体外冲击波联合扩髓骨泥回植对股骨干骨折骨不连的影响
체외충격파연합확수골니회식대고골간골절골불련적영향
The effects of extracorporeal shock wave treatment combined with expanding bone marrow autografts in the treatment of nonunion of femoral shaft fractures with interlocking intramedullary nails
  • 万方数据
    中华物理医学与康复杂志 중화물리의학여강복잡지
    CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
    2013年 2期 134-137 ,共4页

    孙英华%陈连旭%李冰%焦兆德

    손영화%진련욱%리빙%초조덕

    体外冲击波%骨泥植骨%髓内钉%股骨骨折%骨不连 體外遲擊波%骨泥植骨%髓內釘%股骨骨摺%骨不連
    체외충격파%골니식골%수내정%고골골절%골불련
    Extracorporeal shock waves%Bone marrow autografts%Intramedullary nails%Femoral fractures
    目的 观察体外冲击波(ESW)联合扩髓骨泥回植对股骨干骨折骨不连的影响.方法 选取股骨干骨折骨不连患者30例,按随机数字表法将其分为ESW组、扩髓骨泥组和联合治疗组,每组10例.ESW组丢弃扩髓骨泥,于交锁髓内钉固定术后14 d开始行ESW治疗,扩髓骨泥组则在交锁髓内钉固定术中将扩髓骨泥回植于骨折断端,联合治疗组在扩髓骨泥回植基础上辅以ESW治疗.交锁髓内钉固定术后第4、8、12和16周,采用X线对3组患者的骨痂及骨折线愈合情况进行评定.结果 术后第4周,联合治疗组、扩髓骨泥组骨痂及骨折线评分分别为[(1.55±0.52)分和(1.25±1.03)分、(1.50±0.71)分和(1.20±1.01)分],显著高于ESW组骨痂及骨折线评分[(1.11±0.32)分和(0.21±0.63)分,P＜0.05]；术后第8周,联合治疗组骨痂及骨折线评分增高至[(3.01 ±0.22)分和(4.00±1.46)分,P＜0.05],显著高于ESW组和扩髓骨泥组的骨痂及骨折线评分[(2.01 ±0.67)分和(2.03±1.33)分、(2.10±0.57)分和(2.40±1.14)分,P＜0.05]；术后第12和16周,ESW组骨痂及骨折线评分分别为[(3.99±0.67)分和(5.81 ±1.33)分、(4.85±0.57)分和(8.50±1.03)分],扩髓骨泥组骨痂及骨折线评分分别为[(3.10±0.63)分和(3.51±1.26)分、(4.05±0.63)分和(6.30±1.26)分],联合治疗组骨痂及骨折线评分分别为[(4.95±0.24)分和(8.02±1.48)分、(5.75±0.24)分和(10.90±1.05)分],3组患者骨痂及骨折线评分均较前逐渐增高(P＜0.05),同时间点比较后发现,联合治疗组评分显著高于ESW组和扩髓骨泥组,且ESW组评分高于扩髓骨泥组,差异均具有统计学意义(P＜0.05).术后第16周,ESW组、扩髓骨泥组及联合治疗组的治疗有效率分别为60.0％、50.0％和100.0％,联合治疗组疗效优于ESW组和扩髓骨泥组(P＜0.05),ESW组与扩髓骨泥组疗效差异无统计学意义(P＞0.05).结论 ESW联合扩髓骨泥回植对股骨干骨折骨不连具有积极的治疗意义,可更好地促进其愈合.
    목적 관찰체외충격파(ESW)연합확수골니회식대고골간골절골불련적영향.방법 선취고골간골절골불련환자30례,안수궤수자표법장기분위ESW조、확수골니조화연합치료조,매조10례.ESW조주기확수골니,우교쇄수내정고정술후14 d개시행ESW치료,확수골니조칙재교쇄수내정고정술중장확수골니회식우골절단단,연합치료조재확수골니회식기출상보이ESW치료.교쇄수내정고정술후제4、8、12화16주,채용X선대3조환자적골가급골절선유합정황진행평정.결과 술후제4주,연합치료조、확수골니조골가급골절선평분분별위[(1.55±0.52)분화(1.25±1.03)분、(1.50±0.71)분화(1.20±1.01)분],현저고우ESW조골가급골절선평분[(1.11±0.32)분화(0.21±0.63)분,P＜0.05]；술후제8주,연합치료조골가급골절선평분증고지[(3.01 ±0.22)분화(4.00±1.46)분,P＜0.05],현저고우ESW조화확수골니조적골가급골절선평분[(2.01 ±0.67)분화(2.03±1.33)분、(2.10±0.57)분화(2.40±1.14)분,P＜0.05]；술후제12화16주,ESW조골가급골절선평분분별위[(3.99±0.67)분화(5.81 ±1.33)분、(4.85±0.57)분화(8.50±1.03)분],확수골니조골가급골절선평분분별위[(3.10±0.63)분화(3.51±1.26)분、(4.05±0.63)분화(6.30±1.26)분],연합치료조골가급골절선평분분별위[(4.95±0.24)분화(8.02±1.48)분、(5.75±0.24)분화(10.90±1.05)분],3조환자골가급골절선평분균교전축점증고(P＜0.05),동시간점비교후발현,연합치료조평분현저고우ESW조화확수골니조,차ESW조평분고우확수골니조,차이균구유통계학의의(P＜0.05).술후제16주,ESW조、확수골니조급연합치료조적치료유효솔분별위60.0％、50.0％화100.0％,연합치료조료효우우ESW조화확수골니조(P＜0.05),ESW조여확수골니조료효차이무통계학의의(P＞0.05).결론 ESW연합확수골니회식대고골간골절골불련구유적겁적치료의의,가경호지촉진기유합.
    Objective To investigate the effect of extracorporeal shock waves (ESWs) combined with expanding bone marrow autografts in treating nonunion of femoral shaft fractures with interlocking intramedullary nails.Methods Thirty patients with femoral shaft fractures which had not united were divided into an ESW group,an expanding bone marrow group,and a combined treatment group using a table of random numbers.Each group had 10 cases.In the ESW group,no expanding bone marrow was employed in fixing the intramedullary nails and ESW therapy was begun at day 14 after the operation.In the expanding bone marrow group,bone marrow was grafted around the broken ends of fractured bones.In the combined treatment group patients underwent both treatments.The conditions of the callus and the fracture lines in the 3 groups were separately evaluated using X-rays at the 4th,8th,12th and 16th week after the operation.Results At week 4,the average callus and fracture line scores in the combined treatment and expanding bone marrow groups were significantly better than those in the ESW group.At the 8th week after the operation,the average callus and fracture line scores in the combined treatment group were significantly higher than in the ESW group and expanding bone marrow groups.Later,the callus and fracture scores in all 3 groups continued to rise significantly.At the 12th and 16th week the scores in the combined treatment group were significantly better than those in the ESW group and the expanding bone marrow group,while the scores in the ESW group were significantly better than those in the expanding bone marrow group.The cure rates in the ESW,bone marrow and combined treatment groups were 60％,50％ and 100％ respectively at week 16.Conclusions The combined treatment was significantly more effective than either treatment alone.There was no significant difference in effectiveness between the ESW and expanding bone marrow treatments.ESW combined with expanding bone marrow autograft is an effective way to promote bone knitting in the treatment of nonunion of femoral shaft fractures with interlocking intramedullary nails.
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