可注射型人工骨与异体松质骨治疗骨质疏松性胫骨平台Schatzker Ⅱ型骨折的植骨效果比较

目的比较可注射型人工骨与异体松质骨治疗骨质疏松性胫骨平台Schatzker Ⅱ型骨折的植骨效果。方法2015年8月至2017年3月解放军第180医院骨科共收治43例骨质疏松性胫骨平台Schatzker Ⅱ型骨折患者。所有病人随机分为两组,其中治疗组17例,应用Genex-S慢凝型可注射型人工骨进行胫骨平台关节面下注射植骨;对照组26例,应用异体松质骨关节面下填压植骨。分别在术后1周内、术后3个月、术后6个月与术后12个月进行膝关节正侧位X线片及植骨区域骨密度检查,记录胫骨外髁关节面塌陷高度、膝关节外侧间隙高度、外侧间隙角、植骨区域骨密度。结果治疗组术后12个月胫骨外髁关节面总体塌陷高度(1.8 mm±0.7 mm)、外侧间隙总体丢失高度(0.20 mm±0.10 mm)与外侧间隙角总体增加角度(4.62°±0.41°)均小于对照组(8.4 mm±1.7 mm,0.20 mm±0.10 mm,4.62°±0.41°),差异有统计学意义(P0.01)。治疗组各时间点植骨区域骨密度T值均高于对照组,差异均有统计学意义(P0.01)。结论在骨质疏松性胫骨平台Schatkzer Ⅱ型骨折的治疗中,可注射型人工骨的植骨强度与稳定性优于异体松质骨,可能是一种适用于骨质疏松性骨折支撑植骨的良好生物填充材料。

Comparison of bone grafting effect in Schatzker II osteoporotic tibial plateau fractures between injectable artificial bone and allograft bone

Objective To compare the effect of bone graft in osteoporotic tibial plateau fractures with type II according Schatzker classfication between injectable artificial bone and allograft bone. Methods Between Aug 2015 and Mar 2017, 43 patients of osteoporotic tibial plateau fractures with type II underwent open reduction and internal fixation with bone grafting. All patients were divided into two groups, there were 17 cases in treatment group underwent Genex-S injectable artificial bone grafting, and 26 cases in control group underwent allograft bone grafting. Knee posteroanterior and lateral X-ray and bone density test were obtained at first week, 3 months, 6 months and 12 months postoperation, and sink height of lateral articular facet of tibial plateau, height of lateral knee space, angle of lateral knee space and bone density of grafting area were recorded. Results There was significant difference in sink height of lateral articular facet of tibial plateau, height of lateral knee space and angle of lateral knee space between treatment group (1.8 mm±0.7 mm, 0.20 mm±0.10 mm and 4.62°±0.41°) and control group (8.4 mm±1.7 mm, 0.94 mm±0.31 mm and 11.85°±0.60°) 12 months postoperatively(P<0.01). There was significant difference in bone density T score at postoperation, 3 months, 6 months and 12 months postoperatively between treatment group and control group (P<0.01). Conclusion The intension and stability of injectable artificial bone is better than allograft bone in osteoporotic tibial plateau fractures with type II according Schatzer classfication. The injectable artificial bone probably apply to prop graft in osteoporotic fractures.