CAJ | 학술논문

背景：感染性骨不连是目前创伤骨科治疗的难题，既要彻底清除感染病灶组织控制感染，修复缺损软组织闭合创面，又要修复骨缺损促进骨折愈合，最大程度恢复肢体的功能。由于自体微小颗粒骨取材方便，重组人骨形态发生蛋白2来源广泛，其混合植骨模式成骨可靠、安全性高，适于修复感染性骨不连。 　　目的：观察骨形态发生蛋白2混合自体微小颗粒骨移植修复感染性骨不连的治疗效果。 　　方法：采用自体微小颗粒骨(髂骨、长骨干骺端松质骨)混合骨形态发生蛋白2修复感染性骨不连23例，股骨骨髓炎清创外固定固定后骨缺损7例，胫骨骨髓炎清创外固定固定后骨缺损16例，其中11例患者因瘢痕挛缩或软组织条件差继续使用外固定支架，患者12例改用内固定钢板固定，固定后1，3，6个月和1年复查X射线评价骨折愈合情况，并采用Johner-Wruhs评分评估临床疗效。 　　结果与结论：所有病例平均随访13.4个月，骨折愈合，骨不连均得以修复，创面均闭合，无感染复发。Johner-Wruhs 评分优良率为95%。提示骨形态发生蛋白2混合自体微小颗粒骨移植模式，在感染性骨不连修复中来源广泛、成骨可靠和安全性高。
배경：감염성골불련시목전창상골과치료적난제，기요철저청제감염병조조직공제감염，수복결손연조직폐합창면，우요수복골결손촉진골절유합，최대정도회복지체적공능。유우자체미소과립골취재방편，중조인골형태발생단백2래원엄범，기혼합식골모식성골가고、안전성고，괄우수복감염성골불련。 　　목적：관찰골형태발생단백2혼합자체미소과립골이식수복감염성골불련적치료효과。 　　방법：채용자체미소과립골(가골、장골간후단송질골)혼합골형태발생단백2수복감염성골불련23례，고골골수염청창외고정고정후골결손7례，경골골수염청창외고정고정후골결손16례，기중11례환자인반흔련축혹연조직조건차계속사용외고정지가，환자12례개용내고정강판고정，고정후1，3，6개월화1년복사X사선평개골절유합정황，병채용Johner-Wruhs평분평고림상료효。 　　결과여결론：소유병례평균수방13.4개월，골절유합，골불련균득이수복，창면균폐합，무감염복발。Johner-Wruhs 평분우량솔위95%。제시골형태발생단백2혼합자체미소과립골이식모식，재감염성골불련수복중래원엄범、성골가고화안전성고。
BACKGROUND:The treatment of infected nonunion is a difficult problem in orthopedic trauma, which needs to completely eliminate foci of osteomyelitis to control infection, repair soft tissue defect and close the wound, repairs bone defects to promote healing and protect limb function as much as possible. Autogenous micromorselized bone can be easily obtained and recombinant human bone morphogenetic protein-2 has variety of sources. Their mixed grafting mode is safe and reliable in repairing of bone defects, which are suitable for repair of infected nonunion. OBJECTIVE:To study the operating method and clinical results of repairing infected nonunion using autogenous micromorselized bone grafting mixed with bone morphogenetic protein-2. METHODS:Twenty-three cases underwent infected nonunion repair with autogenous micromorselized bone (l ium, long bone metaphyseal cancellous bone) mixed with bone morphogenetic protein-2, including 7 cases of femoral bone defect caused by osteomyelitis after debridement and external fixation and 16 cases of tibial bone infected nonunion. Eleven of 23 cases continued to use the external fixation because of scar contraction or poor conditions of soft tissue, and the other 12 cases switched to use internal fixation. X-tray was taken to evaluate the bone healing at the 1st, 3rd, 6th and 12th months after operation. The function of the affected extremity was assessed by Johner-Wruhs grade. RESULTS AND CONCLUSION:Al of the cases were averagely fol owed up for 13.4 months. The bone defects and bone fracture healed in al cases without infection, and the wounds were al sealed. The excellent and good rate according to Johner-Wruhs grade was 95%. These findings indicate that the bone grafting mode of autogenous micromorselized bone mixed with bone morphogenetic protein-2 is characterized as variety of sources, high safety and reliable osteogenic ability in repair of bone defects.