两种植骨方式治疗骨延迟愈合和骨不连的比较  

Minimally invasive bone grafting versus traditional open bone grafting for delayed union and nonunion

作　　者：屠永刚 任绍东 戚蕉妹 叶柏林 马邦兴 张史飞 TV Yong-gang;REN Shao-dong;QI Jiao-mei;YE Bo-lin;MA Bang-xing;ZHANG Shi-fei(Department of Orthopaedics,Dongguan Eastern Central Hospital,Dongguan 523573,China)

机构地区：[1]广东东莞市东部中心医院骨科,523573 [2]广东中山市古镇人民医院,528421

出　　处：《中国矫形外科杂志》2020年第8期717-720,共4页Orthopedic Journal of China

基　　金：东莞市社会发展项目立项课题(编号:2018507150351458)。

摘　　要：目的]比较微创精准植骨与传统开放植骨治疗骨延迟愈合、骨不连的临床疗效。[方法]2013年5月~2018年3月收治的骨延迟愈合、骨不连患者30例,随机分为微创组和常规组,每组15例。微创组采用微创精准植骨治疗,常规组采用传统开放植骨、更换或增加内固定治疗。比较两组患者手术切口长度、术中出血量、手术时间、术后并发症、住院费用、骨折愈合情况及患肢功能。[结果]两组患者均顺利完成手术,术中未见知名血管及神经损伤等严重并发症。微创组手术切口长度、术中出血量、手术时间及住院费用均小于常规组,差异有统计学意义(P<0.05)。微创组术后伤口均Ⅰ期愈合,2例患者出现局部血肿,术后7~10 d内均可自行消退。常规组术后2例出现伤口感染、愈合不良,1例出现患肢深静脉血栓。随访12~26个月,平均(16.93±3.41)个月。两组患者术后局部疼痛及下肢功能均逐渐好转,未发生内固定失效。患肢功能根据Johner-Wruch评价标准[7],末次随访时微创组优良率(86.67%)高于常规组(80.00%),差异无统计学意义(P>0.05)。影像评估方面,术后1年时骨愈合率微创组为73.33%(11/15),常规组为80.00%(12/15),两组间差异无统计学意义(P>0.05)。[结论]微创精准植骨具有手术损伤小、操作简便、并发症少、经济实用等优点。[Objective] To compare the clinical outcomes of minimally invasive bone grafting versus traditional open bone grafting for delayed union and nonunion of fractures. [Methods] Between May 2013 and March 2018, a total of 30 patients with delayed union and nonunion were included into this study, and divided into 2 groups by random number table method. Of them,15 patients underwent minimally invasive and precise bone grafting, while the remaining 15 patients received traditional open bone grafting, combined with or without replacing or adding internal fixation. The incision length, blood loss, operation time,postoperative complications, hospital costs, limb function and bone healing and were compared between the two groups. [Results] All the patients had operation performed without neurovascular injuries. The minimally invasive group proved significantly superior to the traditional group regarding to the incision length, blood loss, operation time and hospital costs(P<0.05). Primary incision healing achieved in all patients of the minimally invasive group, regardless of only 2 case of local hematoma formation noted, which subsided spontaneously in 7~10 days. In contrast, incision infection or poor incision healing was found in 2,and deep vein thrombosis in 1 patient of traditional group. The patients were followed up for 12-26 months with a mean of(16.93±3.41) months. As time went postoperatively, the local pain relieved, and extremity function improved in all the patients without failure of internal fixation in anyone of them. Based on the Johner-Wruch criteria, the excellent and good rate of clinical outcome was of 86.67% in the minimally invasive group,whereas 80.00% in the traditional group at the latest follow up, which was not statistically significant(P>0.05). With regard to radiographic assessment, the rate of bony healing proved of 73.33%(11/15) in the minimal invasive group, but80.00%(12/15) in the traditional group to the latest follow up, without a statistically significant difference between the two grou

关 键 词：微创精准植骨 传统开放性植骨 骨延迟愈合 骨不连 

分 类 号：R683.42[医药卫生—骨科学]