自体骨髓移植与闭合带锁髓内钉内固定术治疗股骨胫骨骨折术后骨不连

Treatment of postoperative femoral and tibial fracture nonunion with autologous bone marrow transplantation and closed interlocking intramedullary nail fixation

目的观察自体骨髓移植与闭合带锁髓内钉内固定术治疗股骨胫骨骨折术后骨不连的临床效果。方法 50例股骨胫骨骨折不愈合随机分为A、B两组,每组25例。A组采用自体骨髓移植与闭合带锁髓内钉治疗,B组采用传统的更换内固定物（髓内钉或钢板）＋取自体髂骨或异体骨植骨治疗。结果所有患者均获9～23个月（平均15.4个月）的随访,A组中20例获得骨性愈合,2例延迟愈合,3例不愈合;B组14例愈合,2例延迟愈合,9例不愈合。A组骨折的愈合时间和愈合率优于B组,手术时间、术中出血量少于B组,差异有统计学意义（P〈0.05或0.01）,而两组的疼痛VAS评分差异无统计学意义（P〉0.05）。结论自体骨髓移植与闭合带锁髓内钉内固定术是治疗股骨胫骨骨折不愈合的有效方法,明显优于传统的更换内固定物（髓内钉或钢板）＋取自体髂骨或异体骨植骨。

Objective To investigate the clinical effect of autologous bone marrow transplantation and interlocking intramedullary nail fixation in the treatment of postoperative femoral and tibial fracture nonunion. Methods 50 cases with femoral and tibial fracture nonunion were divided into Group A and Group B. Group A was treated with autologous bone marrow transplantation and closed interlocking intramedullary nail. Group B was treated with the traditional replacement of internal fixation（intramedullary nail or plate） ＋ bone grafting with autogeneic iliac bone or allogeneic bone. Results All patients were followed up for 9-23 months（average of 15.4 months）. In Group A,20 cases were healing,2 cases had a delayed union and 3 cases had non-union. In Group B,14 cases were healed,2 cases had a delayed union and 9 cases had non-union. Group A was superior to Group B in terms of healing time and healing rate and had a less operation time and intraoperative bleeding than Group B. The difference was statistically significant（P〈0.05 or 0.01）. There was no significant difference in pain VAS score between the two groups（P〈0.05）. Conclusion Autologous bone marrow transplantation and closed interlocking intramedullary nail fixation is an effective method for the treatment of femur and tibia fracture non-union and is significantly superior to traditional replacement of internal fixation（intramedullary nail or plate） ＋ bone grafting with autogeneic iliac bone or allogeneic bone.