Department of Orthopaedic Surgery, Hoshigaokakouseinenkin Hospital, Hirakata-City, Osaka, Japan.
Arch Orthop Trauma Surg. 2009 Nov;129(11):1539-47. doi: 10.1007/s00402-009-0914-9. Epub 2009 Jun 23.
Osseous defects in nonunited open fracture of the lower limbs are difficult to treat. Autogenous bone grafting is a promising treatment options, but a finite amount of autogenous bone graft is available from each individual and donor site morbidity remains a problem. These limitations have prompted the development and use of synthetic biomaterials such as hydroxyapatite (HA) ceramics. However, little information is available regarding the challenging cases such as nonunited open fractures The purpose of the present study is to evaluate the outcomes associated with the treatment of osseous defects in nonunited open fracture using novel HA ceramics.
Twelve bones (4 femora and 8 tibias) in 11 patients (10 men and 1 woman), with an average age of 49.1 (range 19-71) years, with nonunited osseous defects after open fracture were treated by the grafting of HA ceramics alone or with autogenous iliac bone followed by internal or external fixation.
The patients were followed for an average of 25.2 months in average (range 10.3 -58.1 months). Finally, 11 of 12 fractures united clinically and radiographically, while one fracture required a second procedure for additional autogenous iliac bone grafting. The average time to union from the index surgery was 5.6 months (median 5.3 months, range 2.3-11 months.). Radiographs showed good incorporation of grafted HA into the host bone in most of the united cases. As a complication, transient wound drainage was found in two cases.
The current protocol using the HA ceramics appears to be safe and efficacious for the treatment of osseous defects after the open fractures.
下肢开放性骨折不愈合的骨缺损难以治疗。自体骨移植是一种很有前途的治疗选择，但每个个体可提供的自体骨有限，且供区并发症仍然是一个问题。这些限制促使了合成生物材料如羟基磷灰石（HA）陶瓷的发展和应用。然而，对于开放性骨折不愈合等挑战性病例，相关信息很少。本研究的目的是评估使用新型 HA 陶瓷治疗开放性骨折不愈合的骨缺损的结果。
11 名患者（10 名男性和 1 名女性）共 12 处骨骼（4 处股骨和 8 处胫骨），平均年龄 49.1 岁（19-71 岁），开放性骨折后出现骨不连骨缺损，单独或联合自体髂骨移植 HA 陶瓷，然后进行内固定或外固定。
患者平均随访 25.2 个月（10.3-58.1 个月）。最终，12 处骨折中有 11 处临床和影像学愈合，1 处骨折需要再次进行自体髂骨移植。从初次手术到愈合的平均时间为 5.6 个月（中位数 5.3 个月，范围 2.3-11 个月）。X 线片显示大多数愈合病例中移植的 HA 与宿主骨很好地融合。作为一种并发症，有 2 例出现短暂的伤口引流。
目前使用 HA 陶瓷的方案似乎对开放性骨折后骨缺损的治疗是安全有效的。
