骨不连断端成骨能力区域划分的临床意义  

Clinical significance of range division in bone nonunion site

作　　者：孙亮[1] 李忠[1] 冯卫城 马腾[1] 王谦[1] 薛汉中[1] 卢代刚[1] 路遥[1] 张堃[1] 

机构地区：[1]西安交通大学附属红会医院创伤骨科,西安710054

出　　处：《骨科临床与研究杂志》2017年第3期135-141,共7页Journal Of Clinical Orthopedics And Research

基　　金：陕西省社会发展科技攻关项目(2013K14-02-12);陕西省自然基金(2012JM4024)~~

摘　　要：目的探讨"成骨能力区域划分"概念的合理性及优越性。方法基础研究:收集萎缩性骨不连患者标本30例,包括断端硬化死骨、瘢痕组织及两侧正常骨组织,将其中正常骨组织定义为成骨活跃区,硬化死骨及瘢痕组织定义为成骨失活区,依此分为2组。观察2组HE染色后的病理结构特点,并对2组中骨形态发生蛋白(BMP)-2,转化生长因子(TGF)-β1和血管内皮生长因子(VEGF)的表达进行免疫学分析。临床研究:回顾分析2014年1月至2015年12月西安交通大学附属红会医院创伤骨科收治的103例萎缩性骨不连伴骨缺损病例,术中均按照"成骨能力区域划分"概念植骨,术后随访至骨愈合,分析术后骨骼评分及功能评分。结果基础研究:成骨失活区骨细胞结构多不完整;成骨活跃区骨细胞质量及数量均完好;成骨失活区BMP-2,TGF-β1和VEGF表达均明显低于成骨活跃区,差异有统计学意义。临床研究:所有患者均获得随访,平均随访时间10.5个月,骨愈合率99%,平均骨愈合时间7.4个月,骨骼评分及功能评分优良率100%。结论骨不连断端不同区域间确实存在成骨能力的差异,按照"成骨能力区域划分"概念植骨,能够最大程度发挥自体骨成骨效应,辅以坚强内固定,能够有效提高萎缩性骨不连伴骨缺损的治愈率。Objective To evaluate the rationality and advantage of the divided ranges in bone nonunion site. Methods The“ range division in bone nonunion site” means that the bone nonunion is made of inactive range （scar tissue and harden bone） and active range （normal bone） , and the bone grafts should step over the inactive range totally to connect the two active ranges. Basic reseach Thirty samples of nonunion were select-ed, including two groups of inactive range （ scar tissue and harden bone） and active range （ normal bone） . The cell quantity, BMP-2, TGF-pl and VEGF were observed and analyzed. Clinical research： One hundred and three cases of atrophic nonunion treated according “range division in bone nonunion site” from January 2014 to December 2015 were included in the study. All cases were followed-up and evaluated for clinical effects. Re-sults Basic research： The quality of osteoblast in inactive range were poor, and that in active range were good. Level of BMP-2, TGF-pl and VEGF in inactive range were lower than that in active range. Clinical re-search ：All patients were follow-up by average time of 10. 5 months. The healing rate was 99% , average heal-ing time was 7.4 months. The excellent and good rate of bone score and function score was 100%. Conclusion The osteogenic capability in different ranges are different significantly. It may greatly improve the conduction and osteoinduction of the bone graft and healing rate of atrophic nonunion with bone defect according to the range division in bone nonunion site combining with the rigid internal fixation.

关 键 词：骨折 不愈合 骨肥厚 萎缩 骨移植 转化生长因子Β1 

分 类 号：R683[医药卫生—骨科学]