可注射磷酸钙骨水泥联合骨形态发生蛋白-2治疗老年肱骨近端骨折疗效分析  

Application of Injectable Calcium Phosphate Cement with rh BMP-2 in the Elder Patients with Proximal Humeral Fractures

作　　者：李侠[1,2] 陆晴友[1] 潘玉涛[2] 刘养洲[2] 陈涤[2] 韩宁[1] 韩庆辉[1] 李增春[1] 袁文[2] 

机构地区：[1]同济大学附属东方医院急诊创伤外科,上海200120 [2]第二军医大学研究生院,上海200120

出　　处：《实用骨科杂志》2015年第10期883-887,共5页Journal of Practical Orthopaedics

基　　金：上海市卫生局科研项目(2009161);上海市临床重点专科(ZK2012A28)

摘　　要：目的采用回顾性分析方法,观察可注射磷酸钙骨水泥(calcium phosphate cement,CPC)联合重组骨形态发生蛋白(recombinant human bone morphogenetic protein,rh BMP-2)作为植骨材料在老年肱骨近端骨折中的临床疗效和安全性。方法对59例老年肱骨近端骨折手术复位后的骨缺损分别采用可注射rh BMP-2/CPC(实验组)和单纯CPC(对照组)进行充填,并用PHILOS接骨板进行内固定。比较两组患者术后Lane-Sandhu X线评分和肩关节功能的差异。结果全部病例经过平均14.2个月随访。切口局部无搔痒感或疼痛。随访发现实验组术后平均20.8周获得骨性愈合,优于对照组的25.8周。通过Lane-Sandhu评分结果显示:实验组与对照组的X线评分比较差异有统计学意义(P<0.05)。而实验组和对照组对比术后关节功能评分提示:运用可注射rh BMP-2/CPC人工骨患者在术后1年的Neer关节功能评分表结果优于单纯运用CPC人工骨患者(P<0.05)。结论可注射rh BMP-2/CPC具有安全、方便、副作用小、充填效果确实等优点,能有效避免复位后骨量的再丢失,可促进骨折的愈合过程,是充填老年肱骨近端骨折骨缺损的较佳方法之一。Objective To evaluate the effect and safety of bone grafting with injectable calcium phosphate cement with rhBMP-2 in the elderly patients with proximal humeral fractures. Methods Fifty-nine proximal humeral fractures were treated by CPC with rh BMP-2（ experimental group） or CPC（ control group） with ORIF. The difference between two groups in terms of Lane-Sandhu criterion and the function of the shoulder joint were compared. Results The mean period of follow-up was 14. 2months. All local incision had no itch sensation or pain. The experimental group average period of osseous healing was 20. 8weeks,and the control group was 25. 8 weeks. There was obvious significant difference between two groups in terms of LaneSandhu criterion. Moreover,the function of the shoulder joint was better. 1 year after operation according to Neer Joint function grading. There was obvious significant difference between the two groups（ P〈0. 05）. Conclusion Calcium phosphate cement with rh BMP-2 is safe,conveniente,and has less complicationr. The calcium phosphate cement with rh BMP-2 has better supporting for bone defect area after solidification and increasing the safety of functional motion at the early stage. Meanwhile,rh BMP-2 / CPC can be the suitable bone substitutions for bone defect in fracture of the elder proximal humeral fractures.

关 键 词：磷酸钙 骨形态发生蛋白-2 骨移植替代物 肱骨近端骨折 

分 类 号：R683.41[医药卫生—骨科学]