CAJ | 학술논문

目的利用临床骨缺损自体植骨愈合病例,探讨监测骨密度(BMD)评估骨愈合质量的可行性.方法选取自2011年7月至2012年6月收治的骨缺损自体植骨患者21例,男16例,女5例;年龄17 ～68岁,平均29.6岁;病程为2.5～ 120.0个月,平均45.4个月.所有患者均采取清创+自体髂骨颗粒植骨+外固定支架固定获得治愈.术后第4、6、8、10个月对所有患肢行正、侧位X线片检查及Enneking肢体功能评分评价,对骨缺损植骨区的骨痂及健侧对照区行BMD检测.结果随着时间推移,缺损区骨痂X线表现逐步改善.术后第4、6、8、10个月的患肢Enneking评分、患肢肢体功能百分比、患侧BMD及患侧与健侧BMD比值两两时间点比较,差异均有统计学意义(P＜0.05);第10个月时肢体功能接近正常水平,肢体功能百分比为95.4％±5.9％.术后第4、6、8个月患侧BMD与健侧比较,差异均有统计学意义(P＜0.05);第10个月患侧BMD与健侧比较,差异无统计学意义(t=1.605,P=0.128),此时BMD比值平均为96.7％±5.1％.随着BMD比值的增长,患肢功能也在逐渐恢复正常,两者呈高度正相关(r=0.918,P＜0.001).结论通过监测BMD可以评估临床骨缺损愈合情况,缺损区BMD达到健侧的96.7％±5.1％范围或以上,肢体功能百分比达到95.4％±5.9％范围或以上时,新生骨组织生物力学强度基本可满足肢体生理负重要求,推荐完全负重.
목적 이용림상골결손자체식골유합병례,탐토감측골밀도(BMD)평고골유합질량적가행성.방법 선취자2011년7월지2012년6월수치적골결손자체식골환자21례,남16례,녀5례;년령17 ～68세,평균29.6세;병정위2.5～ 120.0개월,평균45.4개월.소유환자균채취청창+자체가골과립식골+외고정지가고정획득치유.술후제4、6、8、10개월대소유환지행정、측위X선편검사급Enneking지체공능평분평개,대골결손식골구적골가급건측대조구행BMD검측.결과 수착시간추이,결손구골가X선표현축보개선.술후제4、6、8、10개월적환지Enneking평분、환지지체공능백분비、환측BMD급환측여건측BMD비치량량시간점비교,차이균유통계학의의(P＜0.05);제10개월시지체공능접근정상수평,지체공능백분비위95.4％±5.9％.술후제4、6、8개월환측BMD여건측비교,차이균유통계학의의(P＜0.05);제10개월환측BMD여건측비교,차이무통계학의의(t=1.605,P=0.128),차시BMD비치평균위96.7％±5.1％.수착BMD비치적증장,환지공능야재축점회복정상,량자정고도정상관(r=0.918,P＜0.001).결론 통과감측BMD가이평고림상골결손유합정황,결손구BMD체도건측적96.7％±5.1％범위혹이상,지체공능백분비체도95.4％±5.9％범위혹이상시,신생골조직생물역학강도기본가만족지체생리부중요구,추천완전부중.
Objective To study whether bone mineral density (BMD) can be used to evaluate the callus growth and fracture healing in treatment of bone defects with autoallergic bone graft.Methods We enrolled for this study 21 patients with large cortical bone defects who had undergone autoallergic bone graft from July 2011 through June 2012 in our department.They were 16 men and 5 women,aged from 17 to 68 years (average,29.6 years).Their disease courses ranged from 2.5 to 120.0 months (45.4 months).All the patients were cured by debridement plus autoallergic iliac particle graft plus external fixation.At 4,6,8 and 10 months postoperation,X-ray examinations and Enneking evaluations of limb function were performed for all the limbs affected,and BMD examinations of bone callus were conducted at both graft and contralateral areas.Results X-ray manifestations showed the bone callus at the bone defect areas improved gradually with time.The Enneking scores,percentages of functional recovery and BMDs of the limbs affected,and the BMD ratio between the affected and healthy limbs at 4,6,8 and 10 months postoperation were significantly different between one another (P ＜ 0.05).At 10 months postoperation,limb functions recovered almost to the normal,reaching a percentage of 95.4％ ± 5.9％.There were significant differences between affected and healthy limbs regarding BMD at 4,6 and 8 months postoperation (P ＜ 0.05),but there was no significant difference between affected and healthy limbs in BMD at 10 months postoperation (t =1.605,P =0.128).The BMD ratio of affected limbs reached 96.7％ ± 5.1％.The BMD ratio of affected limbs increased with the functional recovery of affected limbs,showing a positive correlation (r =0.918,P ＜ 0.001).Conclusions BMD measurement is effective for evaluation of callus growth and fracture healing.When the BMD ratio reaches 96.7％ ±5.1％ or above and the percentage of functional recovery 95.4％ ±5.9％ or above,the biomechanical strength of new bone can ensure physical load-bearing of the limbs.