骨形态发生蛋白植入长骨干粉碎性骨折周围：预防骨折内固定后的不愈合

Internal fixation plus bone morphogenetic protein for prevention of bone nonunion after comminuted fracture of the shaft of long bones

背景:长骨干粉碎性骨折由于骨折周围软组织损伤较重,血运受到破坏,且骨折块解剖复位较困难,内固定不够坚强,导致骨折内固定后不愈合的发生率高于单纯线性骨折。目的:检验骨形态发生蛋白预防长骨干粉碎性骨折内固定后不愈合的效果。方法:选择长骨干粉碎性骨折患者145例,按患者意愿分为2组治疗。试验组78例,男48例,女30例,年龄18-70岁,闭合骨折57例,开放骨折21例,采用锁定钢板内固定结合植入含有重组人骨形态发生蛋白2的骨修复材料修复。对照组67例,男42例,女25例,年龄18-71岁,闭合骨折49例,开放骨折18例,仅用锁定钢板内固定修复。术后随访6-18个月,对比两组术后骨折愈合时间及骨折不愈合率。结果与结论:试验组骨折平均愈合时间为6.17个月,无骨折不愈合;对照组骨折平均愈合时间为7.24个月,骨折不愈合率为7%。与对照组相比,试验组骨折愈合时间短,骨折不愈合率低,差异有显著性意义(P<0.05)。提示骨形态发生蛋白植入长骨干粉碎性骨折周围,可以缩短骨折愈合时间,降低骨折内固定后不愈合率。

BACKGROUND：In the comminuted fractures of the shafts of long bones, the fracture repair process may be halted after internal fixation by locking compression plate and a higher bone nonunion rate occurs due to severe soft tissue damage, inadequate blood supply, poor cortical apposition, or unstable fracture fixation. OBJECTIVE：To examine the effect of bone morphogenetic protein in the prevention of nonunion of long bone comminuted fractures after internal fixation by locking compression plate. METHODS：Total y 145 long bone comminuted fracture patients were enrol ed and randomly divided into test and control groups according to the wishes of patients. The test group included 78 patients （48 males and 30 females, 18-70 years old;57 cases of closed fractures and 21 cases of open fractures） who were treated with internal fixation by locking compression plate combined with bone morphogenetic protein;the control group included 67 patients （42 males and 25 females, 18-71 years old;49 cases of closed fractures and 18 cases of open fractures） who were treated with internal fixation by locking compression plate. The fracture healing time and rate of non-union were detected and compared in the two groups after a postoperative fol ow-up of 6-18 months. RESULTS AND CONCLUSION：In the test group, the average fracture healing time was 6.17 months, without non-union. In the control group, the average fracture healing time was 7.24 months, and the rate of non-union was 7%. Compared with the control group, the fracture healing time was shorter and the rate of non-union was lower in the test group （P〈0.05）. The use of bone morphogenetic protein is an effective method to shorten fracture healing time and prevent non-union of long bone comminuted fractures after internal fixation by locking compression plate.