脱钙骨基质治疗长骨骨折延迟愈合及骨不连的远期临床观察

目的 探讨脱钙骨基质治疗长骨骨折延迟愈合和骨不连的远期疗效。方法 从1984年至1994年用脱钙骨基质治疗长骨骨延迟愈合、骨不连共96例，其中采用手术植入治疗骨不连38例，经皮注射治疗骨折延迟愈合37例及骨不连21例。结果 96例患者均获随访，随访时间4-16年，平均7．5年。脱钙骨注射治疗骨折延迟愈合的37例中，骨折愈合35例，2例胚骨骨折未愈合，愈合率94．6％；脱钙骨注射治疗骨折骨不连21例中，骨折愈合17例，4例未发生愈合，其中胫骨3例、肱骨1例，愈合率81．0％，愈合时间3-8个月，平均4．5个月。脱钙骨基质移植治疗骨不连38例中，36例愈合，2例胫骨下1／3骨折未发生愈合，愈合率94．7％。结论 脱钙骨基质无论是采用注射移植还是手术方法移植，都能取得较好的效果，甚至达到自体骨移植的疗效。同时，脱钙骨基质的制备经过脱水、脱脂、脱钙、照射消毒等处理，比其他骨移植安全，免疫性小，可以长期保存，便于平时和战时应用。

Long-term clinical observation on treatment of delayed union and nonunion of long bone fractures by using decalcification bone matrix

Objective To explore remote effect of decalcification bone matrix (DBM) in treatment of delayed union and nonunion of long bone fractures. Methods From 1986, 96 cases of delayed union and nonunion of long bone fractures were treated with DBM. Of all, 38 cases of nonunion of long bone were treated with surgical implantation, 37 delayed union and 21 nonunion with percutaneous injection. Results All 96 cases were followed up for 4-16 years (average 7.5 years). Of 37 cases of delayed union treated with percutaneous injection, 35 attained bone union but 2 resulted in nonunion of tibial fractures with a union rate of 94.6%. Of 21 cases of bone nonunion treated with percutaneous injection, 17 got bone union but 4 did nonunion (3 tibial nonunion and 1 humeral nonunion) with a union rate of 80.1% and union time for 3-8 months (average 4.5 months). Of 38 cases treated with implantation of DBM, 36 had bone union but 2 nonunion at 1/3 inferior to the tibia with a union rate of 94.7%. Conclusions Either percutaneous injection or surgical implantation of DBM can attain satisfactory effect even to autograft. After prepared by dehydration, degrease, decalcification and irradiation disinfection, DBM is characterized by safer transplantation and less immunity than other bone transplantations and can be preserved for a long time so as to be applied both in the peacetime and the wartime.