自体髂骨植骨联合自体骨髓干细胞移植治疗骨折术后骨不连

Autologous iliac crest graft combined with autologous bone marrow stem cell transplantation for bone nonunion after fracture surgery

背景:骨不连是骨科治疗的常见并发症,其发病率为5%-10%,如果不能及时处理,将给患者肢体功能带来长期障碍,甚至残疾,自体髂骨植骨是临床治疗骨不连的常用方法,但具有诸多局限性。目的:探讨自体髂骨植骨联合自体骨髓干细胞移植治疗骨折术后骨不连的效果。方法:对69例骨折术后确诊为骨不连患者的治疗及随访资料进行回顾性分析,根据治疗方法分为联合组(自体髂骨植骨联合自体骨髓干细胞移植)37例、髂骨组(自体髂骨植骨)32例,对比两组患者的住院时间、骨折愈合时间、患侧肢体骨密度值、Fereadez-Esteve骨痂评分。结果与结论:1联合组患者的住院时间与髂骨组比较差异无显著性意义(P>0.05);骨折愈合时间显著低于髂骨组(P<0.05);2治疗后第3,6个月联合组的骨密度值、Fereadez-Esteve骨痂评分值均显著高于髂骨组(P<0.05);3联合组的患侧肢体功能优良率显著高于髂骨组(P<0.05);4结果表明,自体髂骨植骨联合自体骨髓干细胞移植治疗骨折术后骨不连可以加快患者骨折愈合、促进骨痂形成和患侧肢体功能恢复。

BACKGROUND：Bone nonunion is a common complication in the orthopedic treatment, and its morbidity reached 5%-10%, which results in the long-term functional disturbance of the limbs, and even disability. Autogenous iliac crest graft has been commonly used to treat bone nonunion, but some limitations stil exist. OBJECTIVE：To investigate the treatment outcomes of autogenous iliac crest graft combined with autologous bone marrow stem cel transplantation for bone nonunion after fracture surgery. METHODS：Clinical and fol ow-up data from 69 patients with bone nonunion were analyzed retrospectively. Al patients were al otted to combination （n=37） and iliac （n=32） groups, fol owed by treated with autologous iliac crest graft combined with autologous bone marrow stem cel transplantation or autologous crest graft, respectively. Afterwards, the hospitalization time, fracture healing time, bone mineral density and Fereadez-Esteve cal us scores were detected and compared between groups. RESULTS AND CONCLUSION：The hospitalization time did not differ significantly between groups （P〉0.05）. The fracture healing time in the combination group was significantly shortened compared with the iliac group （P〈0.05）. The bone mineral density and Fereadez-Esteve callus scores in the combination group were significantly higher than those in the iliac group at 3 and 6 months after surgery （P〈0.05）. The excellent and good rate of the affected limb function in the combination group was significantly higher than that in the iliac group （P〈0.05）. These results suggest that autogenous iliac crest graft combined with autologous bone marrow stem cell transplantation for bone nonunion can accelerate fracture healing, promote porosis and improve the functional recovery of affected limbs.