自体微小颗粒骨与骨形态发生蛋白2混合移植修复感染性骨不连

Autogenous micromorselized bone grafting mixed with bone morphogenetic protein-2 to repair infected nonunion

背景:感染性骨不连是目前创伤骨科治疗的难题,既要彻底清除感染病灶组织控制感染,修复缺损软组织闭合创面,又要修复骨缺损促进骨折愈合,最大程度恢复肢体的功能。由于自体微小颗粒骨取材方便,重组人骨形态发生蛋白2来源广泛,其混合植骨模式成骨可靠、安全性高,适于修复感染性骨不连。目的:观察骨形态发生蛋白2混合自体微小颗粒骨移植修复感染性骨不连的治疗效果。方法:采用自体微小颗粒骨(髂骨、长骨干骺端松质骨)混合骨形态发生蛋白2修复感染性骨不连23例,股骨骨髓炎清创外固定固定后骨缺损7例,胫骨骨髓炎清创外固定固定后骨缺损16例,其中11例患者因瘢痕挛缩或软组织条件差继续使用外固定支架,患者12例改用内固定钢板固定,固定后1,3,6个月和1年复查X射线评价骨折愈合情况,并采用Johner-Wruhs评分评估临床疗效。结果与结论:所有病例平均随访13.4个月,骨折愈合,骨不连均得以修复,创面均闭合,无感染复发。Johner-Wruhs评分优良率为95%。提示骨形态发生蛋白2混合自体微小颗粒骨移植模式,在感染性骨不连修复中来源广泛、成骨可靠和安全性高。

BACKGROUND：The treatment of infected nonunion is a difficult problem in orthopedic trauma, which needs to completely eliminate foci of osteomyelitis to control infection, repair soft tissue defect and close the wound, repairs bone defects to promote healing and protect limb function as much as possible. Autogenous micromorselized bone can be easily obtained and recombinant human bone morphogenetic protein-2 has variety of sources. Their mixed grafting mode is safe and reliable in repairing of bone defects, which are suitable for repair of infected nonunion. OBJECTIVE：To study the operating method and clinical results of repairing infected nonunion using autogenous micromorselized bone grafting mixed with bone morphogenetic protein-2. METHODS：Twenty-three cases underwent infected nonunion repair with autogenous micromorselized bone （l ium, long bone metaphyseal cancellous bone） mixed with bone morphogenetic protein-2, including 7 cases of femoral bone defect caused by osteomyelitis after debridement and external fixation and 16 cases of tibial bone infected nonunion. Eleven of 23 cases continued to use the external fixation because of scar contraction or poor conditions of soft tissue, and the other 12 cases switched to use internal fixation. X-tray was taken to evaluate the bone healing at the 1^st, 3^rd, 6^th and 12^th months after operation. The function of the affected extremity was assessed by Johner-Wruhs grade. RESULTS AND CONCLUSION：Al of the cases were averagely fol owed up for 13.4 months. The bone defects and bone fracture healed in al cases without infection, and the wounds were al sealed. The excellent and good＆nbsp;rate according to Johner-Wruhs grade was 95%. These findings indicate that the bone grafting mode of autogenous micromorselized bone mixed with bone morphogenetic protein-2 is characterized as variety of sources, high safety and reliable osteogenic ability in repair of bone defects.