锁定钢板结合自体骨移植及骨形态发生蛋白治疗前臂骨干骨不连

Locking plate combined with autologous bone transplantation and BMP in the treatment of forearm diaphysis nonunion

目的探讨锁定钢板结合自体骨移植及骨形态发生蛋白(bone morphogenetic protein,BMP)治疗前臂骨干骨不连的临床疗效。方法回顾性分析2018年1月—2021年1月陕西省核工业二一五医院收治的20例前臂骨干骨折术后骨不连患者资料,男性13例,女性7例;年龄33~68岁,平均49.8岁;道路交通伤8例,摔伤12例;尺骨8例,桡骨9例,尺桡骨3例;骨不连类型:肥大型8例,萎缩型12例。患者均行原内固定取出,骨不连断端清创,去除硬化骨,打通断端髓腔,予以复位,恢复前臂长度及良好解剖关系后更换钢板并于远近端锁定螺钉固定,再取自体髂骨与BMP(杭州九源基因工程有限公司)混合后打压植骨于骨不连骨缺损处。对骨不连愈合时间、愈合率及患者功能进行评价。结果所有患者顺利完成手术并获得12个月以上的随访。骨折均愈合,骨不连愈合时间3~7个月,平均4.9个月;所有患者未出现感染、神经损伤、内固定断裂、松动等并发症。末次随访时采用Anderson前臂功能评分标准评价疗效:优12例,良5例,可2例,差1例,优良率85.0%(95%CI:0.621~0.968)。结论锁定钢板结合自体骨移植及BMP可以有效治疗前臂骨干骨不连,矫正畸形,利于骨折愈合,疗效满意。

Objective To investigate the clinical effect of locking plate combined with autologous bone transplantation and bone morphogenetic protein(BMP)in the treatment of forearm diaphysis nonunion.Methods Twenty patients with nonunion afteRforearm shaft fractures treated in the NO.215 Hospital of Shaanxi NucleaRIndustry from Jan.2018 to Jan.2021 were analyzed retrospectively.There were 13 males and 7 females aged 33-68 years,mean 49.8 years.The injury mechanism was caRaccident in 8 cases and falls in the otheR12 cases,with 8 affecting the ulna,9 the radius,and 3 the ulna and radius.The nonunion was of hypertrophic type in 8 cases and atrophic in 12 cases.FoRall the patients,removal of the original internal fixation,debridement of the nonunion broken end,removal of sclerotic bone,opening of the medullary cavity,anatomic reduction and restoration of the forearm length were conducted in sequence,followed by replacement of the steel plate and distal locking screw fixation.AfteRthen autologous ilium grafting well mixed with BMP was conducted at the bone defects with nonunion.The union time and rate and functional recovery were evaluated.Conclusion Locking plate and autogenous bone transplantation mixed with BMP can effectively correct deformity and facilitate fracture healing foRforearm diaphysis nonunion,showing satisfactory curative effects.