BMP2联合骨移植对股骨近端粉碎性骨折愈合及关节功能恢复的价值  

Value of BMP2 combined bone transplantation on healing and joint function recovery of comminuted fracture of proximal femur

作　　者：孙晓望 谢萍 邓明[3] 梁凡[3] 周炎[3] 陈忠辉 SUN Xiao-wang;XIE Ping;DENG Ming(Department of Orthopedics,Huangmei Hospital,Zhongnan Hospital of Wuhan University,Huanggang Hubei 435500,China;Department of Traditional Chinese Medicine,Wuhan Third Hospital,Wuhan Hubei 430060,China;Department of Orthopedics,Wuhan University People's Hospital,Wuhan Hubei 430060,China)

机构地区：[1]武汉大学中南医院附属黄梅医院骨科,湖北黄冈435500 [2]武汉市第三医院中医科,湖北武汉430060 [3]武汉大学人民医院骨科,湖北武汉430060

出　　处：《临床和实验医学杂志》2021年第7期741-745,共5页Journal of Clinical and Experimental Medicine

基　　金：湖北省自然科学基金面上项目(编号:2019CFB457);武汉大学医学部创新种子培育基金(编号:TFZZ2018027);武汉市医学科研项目青年项目(编号:WZ19Q02)。

摘　　要：目的探讨重组人骨形态发生蛋白2(BMP2)联合骨移植治疗股骨近端粉碎性骨折的临床效果。方法选取2016年1月至2018年7月武汉大学中南医院附属黄梅医院骨科收治的104例股骨近端粉碎性骨折患者进行回顾性分析,根据患者是否采用重组人BMP2治疗分为研究组52例和对照组52例,2组患者均采用自体髂骨移植联合锁定钢板内固定的方式治疗,研究组患者同时给予重组人BMP2治疗。统计分析2组患者手术操作时间,术中出血总量,骨折愈合时间,术后6、8周时2组患者X线下骨折断端骨痂形成评分和血清碱性磷酸酶(ALP)水平,术后3、6个月的髋关节功能及并发症发生情况。结果研究组和对照组患者的手术操作时间、术中出血总量比较,差异无统计学意义(P>0.05)。研究组的骨折愈合时间[(10.9±1.4)周]短于对照组[(11.7±1.7)周],差异有统计学意义(P<0.05)。术后6、8周,研究组X线下骨形成[(2.04±0.74)、(3.18±0.59)分],骨连接[(1.67±0.58)、(3.11±0.60)分],骨塑形[(1.73±0.49)、(2.90±0.66)分]均高于对照组[(1.68±0.67)、(2.81±0.54)分;(1.41±0.46)、(2.80±0.54)分;(1.40±0.46)、(2.61±0.52)分],差异有统计学意义(P<0.05)。术后6、8周,研究组患者的血清ALP[(154.9±33.0)、(95.0±26.4)U/L]均低于对照组[(185.1±35.2)、(112.4±31.2)U/L],差异有统计学意义(P<0.05)。术后3个月,研究组患者的Harris评分(77.1±8.4)分高于对照组[(72.6±9.0)分],差异有统计学意义(P<0.05)。研究组患者并发症率(5.77%)低于对照组患者(19.23%),差异有统计学意义(P<0.05)。结论重组人BMP2联合自体髂骨移植联合锁定钢板内固定治疗股骨近端粉碎性骨折可降低患者体内ALP浓度,有效促进骨痂形成,有利于早期骨折愈合,减少并发症发生,从而促进患者关节功能早期恢复。Objective To investigate the clinical effect of recombinant human bone morphogenetic protein 2(BMP2)combined with bone transplantation in the treatment of proximal femoral comminuted fractures.Methods From January 2016 to July 2018,104 patients with comminuted fractures of the proximal femur admitted to the Department of Orthopedics,Huangmei Hospital,Zhongnan Hospital of Wuhan University were retrospectively selected and analyzed.According to whether patients were treated with recombinant human BMP2,they were divided into study group 52 cases and control group 52 cases.Both groups of patients were treated with autologous sacral bone graft combined treatment with locked plate internal fixation.Patients in the study group were treated with recombinant human BMP2 at the same time.The operation time,total intraoperative blood loss,fracture healing time,and X-ray fracture epiphysis formation score,changes in serum alkaline phosphatase(ALP)levels at 6 and 8 weeks after surgery,hip function and complications at different times after surgery were statistically analyzed.Results There was no significant difference between the operation time and total blood loss between the study group and the control group(P>0.05);the fracture healing time of the study group[(10.9±1.4)weeks]was shorter than that of the control group[(11.7±1.7)weeks],the difference was statistically significant(P<0.05).At 6 and 8 weeks after surgery,bone formation under X-ray[(2.04±0.74),(3.18±0.59)points],bone connection[(1.67±0.58),(3.11±0.60)points],bone shaping[(1.73±0.49),(2.90±0.66)points]in the study group were higher than the control group[(1.68±0.67),(2.81±0.54)points;(1.41±0.46),(2.80±0.54)points;(1.40±0.46),(2.61±0.52)points],the differences were statistically significant(P<0.05).At 6 weeks and 8 weeks after surgery,the serum ALP of the the study group patients[(154.9±33.0),(95.0±26.4)U/L]were lower than those of the control group[(185.1±35.2),(112.4±31.2)U/L],the differences were statistically significant(P<0.05).3 months after

关 键 词：粉碎性骨折 重组人骨形态发生蛋白2 骨移植 股骨近端 

分 类 号：R687.3[医药卫生—骨科学]