Wolfe S W, Pike L, Slade J F, Katz L D
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA.
J Hand Surg Am. 1999 Jul;24(4):816-27. doi: 10.1053/jhsu.1999.0816.
We implanted coralline hydroxyapatite bone graft as a substitute for autogenous bone graft to support the reduced articular surface of 21 consecutive patients with distal radius fractures treated with external fixation and K-wires. The purpose of this single-cohort retrospective study was to report the outcomes of treatment with this material, complications associated with its use, and its efficacy in supporting the articular surface reduction. Eighteen patients were available for independent evaluation of motion, subjective outcome analysis, and final radiographic analysis at an average of 35 months after surgery. Wrist motion averaged 90% of the uninjured wrist and grip strength measured 75% of the uninjured side. Results in 17 of the 18 cases were rated as good or excellent by the criteria of Gartland and Werley; 12 by the criteria of Green and O'Brien. Seventeen had good or excellent radiographic results by the modified Lidstrom radiographic scoring system. The average DASH functional/symptom score was 90.3 (maximum, 100). Radiographic parameters were restored to an average of 12 mm radial length, 4 degrees volar tilt, 23 degrees radial inclination, and 0.6 mm positive ulnar variance. Articular reduction was maintained in all patients. A complication related to the use of coral was a 0.5 mm prominence of coralline hydroxyapatite beyond the subchondral line at the radiocarpal joint in 1 patient, which was not present on final radiographs. Coralline hydroxyapatite was effective at maintaining articular surface reduction when used in combination with external fixation and K-wires and had a safety profile comparable to other forms of treatment.
我们植入珊瑚羟基磷灰石骨移植材料替代自体骨移植，以支撑21例连续的桡骨远端骨折患者经外固定和克氏针治疗后降低的关节面。这项单队列回顾性研究的目的是报告使用这种材料的治疗结果、使用相关的并发症以及其在支撑关节面复位方面的疗效。18例患者在术后平均35个月可进行独立的活动评估、主观结果分析和最终影像学分析。腕关节活动度平均为健侧的90%，握力为健侧的75%。根据Gartland和Werley标准，18例中的17例结果评为良好或优秀；根据Green和O'Brien标准，12例评为良好或优秀。根据改良的Lidstrom影像学评分系统，17例患者的影像学结果为良好或优秀。DASH功能/症状平均评分为90.3（满分100）。影像学参数恢复至平均桡骨长度12 mm、掌倾角4°、桡偏角23°、尺骨正向变异0.6 mm。所有患者的关节复位均得以维持。与使用珊瑚相关的并发症是1例患者腕关节处珊瑚羟基磷灰石超出软骨下骨线0.5 mm突出，最终X线片上未显示。当与外固定和克氏针联合使用时，珊瑚羟基磷灰石在维持关节面复位方面有效，且安全性与其他治疗方式相当。
