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ENGLISH ABSTRACT
扩髓-灌洗-吸引器技术在自体骨移植治疗下肢骨折不愈合中的应用
史炎鑫
王爱国
董辉
朱梁豫
李文祥
李兴华
作者及单位信息
·
DOI： 10.3760/cma.j.cn115530-20240905-00357
Application of the reaming-irrigation-aspirator technique in autologous bone grafting for non-union of lower limb fracture
Shi Yanxin
Wang Aiguo
Dong Hui
Zhu Liangyu
Li Wenxiang
Li Xinghua
Authors Info & Affiliations
Shi Yanxin
Department of Lower Limb Orthopaedics I, Zhengzhou Orthopaedic Hospital, Zhengzhou 450052, China
Wang Aiguo
Department of Lower Limb Orthopaedics I, Zhengzhou Orthopaedic Hospital, Zhengzhou 450052, China
Dong Hui
Department of Lower Limb Orthopaedics I, Zhengzhou Orthopaedic Hospital, Zhengzhou 450052, China
Zhu Liangyu
Department of Lower Limb Orthopaedics I, Zhengzhou Orthopaedic Hospital, Zhengzhou 450052, China
Li Wenxiang
Department of Lower Limb Orthopaedics I, Zhengzhou Orthopaedic Hospital, Zhengzhou 450052, China
Li Xinghua
Department of Lower Limb Orthopaedics I, Zhengzhou Orthopaedic Hospital, Zhengzhou 450052, China
·
DOI： 10.3760/cma.j.cn115530-20240905-00357
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摘要

目的探讨扩髓-灌洗-吸引器（RIA）技术在自体骨移植治疗下肢骨折不愈合中的应用效果。

方法回顾性分析2023年7月至2024年3月期间郑州市骨科医院下肢骨科Ⅰ应用RIA技术取自体骨移植治疗的16例下肢骨折不愈合患者资料。男12例，女4例；年龄（47.2±14.3）岁。骨折不愈合部位：股骨14例，胫骨2例。初次手术固定方式：髓内钉固定5例，钢板固定10例，髓内钉联合钢板固定1例。骨折不愈合时间为（21.0±12.0）个月。术中应用RIA系统钻头进行自体骨扩髓，同时进行灌洗液冲洗，通过负压吸引将灌洗液带出的骨碎屑收集进过滤装置，打开过滤器，挤出淤血，取出骨泥备用；再根据骨折不愈合情况调整内固定方式；最后将骨泥植入骨缺损处。记录患者的取骨时间、取骨量、术中出血量、术后供区疼痛情况、骨愈合时间、下肢功能恢复情况及并发症发生情况等。

结果2例患者取胫骨骨髓时发生RIA钻头断裂，经更换钻头后完成手术。16例患者的取骨时间为（31.4±6.1）min，取骨量为（42.6±9.5）mL，术中出血量为（815.6±238.6）mL。本组患者术后切口均一期愈合，术后4周随访无一例患者出现供区疼痛症状。16例患者术后获（8.0±2.0）个月随访，骨愈合时间为（4.4±0.5）个月。随访期间无一例患者发生迟发性感染、供区部位断裂、内固定物松动或断裂等并发症。末次随访时根据下肢功能评分量表评定患肢功能：优7例，良8例，可1例。

结论应用RIA技术取自体骨移植治疗下肢骨折不愈合可获得良好的骨愈合和下肢功能，且患者供区部位无长期疼痛症状。

骨折，不愈合;下肢骨;骨移植;移植，自体;扩髓-灌洗-吸引器技术
ABSTRACT

ObjectiveTo evaluate the application of the reaming-irrigation-aspirator (RIA) technique in autologous bone grafting for non-union of lower limb fracture.

MethodsA retrospective analysis was conducted of the data of 16 patients with non-union of lower limb fracture who had undergone autologous bone grafting using the RIA technique at Department of Lower Limb Orthopaedics Ⅰ, Zhengzhou Orthopaedic Hospital from July 2023 to March 2024. There were 12 males and 4 females with an age of (47.2±14.3) years. Sites of non-union: the femur in 14 cases and the tibia in 2 cases. Initial surgical fixation: intramedullary nail fixation in 5 cases, plate fixation in 10 cases, and intramedullary nail plus plate fixation in 1 case. The time for fracture non-union was (21.0±12.0) months. Intraoperatively, autologous bone reaming was conducted using a drill bit of RIA system, and simultaneous flushing using irrigation fluid. The bone debris carried out by the irrigation fluid was collected into a filtration device through negative pressure aspiration. After the filter was opened to squeeze out congestion, bone paste was taken out for standby. Internal fixation methods were adjusted according to the non-union condition of the fractures. Finally, the bone paste was implanted into bone defects. The time for autologous bone harvest, amount of bone harvested, intraoperative blood loss, postoperative pain at a donor site, fracture healing, functional recovery of a lower limb and occurrence of complications were recorded.

ResultsIn 2 of the 16 patients, fracture of the RIA drill bit occurred when bone marrow was harvested from the tibia, and their operation was completed only after the drill bits were replaced. In the 16 patients, time for bone harvest was (31.4±6.1) min, bone harvest volume (42.6±9.5) mL, and intraoperative blood loss (815.6±238.6) mL. The incisions in this cohort healed primarily after operation, and 4-week follow-up revealed that no patients had pain symptoms at a donor site. The 16 patients were followed up for (8.0±2.0) months after operation. All patients achieved bone union after (4.4±0.5) months. Follow-ups showed that no patients had complications like delayed infection, donor site fracture, or loosening or fracture of an internal fixator. According to the rating scale for lower limb function at the last follow-up, the function of affected limb was evaluated as excellent in 7 cases, as good in 8 cases, and as fair in 1 case.

ConclusionApplication of RIA technique for autologous bone grafting to treat non-union of lower limb fracture can lead to fine fracture healing and good lower limb function, but no long-term pain symptoms in the donor area for the patients.

Fractures, ununited;Bones of lower extremity;Bone grafting;Grafting, autologous;Reaming-irrigation-aspirator technique
Li Xinghua, Email: mocdef.aabnis8810wobniaR
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引用本文

史炎鑫,王爱国,董辉,等. 扩髓-灌洗-吸引器技术在自体骨移植治疗下肢骨折不愈合中的应用[J]. 中华创伤骨科杂志,2025,27(03)：216-221.

DOI:10.3760/cma.j.cn115530-20240905-00357

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髂骨因位置表浅、取材方便，且具有良好的骨诱导性、骨传导性及成骨性，是临床最常见的取骨部位 [ 1 ]。自体髂骨移植是治疗骨折不愈合的最常用手术方法 [ 2 ]。然而，髂骨取骨量有限且部分患者存在取骨部位持续性疼痛、伤口皮肤麻木、切口瘢痕等术后并发症，严重影响患者的术后生活质量 [ 3 ]。Green [ 4 ]于1986年首次提出扩髓-灌洗-吸引器（reaming-irrigation-aspirator, RIA)技术,其设计目的是减少股骨干骨折扩髓过程中脂肪栓塞和热坏死的潜在发生风险，该技术应用RIA钻头进行自体髓腔扩髓的同时行灌洗液冲洗，通过负压吸引将髓腔内产生的碎屑带出并降低髓腔内温度 [ 5 ]。学者们发现应用RIA技术获取的髓腔内碎屑具有高成骨和成骨诱导特性，可作为理想的骨移植物应用于各类非感染性骨折不愈合的治疗 [ 6 , 7 , 8 ]。RIA技术已成为一种新型自体骨采集方法，应用该技术取自体骨在国外已被用于治疗非感染性骨折不愈合 [ 9 ],但是目前国内极少见文献报道其应用效果。我院自2023年7月开始应用RIA技术取自体骨移植治疗骨折不愈合。本研究回顾性分析2023年7月至2024年3月期间郑州市骨科医院下肢骨科Ⅰ应用RIA技术行自体骨移植治疗的16例下肢骨折不愈合患者资料，探讨应用RIA技术采集自体骨移植治疗下肢骨折不愈合的效果。
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备注信息
A
李兴华，Email: mocdef.aabnis8810wobniaR
B

史炎鑫：数据采集、数据处理、论文撰写；王爱国、李兴华：研究指导、论文修改；董辉、朱梁豫、李文祥：数据采集及处理

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