骨密度监测对骨缺损治疗中骨愈合质量的临床评价研究  

Correlation between bone mineral density and bone healing in treatment of bone defects

作　　者：华伟伟[1] 冯靖[2] 吴富章[1] 蔡靖宇[1] 郭涛[1] 吴子祥[2] 桑宏勋[2] 

机构地区：[1]武警安徽省总队医院骨科, 合肥230001 [2]第四军医大学西京医院骨科,710032

出　　处：《中华创伤骨科杂志》2014年第6期465-469,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81270959）

摘　　要：目的 利用临床骨缺损自体植骨愈合病例,探讨监测骨密度（BMD）评估骨愈合质量的可行性.方法 选取自2011年7月至2012年6月收治的骨缺损自体植骨患者21例,男16例,女5例;年龄17 ～68岁,平均29.6岁;病程为2.5～ 120.0个月,平均45.4个月.所有患者均采取清创＋自体髂骨颗粒植骨＋外固定支架固定获得治愈.术后第4、6、8、10个月对所有患肢行正、侧位X线片检查及Enneking肢体功能评分评价,对骨缺损植骨区的骨痂及健侧对照区行BMD检测.结果 随着时间推移,缺损区骨痂X线表现逐步改善.术后第4、6、8、10个月的患肢Enneking评分、患肢肢体功能百分比、患侧BMD及患侧与健侧BMD比值两两时间点比较,差异均有统计学意义（P＜0.05）;第10个月时肢体功能接近正常水平,肢体功能百分比为95.4％±5.9％.术后第4、6、8个月患侧BMD与健侧比较,差异均有统计学意义（P＜0.05）;第10个月患侧BMD与健侧比较,差异无统计学意义（t=1.605,P=0.128）,此时BMD比值平均为96.7％±5.1％.随着BMD比值的增长,患肢功能也在逐渐恢复正常,两者呈高度正相关（r=0.918,P＜0.001）.结论 通过监测BMD可以评估临床骨缺损愈合情况,缺损区BMD达到健侧的96.7％±5.1％范围或以上,肢体功能百分比达到95.4％±5.9％范围或以上时,新生骨组织生物力学强度基本可满足肢体生理负重要求,推荐完全负重.Objective To study whether bone mineral density （BMD） can be used to evaluate the callus growth and fracture healing in treatment of bone defects with autoallergic bone graft.Methods We enrolled for this study 21 patients with large cortical bone defects who had undergone autoallergic bone graft from July 2011 through June 2012 in our department.They were 16 men and 5 women,aged from 17 to 68 years （average,29.6 years）.Their disease courses ranged from 2.5 to 120.0 months （45.4 months）.All the patients were cured by debridement plus autoallergic iliac particle graft plus external fixation.At 4,6,8 and 10 months postoperation,X-ray examinations and Enneking evaluations of limb function were performed for all the limbs affected,and BMD examinations of bone callus were conducted at both graft and contralateral areas.Results X-ray manifestations showed the bone callus at the bone defect areas improved gradually with time.The Enneking scores,percentages of functional recovery and BMDs of the limbs affected,and the BMD ratio between the affected and healthy limbs at 4,6,8 and 10 months postoperation were significantly different between one another （P 〈 0.05）.At 10 months postoperation,limb functions recovered almost to the normal,reaching a percentage of 95.4% ± 5.9%.There were significant differences between affected and healthy limbs regarding BMD at 4,6 and 8 months postoperation （P 〈 0.05）,but there was no significant difference between affected and healthy limbs in BMD at 10 months postoperation （t =1.605,P =0.128）.The BMD ratio of affected limbs reached 96.7% ± 5.1%.The BMD ratio of affected limbs increased with the functional recovery of affected limbs,showing a positive correlation （r =0.918,P 〈 0.001）.Conclusions BMD measurement is effective for evaluation of callus growth and fracture healing.When the BMD ratio reaches 96.7% ±5.1% or above and the percentage of functional recovery 95.4% ±5.9% or above,the biomechanical strength of new bone can ensure physical load-bearing

关 键 词：骨密度 X线 骨痂 骨缺损 

分 类 号：R687.3[医药卫生—骨科学]