85±0．57）分和（8．50±1．03）分]，扩髓骨泥组骨痂及骨折线评分分别为[（3．10±0．63）分和（3．51±1．26）分、（4．05±0．63）分和（6．30±1．26）分]，联合治疗组骨痂及骨折线评分分别为[（4．95±0．24）分和（8．02±1．48）分、（5．75±0．24）分和（10．90±1．05）分]，3组患者骨痂及骨折线评分均较前逐渐增高（P〈0．05），同时间点比较后发现，联合治疗组评分显著高于ESW组和扩髓骨泥组，且ESW组评分高于扩髓骨泥组，差异均具有统计学意义（P〈0．05）。术后第16周，ESW组、扩髓骨泥组及联合治疗组的治疗有效率分别为60．0％、50．0％和Objective To investigate the effect of extracorporeal shock waves （ESWs） combined with ex- panding bone marrow autografts in treating nonunion of femoral shaft fractures with interlocking intramedullary nails. Methods Thirty patients with femoral shaft fractures which had not united were divided into an ESW group, an ex- panding bone marrow group, and a combined treatment group using a table of random numbers. Each group had 10 cases. In the ESW group, no expanding bone marrow was employed in fixing the intramedullary nails and ESW thera- py was begun at day 14 after the operation. In the expanding bone marrow group, bone marrow was grafted around the broken ends of fractured bones. In the combined treatment group patients underwent both treatments. The conditions of the callus and the fracture lines in the 3 groups were separately evaluated using X-rays at the 4th, 8th, 12th and 16th week after the operation. Results At week 4, the average callus and fracture line scores in the combined treatment and expanding bone marrow groups were significantly better than those in the ESW group. At the 8th week after the operation, the average callus and fracture line scores in the combined treatment group were significantly higher than in the ESW group and expanding bone marrow groups. Later, the callus and fracture scores in all 3groups continued to rise significantly. At the 12th and 16th week the scores in the combined treatment group were sig- nificantly better than those in the ESW group and the expanding bone marrow group, while the scores in the ESW group were significantly better than those in the expanding bone marrow group. The cure rates in the ESW, bone mar- row and combined treatment groups were 60% , 50% and 100% respectively at week 16. Conclusions The com- bined treatment was significantly more effective than either treatment alone. There was no significant difference in ef- fectiveness between the ESW and expanding bone marrow treatments. ESW combined with expanding bone marrow autograft is an effective

关 键 词：体外冲击波 骨泥植骨 髓内钉 股骨骨折 骨不连 

分 类 号：R687.3[医药卫生—骨科学]