自体富血小板血浆与人工骨混合物治疗胫骨平台骨折合并骨缺损的临床应用

The clinical application of platelet-rich plasma(PRP) and artificial bone complex to cure ibial plateau fracture with bone defects

背景：骨缺损修复一直是骨科临床面临的难题之一。近年来,骨组织工程学的发展为骨缺损修复开辟了新的途径,但骨髓基质细胞体外培养回植入体内修复骨缺损还仅限于实验研究。目的：评价临床上应用自体富血小板血浆（PRP）与人工骨混合物治疗胫骨平台骨折合并骨缺损的临床疗效。方法：2006年7月至2010年7月收治胫骨平台骨折合并骨缺损患者（SchatzkerⅡ~Ⅴ型）36例。随机分成：A组（17例）采用自体PRP与人工骨复合物填充骨缺损;B组（19例）采用自体髂骨填充。所有患者于术后1.5、3、6、12个月复查植骨部位的X线片观察骨折愈合时间,采用Rasmussen评分标准评价胫骨平台骨折复位及固定效果,Hss评分评价膝关节术后功能恢复情况,NRS分级法对疼痛进行量化评分,配对T检验对两组数据进行比较。结果：36例全部获得随访,随访时间11-36个月,平均16个月。A组患者平均手术时间、术中出血量及术后疼痛评分（不包括供骨区）明显低于B组（P〈0.05）,而Rasmussen评分、HSS评分及骨折平均愈合时间与B组无明显差异（P〉0.05）。结论：自体PRP与人工骨混合物填充治疗胫骨平台骨折合并骨缺损较传统自体髂骨填充显著缩短手术时间,减少术中出血,减轻术后疼痛,避免供骨区并发症,修复效果理想,为胫骨平台骨折合并骨缺损的治疗提供了一个新的方法。

Background： Repair of bone defect is always one of the difficult problems facing, Department of orthopedics clinic in recent years, the development of bone tissue engineering has opened up a new way for the repair of bone defects. But the bone marrow stromal cells cultured in vitro to in vivo implantation in repairing bone defects is also limited to the experimental study.Objective： To investigate the effect of platelet-rich plasma（PRP） and artificial bone complex to cure tibial plateau fracture with bone defects.Methods： 36 patients suffered from tibial plateau fracture and bone defects（Schatzker Ⅱ~Ⅴ） were randomized into two groups. The defect was filled by platelet-rich plasma（PRP） and artificial bone complex in Group A（17 patients）, while it was filled by autogenic ilium in group B（19 patients）. All patients were examined by X-ray when 1.5, 3, 6 and 12 months after the operation. Reposition and fixation were investigated by Rasmussen standardization. Knee function after the operation was investigated by Hss scales. The results were compared in the two groups.The data were analyzed by using Student＇s t test.Results： the average operation time, bleeding amount during the operation, and NRS post operation of group A were significant lower than those of group B, while there were no obvious different of Rasmussen scores, HSS scores and the average time of healing time between the two groups（P〈0.05）.Conclusions： it can shorten the operation time,reduce the amount of bleeding, alleviate the pain post the operation, and avoid the potential infection of bone-supply area by filling the defects with platelet-rich plasma（PRP） and artificial bone complex, and there is no significant different of the therapeutic effect of tibial plateau fracture with bone defects by filling the defects with platelet-rich plasma（PRP） and artificial bone complex and with autogenic ilium, and it provide a new method to cure tibial plateau fracture with bone defects.