中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (12): 1766-1771.doi: 10.3969/j.issn.2095-4344.2016.12.014

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials • 上一篇    下一篇

同种异体骨移植强化高危人群肱骨近端骨折内固定的疗效观察

苏志辉1，鲁厚根2，刘 军2，邹立学2，胡 伟1   

  1. 1长江大学，湖北省荆州市 434023；2荆州市中心医院骨科一病区，湖北省荆州市 434020
  • 收稿日期:2016-01-26 出版日期:2016-03-18 发布日期:2016-03-18
  • 通讯作者: 鲁厚根，主任医师，硕士生导师，荆州市中心医院骨科一病区，湖北省荆州市 434020
  • 作者简介:苏志辉，男，1988年生，长江大学在读硕士，主要从事关节与创伤研究。

Allogeneic bone grafting strengthens the internal fixation of proximal humeral fractures in high-risk groups

Su Zhi-hui1, Lu Hou-gen2, Liu Jun2, Zou Li-xue2, Hu Wei1   

  1. 1Yangtze University, Jingzhou 434023, Hubei Province, China; 2First Ward, Department of Orthopedics, Jingzhou Central Hospital, Jingzhou 434020, Hubei Province, China
  • Received:2016-01-26 Online:2016-03-18 Published:2016-03-18
  • Contact: Lu Hou-gen, Chief physician, Master’s supervisor, First Ward, Department of Orthopedics, Jingzhou Central Hospital, Jingzhou 434020, Hubei Province, China
  • About author:Su Zhi-hui, Studying for master’s degree, Yangtze University, Jingzhou 434023, Hubei Province, China

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摘要：

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文题释义：

同种异体骨：作为取自同物种的骨组织, 具有来源丰富不受形态大小限制，且具有一定生物活性等优点。同种异体骨采集来源主要有截肢的骨组织;胸部手术中切除的肋骨和新鲜尸体骨骼等,保存方法国内外骨库应用最多的是深低温冷冻法(深冻法) 和冷冻干燥法(冻干法)。
骨折内固定：是指用金属螺钉、钢板、髓内针、钢丝或骨板等物直接在断骨内或外面将断骨连接固定起来，这种手术多用于骨折切开复位术及切骨术，以保持折端的复位。内固定术的主要优点是可以较好地保持骨折的解剖复位，比单纯外固定直接而有效，特别在防止骨折端的剪式或旋转性活动方面更为有效。

 

背景：大量研究对同种异体骨移植和人工肱骨头置换治疗肱骨近端骨折的临床效果进行了评价，但关于二者的对比性研究报道却非常有限。
目的：分析同种异体骨移植强化高危人群肱骨近端骨折内固定的效果。
方法：回顾性分析120例年龄≥60岁肱骨近端骨折患者的临床资料，其中60例采用同种异体骨移植联合锁定钢板固定治疗，作为试验组；60例采用半肩关节置换治疗，作为对照组。治疗后随访8-24个月，观察骨折愈合、颈干角、肱骨头高度及肩关节功能恢复情况。
结果与结论：随访8-24个月，所有患者肱骨近端骨折均愈合，愈合时间18-24周，未发生植入物排斥反应，无大小结节、肱骨头移位、螺钉松动及坏死。试验组末次随访时的肱骨头高度丢失、治疗后12周的主动前屈上举角度高于对照组(P < 0.05)，前臂、肩、手功能障碍评分低于对照组(P < 0.05)，两组颈干角、SF-36量表评分比较差异无显著性意义。结果表明同种异体骨移植强化高危人群肱骨近端骨折内固定效果，可显著改善上肢功能。 
ORCID: 0000-0001-7682-2076(鲁厚根)

关键词: 生物材料, 骨生物材料, 同种异体骨, 人工肱骨头置换, 肱骨近端骨折, 高危人群

Abstract:

BACKGROUND: Numerous studies have focused on the clinical efficacy of allogeneic bone graft and humeral head replacement for the treatment of proximal humeral fractures, but their comparative studies are rarely reported.
OBJECTIVE: To investigate the effect of allogeneic bone grafting in the treatment of proximal humeral fractures in the high risk group.
METHODS: Clinical data of 120 cases of proximal humeral fractures aged ≥ 60 years were retrospectively analyzed. Sixty of the 120 cases underwent allogeneic bone grafting combined with locking plate fixation as experimental group, and the other 60 cases were subjected to semi-shoulder joint replacement as control group. All patients were followed up for 8-24 months. Fracture healing, collodiaphyseal angle, humeral head height and shoulder joint function were observed and measured.
RESULTS AND CONCLUSION: During the postoperative 8-24 months, all the fractures were healed by first intention, and there were no rejection reactions, large/small nodules, humeral head displacement, necrosis, and screw loosening. Loss of the humeral head height at the last follow-up and the active flexion angle of the shoulder at postoperative 12 weeks were significantly higher in the experimental group than the control group (P < 0.05). Scores on forearm, shoulder and hand dysfunction were significantly lower in the experimental group than the control group (P < 0.05). However, no significant difference was observed in the collodiaphyseal angle and SF-36 scores between the two groups. These finding indicate that allogeneic bone grafting can strength the internal fixation of proximal humeral fractures in the high-risk group, and improve patient’s upper limb function.