Young Andrew, Mirarchi Adam
Department of Anesthesia & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Department of Orthopedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA.
J Orthop Case Rep. 2015 Jul-Sep;5(3):18-21. doi: 10.13107/jocr.2250-0685.297.
This report describes two cases of long bone non-union associated with the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) and is the first of its kind. The first case describes a 25-year-old male who sustained a left diaphyseal femoral shaft fracture initially treated with operative fixation using an intramedullary nail, which subsequently loosened distally and was treated with exchange nailing and rhBMP-2 application. This patient developed acute local soft tissue inflammation post-operatively. The second case describes a 61-year-old female who sustained a right diaphyseal humeral shaft fracture that was initially treated with intramedullary nail fixation with subsequent distal interlock screw loosening. She underwent nail removal, and compression plating with rhBMP-2 placement, and postoperatively developed severe acute local tissue swelling centered over the rhBMP-2 sponge. Surgeons should be aware that rhBMP-2 may cause local acute tissue swelling and recombinant bone morphogenic proteins such as rhBMP-2 may have a role in the management for atrophic fracture non-unions. The authors recommend careful consideration prior to rhBMP-2 use in long bone non-unions.
本报告描述了两例与使用重组人骨形态发生蛋白-2（rhBMP-2）相关的长骨不愈合病例，此类报告尚属首次。第一例为一名25岁男性，其左股骨干骨折，最初采用髓内钉手术固定治疗，随后远端髓内钉松动，遂行更换髓内钉并应用rhBMP-2治疗。该患者术后出现急性局部软组织炎症。第二例为一名61岁女性，其右肱骨干骨折，最初采用髓内钉固定治疗，随后远端交锁螺钉松动。她接受了取出髓内钉、加压钢板固定并放置rhBMP-2治疗，术后在rhBMP-2海绵部位出现严重的急性局部组织肿胀。外科医生应意识到，rhBMP-2可能会导致局部急性组织肿胀，且诸如rhBMP-2等重组骨形态发生蛋白可能在萎缩性骨折不愈合的治疗中发挥作用。作者建议在长骨不愈合中使用rhBMP-2之前应谨慎考虑。
