不同治疗方案在肱骨髁部骨不连合并骨缺损患者中的应用效果对比

Comparison of different therapeutic schemes in treatment of patients with nonunion of humeral condylar bone

目的比较不同治疗方案在肱骨髁部骨不连合并骨缺损患者中的应用效果。方法选取2011年6月-2016年6月该院收治的62例肱骨髁部骨不连合并骨缺损患者为研究对象,采用随机数表法将患者分为观察组和对照组,各31例。对照组患者采用单纯髂骨移植对骨缺损进行重建,观察组患者采用自体富血小板血浆联合髂骨移植对骨缺损进行重建。比较两组患者的围术期各时间、肘关节活动度、Cassebaum评分及并发症发生率。结果观察组与对照组手术时间、住院天数、骨性愈合时间及临床愈合时间的比较,经t检验,差异有统计学意义(P<0.05),观察组患者的手术时间、住院天数、骨性愈合时间及临床愈合时间均低于对照组患者。治疗前观察组与对照组肘关节屈和伸活动度比较经t检验差异无统计学意义(t=1.835和1.915,P=0.075和0.067)。治疗后观察组与对照组肘关节屈和伸活动度比较经t检验差异有统计学意义(t=2.377和2.549,P=0.033和0.016),观察组患者屈活动度高于对照组患者,伸活动度低于对照组患者。治疗后观察组优良率80.63%,对照组优良率77.41%,经χ~2检验,差异无统计学意义(χ~2=1.653,P=0.081)。治疗后,观察组31例患者中1例延迟愈合,1例褥疮,对照组31例患者中2例延迟愈合,2例褥疮,2例深静脉血栓,观察组并发症发生率6.45%(2/31),对照组患者的并发症发生率19.35%(6/31),经χ~2检验,差异有统计学意义(χ~2=6.035,P=0.030),对照组患者的并发症发生率高于观察组患者。结论给予肱骨髁部骨不连合并骨缺损患者自体富血小板血浆联合髂骨移植治疗较单纯髂骨移植治疗术后恢复快,修复效果好,可以在临床上进一步推广和使用。

Objective To compare the effect of different therapeutic schemes in the treatment of patients with nonunion of humeral condylar bone. Methods From June 2011 to June 2016, 62 cases of humeral condylar defect nonunion patients in our hospital were selected as research objects, and were divided into observation group and control group with random number table method, 31 cases in each group. Patients in the control group were treated with simple iliac bone graft to reconstruct the bone defect, and the observation group were treated with autologous platelet rich plasma combined with iliac bone graft to reconstruct the bone defect. The duration of perioperative, elbow activity, cassebaum score and complication were compared between two groups. Results The operative time, length of hospital stay, and bone healing time in two groups had significant difference （P〈 0.05）. The time of operation, the number of days of hospitalization, the time of bone healing and clinical healing time in the observation group were statistically shorter than those in the control group. The flexion activity before treatment had no significant difference between two groups （t = 1.835 and1.915, P=0.075 and 0.067）. （t=2.377 and 2.549, P=0.033 and 0.016）. After treatment, the flexion activity of the observation group was higher than that of the control group （P〈 0.05）, and the difference was statistically significant （t = 2.377 and 2.549, P= 0.033 and 0.016）. After treatment, the excellent rate was 80.63% in the observation group and 77.41% in the control group. The difference was not statistically significant （χ2= 1.653, P= 0.081）. After treatment, there were 1 case with delayed healing, 1 case with bed sores in the observation group, while there were 2 cases with delayed healing, 2 cases with pressure ulcer and 2 cases with deep vein thrombosis in the control group. The complication rate of two groups were 6.45% and 19.35% respectively, and the difference was statistically significant （χ2= 6.035, P = 0.030）. The incidence of complications in the control group was higher than the observation group. Conclusions Autologous platelet rich plasma combined with bone grafting is effective for humeral condylar defect nonunion patients.