三种骨移植物填充复杂胫骨平台骨折骨缺损比较

Comparison of three bone graft materials used for bone defects in complex tibial plateau fractures

[目的]比较三种骨移植物材料填充复杂胫骨平台骨折骨缺损的临床效果。[方法]回顾性分析92例复杂胫骨平台骨折患者的临床资料。92例均行开放复位,钢板螺钉固定,其中,31例采用自体髂骨,34例采用异体骨,27例采用人工骨填充复位后的骨缺损。对比三组患者围手术期情况、随访结果及影像学指标。[结果]自体骨组术中出血量及手术时间高于异体骨组、人工骨组(P<0.05),但异体骨组和人工骨组间差异无统计学意义(P>0.05);三组术后引流量差异无统计学意义(P>0.05)。自体骨组主要并发症为供区疼痛不适(19.35%),异体骨组主要为伤口渗液(14.71%)和排斥反应(11.76%),人工骨组仅1例伤口渗液。三组患者随访12~24个月,三组患者在下地活动时间和完全负重时间差异无统计学意义(P>0.05)。随术后时间推移,三组患者HSS评分和膝关节ROM均显著增加(P<0.05),但是,相应时间点三组间上述指标的差异均无统计学意义(P>0.05)。影像方面,三组患者间术后Rasmussen评分和TPA、PTS的差异均无统计学意义(P>0.05),末次随访时关节面塌陷>1.5 mm分别为自体骨组12.90%、异体骨组14.71%和人工骨组3.70%,人工骨组显著低于其余两组(P<0.05)。[结论]不同骨修复材料植骨治疗复杂胫骨平台骨折均可获得良好疗效,但仿生人工骨修复材料使用方便,无免疫排斥反应。

[Objective] To compare the clinical outcomes of three bone graft materials used for bone defects in complex tibial plateau fractures. [Methods] A retrospective study was conducted on 92 patients who received open reduction and internal fixation(ORIF) with plate and screw for complex tibial plateau fractures. Of them, 31 patients had bone autograft harvest from iliac crest, 34 patients had bone allograft and 27 patients had artificial bone graft substitute filled into the bone defects secondary to fracture reduction. The perioperative,follow-up and radiographic documents were compared among the 3 groups. [Results] The autograft group consumed significantly longer operation time, associated with significantly greater intraoperative blood loss than the allograft group and bone substitute group(P<0.05), nevertheless no a statistical difference was proved in postoperative drainage among the 3 groups. In term of postoperative early complication,the autograft group suffered mainly from pain of donor site(19.35%), the allograft graft group presented predominantly incision exudation(14.71%) and reject reaction(11.76%), whereas the bone substitute group had only 1 case of incision exudation. As time went in the follow-up period lasted for 12 to 24 months, the HSS score and knee extension-flexion range of motion(ROM) significantly increased in all the 3 groups(P<0.05), although no statistically significant differences in the time to return ambulation and full-weight bearing activity, as well as the HSS score and ROM were noticed among the 3 groups(P>0.05). With regard to radiographic assessment, there were no statistical differences regarding to Rasmussen score, tibial plateau angle(TPA) and posterior tibial slop(PTS) postoperatively among the 3 groups.However, the collapse of articular surface more than 1.5 mm at the latest follow up was of 12.90% in the autograft group, 14.71% in the allograft group and 3.70% in the bone substitute group, the collapse of articular surface rate in the bone substitute group was significantly lower than the other two groups(P<0.05). [Conclusion] All the three bone graft materials do achieve good clinical outcomes for complex tibial plateau fractures. In comparison, the artificial bone substitute is more easy in operative application with no rejection.