断端局部注射治疗骨折术后骨不连的疗效

The effect of local injection in the broken end of fracture for treatment of nonunion

目的探讨骨折断端局部注射金葡素注射液(简称金葡液)或金葡液联合自体红骨髓治疗骨折术后骨不连疗效。方法112例术后骨不连患者中,89例骨折间隙≤5 mm患者在X线下取金葡液2 ml骨折处注射,每周1次,共6次;23例5 mm<骨折间隙≤10 mm患者取金葡液2 ml联合自体红骨髓15~20 ml骨折处注射,自体红骨髓每月1次,共1~2次,金葡液2 ml每周1次,共6次。注射结束后1个月摄X线片复查,如骨折线模糊或消失视为治疗有效,骨折间隙仍清晰视为无效。治疗有效患者,继续观察,注射结束后3、6个月分别摄X线片评估骨折愈合时间及愈合状况;无效患者需针对骨不连的原因采取不同的手术干预措施。结果112例均获得随访,时间12~36个月。95例注射结束后1个月骨折线模糊或消失,3~5个月骨愈合,治愈率84.8%;17例治疗无效,再次采用植骨、更换或附加钢板固定治疗,术后5~8个月骨愈合。结论严格掌握适应证,采用骨折断端局部注射金葡液或金葡液联合自体红骨髓治疗骨折术后骨不连可促进骨愈合,该方法简单,临床疗效满意。

Objective To investigate the effect of local injecting highly agglutinative staphylococin(HAS)and combination of HAS and autogenous red bone marrow on postoperative nonunion.Methods The 112 patients with postoperative nonunion were treated in groups.In 89 cases,the fracture interval was≤5 mm,and 2 ml HAS was injected into the fracture site under X-ray positioning,once 1 week for 6 times in total.In 23 cases,5 mm<fracture interval≤10 mm,2 ml of HAS solution was taken and 15~20 ml of autologous red bone marrow was injected at the fracture site,once a month for 1~2 times,2 ml HAS solution once a week for 6 times in total.At 1 month after the end of the injection,the re-examination of X-ray film was performed,if the fracture line was blurred or disappeared,the treatment was considered effect.The re-examination of X-ray film at 3,6 months were used to evaluate the fracture healing time and healing status for those who were effective.The fracture gap was still clearly invalid,and different surgical intervention measures were adopted for the cause of nonunion.Results All 112 cases were followed up for 12~36 months,among which 95 cases had blurred or disappeared fracture line at 1 month after injection,and bone healed in 3~5 months,with a cure rate of 84.8%.Seventeen cases were treated with bone graft,replacement or additional plate fixation,and the bone healed within 5~8 months after the operation.Conclusions Strictly grasping the indications,local injection of HAS or HAS combined with autogenous red bone marrow in the treatment of fracture nonunion after fracture can promote bone healing,the method is simple and the clinical effect is satisfactory.