纳米人工骨与同种异体骨植骨治疗肱骨近端Ⅲ、Ⅳ型骨折的临床疗效对比

Comparison of Nano-artificial bone with allogeneic bone graft for Ⅲ and Ⅳ type proximal humeral fracture

目的比较应用肱骨近端锁定加压钢板内固定联合纳米人工骨与同种异体骨植骨治疗肱骨近端Ⅲ、Ⅳ型骨折的疗效。方法选取45例肱骨近端Ⅲ、Ⅳ型骨折患者,采用三角肌胸大肌间隙入路,复位后于骨缺损处分别进行纳米人工骨(纳米人工骨组,25例)及同种异体骨(同种异体骨组,20例)植骨,然后均放置肱骨近端锁定加压钢板。观察两组的手术时间、术中出血量、术后伤口愈合及并发症情况,检测患者的血清钙及血清磷水平,并根据Neer肩关节功能评分对肩关节功能恢复情况进行评定。结果两组患者均获随访,随访时间6～36个月,平均随访时间为(17.0±3.6)个月。两组间手术时间、术中出血量、Neer肩关节功能评分的差异均无统计学意义(P值均>0.05)。两组间术后1周和术后1、3、6个月的血清钙及血清磷水平的差异均无统计学意义(P值均>0.05)。同种异体骨组有5例患者发生排异反应,因引流量增多而延迟拔管,术后患者的C反应蛋白水平为(14.0±2.7)μg/L,显著高于术前的(3.0±2.5)μg/L(P<0.05)。根据Neer肩关节功能评分,纳米人工骨组肩关节功能恢复的疗效为优11例、良7例、一般6例、差1例,优良率为72%;同种异体骨组肩关节功能恢复的疗效为优10例、良6例、一般2例、差2例,优良率为80%。两组间肩关节功能恢复优良率的差异无统计学意义(P>0.05)。结论纳米人工骨是一种满意的植骨填充材料,安全性较同种异体骨好,疗效满意,值得推广运用。

Objective To compare the clinical outcomes of locking compression plate fixation with Nano- artificial bone and allogeneic bone for proximal humeral fractures （type Ⅲ and Ⅳ, Neer classification）. Methods Totally 45 patients with humeral fractures of Neer Ⅲ, Ⅳ were enrolled in this study. The surgical approach was between the deltoid muscle and major pectoral muscle. After open reduction, Nano-artificial bone （n = 25） or allogeneic bone （n = 20） were implanted, and locking plates were placed. The operative time, intraoperative blood loss, wound healing and postoperative complications were recorded. Serum calcium and phosphorus concentrations were detected. The functional assessment was made according to the Neer shoulder function score. Results All the patients were followed up for 6 to 36 months （[17.0± 3.61 months on average）. There were no significant difference between Nano-artificial bone group and allogeneic bone group with respect to the operative time, blood loss, or Neer score （all P〉0.05）; neither were the levels of serum calcium and phosphorus at 1 week and 1, 3, and 6 months after surgery between the two groups （all P〉0.05）. Five patients suffered from rejection in allogeneic bone group. Therefore, drainage was increased and extubation was delayed. The level of Creactive protein in the five patients after surgery was significantly higher than that before surgery （[14.0＋ 2.71 μg/L vs. [3.0＋2.51 ]μ/L, P〈0. 05）. According to Neer shoulder scoring, the outcome was excellent in 11 cases, good in 7, fair in 6, and poor in one in Nano-artificial bone group （the excellent and good rate was 72%）; in al!ogeneic group, excellent in 10 cases, good in 6, fair in 2, and poor in 2 （the excellent and good rate was 80%）. There was no significant difference in shoulder joint function between the two groups （P〉0.05）. Conclusion Nano-artificial bone is also a suitable graft for bone defects as compared with allogeneic bone.