磷酸钙复合重组人骨形态发生蛋白2修复和重建胫骨感染性骨缺损  

Calcium phosphate combined with recombinant human bone morphogenetic protein-2 in repair and reconstruction of tibial infectious bone defects

作　　者：贾叙锋 龙苗 黄光平 钟庆 张兆尧 齐宇新 田鹏 李萍 陈宇驰 Jia Xufeng;Long Miao;Huang Guangping;Zhong Qing;Zhang Zhaoyao;Qi Yuxin;Tian Peng;Li Ping;Chen Yuchi(Department of Orthopedics,Southwest Medical University·The People’s Hospital of Jianyang City,Jianyang 641400,Sichuan Province,China;Department of Ultrasound,Southwest Medical University·The People’s Hospital of Jianyang City,Jianyang 641400,Sichuan Province,China;Department of Anesthesiology,Southwest Medical University·The People’s Hospital of Jianyang City,Jianyang 641400,Sichuan Province,China;Department of Radiology,Jianyang Hospital,Southwest Medical University·The People’s Hospital of Jianyang City,Jianyang 641400,Sichuan Province,China)

机构地区：[1]西南医科大学附属简阳医院•简阳市人民医院骨科,四川省简阳市641400 [2]西南医科大学附属简阳医院•简阳市人民医院超声科,四川省简阳市641400 [3]西南医科大学附属简阳医院•简阳市人民医院麻醉科,四川省简阳市641400 [4]西南医科大学附属简阳医院•简阳市人民医院放射科,四川省简阳市641400

出　　处：《中国组织工程研究》2024年第17期2625-2630,共6页Chinese Journal of Tissue Engineering Research

基　　金：四川省医学科研课题计划项目(S20037),项目名称:PARP-1调控自噬流在丙泊酚减轻心肌细胞缺血/再灌注损伤中的作用研究,项目负责人:钟庆;四川省卫生和计划委员会科研课题项目(17PJ212),项目名称:3D打印技术在骨盆前环骨折微创化治疗中的应用价值研究,项目负责人:黄光平;成都市卫生简阳委员会科研课题项目(2020085),项目名称:简阳地区去细胞同种异体神经修复周围神经损伤(缺损)的临床疗效分析,项目负责人:张兆尧。

摘　　要：背景:尽管Masquelet技术在临床的应用取得了广泛成功,但目前优化该技术各个环节的研究仍在不断开展,其中加快植骨后骨愈合速度、缩短骨愈合时间是医生关注的焦点。目的:观察磷酸钙复合重组人骨形态发生蛋白2材料修复胫骨感染性骨缺损的效果。方法:选择2017年6月至2022年6月简阳市人民医院收治的感染性胫骨缺损患者31例,均接受Masquelet技术分期治疗,二期手术根据植骨材料的不同分为对照组(n=15)与研究组(n=16),对照组植入异体骨/自体骨颗粒,研究组植入磷酸钙复合重组人骨形态发生蛋白2/自体骨颗粒。二期术后6个月,检测患者外周血白细胞数、C-反应蛋白、血沉等炎性指标,记录影像学骨愈合时间、骨愈合X射线评分、骨缺损愈合分级和邻近关节功能,观察是否存在钉道感染、植入吸收、取骨区疼痛、感染等情况。结果与结论:①两组患者二期术后6个月外周血白细胞计数、血沉、C-反应蛋白水平均低于一期术前(P<0.05),两组间各指标比较差异无显著性意义(P>0.05);②研究组骨愈合时间短于对照组(P<0.05);③研究组患者二期术后6个月的骨愈合X射线评分高于对照组(P<0.05),骨缺损愈合优良率与邻近关节功能优良率均高于对照组(P<0.05);两组间感染复发率与并发症发生率比较差异均无显著性意义(P>0.05);④结果表明,Masquelet技术二期术中应用磷酸钙复合重组人骨形态发生蛋白2治疗胫骨感染性骨缺损的愈合效果良好、安全性高。BACKGROUND:Although the clinical application of Masquelet technology has achieved extensive success,the research on optimizing all aspects of Masquelet technology is still being carried out.The focus of doctors is to speed up bone healing and shorten bone healing time after bone grafting.OBJECTIVE:To observe the effect of calcium phosphate combined with recombinant human bone morphogenetic protein-2 in repairing tibial infectious bone defects.METHODS:Thirty-one patients with tibial infectious bone defects were selected from The People’s Hospital of Jianyang City from June 2017 to June 2022.They were treated with the Masquelet membrane induction technique.During the second stage of operation,they were divided into a control group(n=15)and a study group(n=16)according to different bone graft materials.Patients in the control group were implanted with autologous bone/allogeneic bone particles,and those in the study group were implanted with calcium phosphate combined with recombinant human bone morphogenetic protein-2/autologous bone particles.Six months after the second stage operation,peripheral blood inflammatory indexes such as white blood cell count,C-reactive protein,and erythrocyte sedimentation rate were detected.Imaging bone healing time,bone healing X-ray score,bone defect healing classification,and adjacent joint function were recorded.The presence of nail track infection,implant absorption,pain,and infection in the bone extraction area were observed.RESULTS AND CONCLUSION:(1)White blood cell count,erythrocyte sedimentation rate,and C-reactive protein levels of the two groups 6 months after the second stage operation were significantly lower than those before the first stage operation(P<0.05).There was no significant difference in each index between the two groups(P>0.05).(2)Bone healing time in the study group was shorter than that in the control group(P<0.05).(3)The Samantha X-ray score of the study group 6 months after the second stage operation was higher than that of the control group(P<0.05).The e

关 键 词：胫骨感染性骨缺损 诱导膜技术 自体骨 异体骨 磷酸钙 骨形态发生蛋白2 人工骨 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683