带血管蒂骨瓣与自体骨移植治疗陈旧性腕舟骨骨折的疗效比较  

The efficacy comparison of the vascularized bone graft and autologous bone graft treatment for the obsolete scaphoid fracture

作　　者：张健[1] 王剑利[2] 刘兴龙[2] 王福宁[1] 

机构地区：[1]潍坊医学院,山东潍坊261000 [2]中国人民解放军第89医院骨科,山东潍坊261000

出　　处：《实用手外科杂志》2016年第1期5-9,共5页Journal of Practical Hand Surgery

基　　金：全军十二五重大科研计划项目（项目编号：BJNl3J001）

摘　　要：目的 通过比较带血管蒂骨瓣与自体骨移植治疗陈旧性腕舟骨骨折的效果，探寻其最佳治疗方案。方法对2012年3月-2015年5月收治的67例陈旧性腕舟骨骨折患者进行回顾性分析，其中采用带血管蒂骨瓣联合内固定（A组）25例，采用自体植骨＋rhBMP-2联合内固定（B组）27例，采用单纯Herbert螺钉内固定（c组）15例。比较骨折愈合时间、骨折愈合率、关节功能恢复情况、优良率、术后4个月Kfimmer评分等。结果经15-24个月随访，关节功能的恢复：A,B组均优于C组（P〈0．05）；骨折愈合率：A，B组均明显优于C组（P〈0．05）；术后腕关节活动度比较：A，B组均优于C组（P〈0．05）；住院时间：A组〉B，C组（P〈0．05）；手术时间：A组〉B组〉c组（P〈0．01）；骨折愈合时间：A，B组〈c组（P〈0．01）：术后4个月Kfimmer评分：A组〉B．C组（P〈0．01）。结论带血管蒂骨瓣与自体骨移植分别联合内固定治疗手舟骨骨折，均可明显缩短骨折愈合时间，提高愈合率，降低术后并发症的发生率。联合带蒂骨瓣较自体骨移植略明显。两种方法在缩短手术时间、住院时间、降低术后的切口感染风险等方面各有优势．可根据术者的手术技术及患者的个人需求进行选择。Objective To compare the efficacy between the vascularized bone graft and autologous bone graft combined with treatments of obsolete scaphoid fractures. Methods Totally 67 patients with obsolete scaphoid fracture were retrospectively reviewed and divided into 3 groups： A group （n=25, patients treated with vascular pedicle bone combined with internal fixation）, B group （n =27, patients treated with autologous bone graft ＋ rhBMP-2 combined with internal fixation ）, C group （n=15, patients treated with Herbert screw internal fixation）. According krimmer wrist function scoring system,the fracture healing time, fracture healing rate, excellent and good rate and Krimmer score in postoperative 4 months were compared among the three groups. Results All patients were followed up for 15-24 months（ 14.6 months in average）. The average fracture healing time, excellent and good rate, fracture healing rate and Krimmer score in postoperative 4 months were（12.5±2.3）w, 100%, 100%,（92.6±15.4）rain in A group, （13.6±2.5） w, 96.3%, 100%, （86.9±13.7）min in B group, （17.2±4.3）weeds, 60.0%, 73.3%, （66.8±11.9）min in C group. Respectively, there were significant difference in the average fracture healing time, excellent and good rate, fracture healing rate and Krimmer score in postoperative 4 months between A and C （P 〈0.05）, same with B and C, while no statistically significant difference was seen between A group and B group （P 〉0.05）. Conclusion The two methods available similar therapeutic effect, two methods were significantly increas healing rate, shorten healing time and reduce the incidence of complications and scaphoid nonunion. Autologous bone graft within the rhBMP-2 combined with internal fixationcan significantly shorten the operation time and postoperative hospital stay, reduce the risk of wound infection after surgery. This two surgical methods can be selected according to the surgeon＇s surgical technique and individual needs of the patient.

关 键 词：陈旧性腕舟骨骨折 HERBERT螺钉 带血管蒂骨瓣 RHBMP-2 

分 类 号：R683.41[医药卫生—骨科学]