Ollivier M, Gay A M, Cerlier A, Lunebourg A, Argenson J N, Parratte S
Department of Orthopedic Surgery, Institute of Movement, UMR 7287: Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
Department of Hand Surgery and Limb Reconstruction, Aix-Marseille University, Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France.
Injury. 2015 Jul;46(7):1383-8. doi: 10.1016/j.injury.2015.03.036. Epub 2015 Apr 11.
The purpose of this study was to evaluate the efficacy and safety of a combination of recombinant human bone morphogenetic protein 7 (rhBMP-7) and resorbable calcium phosphate bone substitute (rCPBS) as a salvage solution for recalcitrant tibial fracture nonunions. Twenty consecutive patients, 16 male and four female, with a mean age of 46.8±15.7 years (21-78) and a mean body mass index (BMI) of 24.2±5.3kgm(-2) (21.5-28.5), suffering from 20 recalcitrant tibial fracture nonunions were included. The mean number of operations performed prior to the procedure was 3.3, with homolateral iliac crest bone grafts being used for all of the patients. All patients were treated with a procedure including debridement and decortications of the bone ends, nonunion fixation with a locking plate, and filling of the bony defect with a combined graft of rhBMP-7 (as osteoinductor) with an rCPBS (as scaffold). The mean follow-up was 14±2.7 months. Both clinical and radiological union occurred in 18 cases, within a mean time of 4.7±3.2 months. A recurrence of deep infection was diagnosed for one of the non-consolidated patients. No specific complication of rCPBS or rhBMP-7 was encountered. This study supports the view that the application of rCPBS combined with rhBMP-7, without any bone grafting, is safe and efficient in the treatment of recalcitrant bone union.
本研究的目的是评估重组人骨形态发生蛋白7（rhBMP - 7）与可吸收磷酸钙骨替代物（rCPBS）联合使用作为顽固性胫骨骨折不愈合挽救治疗方案的有效性和安全性。纳入了20例连续患者，其中男性16例，女性4例，平均年龄46.8±15.7岁（21 - 78岁），平均体重指数（BMI）为24.2±5.3kg/m²（21.5 - 28.5），均患有顽固性胫骨骨折不愈合。手术前平均手术次数为3.3次，所有患者均使用同侧髂嵴骨移植。所有患者均接受包括骨端清创和去皮质、用锁定钢板固定不愈合以及用rhBMP - 7（作为骨诱导剂）与rCPBS（作为支架）的联合移植物填充骨缺损的手术治疗。平均随访时间为14±2.7个月。18例患者实现了临床和影像学愈合，平均时间为4.7±3.2个月。1例未愈合患者被诊断为深部感染复发。未遇到rCPBS或rhBMP - 7的特定并发症。本研究支持以下观点：在不进行任何骨移植的情况下，应用rCPBS联合rhBMP - 7治疗顽固性骨不愈合是安全有效的。
