骨形态发生蛋白复合物联合自体红骨髓移植治疗四肢长骨骨折不愈合

[Treatment of long bone fracture nonunion in limbs by bone morphogenetic protein compounds combined with autologous red bone marrow graft].

作者信息

Li Gang, Liu Zhi

机构信息

Department of Orthopaedics and Traumatology, TCM Hospital of Pinghu, Zeijiang, China.

出版信息

Zhongguo Gu Shang. 2013 Apr;26(4):277-80.

PMID:23844484

Abstract

OBJECTIVE

To observe the clinical therapeutic effect of treatment for long bone fracture nonunion in limbs by bone morphogenetic protein compounds combined with autologous red bone marrow graft.

METHODS

From January 2004 to December 2010,36 cases of long bone fracture nonunion in limbs were treated by bone morphogenetic protein compounds combined with autologous red bone marrow graft. There were 22 males and 14 females with an average age of 36.8 years old ranging from 22 to 68 years. Nonunion sites included humerus in 6 cases,ulna in 4 cases,radius in 3 cases,femur in 10 cases,and tibia in 13 cases. The latest reconstruction was performed on these 36 cases during 8 to 24 months (means 13.7 months) after injuries. There were 22 cases of hypertrophic nonunion,14 cases of atrophic nonunion. Main clinical symptoms were pain of fracture sites on weight bearing: and swelling of limbs. Clearness of fracture line and bone defect were indicated on X-ray. The therapeutic effect of the treatment after operation was been evaluated by wound healing, reaction in the area of bone graft and bone marrow aspiration,fracture healing,and recovery of adjacent joint function.

RESULTS

All incisions primarily healed,immunologic rejection and anaphylaxis were not detected in these incisions. Infection and haematoma formation were not detected in the area of bone marrow aspiration. All these 36 cases were followed up for 3 to 20 months (means 16.2 months). Chronic pain in the area of bone marrow aspiration, bone infection in the area of bone graft, and red swelling of the skin near incisions or sinus tract were not detected. Bony union was achieved in all cases in 3 to 12 months (means 6.2 months) after operation, malunion was not detected. Pain of fracture sites on weight bearing and swelling of limbs disappeared after bony union. The adjacent joint function completely recovered in most cases,only 5 cases remained some function limited part.

CONCLUSION

In the treatment of long bone fracture nonunion in limbs, bone morphogenetic protein compounds combined with autologous red bone marrow graft have the advantage of wide range of sources, safety and promoting bone union,which is one of the ideal bone graft

摘要

目的

观察骨形态发生蛋白复合物联合自体红骨髓移植治疗四肢长骨骨折不愈合的临床疗效。

方法

2004年1月至2010年12月，采用骨形态发生蛋白复合物联合自体红骨髓移植治疗36例四肢长骨骨折不愈合患者。其中男22例，女14例，平均年龄36.8岁，年龄范围22～68岁。骨折不愈合部位：肱骨6例，尺骨4例，桡骨3例，股骨10例，胫骨13例。这36例患者均在受伤后8～24个月（平均13.7个月）进行了最新的重建手术。其中肥大性不愈合22例，萎缩性不愈合14例。主要临床症状为骨折部位负重时疼痛，肢体肿胀。X线显示骨折线清晰及骨缺损。通过伤口愈合情况、骨移植和骨髓穿刺部位反应、骨折愈合情况及相邻关节功能恢复情况评估术后治疗效果。

结果

所有切口均一期愈合，未发现切口有免疫排斥及过敏反应。骨髓穿刺部位未发现感染及血肿形成。这36例患者均获随访3～20个月（平均16.2个月）。未发现骨髓穿刺部位慢性疼痛、骨移植部位骨感染及切口或窦道附近皮肤红肿。术后3～12个月（平均6.2个月）所有病例均达到骨性愈合，未发现畸形愈合。骨性愈合后骨折部位负重疼痛及肢体肿胀消失。多数病例相邻关节功能完全恢复正常，仅5例仍有部分功能受限。