自体骨髓移植在Pilon骨折植骨中应用.docVIP

自体骨髓移植在Pilon骨折植骨中应用【摘要】目的：采用外固定架支撑，同种异体骨联合自体骨髓移植治疗Ⅲ型Pilon骨折，并对其临床疗效进行评价。方法：自2005年2月～2008年3月采用超关节“T”形外固定支架固定、自体骨髓联合同种异体骨植骨治疗Ⅲ型Pilon骨折共17例， 男14例，女3例。年龄24～ 59 岁，平均36.1 岁。致伤原因：坠落伤13 例， 交通事故伤4 例。17例均为闭合性III型Pilon骨折， 合并腓骨骨折。结果：17例获随访12～ 24 个月， 平均18.7个月。术后切口I期愈合13例，小面积浅表皮肤坏死致切口延迟愈合2侧， 缝合口处因排异渗出而导致延迟愈合2例，延迟愈合伤口均于1 个月内愈合。钉道渗液4例，换药后好转，无感染性骨髓炎发生。按Mazur踝关节症状与功能评分系统进行功能评估， 本组优3 侧， 良8 侧， 可5 侧， 差1 侧， 优良率64.71%。结论：采用外固定架支撑，同种异体骨联合自体骨髓移植治疗Ⅲ型Pilon骨折，手术操作简单，安全有效，是一种值得推广的方法。 【关键词】Pilon；异体骨；自体骨髓；移植；外固定架 【中图分类号】R687.3【文献标识码】A【文章编号】1008-6455（2011）04-0011-02 The use of allograft bones with autologous bone marrow in treatment of fracture of Pilon Ⅲ FangYaqun Li Ning Zhang Yilong Qian Wenru 【Abstract】Objective:Aim to evaluate the therapeutic effect of use of allograft bones with autologous bone marrow in treatment of fracture of Pilon Ⅲ. Methods: Of the Pilon Ⅲ distal tibia fracture of patients hospitalized from February 2005 to March 2008 in our hospital, 17 cases were included in the group, of which, 14 men and 3 wemen. The age are from 24 to 59 years, mean 36.1years. The injuries are caused by crashing of 13,traffic accidents of 4, and they are all closed fractures combined with fracture of fibula. Results: The patients were followed up from 12 to 24 months, mean 18.7 months. The incisions were healed primarily of 13,and delayedly 4. The final score of the ankle with the excellent and satisfactory results reached 64.71%. Conclusions: Treatment of external fixator combined with allograft bones and autologous bone marrow has advantages of simple operationand reliablely satisfactory outcome. 【Key words】pilon; allograft bones ; autologous bone marrow ; transplantation ; external fixator Pilon骨折是指胫骨远端干骺端累及踝关节的骨折，其中Ⅲ型（Rüedi-Allgower分型）骨折由于胫骨远端严重的高能量粉碎性骨折，关节面或干骺端嵌压或爆裂，负重轴线损坏，骨量严重丢失，其治疗极其困难常导致预后不良。我科自2005年2月～2008年3月采用超关节“T”形外固定支架、锁定钉板系统固定，自体骨髓联合同种异体骨、人工骨植骨治疗Ⅲ型Pilon骨折共17例， 疗效满意，报告如下。 1 临床资料 1.1 一般资料:本组17例（侧），男14例，女3例。年龄24～59 岁，平均36.1 岁。致伤原因：坠落伤13 例，交通事故伤4 例。17例均为闭合性III型