中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
9期
741-747
,共7页
杨新明%孟宪勇%张瑛%王耀一%胡振顺%阴彦林%张军威%张培楠%赵御森%王海波
楊新明%孟憲勇%張瑛%王耀一%鬍振順%陰彥林%張軍威%張培楠%趙禦森%王海波
양신명%맹헌용%장영%왕요일%호진순%음언림%장군위%장배남%조어삼%왕해파
骨%创伤和损伤%骨髓%外科手术
骨%創傷和損傷%骨髓%外科手術
골%창상화손상%골수%외과수술
Bone%Wounds and injuries%Bone marrow%Surgical procedures,operative
目的 通过与病灶清除植入自体红骨髓(ARBM)复合体进行比较,探讨病灶清除植入带蒂筋膜瓣包裹ARBM复合体治疗四肢创伤后低毒力感染性骨缺损的效果.方法 将2006年1月至2011年4月收治的42例四肢创伤后低毒力感染性骨缺损患者分为A、B两组,A组20例患者病灶清除植入ARBM与含骨形态发生蛋白的骨诱导活性材料复合体,B组22例患者采用病灶清除在骨缺损邻近制备一个带蒂筋膜瓣,使其包裹复合体并充填骨缺损.两组患者一般资料比较差异均无统计学意义(P＞0.05),具有可比性.部分患者做组织学和细菌学检查,并比较两组患者术后3、6、12、18个月的血常规、血沉、超敏C反应蛋白、X线片量化评分及骨折愈合时间.结果 所有患者术后平均随访14.3个月.术后A组5例、B组1例患者原伤口有窦道形成且有炎性分泌物,术后10个月再次行病灶清除植入带蒂筋膜瓣包裹的ARBM复合体,随访12个月效果良好.两组其他患者伤口愈合好且无炎性窦道形成.A组5例患者原病变区骨断端之间仍有纤维结缔组织相连,骨髓腔未通,有炎性细胞浸润;B组6例患者组织学显示原筋膜瓣形成类似骨膜样纤维组织,新骨中散在少量软骨,骨髓腔再通,无炎性细胞浸润,细菌学检查阴性.阴组术后各时间点血常规、血沉、超敏C反应蛋白、X线量化评分及不同部位骨折愈合时间比较,B组明显优于A组,差异均有统计学意义(P＜0.05).结论 与植入ARBM复合体治疗低毒力感染性骨缺损比较,病灶清除植入带蒂筋膜瓣包裹ARBM复合体,抗感染的能力更强,在缩短骨缺损修复时间方面有显著优势.
目的 通過與病竈清除植入自體紅骨髓(ARBM)複閤體進行比較,探討病竈清除植入帶蒂觔膜瓣包裹ARBM複閤體治療四肢創傷後低毒力感染性骨缺損的效果.方法 將2006年1月至2011年4月收治的42例四肢創傷後低毒力感染性骨缺損患者分為A、B兩組,A組20例患者病竈清除植入ARBM與含骨形態髮生蛋白的骨誘導活性材料複閤體,B組22例患者採用病竈清除在骨缺損鄰近製備一箇帶蒂觔膜瓣,使其包裹複閤體併充填骨缺損.兩組患者一般資料比較差異均無統計學意義(P＞0.05),具有可比性.部分患者做組織學和細菌學檢查,併比較兩組患者術後3、6、12、18箇月的血常規、血沉、超敏C反應蛋白、X線片量化評分及骨摺愈閤時間.結果 所有患者術後平均隨訪14.3箇月.術後A組5例、B組1例患者原傷口有竇道形成且有炎性分泌物,術後10箇月再次行病竈清除植入帶蒂觔膜瓣包裹的ARBM複閤體,隨訪12箇月效果良好.兩組其他患者傷口愈閤好且無炎性竇道形成.A組5例患者原病變區骨斷耑之間仍有纖維結締組織相連,骨髓腔未通,有炎性細胞浸潤;B組6例患者組織學顯示原觔膜瓣形成類似骨膜樣纖維組織,新骨中散在少量軟骨,骨髓腔再通,無炎性細胞浸潤,細菌學檢查陰性.陰組術後各時間點血常規、血沉、超敏C反應蛋白、X線量化評分及不同部位骨摺愈閤時間比較,B組明顯優于A組,差異均有統計學意義(P＜0.05).結論 與植入ARBM複閤體治療低毒力感染性骨缺損比較,病竈清除植入帶蒂觔膜瓣包裹ARBM複閤體,抗感染的能力更彊,在縮短骨缺損脩複時間方麵有顯著優勢.
목적 통과여병조청제식입자체홍골수(ARBM)복합체진행비교,탐토병조청제식입대체근막판포과ARBM복합체치료사지창상후저독력감염성골결손적효과.방법 장2006년1월지2011년4월수치적42례사지창상후저독력감염성골결손환자분위A、B량조,A조20례환자병조청제식입ARBM여함골형태발생단백적골유도활성재료복합체,B조22례환자채용병조청제재골결손린근제비일개대체근막판,사기포과복합체병충전골결손.량조환자일반자료비교차이균무통계학의의(P＞0.05),구유가비성.부분환자주조직학화세균학검사,병비교량조환자술후3、6、12、18개월적혈상규、혈침、초민C반응단백、X선편양화평분급골절유합시간.결과 소유환자술후평균수방14.3개월.술후A조5례、B조1례환자원상구유두도형성차유염성분비물,술후10개월재차행병조청제식입대체근막판포과적ARBM복합체,수방12개월효과량호.량조기타환자상구유합호차무염성두도형성.A조5례환자원병변구골단단지간잉유섬유결체조직상련,골수강미통,유염성세포침윤;B조6례환자조직학현시원근막판형성유사골막양섬유조직,신골중산재소량연골,골수강재통,무염성세포침윤,세균학검사음성.음조술후각시간점혈상규、혈침、초민C반응단백、X선양화평분급불동부위골절유합시간비교,B조명현우우A조,차이균유통계학의의(P＜0.05).결론 여식입ARBM복합체치료저독력감염성골결손비교,병조청제식입대체근막판포과ARBM복합체,항감염적능력경강,재축단골결손수복시간방면유현저우세.
Objective To study the effect of implantation of bone composite with autologous red bone marrow (ARBM) and wrapped by a pedicle fascial flap following debridement of infection focus in the treatment of bone defect after limb wound with low toxicity infection in comparison with implantation of bone composite only with ARBM. Methods From January of 2006 to April of 2011,42 patients with limb wound with low toxicity infection were randomized into Group A and Group B.In Group A (20 cases),ARBM bone composite containing bone morphogenetic protein (BMP) and osteoinductive absorbing material (OAM) was implanted after debridenent of infection focus; in Group B (22 cases),a pedicle fascial flap was prepared close to the bone defect to wrap the same bone composite as used in Group A before it was implanted.The 2 groups were comparable in general clinical data ( P ≥ 0.05). Histological and bacteriological tests were conducted for necessary cases. Blood routine,blood sedimentation,C-reactive protein,X-ray evaluation and fracture healing time were compared between the 2 groups at the 3rd,6th,12th and 18th months postoperation. Results The 42 patients were followed up for 14.3 months on average. Inflammatory sinus tract and inflammatory secretion,occurring in 5 cases in Group A and one case in Group B,were treated secondarily 10 months postoperation by infection focus debridement before implantation of ARBM bone composite wrapped by a pedicle fascial flap.The follow-up at 12 months showed fine outcomes.The wounds healed well and there was no sinus tract in the other cases in the 2 groups.The histological examinations showed 5 cases in Group A had still fibrous connective tissue between the previous broken bone ends,an obstructed medullary canal and inflammatory cell infiltration while 6 cases in Group B had periosteum-like tissue forming from the previous pedicle fascial flap,a little cartilage scattered in the new bone,an unobstructed medullary cavity,no inflammatory cell infiltration,and negative results of bacterial examination.At all time points,Group B was significantly superior to Group A in terms of blood routine,blood sedimentation,C-reactive protein,X-ray quantization score of osteoanagenesis and bone healing time at different parts ( P ＜ 0.05 ). Conclusion Compared with simple ARBM bone composite for the treatment of bone defect after limb wound with low toxicity infection,ARBM bone composite wrapped by a pedicle fascial flap is more effective in anti-infection and in reducing the bone healing time as well after it is implanted in the cleared infection focus.
