自体细胞生长因子注射联合体外冲击波治疗下肢骨折不愈合的临床研究
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摘要
目的:观察自体细胞生长因子注射联合体外冲击波治疗下肢骨折不愈合的临床疗效。方法:将48例下肢骨折不愈合患者随机分为联合治疗组和冲击波治疗组,每组24例。联合治疗组先向骨折两断端注射以自体外周血制备的细胞生长因子,然后进行体外冲击波治疗;冲击波治疗组仅进行冲击波治疗。自体细胞生长因子注射和体外冲击波治疗均每隔4 d治疗1次,共治疗3次。治疗结束后定期拍摄X线片,观察骨折愈合情况。结果:制备的细胞生长因子中主要包括血管内皮生长因子、转化生长因子-β,含量分别为(583.87±23.51)pg·m L~(-1)和(195.73±26.08)pg·m L~(-1)。48例患者均获得随访,随访时间3~10个月,中位数4.5个月。治疗后2个月时,2组均有骨折开始愈合的病例,至治疗后10个月时,联合治疗组23例骨折愈合、冲击波治疗组18例骨折愈合,联合治疗组的骨折愈合率高于冲击波治疗组(χ~2=4.181,P=0.041)。结论:自体细胞生长因子注射联合体外冲击波能有效治疗下肢骨折不愈合,其效果优于单纯体外冲击波治疗。
Objective: To observe the clinical curative effects of injection of autologous cell growth factors combined with extracorporeal shock wave( ESW) therapy for treatment of nonunion of lower limb fractures. Methods: Forty-eight patients with nonunion of lower limb fractures were randomly divided into combination therapy group and ESW therapy group,24 cases in each group. The cell growth factors prepared by using autologous peripheral blood were injected into both broken ends of fractured bone and then ESW therapy was performed on patients in combination therapy group,while the patients in ESW therapy group were merely treated with ESW therapy. Both injection of autologous cell growth factors and ESW therapy were performed on patients for consecutive 3 times with a 4-day rest-insertion between times.The X-ray films of lower limbs were periodically taken after the end of the treatment,and the fracture healing was observed. Results: The prepared cell growth factors consisted mainly of vascular endothelial growth factor( VEGF) and transforming growth factor-β( TGF-β),which contents were 583. 87 +/-23. 51 and 195. 73 +/-26. 08 pg/m L respectively. All patients were followed up for 3-10 months with a median of 4. 5 months. The fractures of some patients began to heal in both of the 2 groups at 2 months after the treatment. The fractures healed in 23 patients of combination therapy group and 18 patients of ESW therapy group at 10 months after the treatment,and the fracture healing rate was higher in combination therapy group compared to ESW therapy group( χ~2= 4. 181,P = 0. 041). Conclusion: The combination therapy of injection of autologous cell growth factors and ESW therapy can effectively treat nonunion of lower limb fractures,and its curative effect is better than that of monotherapy of ESW.
Objective: To observe the clinical curative effects of injection of autologous cell growth factors combined with extracorporeal shock wave( ESW) therapy for treatment of nonunion of lower limb fractures. Methods: Forty-eight patients with nonunion of lower limb fractures were randomly divided into combination therapy group and ESW therapy group,24 cases in each group. The cell growth factors prepared by using autologous peripheral blood were injected into both broken ends of fractured bone and then ESW therapy was performed on patients in combination therapy group,while the patients in ESW therapy group were merely treated with ESW therapy. Both injection of autologous cell growth factors and ESW therapy were performed on patients for consecutive 3 times with a 4-day rest-insertion between times.The X-ray films of lower limbs were periodically taken after the end of the treatment,and the fracture healing was observed. Results: The prepared cell growth factors consisted mainly of vascular endothelial growth factor( VEGF) and transforming growth factor-β( TGF-β),which contents were 583. 87 +/-23. 51 and 195. 73 +/-26. 08 pg/m L respectively. All patients were followed up for 3-10 months with a median of 4. 5 months. The fractures of some patients began to heal in both of the 2 groups at 2 months after the treatment. The fractures healed in 23 patients of combination therapy group and 18 patients of ESW therapy group at 10 months after the treatment,and the fracture healing rate was higher in combination therapy group compared to ESW therapy group( χ~2= 4. 181,P = 0. 041). Conclusion: The combination therapy of injection of autologous cell growth factors and ESW therapy can effectively treat nonunion of lower limb fractures,and its curative effect is better than that of monotherapy of ESW.
引文
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[3]谭训香,金鑫,谭勇海,等.自体骨髓联合细胞生长因子治疗胫腓骨骨不连42例的体会[J].中国中医骨伤科杂志,2016,24(1):44-45.
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[10]MELNYK M,HENKE T,CLAES L,et al.Revascularisation during fracture healing with soft tissue injury[J].Arch Orthop Trauma Surg,2008,128(10):1159-1165.
[11]彭国常,汪玉辉,李跃,等.胫骨内固定术后非感染性骨不连的原因分析及治疗[J].临床医学工程,2014,21(1):52-53.
[12]蒋亮东,陶澄,何爱咏,等.75例股骨骨折不愈合发生的原因分析[J].重庆医学,2014,43(8):970-972.
[13]崔博,郑学清,舒畅,等.体外冲击波诱导骨髓间充质干细胞向成骨细胞分化[J].中国老年学杂志,2012,32(3):554-556.
[14]CHEN HS,CHEN LM,HUANG TW.Treatment of painful heel syndrome with shock waves[J].Clin Orthop Relat Res,2001,(387):41-46.
[15]MCCLURE SR,VAN SICKLE D,WHITE MR.Effects of extracorporeal shock wave therapy on bone[J].Vet Surg,2004,33(1):40-48.
[16]FRAIRIA R,BERTA L.Biological effects of extracorporeal shock waves on fibroblasts.A review[J].Muscles Ligaments Tendons J,2011,1(4):138-147.
[17]WANG CJ,HUANG KE,SUN YC,et al.VEGF modulates angiogenesis and osteogenesis in shockwave-promoted fracture healing in rabbits[J].J Surg Res,2011,171(1):114-119.
[18]VULPIANI MC,VETRANO M,CONFORTI F,et al.Effects of extracorporeal shock wave therapy on fracture nonunions[J].Am J Orthop(Belle Mead NJ),2012,41(9):122-127.
[19]鲍小明.VEGF在骨质疏松性骨折愈合中的作用[J].中国矫形外科杂志,2012,20(22):2054-2056.
[20]BROWN GA.AAOS clinical practice guideline:treatment of osteoarthritis of the knee:evidence-based guideline,2nd edition[J].J Am Acad Orthop Surg,2013,21(9):577-579.
[2]谭勇海,姜红江,秦立武,等.自体细胞生长因子治疗中青年股骨颈骨折延迟愈合62例[J].中国中医骨伤科杂志,2014,22(4):61-62.
[3]谭训香,金鑫,谭勇海,等.自体骨髓联合细胞生长因子治疗胫腓骨骨不连42例的体会[J].中国中医骨伤科杂志,2016,24(1):44-45.
[4]贾朗,黄荣忠,王愉乐,等.不同强度体外冲击波联合骨髓间充质干细胞移植对大鼠骨缺损的修复效果[J].上海交通大学学报(医学版),2016,36(12):1706-1712.
[5]李恩.体外冲击波治疗骨不连临床研究[D].太原:山西医科大学,2016.
[6]RODRIGUEZ-MERCHAN EC,FORRIOL F.Nonunion:general principles and experimental data[J].Clin Orthop Relat Res,2004,20(419):4-12.
[7]葛站勇,白俊清.胫骨骨不连的常见原因及治疗进展[J].中国煤炭工业医学杂志,2013,16(3):508-510.
[8]潘治军,杨涛,思玉楼,等.280例骨不连病例原因分析[J].中国骨伤,2013,26(4):284-286.
[9]黄志明,熊涛,林川.18例肱骨干骨折术后骨不连原因分析[J].重庆医学,2008,37(21):2472-2474.
[10]MELNYK M,HENKE T,CLAES L,et al.Revascularisation during fracture healing with soft tissue injury[J].Arch Orthop Trauma Surg,2008,128(10):1159-1165.
[11]彭国常,汪玉辉,李跃,等.胫骨内固定术后非感染性骨不连的原因分析及治疗[J].临床医学工程,2014,21(1):52-53.
[12]蒋亮东,陶澄,何爱咏,等.75例股骨骨折不愈合发生的原因分析[J].重庆医学,2014,43(8):970-972.
[13]崔博,郑学清,舒畅,等.体外冲击波诱导骨髓间充质干细胞向成骨细胞分化[J].中国老年学杂志,2012,32(3):554-556.
[14]CHEN HS,CHEN LM,HUANG TW.Treatment of painful heel syndrome with shock waves[J].Clin Orthop Relat Res,2001,(387):41-46.
[15]MCCLURE SR,VAN SICKLE D,WHITE MR.Effects of extracorporeal shock wave therapy on bone[J].Vet Surg,2004,33(1):40-48.
[16]FRAIRIA R,BERTA L.Biological effects of extracorporeal shock waves on fibroblasts.A review[J].Muscles Ligaments Tendons J,2011,1(4):138-147.
[17]WANG CJ,HUANG KE,SUN YC,et al.VEGF modulates angiogenesis and osteogenesis in shockwave-promoted fracture healing in rabbits[J].J Surg Res,2011,171(1):114-119.
[18]VULPIANI MC,VETRANO M,CONFORTI F,et al.Effects of extracorporeal shock wave therapy on fracture nonunions[J].Am J Orthop(Belle Mead NJ),2012,41(9):122-127.
[19]鲍小明.VEGF在骨质疏松性骨折愈合中的作用[J].中国矫形外科杂志,2012,20(22):2054-2056.
[20]BROWN GA.AAOS clinical practice guideline:treatment of osteoarthritis of the knee:evidence-based guideline,2nd edition[J].J Am Acad Orthop Surg,2013,21(9):577-579.