磷酸钙活性人工骨与自体骨颗粒环抱式植骨治疗四肢骨不连

RhBMP-2-loaded calcium phosphate cement scaffold combined with autogenous bone grafting in the treatment of limbs nonunion

目的探讨固化型磷酸钙活性人工骨(CPC/rhBMP-2)与自体骨颗粒环抱式植骨治疗四肢非感染性萎缩型骨不连的临床疗效。方法对2013年9月至2017年9月年间治疗的16例四肢非感染性萎缩型骨不连患者进行回顾性分析,其中男12例,女4例;年龄(37.06±16.31)岁(16~67岁)。骨不连部位:下肢11例(胫骨6例、股骨3例、跟骨1例、腓骨1例),上肢5例(桡骨3例、锁骨1例、手舟骨1例),所有患者均行断端新鲜化,骨缺损中央植入自体骨颗粒,外周植入CPC/rhBMP-2形成环抱式植骨。术后复查X线片观察骨折愈合情况,记录并发症发生情况,随访患者直到骨折愈合。采用上肢功能障碍评定量表(DASH)、下肢功能量表(LEFS)和SF-12生活质量量表对治疗前、后进行疗效评定。结果本组16例均获随访,随访时间(16.93±4.06)月(12~26月)。X片显示全部病例均获得骨性愈合,愈合时间(5.43±2.25)月(3~10月);术后DASH、LEFS和SF-12评分与术前比较均有统计学差异(P<0.05)。结论固化型磷酸钙活性人工骨(CPC/rhBMP-2)和自体骨颗粒环抱式植骨治疗四肢萎缩型骨不连的愈合率及安全性高,疗效可靠。

Objective To investigate the clinical effect of recombinant human bone morphogenetic protein 2(CPC/rhBMP-2)-loaded calcium phosphate cement scaffold combined with autogenous bone graft in the treatment of non-infectious atrophy type limbs nonunion.Methods A total of 16 patients(12 males,4 females;aged from 16ys to 67ys,mean age:37.06±16.31 ys)with limbs nonunion after surgical treatment of fractures from September 2013 to September 2017 were analyzed retrospectively.Bone nonunion part were lower limbs(tibia 5 cases,femur 3 cases,calcaneus 1 case,fibula 1 case)and upper limbs(radius 3 cases,clavicle 1 case,scaphoid 1 case).All patients were treated with CPC/rhBMP-2 scaffold combined with autogenous bone grafting in the center of bone defect.Follow-up patients were treated with X-ray to observe the fractures healing after operation and record the complication till fractures healed.Upper extremity dysfunction assessment scale(DASH),lower extremity function scale(LEFS)and SF-12 quality of life scale were used to evaluate the effect pre-and post-treatment.Results Mean follow-up period was 16.93±4.06 months(ranged from 12 to 26 months).X-ray film showed that all fractures were healed,healing time was 3~10 months(mean 5.43±2.25 months).There were statistical difference between preoperative and postoperative DASH,LEFS and SF-12 scale(P<0.05).Conclusions CPC/rhBMP-2 combined with autogenous bone graft are effective and safe in the treatment of non-infectious atrophy type limbs nonunion.