CAJ | 학술논문

背景：关节周围骨折复位后常出现骨缺损，需进行植骨填充骨缺损以早期支撑关节面以防止关节面塌陷及移位。同种异体骨是治疗骨缺损的移植材料，但成骨能力差。自体红骨髓有成骨能力，但同种异体骨复合自体红骨髓移植治疗关节周围骨折的临床效果有待评定。 　　目的：采用锁定板固定、同种异体骨复合自体红骨髓移植治疗关节周围骨折的临床效果。 　　方法：纳入河北医科大学第三医院骨伤科治疗关节周围骨折患者43例。采用切开解剖复位关节面、将红骨髓与同种异体骨颗粒复合体植于骨缺损处，植骨完成后常规解剖锁定板内固定。胫骨平台骨折采用内侧、外侧或双侧锁定板固定。桡骨远端骨折采用背侧或掌侧锁定板固定，胫骨远端骨折采用胫骨远端内侧或外侧板锁定内固定。 　　结果与结论：患者43例共随访12个月至6年，平均4.3年。X射线片及CT复查结果显示，43例患者达骨性愈合，塌陷骨折复位良好。其中新鲜骨折愈合时间2-6个月，平均4个月；陈旧骨折愈合时间3-7个月，平均5.5个月。植骨后43例患者无明显免疫排斥反应，2例患者切口渗液较多，经换药2周愈合。切口感染患者1例，经引流换药4周伤口愈合，随访4年1个月至今感染未复发。根据 Mankin 和Komender标准评定，同种骨移植满意患者40例，占93%；不满意患者3例，占7%。结果证实，在锁定板支撑固定下，异体松质骨与自体红骨髓复合体移植治疗周围关节骨折可以起到近期支撑作用，防止关节面塌陷及骨折移位，并为关节周围骨折骨缺损提供骨重建材料，远期可以达到骨折愈合的目的。
배경：관절주위골절복위후상출현골결손，수진행식골전충골결손이조기지탱관절면이방지관절면탑함급이위。동충이체골시치료골결손적이식재료，단성골능력차。자체홍골수유성골능력，단동충이체골복합자체홍골수이식치료관절주위골절적림상효과유대평정。 　　목적：채용쇄정판고정、동충이체골복합자체홍골수이식치료관절주위골절적림상효과。 　　방법：납입하북의과대학제삼의원골상과치료관절주위골절환자43례。채용절개해부복위관절면、장홍골수여동충이체골과립복합체식우골결손처，식골완성후상규해부쇄정판내고정。경골평태골절채용내측、외측혹쌍측쇄정판고정。뇨골원단골절채용배측혹장측쇄정판고정，경골원단골절채용경골원단내측혹외측판쇄정내고정。 　　결과여결론：환자43례공수방12개월지6년，평균4.3년。X사선편급CT복사결과현시，43례환자체골성유합，탑함골절복위량호。기중신선골절유합시간2-6개월，평균4개월；진구골절유합시간3-7개월，평균5.5개월。식골후43례환자무명현면역배척반응，2례환자절구삼액교다，경환약2주유합。절구감염환자1례，경인류환약4주상구유합，수방4년1개월지금감염미복발。근거 Mankin 화Komender표준평정，동충골이식만의환자40례，점93%；불만의환자3례，점7%。결과증실，재쇄정판지탱고정하，이체송질골여자체홍골수복합체이식치료주위관절골절가이기도근기지탱작용，방지관절면탑함급골절이위，병위관절주위골절골결손제공골중건재료，원기가이체도골절유합적목적。
BACKGROUND:Bone defects often occur after the reduction of periarticuar fractures, and bone grafting is required to fil bone defects, thereby to make the early support of articular surface and prevent the col apse and shift of the articular surface. Al ograft cancellous bone is the transplant material for the treatment of bone defects, but its osteogenesis ability is poor. Autologous red marrow has osteogenesis ability. Therapeutic efficiency of al ograft cancellous bone combined with autologous red marrow for periarticular fractures is stil yet to be assessed. OBJECTIVE:To study clinical effect of locking plate fixation and al ograft cancellous bone combined with autologous red marrow in the treatment of periarticular fractures. METHODS:Forty-three cases of periarticular fractures were incorporated into the Orthopaedics Department of the Third Hospital of Hebei Medical University. After cutting the articular surface anatomical y, composite particles of the red marrow and al ograft cancellous bone were implanted into bone defects, and then, an anatomic locking plate was used. Medial lateral or bilateral locking plate was used for tibial plateau fractures. Dorsal or volar locking plate was used for distal radius fractures, and distal tibial medial or lateral locking plate was used for distal tibial fractures. RESULTS AND CONCLUSION:Forty-three patients were fol owed up for 12 months to 6 years, an average of 4.3 years. X-ray films and CT scans review showed that 43 patients’ col apse fracture al reached bony union. Fresh fracture healing time was 2-6 months, an average of 4 months;the healing time for old fracture was 3-7 months, an average of 5.5 months. After bone grafting, 43 patients al had no significant immune rejection, two cases showed more wound exudates, and the wound was healed by dressing after 2 weeks. One case had wound infection, the wound was healed after 4 weeks of draining and dressing, and the infection had no recurrence fol owing up for 4 years and 1 month. Forty patients were satisfied with bone grafting, accounting for 93%, and three cases dissatisfied, accounting for 7%, based on Mankin and Komender’s standard assessment. The results confirmed that al ograft cancellous bone combined with autologous red marrow transplantation can play a supporting role in treating periarticular fractures to prevent the col apse of the articular surface and fracture displacement, and to provide reconstruction materials for periarticular defects. Its long-term goal is fracture healing.