复合富血小板血浆的自体骨移植联合体外冲击波治疗骨不连
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摘要
目的:探讨自体髂骨移植、富集血小板血浆和体外冲击波治疗骨不连的临床疗效。方法 :2015年1月至2016年12月收治骨不连患者60例,男41例,女19例,年龄18～42岁,平均29岁。将骨不连患者分为自体骨移植治疗组(对照组)、自体骨移植与富血小板血浆联合体外冲击波治疗组(实验组),两组各30例,比较两组患者术后3个月骨痂生成情况、局部并发症发生状况、骨折最终生长状况以及术侧肢体Johner-Wruhs功能分级。结果:55例患者获得随访,对照组27例,实验组28例,有5例患者失访。随访时间8～24个月。患者术后3个月骨痂评分,对照组明显低于实验组(P<0.05)。两组患者的髂骨获取部位及骨不连手术部位皮肤均无红肿及感染。对照组临床及骨性愈合时间均明显长于实验组(P<0.05)。实验组28例患者均达到了骨性愈合;对照组24例患者达到了骨性愈合,3例患者再次发生骨不连。对照组患侧肢体Johner-Wruhs功能分级优良率明显低于实验组(P<0.05)。结论:自体髂骨移植与富集血小板血浆联合体外冲击波方案治疗骨折术后的骨不连有一定的疗效,可以显著改善新生骨的生成情况,是临床工作中治疗骨折术后骨不连的一种综合有用的方式。
Objective:To investigate the methods and clinical effects of autologous iliac bone transplantation, platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) in the treatment of nonunion. Methods:From January 2015 to December 2016,60 patients with nonunion were treated, including 41 males and 19 females,aged 18 to 42 years old with an average age of 29 years old. Patients with nonunion were divided into autologous bone transplantation treatment group(control group), autologous bone transplantation and platelet-rich plasma(PRP) combined with extracorporeal shock wave(ESW)treatment group(experimental group). The callus formation,local complications,final growth of fracture and Johner-Wruhs functional classification of operative limbs of the two groups were compared 3 months after operation. Results : Fifty-five patients were followed up,27 in the control group and 28 in the experimental group,5 patients were lost. The follow-up period ranged from 8 to 24 months. The callus score in the control group was significantly lower than that in the experimental group at3 months after operation(P<0.05). There was no swelling and infection in the skin of the iliac bone acquisition site and non-union operation site in both groups. The clinical and bone healing time of the control group was significantly longer than that of the experimental group(P<0.05). In the experimental group,28 patients achieved bone union; in the control group,24 patients achieved bone union,and 3 patients had bone nonunion again. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the control group was significantly lower than that in the experimental group(P<0.05). Conclusion:Autologous iliac bone transplantation combined with platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) has a certain effect in the treatment of bone nonunion after fracture surgery. It can significantly improve the formation of new bone.It is a comprehensive and useful way to treat bone nonunion after fracture surgery in clinical work.
Objective:To investigate the methods and clinical effects of autologous iliac bone transplantation, platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) in the treatment of nonunion. Methods:From January 2015 to December 2016,60 patients with nonunion were treated, including 41 males and 19 females,aged 18 to 42 years old with an average age of 29 years old. Patients with nonunion were divided into autologous bone transplantation treatment group(control group), autologous bone transplantation and platelet-rich plasma(PRP) combined with extracorporeal shock wave(ESW)treatment group(experimental group). The callus formation,local complications,final growth of fracture and Johner-Wruhs functional classification of operative limbs of the two groups were compared 3 months after operation. Results : Fifty-five patients were followed up,27 in the control group and 28 in the experimental group,5 patients were lost. The follow-up period ranged from 8 to 24 months. The callus score in the control group was significantly lower than that in the experimental group at3 months after operation(P<0.05). There was no swelling and infection in the skin of the iliac bone acquisition site and non-union operation site in both groups. The clinical and bone healing time of the control group was significantly longer than that of the experimental group(P<0.05). In the experimental group,28 patients achieved bone union; in the control group,24 patients achieved bone union,and 3 patients had bone nonunion again. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the control group was significantly lower than that in the experimental group(P<0.05). Conclusion:Autologous iliac bone transplantation combined with platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) has a certain effect in the treatment of bone nonunion after fracture surgery. It can significantly improve the formation of new bone.It is a comprehensive and useful way to treat bone nonunion after fracture surgery in clinical work.
引文
[1] Marsell R,Einhorn TA. Emerging bone healing therapies[J]. J Orthop Trauma,2010,24(Suppl 1):S4-S8.
[2] Marsell R,Einhorn TA. The biology of fracture healing[J]. Injury,2011,42(6):551-555.
[3] Flouzat Lachaniette CH,Heyberger C,Bouthors C,et al. Osteogenic progenitors in bone marrow aspirates have clinical potential for tibial non unionshealing in diabetic patients[J]. Int Orthop,2016,40(7):1375-1379.
[4] Homma Y,Zimmermann G,Hernigou P. Cellular therapies for the treatment of non union:the past,present and future[J]. Injury,2013,44(Suppl 1):S46-S49.
[5]秦泗河.突破骨不连与骨缺损治愈的瓶颈[J].中国骨伤,2013,26(4):267-270.QIN SH. Breakthrough of the bottleneck of nonunion and bone defect treatment[J]. Zhongguo Gu Shang/China J Orthop Trauma,2013,26(4):267-270. Chinese.
[6] Janicki P,Schmidmaier G. What should be the characteristics of the ideal bone graft substitute Combining scaffolds with growth factors and/or stem cells[J]. Injury,2011,42(Suppl 2):S77-S81.
[7] Longo UG,Trovato U,Loppini M,et al. Tissue engineered strategies for pseudoarthrosis[J]. Open Orthop J,2012,6:564-570.
[8] D'Agostino C,Romeo P,Amelio E,et al. Effectiveness of ESWT in the treatment of Kienb ck's disease[J]. Ultrasound Med Biol,2011,37(9):1452-1456.
[9] Johner R,Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation[J]. Clin Orthop Relat Res,1983,(178):7-25.
[10]李刚,刘智.骨形态发生蛋白复合物联合自体骨髓移植治疗四肢长管状骨骨不连[J].中国骨伤,2013,26(4):277-280.LI G,LIU Z. Treatment of long bone fracture nonunion in limbs by bone morphogenetic protein compounds combined with autologous red bone marrow graft[J]. Zhongguo Gu Shang/China J Orthop Trauma,2013,26(4):277-280. Chinese with abstract in English.
[11]梁辉,丁真奇,郭志民.微创疗法在骨不连中的应用现状[J].中国骨伤,2006,19(10):638-640.LIANG H,DING ZQ,GUO ZM. Application of minimal invasive surgery in bone nonunion[J]. Zhongguo Gu Shang/China J Orthop Trauma,2006,19(10):638-640. Chinese.
[12] Honma T,Itagaki T,Nakamura M,et al. Bone formation in rat calvaria ceases within a limited period regardless of completion of defect repair[J]. Oral Dis,2008,14(5):457-464.
[13] Kim MG,Shin DM,Lee SW. The healing of critical sized bone defect of rat zygomatic arch with particulate bone graft and bone morphogenetic protein 2[J]. J Plast Reconstr Aesthet Surg,2010,63(3):459-466.
[14]张福田,刘瑞文,李慧,等.富血小板血浆复合自体髂骨治疗骨不连的临床疗效[J].中华关节外科杂志(电子版),2016,10(6):598-603.ZHANG FT,LIU RW,LI H,et al. Clinical efficacy of platelet rich plasma combined with autologous iliac bone in the treatment of nonunion[J]. Zhonghua Guan Jie Wai Ke Za Zhi(Dian Zi Ban),2016,10(6):598-603. Chinese.
[15]张松,张涛,付桂红,等.自体富血小板血浆联合骨髓间充质干细胞治疗长骨干骨折术后骨不连[J].中国组织工程研究,2017,21(29):4716-4721.ZHANG S,ZHANG T,FU GH,et al. Autologous platelet rich plasma combined with bone marrow mesenchymal stem cells for treatment of nonunion after long bone fracture[J]. Zhongguo Zu Zhi Gong Cheng Yan Jiu,2017,21(29):4716-4721. Chinese.
[16] Zelle BA,Gollwitzer H,Zlowodzki M,et al. Extracorporeal shock wave therapy:current evidence[J]. J Orthop Trauma,2010,24(Suppl 1):S66-S70.
[17] Kaulesar Sukul DM,Johannes EJ,Pierik EG,et al. The effect of high energy shock waves focused on cortical bone:an in vitro study[J]. J Surg Res,1993,54(1):46-51.
[2] Marsell R,Einhorn TA. The biology of fracture healing[J]. Injury,2011,42(6):551-555.
[3] Flouzat Lachaniette CH,Heyberger C,Bouthors C,et al. Osteogenic progenitors in bone marrow aspirates have clinical potential for tibial non unionshealing in diabetic patients[J]. Int Orthop,2016,40(7):1375-1379.
[4] Homma Y,Zimmermann G,Hernigou P. Cellular therapies for the treatment of non union:the past,present and future[J]. Injury,2013,44(Suppl 1):S46-S49.
[5]秦泗河.突破骨不连与骨缺损治愈的瓶颈[J].中国骨伤,2013,26(4):267-270.QIN SH. Breakthrough of the bottleneck of nonunion and bone defect treatment[J]. Zhongguo Gu Shang/China J Orthop Trauma,2013,26(4):267-270. Chinese.
[6] Janicki P,Schmidmaier G. What should be the characteristics of the ideal bone graft substitute Combining scaffolds with growth factors and/or stem cells[J]. Injury,2011,42(Suppl 2):S77-S81.
[7] Longo UG,Trovato U,Loppini M,et al. Tissue engineered strategies for pseudoarthrosis[J]. Open Orthop J,2012,6:564-570.
[8] D'Agostino C,Romeo P,Amelio E,et al. Effectiveness of ESWT in the treatment of Kienb ck's disease[J]. Ultrasound Med Biol,2011,37(9):1452-1456.
[9] Johner R,Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation[J]. Clin Orthop Relat Res,1983,(178):7-25.
[10]李刚,刘智.骨形态发生蛋白复合物联合自体骨髓移植治疗四肢长管状骨骨不连[J].中国骨伤,2013,26(4):277-280.LI G,LIU Z. Treatment of long bone fracture nonunion in limbs by bone morphogenetic protein compounds combined with autologous red bone marrow graft[J]. Zhongguo Gu Shang/China J Orthop Trauma,2013,26(4):277-280. Chinese with abstract in English.
[11]梁辉,丁真奇,郭志民.微创疗法在骨不连中的应用现状[J].中国骨伤,2006,19(10):638-640.LIANG H,DING ZQ,GUO ZM. Application of minimal invasive surgery in bone nonunion[J]. Zhongguo Gu Shang/China J Orthop Trauma,2006,19(10):638-640. Chinese.
[12] Honma T,Itagaki T,Nakamura M,et al. Bone formation in rat calvaria ceases within a limited period regardless of completion of defect repair[J]. Oral Dis,2008,14(5):457-464.
[13] Kim MG,Shin DM,Lee SW. The healing of critical sized bone defect of rat zygomatic arch with particulate bone graft and bone morphogenetic protein 2[J]. J Plast Reconstr Aesthet Surg,2010,63(3):459-466.
[14]张福田,刘瑞文,李慧,等.富血小板血浆复合自体髂骨治疗骨不连的临床疗效[J].中华关节外科杂志(电子版),2016,10(6):598-603.ZHANG FT,LIU RW,LI H,et al. Clinical efficacy of platelet rich plasma combined with autologous iliac bone in the treatment of nonunion[J]. Zhonghua Guan Jie Wai Ke Za Zhi(Dian Zi Ban),2016,10(6):598-603. Chinese.
[15]张松,张涛,付桂红,等.自体富血小板血浆联合骨髓间充质干细胞治疗长骨干骨折术后骨不连[J].中国组织工程研究,2017,21(29):4716-4721.ZHANG S,ZHANG T,FU GH,et al. Autologous platelet rich plasma combined with bone marrow mesenchymal stem cells for treatment of nonunion after long bone fracture[J]. Zhongguo Zu Zhi Gong Cheng Yan Jiu,2017,21(29):4716-4721. Chinese.
[16] Zelle BA,Gollwitzer H,Zlowodzki M,et al. Extracorporeal shock wave therapy:current evidence[J]. J Orthop Trauma,2010,24(Suppl 1):S66-S70.
[17] Kaulesar Sukul DM,Johannes EJ,Pierik EG,et al. The effect of high energy shock waves focused on cortical bone:an in vitro study[J]. J Surg Res,1993,54(1):46-51.