自体骨髓复合人工骨联合髂骨骨膜移植治疗四肢难治性骨不连

目的评价自体骨髓复合人工骨联合髂骨骨膜移植治疗四肢难治性骨不连的初步临床疗效。方法2004年1月-2006年7月，收治难治性四肢长骨骨不连12例13肢，取自体骨髓复合人工骨联合髂骨骨膜移植治疗。其中男8例，女4例；年龄17～58岁。骨不连部位：胫骨中、下段7肢，股骨中、下段3肢，尺桡骨1肢，肱骨中段2肢。曾接受治疗骨不连手术次数1～4次，平均2．5次。骨折至本次治疗时间13个月～9年，平均47．6个月。术前摄X线片示骨不连骨断端距离6～30mm，平均15mm。采用内固定11肢，其中交锁髓内钉10肢，限制性接触．动力加压钢板1肢；支架外固定2肢。术后第1天及1、3、6、9、12个月摄x线片，观察骨折愈合情况。结果术后供受区愈合良好。患者均获随访，随访时间12～26个月，平均17，5个月。骨折愈合时间4～7个月，平均6个月。x线片示13肢均骨折愈合，无旋转、成角及短缩畸形。6肢因关节僵硬、瘢痕挛缩等，骨折愈合后遗留功能障碍。结论自体骨髓复合人工骨联合髂骨骨膜移植治疗四肢难治性骨不连效果满意。

AUTOLOGOUS BONE MARROW INTEGRATING ARTIFICIAL BONE AND ILIUM PERIOSTEUM TRANSPLANTATION FOR TREATMENT OF BONE NONUNION

OBJECTIVE: To evaluate the initial clinical effect of the autologous bone marrow integrating artificial bone and ilium periosteum transplantation in treatment of problematic nonunion. METHODS: From January 2004 to July 2006, 12 patients (13 limbs)with problematic nonunion were treated with autologous bone marrow integrating artificial bone and ilium periosteum. There were 8 males and 4 females, aged 17-58 years old. The position of nonunion were the tibia in 7 limbs, the femur in 3 limbs, the humerus in 2 limbs. The operated number was 1-4, mean 2.5. The time from injury to therapy was 13 months to 9 years, mean 47.6 months. The bone defect distance was 6-30 mm (mean 15 mm) through 1 : 1 X-rays before operation. Eleven limbs were treated by internal fixation (10 limbs by the bone nail and 1 limb by the limited contact-dynamic compression plate), 2 limbs were treated by the external fixation. The X-ray films were taken at 1 day, 1, 3, 6, 9, 12 months after operation to observe fracture union. RESULTS: All patients were followed up for 12-26 months (mean 17.5 months) and achieved union within 4-7 months (mean 6 months). No deformity of rotation, angulation and crispation occurred in 13 limbs, but functional impairment occurred in 6 limbs after union of fracture. CONCLUSION: Autologous bone marrow integrating artificial bone and ilium periosteum transplantation for treatment of problematic nonunion has the satisfactory result.