长骨不连断端成骨能力区域划分研究

目的：分析骨不连断端区域划分的合理性及临床意义，并探讨通过区域划分植骨的方法及要点。方法：回顾性分析2011年5月，2013年10月采用锁定钢板桥接技术内固定的48例骨不连患者资料，男35例，女13例；年龄13～62岁，平均40．5岁。骨不连部位：肱骨干骨不连4例，胫腓骨骨不连15例，股骨干骨不连26例，尺骨骨不连1例，桡骨骨不连1例，锁骨骨不连1例。骨不连分型：萎缩型15例，缺血型28例，假关节型5例。入院前固定方式：钢板固定31例（断裂20例），髓内钉固定10例，外固定支架7例。术中将骨不连断端假设分为成骨失活区（瘢痕组织、硬化死骨组织）及成骨活跃区（正常骨痂形成组织），植骨范围完全跨越成骨失活区，桥接成骨活跃区。术后比较成骨细胞及成纤维细胞数量，观察细胞结构、局部血管情况等，统计骨愈合时间及并发症发生率。结果：所有患者术后获6～24个月（平均12．8个月）随访；47例骨不连患者在4-8个月（平均5．4个月）愈合。1例股骨干骨不连患者术后6个月出现钢板断裂。所有患者均无感染、畸形、双下肢不等长、取骨区疼痛等并发症发生。病理结果提示：正常骨痂组织中的成骨细胞数量、骨细胞活性、血管组织数量明显大于瘢痕组织及硬化死骨组织。结论：成骨活跃区与成骨失活区之间存在明显的成骨能力差异。自体骨植骨块完全跨越成骨失活区，最大程度发挥植骨块的成骨效应，达到治愈骨不连的目的。

How to divide the area of ossification capability on the broken ends of bone non-union

Objective： To analyze the rationality and clinical significance of dividatur on broken ends of bone non-union, and explore the methods and main points of bone graft. Methods： The data of 48 nonunion patients （35 male and 13 female, 13~62 years） was analyzed retrospectively between May 2011 and October 2013. Location of nonunion： shaft of humerus 4, tibiofibula 15, shaft of femur 26, ulna 1, radi- al bone 1. Typing of nonunion： analosis 15, ischemia 28, pseudarthrosis 5. The nonunion area was intranp- eratively divided into inactive region （scar tissue, sclerified dead bone） and active region （normal porosis）, the range of bone graft strided over the inactive area totally and connected those two active area. The quan- tity of osteoplasts and desmocyte, cellular structure, newborn vessels, healing time and complications were analyzed postoperatively. Results： All eases were followed-up for 6-24 months, 47 cases obtained a bony u- nion in 4~8 months, plates were broken in 1 case at 6 months after operation. No complications, such as infection, deformity, deformity, inequality of lower limb or donor site pain, happed in all patients. Pathology result showed that the quantity of osteoplast and vascular tissue, as well as osteocyte activity in active re- gion were obviously higher than those in inactive region. Conclusion： There was an obvious difference in the bone formation capability between active and inactive regions. Autologous bone graft completely spanning inactive area can maximatily exert the conduction and osteoinductive, and get to the purpose of nonunion healing in the end.