带锁髓内钉复合异种骨基质明胶治疗股骨干骨折钢板内固定失败

Treatment of Failed Femoral Fracture Fixation by the Combination of Heterogeneous Bone Matrix Gelatin and Cross-lock Intramedullary Nail /

目的:探讨股骨干骨折钢板内固定失败后内固定的选择,骨基质明胶(bone martrix gelatin,BMG)促进骨折愈合的作用。方法:16例股骨干骨折钢板内固定失败病人,选择带锁髓内钉固定,异种BMG植入骨折端周围;术前、术后检测血清中代表骨生成的标志物,包括骨钙素(osteocalcin,BGP),骨特异碱性磷酸酶(bone specificalkaline phosphatase,BSAP),检测白细胞介素2(interleukin-2,IL-2)、IL-4、IL-6、IL-10,监测免疫应答反应;术后观察伤口愈合情况及定期拍X线片评价骨折愈合情况。结果:16例骨折术后8～12个月骨折愈合;术后BGP、BSAP均高于术前,BGP、BSAP术前与术后的差异有显著意义(P<0.01);IL-2、IL-4、IL-6、IL-10术前、术后的差异无显著意义(P>0.05)。结论:带锁髓内钉固定是股骨干骨折钢板内固定失败后一种很好的固定方法,BMG可促进骨折愈合,可替代自体植骨。

Objective: To observe the treatment of failed femoral fracture fixation by the combinatin of bone matrix gelatin (BMG) and cross-lock intramedullary nails. Methods: From Jan. 1999 ~Jun. 2002, 16 cases with failed femoral shaft fracture fixation by crosslock intramedullary nails infixation with heterogenous bone matrix gelatin implanted to the fracture site.Osleo-calcin(BGP) and bone specific alkaline phosphatase (BSAP) were detected before and after operation. While the interleukin-2 (IL-2) ,IL-4,IL-6,IL-10 were detected before and after operation for monitor the immune reaction. Postoperative observations of incisions and X-ray film examination of fracture union were carried out. Results: Sixteen cases fracture healing. BGP and BSAP were higher than those pre-operation, there were different significance between pre and post-operation(P<0. 01); IL-2,IL-4, IL-6,IL-10 were no significant between pre and post-operation(P>0.05). Conclusion:Cross-lock intramedullary nail infixation may be good remedial measure of the femoral shaft fracture after the platel infixation failed,and BMG are beneficial to the fracture healing and it can take place of the autogenous bone transplant.