外固定架联合经皮自体骨髓移植治疗四肢长骨骨不连32例

External fixator combined with percutaneous autologous bone marrow grafting for treatment of 32 fracture nonunion cases

回顾性分析1998-10/2003-09潍坊市益都中心医院骨科收治的骨不连患者32例,作为实验组。其中男27例,女5例,年龄15～58岁。首先清理骨折端组织,畅通骨髓腔,然后应用单臂外固定架固定骨折,固定3周后行自体骨髓移植,应用骨穿针在X射线透视下定位穿针,自髂后上棘抽取红骨髓注入骨不连部位,20～30mL/次,共3次,每次间隔2周。另选1993-08/1998-09潍坊市益都中心医院骨科收治的骨不连患者31例作为对照组,其中男23例,女8例,年龄17～68岁。应用常规方法切开植骨内固定治疗。对患者进行定期随访,观察骨愈合情况及并发症。复查时间分别为术后3,6,9,12个月。实验组32例患者中随访28例,骨不连愈合25例,愈合时间为3～9个月。对照组31例患者中随访27例,22例骨不连愈合,愈合时间为6～12月。在术后3个月,6个月和9个月时,两组患者骨不连的愈合率相比,差异有显著性意义(P<0.05)。实验组1例发生针道感染,经换药后痊愈;2例患者发生螺纹针松动现象,消毒后再扭紧即可;无固定架断裂和骨筋膜室综合征发生;桡神经损伤1例,保守治疗恢复;骨髓穿刺及移植部位无感染、皮肤坏死和明显异位骨化发生。对照组4例患者发生切口感染,1例钢板断裂,1例桡神经损伤。提示外固定架联合经皮自体骨髓移植治疗骨不连与切开植骨内固定治疗骨不连相比,能加速骨不连的愈合,缩短愈合时间。

Thirty-two patients with nonunion of fractures were treated in Department of Orthopedics, Yidu Central Hospital, including 25 male and 5 female, aged 15-58 years. The site of nonunion was debrided, cavity of marrow was got through, and then the fracture was fixed with unilateral external fixator. Percutaneous autologous bone marrow grafting was performed at 3 weeks post-operation. The fracture nonunion site was approached under X-ray with the bone marrow aspiration needle, which was left in situ; 20-30 mL bone marrow was aspirated from the posterosuperior iliac crest with the second bone marrow aspiration needle and injected immediately into the nonunion site through the first needle. Injection was repeated for three times with interval for two weeks. Another group of 31 patients with fracture nonunion were selected as control, who underwent technique of opening, bone grafting and internal fixation. All patients were followed up to observe bone union and complications, and reexamined at postoperative months 3, 6, 9 and 12. Twenty-eight of thirty-two patients were followed up, and 25 patients of fracture nonunion were united （range 3-9 months）. Twenty-seven of 31 control patients were followed-up, and 22 patients of fracture nonunion were recovered （range 6-12 months）. The healing rate of fracture nonunion at postoperative months 3, 6, 9 and 12 was significantly different between two groups （P 〈 0.05）. In experimental group, needle hole infection was found in one patient, and cured by dress changing; threaded needle loosening was found in 2 cases, and twisted after disinfection; no fixation frisket breakage or osteofascial compartment syndrome occurred; radial nerve injury in one case was recovered after conservative treatment; no injection, skin necrosis or obvious ectopic ossification was found at the puncture or grafting sites. In the control group, 4 patients developed incision infection, 1 plate breakage, and 1 radial nerve injury. Compared to the technique of opening, bone grafting and internal fixation, combined external fixator with percutaneous autologous bone marrow grafting for treatment of fracture nonunion could accelerate the union, and shorten the healing time of fracture nonunion.