摘要
目的:比较采用骨形态发生蛋白人工骨植骨加骨折内固定与自体髂骨植入加骨折内固定治疗骨质疏松性转子间骨折的效果。方法:选择2003-10/2005-10桂林医学院附属医院骨科收治的Ⅲ、Ⅳ、V型骨质疏松性转子间骨折患者51例,均知情同意。实验分组:随机将病例分为2组,骨形态发生蛋白人工骨植入组26例,自体髂骨植入组25例。实验干预:采用股骨上段外侧切口,DHS或加防旋钉内固定,骨形态发生蛋白人工骨由处理后的牛松质骨与成品重组人骨形态发生蛋白2按一定比例复合而成,骨折固定后在骨折缺损处、内侧及骨折周围植骨,骨形态发生蛋白人工骨组采用骨形态发生蛋白人工骨植入,自体髂骨组取自体髂骨植入。实验评估:术后定期随访,比较二组患者的基本情况、临床效果和影像学结果(骨折愈合情况和颈干角的变化)。随访时关节功能评定参照采用黄公怡等提出的标准,分为优、良、可、差4级。髋内翻分类标准为颈干角<100°。结果:术后随访1年,51例患者全部进入结果分析。①术后X射线片观察:骨形态发生蛋白人工骨组临床愈合时间短于自体髂骨组[(94.50±22.45),(116.96±15.90)d,P<0.01];骨形态发生蛋白人工骨组术后1年颈干角大于自体髂骨组[(127.19±3.23)°,(120.4±5.22)°,P<0.01]。②髋关节功能及不良事件和副反应:骨形态发生蛋白人工骨组术后以1年髋关节功能优良率优于自体髂骨组(P<0.05);骨形态发生蛋白人工骨组髋内翻、下肢短缩(>2cm)的发生率均低于自体髂骨组[髋内翻(n):4,7;下肢短缩(n):3,5,P均<0.01];钉退出二组差异均无显著性意义(P>0.05)。结论:伴有骨质疏松的转子间骨折患者,采用骨形态发生蛋白人工骨植骨优于自体髂骨植骨,可缩短骨折愈合期,减少髋内翻等并发症的发生率,提高术后髋关节功能优良率,提示骨形态发生蛋白人工骨能替代自体髂骨植骨治疗骨质疏松性转子间骨折。
AIM： To evaluate the clinical outcomes of osteoporotic intertrochanteric fracture treated with bone morphogenetic protein （BMP） and lilac bone graft substitute with interval fixation. METHODS： From October 2003 to October 2005, 51 patients with osteoporotic intertrochanteric fracture were recruited from Department of Orthopedics, Affiliated Hospital of Guilin Medical College, with their informed consents. The patients were randomly divided into BMP/bone graft substitute group （n =26） and lilac autograft group （n =25）. Interval fixation was performed with DHS or cancellous screw at lateral incision of superior femoral bone. BMP bone graft was consisted of bovine cancellous bone and recombinant BMP2 at certain percentage. Then bone fracture defect, inside and surround the fracture were implanted with corresponding materials respectively. The general condition, clinical outcomes and radiographic results （fracture healing and collodiaphyseal angle change） of the patients were compared between two groups during the follow-ups. Joint function was evaluated according to the standard of Huang Gong-yi et al, including 4 ranks of excellent, good, fair and bad. Coxa vara was defined as collodiaphyseal angle 〈 100% RESULTS： All the 51 patients were followed up for one year and involved in the result analysis. （1）Actinogram： The fracture healing time in the BMP/bone graft substitute group was significantly shorter than that in the iliac autograft group [（94.50±.22.45）, （116.96±15.90） days, P 〈 0.01]; the rate of coxa vara in the BMP/bone graft substitute group was significantly lower than that in the lilac autograft group [（127.19±3.23） °, （120.4±5.22）° p 〈 0.01）.（2）Hip joint function, side effect and adverse event： The satisfactory rate of hip joint function in the BMP/bone graft substitute group was significantly higher than that in the Uiac autograft group （P 〈 0.05）. The incidence rates of coxa vara and shortening of lower legs were lower in the BMP/bone graft substitute group than in Uiac autegraft group [coxa vara （n）： 4, 7; shortening of lower legs （n）： 3, 5, P〈 0.01]; There was no significant difference between the two groups without screws （P〉 0.05）. CONCLUSION： Higher satisfactory rate of function of hip, shorter fracture healing time and lower rate of coxa vara have been obtained dealing with osteoporotic intertrochanteric fracture with BMP/bone graft substitute, indicating that BMP/bone graft substitute is superior to lilac autograft in the treatment osteoporotic intertrochanteric fracture.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第21期4077-4080,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
桂林市科技局科学研究与技术开发计划项目资助(20055211)~~
