摘要
目的比较分析经皮自体骨髓移植与自体髂骨植骨治疗胫骨骨折术后不愈合的疗效。方法前瞻性对照研究2010年1月—2018年1月广东省惠东县人民医院骨伤科收治胫骨骨折术后不愈合患者60例,男性35例,女性25例;年龄19~66岁,平均45.3岁。按随机数字表法分为骨髓移植组和骨骼植骨组,各30例,骨髓移植组行经皮自体骨髓移植术,骨骼植骨组行自体髂骨植骨术。术后前6个月每个月均进行门诊随访,之后改为每3个月门诊随访1次。比较两组患者临床疗效、X线片骨折线消失时间、骨折愈合时间、骨痂评分,治疗前后骨形成蛋白-2(BMP-2)、胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子-2(IGF-2)、血管内皮细胞生长因子(VEGF)。结果患者均获得随访,随访时间8~24个月,平均15.7个月。骨髓移植组临床疗效优良率相比骨骼植骨组显著提高(96.67%vs.76.67%);骨髓移植组X线片骨折线消失时间及骨折愈合时间均显著低于骨骼植骨组[(20.14±2.21)周vs.(24.26±2.28)周、(28.10±2.29)周vs.(32.63±2.31)周],差异有统计学意义(P<0.05)。骨髓移植组骨痂评分(3.78±0.75)分显著高于骨骼植骨组(2.36±0.72)分,差异有统计学意义(P<0.05)。骨髓移植组术后未愈合1例,骨骼植骨组未愈合7例,重新固定或更换内固定方式后均获得愈合。术前两组患者BMP、IGF-1、IGF-2、VEGF指标水平比较差异无统计学意义(P>0.05),术后骨髓移植组BMP、IGF-1、IGF-2、VEGF指标水平分别为(85.19±4.52)ng/L、(9.82±1.24)μg/L、(7.92±1.30)μg/L、(23.10±3.31)ng/L,骨骼植骨组(70.37±4.60)ng/L、(7.41±1.36)μg/L、(6.31±1.25)μg/L、(16.81±2.95)ng/L,差异均有统计学意义(P<0.05)。结论经皮自体骨髓移植治疗胫骨骨折术后不愈合可显著提高临床疗效,促进骨痂生成,缩短骨折愈合时间,提高BMP、IGF-1、IGF-2、VEGF等成骨诱导因子指标水平,值得临床推广。
Objective To compare and analyze the therapeutical efficacy of percutaneous autologous bone marrow transplantation and autologous iliac bone grafting in the treatment of nonunion after surgery of tibial fracture.Methods A prospective controlled study was conducted on 60 patients with nonunion after surgery of tibial fracture who were admitted to the Department of Orthopedics and Traumatology,Huidong People's Hospital from Jan.2010 to Jan.2018.There were 35 males and 25 females,with an average age of 45.3 years(range,19-66 years).They were randomly divided into bone marrow transplantation group and iliac bone grafting group,with 30 cases in each group.The bone marrow transplantation group underwent percutaneous autologous bone marrow transplantation,and iliac bone grafting group underwent autologous iliac bone grafting.Outpatient and follow-up was conducted every month during the first 6 months after surgery,and after 6 months,and follow-up frequency was changed to once every 3 months.The clinical efficacy,X-ray fracture line disappearance time,fracture healing time,callus score,and bone morphogenetic protein-2(BMP-2),insulin-like growth factor-1(IGF-1),insulin-like growth factor-2(IGF-2),vascular endothelial cell growth factor(VEGF)before and after treatment were compared between the two groups.Results After treatment,the clinical efficacy of patients in the bone marrow transplantation group was significantly improved compared with that in the iliac bone graft group,and the ratio of excellent and good rate of bone marrow transplantation group and iliac bone grafting group was 96.67%vs.76.67%.All patients were followed up,and the follow-up time was 8-24 months,with an average of 15.7 months.In the bone marrow transplantation group,X-ray fracture line disappearance time was(20.14±2.21)weeks,and the fracture healing time was(28.10±2.29)weeks,while in the iliac bone graft group,X-ray fracture line disappearance time was(24.26±2.28)weeks,and the fracture healing time was(32.63±2.31)weeks,and the X-ray fracture lin
作者
刘颗星
邓颂波
曾日祥
黄文显
石林毅
LIU Ke-xing;DENG Song-bo;ZENG Ri-xiang;HUANG Wen-xian;SHI Lin-yi(Huidong People's Hospital,Huidong,Guangdong 516300,China)
出处
《创伤外科杂志》
2020年第9期692-695,700,共5页
Journal of Traumatic Surgery
基金
惠州市科技计划项目(170530231745249)。
关键词
胫骨骨折
自体骨髓移植
自体髂骨植骨
不愈合
tibial fracture
autologous bone marrow transplantation
autologous iliac bone grafting
nonunion
