重组合异种骨替代自体骨治疗骨不连的长期疗效观察

Long-term Efficacy Observation of Recombinant Bone Xenograft in Treatment of Nonunion

探讨重组合异种骨替代自体骨治疗四肢长骨非感染性骨不连的长期临床疗效,对2000年1月至2006年9月西京医院应用重组合异种骨(RBX)移植治疗的62例非感染性骨不连患者进行回顾性分析;其中男52例,女10例;年龄4～70岁,平均30.1岁。骨折部位:尺桡骨11例、肱骨9例、胫腓骨22例、股骨20例。骨不连类型:肥大型15例、营养不良型10例、萎缩型37例。固定方式:钢板21例、髓内钉19例、外固定架22例。62例患者均获得随访,随访时间50—131个月的结果,平均89.3个月,一次手术愈合率94.9%,19例上肢骨不连患者采用DASH评分标准评定疗效,优13例,例良5例,差1例,优良率94.7%。43例下肢骨不连患者采用Harris评分系统和美国膝关节协会评分(KSS评分)评定疗效,优26例,良15例,差2例,优良率95.3%。总优良率95.2%。长期观察未见不良免疫排斥反应。说明RBX用于治疗四肢长骨骨不连可获得满意的临床效果,兼具取材广泛、组织兼容性好、无免疫排斥反应等诸多优点,可替代自体骨应用于临床工作。

To evaluate long-term efficacy of recombinant bone xenograft in treatment of nonunion, 62 patients suffered with femoral non-infected nonunion from 2000-1 to 2006-9 was analyzed retrospectively ,which included 52 males and 10 females,with the mean age of 30. 1 years （ ulna in 11 cases, humerus 9 cases, tTibia and fibula 22 ranged cases, from 4 to 70 years）. The nonunion site ： radius and and 20 cases of femur. There were 15 hypertrophic cases, 10 malnourished and 37 atrophic. 21 cases with plate, 19 cases with intramedullary nailing and 22 cases with external fixation. It is resulted that average follow-up time of these cases was 89.3 months,from 50 months to 131 months. 94.9% of these patients healed with only one operation. Using DASH scale to assessment the function of 19 upper limb cases, excellent in 13 igood in 5 and 1 fair,with an excellent to good rate of 94.7%. 43 lower limb cases were scaled with the American Knee Society Score （KSS）and Harris, the function was rated as excellent in 26, good in 15 and fair in 2, with an excellent to good rate of 95.3 %. The total excellent to good rate was 95.2%. No one has immune rejection in this long-term observation. It is conlused that RBX for the treatment of nonunion has many advantages, such as sufficient materia, a nice biological compatibility, it can be used in the clinic instead of autologous bone.