富血小板血浆联合带皮质髂骨块移植和内固定治疗内踝骨折骨不连的效果

Effect of platelet rich plasma combined with cortical iliac bone graft and internal fixation in the treatment of nonunion of fracture of medial malleolus

目的探讨富血小板血浆(PRP)联合带皮质髂骨块移植和内固定治疗内踝骨折骨不连的临床价值,为其临床应用提供一定的理论依据。方法回顾性分析我院2018年1月至2021年8月收治的19例内踝骨折骨不连患者的临床资料,所有患者均清除断端硬化骨组织后植入PRP凝胶混合带皮质髂骨块填补骨缺损,改用钢板内固定进行骨折断端固定,其中6例骨缺损较大患者采用多皮质髂骨块填补缺损,并植入骨修复材料促进骨生成。结果所有患者均获得获得12~23个月随访,平均随访时间(14.23±4.75)个月;术后仅1例患者出现再次骨不连,其余患者骨折均获愈合,无再次骨不连;术后1例骨不连患者,经其要求,于术后9个月于断端处局部注射PRP,半年后骨折愈合;骨愈合时间7~14个月,平均(9.23±2.48)个月;末次随访时视觉模拟评分法(VAS)评分为(1.30±0.90)分;末次随访时美国矫形足踝协会(AOFAS)评分为优的患者17例,另外2例患者均为良,优良率100.00%。结论PRP联合带皮质髂骨块移植和内固定治疗内踝骨折骨不连具有较好的临床效果,其成骨可靠,安全性高,操作方便,患者术后功能恢复较好。

Objective To explore the clinical value of platelet rich plasma(PRP)combined with cortical iliac bone graft and internal fixation in the treatment of nonunion of fracture of medial malleolus,and to provide a certain theoretical basis for its clinical application.Methods The clinical data of 19 patients with nonunion of fracture of medial malleolus admitted from January 2018 to August 2021 in our hospital were retrospectively analyzed.All patients removed the sclerotic bone tissue at the fracture end and implanted PRP gel mixed with cortical iliac bone block to fill the bone defect,and the fracture end was fixed by internal fixation with steel plate.Among them,six patients with large bone defect used multi-cortical iliac bone block to fill the defect and implanted bone repair materials to promote osteogenesis.Results All patients were followed up for 12 to 23 months,with an average follow-up time of(14.23±4.75)months;second nonunion occurred in only 1 patient after surgery,and the fractures of other patients were healed without second nonunion;after surgery,one patient with nonunion required to receive local injection of PRP in fracture end at 9 months after surgery,and the fracture healed half a year later;the healing time of bone was 7-14 months,and the average was(9.23±2.48)months;Visual Analogue Scale(VAS)score was(1.30±0.90)at the last follow-up;at the last follow-up,17 patients had excellent American Orthopaedic Foot and Ankle Society(AOFAS)score,and the other 2 patients were good,with an excellent and good rate of 100.00%.Conclusion PRP combined with cortical iliac bone graft and internal fixation in the treatment of nonunion of fracture of medial malleolus has good clinical effect,reliable osteogenesis,high safety,convenient operation,and good postoperative functional recovery of patients.