Singh Rahul, Bleibleh Sabri, Kanakaris Nikolaos K, Giannoudis Peter V
Academic department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, Leeds, United Kingdom.
Academic department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
Injury. 2016 Dec;47 Suppl 6:S33-S39. doi: 10.1016/S0020-1383(16)30837-3.
The management of upper limb non-unions can be challenging and often with unpredictable outcomes. In this study we present our experience with the use of BMP-7 in the treatment of upper limb non-unions. Between 2004 and 2011 all consecutive patients who were treated with BMP-7 were followed up prospectively until fracture union. Fracture union was assessed with regular radiological and clinical assessment. At the final follow up clinical assessment included the short Disabilities of the Arm, Shoulder and Hand (DASH) score. The minimum follow up was 12 months (12-36). In total 42 patients met the inclusion criteria with a mean age of 47 years. Anatomical distribution of the nonunion sites included 19 cases of mid/proximal forearm, 14 humeri, 6 distal radius and 3 clavicle. 35 patients had atrophic non-union, 11 had previous open fractures, and 10 had bone loss (range 1-3 cm). The mean number of operations performed and the mean time from injury to BMP-7 application was 1.5 and 26 months, respectively. 40 fractures had both clinical and radiological union whereas 2 patients had partial radiological union but a pain free range of motion. BMP-7 was applied in isolation in 1 case and in 41 cases the application was combined with autologous bone grafting. DASH scores were available at final follow up in 23 (55%) patients with a mean of 33 score (range 2-86.4). This study supports the view that the combination of ABG and BMP-7 can be considered as a successful treatment modality for the treatment of recalcitrant upper limb non-unions. Further studies preferably randomised controlled trials are desirable to throw more light into the role of BMP-7 in the treatment of upper limb nonunions.
上肢骨不连的治疗颇具挑战性，且结果往往难以预测。在本研究中，我们介绍了使用骨形态发生蛋白-7（BMP-7）治疗上肢骨不连的经验。2004年至2011年期间，所有连续接受BMP-7治疗的患者均进行了前瞻性随访，直至骨折愈合。通过定期的影像学和临床评估来评定骨折愈合情况。在最后一次随访时，临床评估包括上肢、肩部和手部功能障碍简易评分（DASH）。最短随访时间为12个月（12 - 36个月）。共有42例患者符合纳入标准，平均年龄为47岁。骨不连部位的解剖分布包括19例前臂中/近端、14例肱骨、6例桡骨远端和3例锁骨。35例患者为萎缩性骨不连，11例曾有开放性骨折，10例有骨缺损（范围为1 - 3厘米）。手术的平均次数以及从受伤到应用BMP-7的平均时间分别为1.5次和26个月。40处骨折实现了临床和影像学愈合，而2例患者实现了部分影像学愈合，但活动时无痛。1例单独应用了BMP-7，41例的应用与自体骨移植相结合。23例（55%）患者在最后一次随访时有DASH评分，平均评分为33分（范围为2 - 86.4）。本研究支持以下观点，即自体骨移植（ABG）与BMP-7联合应用可被视为治疗顽固性上肢骨不连的一种成功治疗方式。更理想的是开展进一步研究，最好是随机对照试验，以更清楚地了解BMP-7在上肢骨不连治疗中的作用。
