骨又生移植结合钢板内固定治疗上肢骨不连  

Decalcification Dentinal Matrix Grafting Combined with Plate in Treatment of Upper Extremity Nonunions

作　　者：吴飞[1] 李亚明[1] 张弩[1] 张卫兵[1] 胡戈亮[1] 

机构地区：[1]武汉大学人民医院骨外科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2016年第2期305-308,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨骨又生(DDM)移植结合钢板内固定治疗上肢骨不连的临床疗效。方法:对43例2005年8月至2014年11月间上肢骨不连进行回顾性分析,其中男35例,女8例;10-53岁,平均32.5岁。骨不连部位:锁骨骨不连4例,肱骨近端骨不连5例,肱骨干骨不连16例,尺、桡骨骨不连6例,桡骨骨不连4例,指骨骨不连6例。39例患者行切开复位内固定,4例患者行外固定保守治疗。病程为5个月到3年,平均1.1年。38例患者行骨又生植骨,5例行骨又生联合同种异体骨植骨。结果:43例患者中2例失访。41例随访19-54个月,平均32.6个月。所有患者术后均达骨性愈合,愈合时间为3-6个月,平均4.5个月。锁骨骨不连优良率100%,肱骨近端骨不连优良率87.5%,肱骨干骨不连优良率80%,尺、桡骨骨不连优良率83.3%,桡骨骨不连优良率100%,指骨骨不连优良率75%。结论:骨又生具有促进骨组织再生和骨折愈合的作用,对减轻病人痛苦、减少医疗费用、提高患者生活质量具有重要的临床意义。Objective： To evaluate the result of treating nonunion of upper extremity with Decalcification Dentinal Matrix （DDM）. Methods： From August 2005 to November 2014, 43 cases of nonunion of upper extremity were treated. There were 35 males and 8 females with an average age of 32.5 years （range, 10-55 years）. According to position of fracture classification, there were 4 cases of clavicle fractures, 5 cases of proximal humeral fractures, 16 cases of humeral shaft fractures, 6 cases of fractures of both forearm bones, 4 cases of fractures of radius, 6 case of fractures of phalange. 39 cases of nonunion occurred after internal fixation, and 4 cases of nonunion occurred following conservative treatment. An average time of nonunion was 1.1 years （from 9 months to 3 years）. 38 cases were treated with DDM grafting, and 5 cases were treated with combination of DDM grafting and heterologous bone grafting. Results： Two cases among 43 cases lost follow-up. The patients were followed up for an average time of 32.6 months （range, 19-54 months）. Bony union was achieved in all cases after an average time of 4.5 months （range, 3-6 months） after op- eration. The excellent and good rate of clavicle fracture was 100%, proximal humeral fractures was 87.5%, humeral shaft fractures was 80.0%, fractures of both forearm bones was 83.3%, fractures of radius was 100%, and fractures of phalange was 65%. Conclusion： DDM plays an important role in osteogenesis at the site of bone nonunion. It significantly relieves patient＇ s pain, reduces the medical expense and improvesthe quality of life in patients.

关 键 词：骨不连 脱钙人牙基质(骨又生) 自体骨移植 

分 类 号：R641[医药卫生—外科学]