注射型人工骨经皮穿刺微创治疗长骨干骨不连的初步研究

摘要

目的：探讨注射型人工骨经皮穿刺微创治疗长骨干骨不连的疗效。方法将2011年1月至2014年6月广州医科大学附属第一医院收治的符合研究标准的36例长骨干骨不连患者随机分为观察组（经皮穿刺注射型人工骨注射植骨，18例）和对照组（常规自体髂骨开放式植骨，18例）。比较两组手术时间、术中出血量、住院时间、视觉模拟量表（VAS）评分、骨折愈合情况及Johner-Wruhs疗效评定结果等方面的差异。结果术后36例患者获得6～18个月随访，平均随访时间为10.6个月。观察组和对照组手术时间、术中出血量、住院时间、术后1 d VAS评分分别为（38±10）min和（89±14）min、（6±3）mL和（34±12）mL、（5±3）d和（13±3）d、（2.3±1.4）分和（5.6±1.8）分，观察组上述指标均优于对照组，两组比较，差异有统计学意义（P ＜0.05）。按Johner-Wruhs疗效评定标准，对照组优16例、良2例，植骨端全部骨性愈合；观察组优13例、良3例、差2例，除2例愈合情况为差的患者另行切开植骨外，其余均获得稳定骨性愈合。两组Johner-Wruhs功能分级优良率比较，差异无统计学意义（P＞0.05）。结论注射型人工骨经皮穿刺微创治疗长骨干骨不连具有手术时间短、创伤小、恢复快、疼痛症状改善明显等优点。%Objective To investigate the clinical effects of percutaneous minimally invasive treatment of nonunion in long bone shaft using injectable artificial bone. Methods Thirty-six patients with long bone shaft nonunion treated in the First Affiliated Hospital of Guangzhou Medical University from January 2011 to June 2014 were included, which was randomly divided into observation group ( percutaneous injectable artificial bone graft, n = 18) and control group (autogenous iliac bone graft, n = 18). The differences of the operation time, intraoperative estimate blood loss, length of hospital stay, visual analogue scale (VAS) score, bone healing rate, and Johner-Wruhs therapeutic effect rating results were compared between two groups. Results All patients were followed up for 6 to 18 months (average, 10.6 months). The operation time, intraoperative estimate blood loss, length of hospital stay and VAS score 1 d after the operation in observation group and control group were (38 ± 10) and (89 ± 14) min, (6 ± 3) and (34 ± 12) mL, (5 ± 3) and (13 ± 3) d, 2.3 ± 1.4 and 5.6 ± 1.8 respectively, these indicators in observation group were better than those in control group (P <0.05). According to the Johner-Wruhs standard, there were excellent in 16 cases and good in 2 cases in observation group, with bony healing in all patients; While in control group, there were excellent in 13 cases, good in 3 and poor in 2, bony healing was obtained in 16 patients, the other 2 patients who were poor conditions needed to perform another open bone grafting. There was no statistical difference of excellent and good rate between two groups (P >0.05). Conclusion Percutaneous minimally invasive treatment of long bone shaft nonunion using injectable artificial bone has the advantages of short operation time, less injury, quick recovery and good pain symptom improvement.