Kong Zhigang, Tian Dehu, Yu Haiquan, Feng Wenling, Liu Changcheng
Department of Orthopaedics, Third Affiliated Hospital of Hebei Medical University, Shijiazhuang Hebei 050051, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Oct;22(10):1251-4.
To study clinical effects of the graft material of allogenic cancellous combined with autologous red marrow in the treatment of traumatic bone defect.
From February 2002 to April 2006, 38 patients of traumatic bone defect, 25 males and 13 females, aged 21-68 years old (38 on average), were treated with allogenic cancellous combined with autologous red marrow. Among them, there were 11 cases of bone nonunion caused by failure of internal fixation, 13 of serious comminuted fracture, 9 of bone defect caused by open fractures or bone infection, 5 of old fracture in need of graft. Of these fractures, there were 8 cases of shaft of humerus, 4 of intercondylar comminuted fracture of humerus, 8 of intercondylar comminuted fracture of femur, 5 of shaft of femur, 4 of open tibia fracture (Gustilo I, II type) and 9 of tibial plateau fracture. They included 17 cases of fresh fracture and 21 of old fracture. There were 23 cases of limitations of bone defect, and the range was 3 cm x 3 cm x 2 cm - 7 cm x 4 cm x 3 cm; and the range of the large bone defect was less than 3 cm in 15 cases. According to AO/ASIF classification, there were 5 cases of type B2, 10 of type B3, 16 of type C2 and 7 of type C3. The time from fresh fracture to operation was 5-17 days (8 days on average), and the time from old fracture to operation was 5-13 months (7.5 months on average). The amount of the allograft implantation was 20-50 g (28 g on average).
The wounds in all 38 cases obtained healing by first intention. All the patients were followed up for 8 months to 4 years (3.2 years on average). The X-ray films at reexamination showed that 36 patients had bone healing, with fresh fracture healing time of 2-6 months (4 months on average) and old fracture healing time of 3-10 months (7 months on average). The allogenic cancellous particles began to be fused with autogenous bone through creeping substitution 6-8 weeks after operation. One case, which had delayed infection, had bone union by removing internal fixation, placing irrigating tube and grafting after local stability. During the follow-up of 25 months, no relapse was found. Another case had nonunion because of plate loosening. According to the Mankin and Komender standard evaluation, there were 36 cases with satisfaction (94.7%) and 2 with dissatisfaction (5.3%).
The composite graft material of allogenic cancellous combined with autologous red marrow is safe and effective for repairing fractures and bone defect.
研究同种异体松质骨联合自体红骨髓移植材料治疗创伤性骨缺损的临床效果。
2002年2月至2006年4月，对38例创伤性骨缺损患者进行同种异体松质骨联合自体红骨髓治疗，其中男25例，女13例，年龄21 - 68岁（平均38岁）。其中内固定失败致骨不连11例，严重粉碎性骨折13例，开放性骨折或骨感染致骨缺损9例，陈旧性骨折需植骨5例。这些骨折中，肱骨干骨折8例，肱骨髁间粉碎性骨折4例，股骨髁间粉碎性骨折8例，股骨干骨折5例，开放性胫骨骨折（Gustilo I、II型）4例，胫骨平台骨折9例。新鲜骨折17例，陈旧性骨折21例。骨缺损局限者23例，范围为3 cm×3 cm×2 cm - 7 cm×4 cm×3 cm；大骨缺损范围小于3 cm者15例。按AO/ASIF分类，B2型5例，B3型10例，C2型16例，C3型7例。新鲜骨折至手术时间为5 - 17天（平均8天），陈旧性骨折至手术时间为5 - 13个月（平均7.5个月）。同种异体骨植入量为20 - 50 g（平均28 g）。
38例患者伤口均一期愈合。所有患者随访8个月至4年（平均3.2年）。复查X线片显示，36例患者骨愈合，新鲜骨折愈合时间为2 - 6个月（平均4个月），陈旧性骨折愈合时间为3 - 10个月（平均7个月）。同种异体松质骨颗粒术后6 - 8周开始通过爬行替代与自体骨融合。1例延迟感染患者经取出内固定、放置冲洗管及局部稳定后植骨达到骨愈合。随访25个月无复发。另1例因钢板松动出现骨不连。按Mankin和Komender标准评价，满意36例（94.7%），不满意2例（5.3%）。
同种异体松质骨联合自体红骨髓复合移植材料修复骨折及骨缺损安全有效。
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