Recombinant Bone Morphogenetic Protein-2 (rhBMP-2) in High-Risk Ankle and Hindfoot Fusions
Recombinant Bone Morphogenetic Protein-2 (rhBMP-2) in High-Risk Ankle and Hindfoot Fusions
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DOI：
10.3113/fai.2009.0597
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发表时间：
2009-07-01
影响因子：
2.7
通讯作者：
Haskell, Michelle D.
中科院分区：
文献类型：
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作者：
Bibbo, Christopher;Patel, Dipak V.;Haskell, Michelle D.
背景资料：本研究的目的是评估rhBMP-2对高风险踝关节和后足融合患者骨愈合的影响。材料和方法：对接受rhBMP-2增强治疗的高风险、选择性踝关节和后足融合术的患者的临床结局和并发症进行了审查。共审查了112个融合部位（69例患者）进行分析。患者的平均年龄为52岁（范围：21 - 84岁）。男性37人（53%），女性32人（47%）。44例患者（64%）为吸烟者，13例患者（19%）为糖尿病患者。47例（68%）患者存在高能量创伤史，22例（32%）患者存在距骨缺血性坏死。45例患者（65%）有多种风险因素。排除标准为外周血管疾病、感染和无法接受常规随访方案的患者。踝关节和后足融合采用内固定和/或外固定。骨移植仅用于有缺损或对线不良的患者。术后，每2 - 4周拍摄一次非负重X线片（每个部位3次）。当X线平片显示明显愈合时，进行了确认性CT扫描。结果如下：总体而言，108个融合部位在平均11周时愈合（愈合率96%）（通过CT扫描评估）[踝关节10周;距下关节12.3周;距舟关节12.7周和跟骰关节10.9周]。踝关节、距下关节、距舟关节和跟骰关节之间的不同愈合时间不显著（p = 0.2571，Kruskal-Wallis检验非参数ANOVA）。所有部位：[无移植物] vs. [自体移植物] vs. [同种异体移植物]：p = 0.2421（Kruskal-Wallis检验非参数ANOVA），无统计学显著性。并发症包括5/11例骨不连，3例患者2个关节骨不连（4%关节骨不连率; 4%患者骨不连率）[距下关节2例;距舟关节1例;跟骰关节1例]。两名患者出现伤口并发症，另一名患者出现深部感染;所有患者均通过局部伤口护理、负压敷料和抗生素成功治疗。结论：我们认为rhBMP-2是一种有效的辅助骨愈合的患者进行高风险的踝关节和后足融合。本研究中观察到的并发症发生率较低。
Background: The purpose of this study was to evaluate the effect of rhBMP-2 on bone healing in patients who undergo high-risk ankle & hindfoot fusions. Materials & Methods: Patients who underwent high-risk, elective ankle and hindfoot fusions treated with rhBMP-2 augmentation were reviewed for clinical outcomes and complications. A total of 112 fusion sites (69 patients) were reviewed for analysis. The mean age of the patients was 52 years (range, 21 to 84 years). There were 37 males (53%) and 32 females (47%). Forty-four patients (64%) were smokers and 13 patients (19%) were diabetic. A history of high-energy trauma was present in 47 (68%) patients and avascular necrosis of the talus was present in 22 patients (32%). Forty-five patients (65%) had multiple risk-factors. The exclusion criteria were peripheral vascular disease, infection, and patients who were not available for the usual follow-up protocol. Internal and/or external fixation was utilized for ankle and hindfoot fusions. Bone graft was used only for patients who had defects or malalignment. Postoperatively, nonweightbearing radiographs were taken every 2 to 4 weeks (3 views per site). When plain radiographic union was evident, a confirmatory CT scan was obtained. Results: Overall, 108 fusion sites went on to union (96% union rate) at a mean time of 11 weeks (as assessed by a CT scan) [ankle joint at 10 weeks; subtalar joint at 12.3 weeks; talonavicular joint at 12.7 weeks and calcaneocuboid joint at 10.9 weeks]. Different union times between ankle, subtalar, talonavicular, and calcaneocuboid joint were not significant (p = 0.2571, Kruskal-Wallis Test Nonparametric ANOVA). All sites: [No graft] vs. [Autograft] vs. [Allograft]: p = 0.2421 (Kruskal-Wallis Test Nonparametric ANOVA), were not statistically significant. Complications included nonunion in 5 of 11,2 joints in 3 patients (4% joint nonunion rate; 4% patient nonunion rate) [subtalar joint, n = 2; talonavicular joint, n = 1; and calcaneocuboid joint, n = 1]. Two patients had wound complications and one other patient had a deep infection; all were successfully treated with local wound care, negative-pressure dressings and antibiotics. Conclusion: We believe rhBMP-2 is an effective adjunct for bone healing in patients who undergo high-risk ankle and hindfoot fusions. Low complication rates were observed in this study.