椎间盘镜下异体松质骨复合自体红骨髓植骨治疗骨不连及骨缺损

Implantation of Homologous Cancellous Bone and Autologous Red Marrow under Endoscope for Bone Nonunion and Bone Defect

目的探讨椎间盘镜下异体松质骨复合自体红骨髓植骨治疗四肢长骨干骨不连及骨缺损的临床疗效。方法2003年9月～2006年9月,选择25例创伤后骨不连、骨缺损患者,其中胫骨9例,股骨13例,肱骨3例。骨不连、骨缺损引起须植骨长度1～6 cm,平均2.7 cm,均在椎间盘镜下行瘢痕清除,然后在骨缺损部位植入异体松质骨,再于髂骨取自体红骨髓15～20 ml注入植骨处。结果25例随访12～36个月,平均25个月,切口均一期愈合,无一例发生神经血管损伤症状。除2例术后内固定失败外,余23例骨不连、骨缺损均获骨性愈合,植骨生长良好,骨愈合时间4～9个月,平均5.1月,无感染及再出现骨不连。结论椎间盘镜下异体松质骨复合自体红骨髓植骨治疗骨不连和骨缺损,无须自体髂骨取骨,局部创伤小,血运破坏小,并发症少,骨愈合率高,是一种微创有效的治疗方法。

Objective To investigate the effectiveness of implantation of homologous cancellous and autologous red marrow under endoscope in the treatment of traumatic bone nonunion or bone defect. Methods Totally 25 patients with traumatic bone nonunion or bone defect were enrolled in this study. The lesion involved the tibia bone in 9 cases, the femur in 13, and the humerus in 3. The grafts were sized 1 to 6 cm in length （mean, 2.7 cm）. Before the implantation of the cancellous bones, the scar fibrous tissues within the nonunion were removed completely by endoscopy, and then autologous red marrow obtained from the iliac crest was injected. Results All the patients were followed up for 12 to 36 months （ mean, 25 months）. The surgical wounds healed primarily in all of the cases without injuries to the blood vessels and nerves. Bony union was achieved within 4 to 9 months （ mean, 5.1 months） in 23 of the patients, the other 2 failed because of breaking and loosing of internal fixators. No patient developed re-nonunion and infection. Conclusions Implantation of homologous cancellous and autologous red marrow under endoscope is effective for traumatic bone nonunion or bone defect with a low rate of complication and high rate of bony union. Since no need to harvest the ilium bone, the method is minimally invasive for the patients.