Moghaddam-Alvandi A, Zimmermann G, Büchler A, Elleser C, Biglari B, Grützner P A, Wölfl C G
Department Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
Unfallchirurg. 2012 Jun;115(6):518-26. doi: 10.1007/s00113-011-2100-0.
Complex patterns of impaired bone healing can result in a severe economic and social burden for the patient. Herein we describe the local application of recombinant human bone morphogenetic protein 7 (BMP-7). The goal of this prospective study is to review the indications, application and validation of this therapy.
From June 2002 to June 2008, we applied 101 BMP-7 treatments in 101 nonunions of 98 patients. The average age of the patients was 50 years (18-88 years). The gender composition was 29 women (30%) and 69 men (70%). Before BMP-7 application, patients had already underwent surgical treatement an average of 3.3 times (median 3, 1- to 13-times). We used BMP-7 "off-label" in all long bones.
In 93 cases (92%), we observed proper bone healing. The average healing time was 4.8 months (range 1.5-11 months). The average time from injury to BMP-7 application was 18.4 months (3-84 months). In 65 cases, BMP-7 application was combined with re-osteosynthesis and autologous bone grafting. Serious side effects were not observed.
BMP-7 should not be used as general treatment of nonunion in all patients, but appears to be effective for the treatment of complex cases. In clinical practice, the decision to proceed with off-label use of BMP-7 should be made on a case-by-case basis.
复杂的骨愈合受损模式会给患者带来沉重的经济和社会负担。在此我们描述重组人骨形态发生蛋白7（BMP - 7）的局部应用。这项前瞻性研究的目的是回顾该疗法的适应证、应用及验证情况。
从2002年6月至2008年6月，我们对98例患者的101处骨不连应用了101次BMP - 7治疗。患者的平均年龄为50岁（18 - 88岁）。性别构成是29名女性（30%）和69名男性（70%）。在应用BMP - 7之前，患者平均已经接受了3.3次手术治疗（中位数为3次，范围1至13次）。我们在所有长骨中“超适应证”使用BMP - 7。
在93例（92%）中，我们观察到了良好的骨愈合。平均愈合时间为4.8个月（范围1.5 - 11个月）。从受伤到应用BMP - 7的平均时间为18.4个月（3 - 84个月）。在65例中，BMP - 7的应用与再次骨固定及自体骨移植相结合。未观察到严重的副作用。
BMP - 7不应作为所有患者骨不连的常规治疗方法，但似乎对复杂病例的治疗有效。在临床实践中，对于“超适应证”使用BMP - 7的决定应逐案做出。
