The Clinical Follow-up Study Of Three Surgical Methods For Nonunion Of Extremities

bjective: To demonstrate the Advantage of autologous bone marrow integrating artificial bone and ilium periosteum transplantation for treate nonunion of extremities according to the clinical follow-up. And to supply an objective basis and theoretical support for followed clinical expansion. Methods : 1. To collecte the 50 cases patients of nonunion of extremities including 17 cases of refractory nonunion. 2. To comprehensively grades the patients according to the functional evaluation standard of the patients of nonunion before and after surgical treatment. The score system includs 5 indexes such as pain, daily Life, local soft tissue conditions,the features of X-ray film and patient satisfaction. All the data should be recorded accurately. 3. The 50cases were divided into 3 groups: group A (combined group) 17 cases, group B (bone marrow group) 20 cases, and group C (iliac bone group) 13 cases. Removed the fibrous tissue and sclerotic bone between the fracture site.And get throught the medullary cavity. To fixation the fracture with intramedullary nail, plate or external fixator. 4. The payients of group A were cut out of the Vascular Pedicled Iliac Periosteal according to the area of fracture face to anastomosis with corresponding vascular in the regional(Done it under the microscope). The bone marrow was aspirated from patients of group A were mixed uniform with artificial bone.Then placed it between the fracture site. The bone marrow aspirated from the patients of group B was placed into the fracture site after mixed uniform with artificial bone. The iliac bone from group C was placed into fractue site directly. 5. Using antibiotics 3-5 days after operation. To guide the limb passive training partly. The affected limb began to train actively extension and flexion activity after 3 days postoperation. 6. Conventional postoperative dressing change, suture removal and observed the wound healing condition. Record hospitalization time Accurately. 7. Made CR film 1,3,6,9,12 months after operated(All the CR films were made under the same condition.). Determining the bone mineral density of affected part 1,6,12 months postop. The data was Stored in mobile hard disk. 8. Recorded the time of the fixture removed. Determining for the affected limb function score 4 weeks after fixture removed under the same condition. 9. To data analysis by statistical package of SPSS 14.0. 10. All the patients take part in this subject are voluntary. And identificated to signing the relevant legal instruments. 11. All the standards of clinical treatment and functional recovery were referenced to international or national Authoritative relevant instruments. Results: All the patients were received follow-up,the time ranged from 12-28 months, minimum 17.5 months. The bone healing time ranged from 5.5 to 14 months, minimum 7.5 months. The CR films shown that 45 cases healed without spiral,angulation and shortened deformity. One case left over dysfunction after fracture healed because of ankylosis and scar contracture. Five cases did not heal postoperation 12-14 months. Four cases were healed 7-8 months after 2nd operated with autologous bone marrow integrating artificial bone and ilium periosteum transplantation. One case of long bone defect was healed 7 months after operated with fibula flap with vascular pedicle. The excellent and good rate of 1st operation was 88.2% in group A, 70.0% in group B and 61.5% in group C. Conclusion: Among the three methods using autologous bone marrow integrating artificial bone and ilium periosteum transplantation to treat the nonunion of the extremities have the advantages of the shortest healing time, the highest patient satisfaction and the best efficacy. The cure rate was equivalent between the two operational methods of autologous bone marrow integrating artificial bone transplantation and iliac bone transplantation. And compared with iliac bone transplantation purely, the method of autologous bone marrow integrating artificial bone transplantation has the advantages of small trauma and shorten hospitalization time.