经皮自体骨髓移植治疗前臂新鲜骨折伴骨缺损患者的临床研究

Clinical research of percutaneous autologous bone marrow transplantation in treatment of fresh forearm fracture with bone defect

目的:分析经皮自体骨髓移植治疗前臂新鲜骨折伴骨缺损患者的临床效果。方法:随机选取11例前臂新鲜骨折伴骨缺损因局部皮损感染不能一期手术植骨内固定的患者为研究组,经伤口清创、骨折复位、石膏或外固定架固定、抗生素抗感染治疗无明显感染症状后,于3、6、9周采用透视下经皮自体骨髓移植方法治疗骨折缺损;随机选取12例前臂新鲜骨折伴骨缺损患者为对照组,给予植骨内固定治疗。两组患者均以6、9、12、24周X线复查结果评估骨折愈合情况。结果:研究组10例患者骨折24周后完全愈合,1例患者骨缺损明显减少,骨折线清晰,断端硬化,未完全愈合;对照组12例患者24周骨折均顺利愈合。结论:对于前臂新鲜骨折伴骨缺损的患者,植骨内固定术是可靠治疗方法;对于部分开放骨折伴缺损不能一期植骨内固定治疗的患者,经皮自体骨髓移植于骨折骨缺损处,能促进骨折愈合,修复骨缺损,可取得与早期植骨内固定术相似的一期愈合的效果,避免二次植骨手术。

Objective:To analyze clinical effects of percutaneous autologous bone marrow transplantation in treatment of fresh forearm fracture with bone defect. Methods:11 patients, who suffered from fresh forearm fracture with bone defect and could not get I Phase operation of bone graft fixation because of local skin infection, were randomly selected as experimental group. After debride-ment, reduction, plaster or external fixator fixation, and no obvious symptoms of infection after a antibiotics treatment, the percutane-ous autologous bone marrow transplantation therapy was used for fracture defect using the X-ray at the 3rd, 6th and 9th week. 12 pat-ines with forearm fresh fractures combined with bone defect were chosen as control group, and given internal fixation treatment. The fracture healing at 6th, 9th, 12th, and 24th weeks under X-ray was reviewed regularly. Results: For experimental group, 10 cases with fracture were healed completely 24 weeks after the treatment;and the bone defect in 1 case was decreased significantly, fracture line was clear, and broken end was hardened and not completely healed. For control group, 12 cases were all healed smoothly 24 weeks after the treatment. Conclusions:To the patients with forearm fresh fractures and bone defect, bone graft and internal fixation is a reliable treatment. For the patients with part open fracture and defect who can't get the I phase bone graft fixation treatment, percuta-neous autologous bone marrow transplantation in fracture and bone defect can promote the fracture healing, repair of bone defect, obtain the similar primary healing effect of early bone graft and internal fixation, and avoid the secondary bone graft surgery.