同种异体骨移植强化高危人群肱骨近端骨折内固定的疗效观察  

Allogeneic bone grafting strengthens the internal fixation of proximal humeral fractures in high-risk groups

作　　者：苏志辉[1] 鲁厚根[2] 刘军[2] 邹立学[2] 胡伟[1] 

机构地区：[1]长江大学,湖北省荆州市434023 [2]荆州市中心医院骨科一病区,湖北省荆州市434020

出　　处：《中国组织工程研究》2016年第12期1766-1771,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:大量研究对同种异体骨移植和人工肱骨头置换治疗肱骨近端骨折的临床效果进行了评价,但关于二者的对比性研究报道却非常有限。目的:分析同种异体骨移植强化高危人群肱骨近端骨折内固定的效果。方法:回顾性分析120例年龄≥60岁肱骨近端骨折患者的临床资料,其中60例采用同种异体骨移植联合锁定钢板固定治疗,作为试验组;60例采用半肩关节置换治疗,作为对照组。治疗后随访8-24个月,观察骨折愈合、颈干角、肱骨头高度及肩关节功能恢复情况。结果与结论:随访8-24个月,所有患者肱骨近端骨折均愈合,愈合时间18-24周,未发生植入物排斥反应,无大小结节、肱骨头移位、螺钉松动及坏死。试验组末次随访时的肱骨头高度丢失、治疗后12周的主动前屈上举角度高于对照组(P<0.05),前臂、肩、手功能障碍评分低于对照组(P<0.05),两组颈干角、SF-36量表评分比较差异无显著性意义。结果表明同种异体骨移植强化高危人群肱骨近端骨折内固定效果,可显著改善上肢功能。BACKGROUND： Numerous studies have focused on the clinical efficacy of allogeneic bone graft and humeral head replacement for the treatment of proximal humeral fractures, but their comparative studies are rarely reported. OBJECTIVE： To investigate the effect of allogeneic bone grafting in the treatment of proximal humeral fractures in the high risk group. METHODS： Clinical data of 120 cases of proximal humeral fractures aged ≥ 60 years were retrospectively analyzed. Sixty of the 120 cases underwent allogeneic bone grafting combined with locking plate fixation as experimental group, and the other 60 cases were subjected to semi-shoulder joint replacement as control group. All patients were followed up for 8-24 months. Fracture healing, collodiaphyseal angle, humeral head height and shoulder joint function were observed and measured. RESULTS AND CONCLUSION： During the postoperative 8-24 months, all the fractures were healed by first intention, and there were no rejection reactions, large/small nodules, humeral head displacement, necrosis, and screw loosening. Loss of the humeral head height at the last follow-up and the active flexion angle of the shoulder at postoperative 12 weeks were significantly higher in the experimental group than the control group（P〈0.05）. Scores on forearm, shoulder and hand dysfunction were significantly lower in the experimental group than the control group（P〈0.05）. However, no significant difference was observed in the collodiaphyseal angle and SF-36 scores between the two groups. These finding indicate that allogeneic bone grafting can strength the internal fixation of proximal humeral fractures in the high-risk group, and improve patient＇s upper limb function.

关 键 词：骨移植 人工关节 组织工程 生物材料 骨生物材料 同种异体骨 人工肱骨头置换 肱骨近端骨折 高危人群 

分 类 号：R318[医药卫生—生物医学工程]