富血小板血浆联合自体髂骨松质骨植入治疗胫骨骨折术后骨不连的疗效

Efficacy of platelet-rich plasma combined with autogenous iliac cancellous bone implantation in treatment of postoperative nonunion of tibia fracture

目的观察富血小板血浆(PRP)联合自体髂骨松质骨植入治疗胫骨骨折术后骨不连的疗效。方法胫骨骨折术后骨不连患者30例随机均分为试验组和对照组。对照组仅植入自体髂骨松质骨10 g治疗,试验组加用骨折端注射自体PRP 10 mL。比较两组临床愈合和骨性愈合时间。采用Fernadez-Esteve评分记录两组治疗后第3、6、9个月骨痂生长情况,采用Johner-Wruhs功能分级标准记录两组治疗后第9个月患肢功能恢复程度。结果试验组临床愈合时间和骨性愈合时间均短于对照组[(3.95±1.81)个月vs.(6.84±1.64)个月和(11.75±2.03)个月vs.(16.44±1.34)个月](P<0.01)。试验组治疗后第3、6、9个月Fernadez-Esteve评分均高于对照组(P<0.05)。试验组治疗后第9个月优良患者比例多于对照组(P<0.05)。结论与单用植入自体髂骨松质骨比较,加用骨折端注射PRP治疗胫骨骨折术后骨不连的疗效更好。

Objective To observe the efficacy of platelet-rich plasma(PRP)combined with autogenous iliac cancellous bone implantation in the treatment of postoperative nonunion of tibia fracture.Methods Thirty patients with postoperative nonunion of tibia fracture were randomly and equally divided into groups of A and B.Group B was treated with an implantation of autogenous iliac cancellous bone 10 g,while group A was treated additionally with an injection of autogenous PRP 10 mL in the end of fracture.Clinical healing time and bone healing time were compared between the two groups.Fernadez-Esteve score was used to record the callus growth in the 3^(rd),6^(th)and 9^(th)month after treatment,and Johner-Wruhs functional grading standard was used to record the functional recovery of the affected limb in the 9^(th)month after treatment.Results The clinical healing time and bone healing time of group A were shorter than those of group B[(3.95±1.81)months vs.(6.84±1.64)months and(11.75±2.03)months vs.(16.44±1.34)months](P<0.01).Fernadez-Esteve scores in group A were higher than those in group B in the 3^(rd),6^(th)and 9^(th)month after treatment(P<0.05).The proportion of the patients with good recovery in group A in the 9^(th)month after treatment was more than that in group B(P<0.05).Conclusion Compared with autogenous iliac cancellous bone implantation alone,additionally with an injection of autogenous PRP in the end of fracture is more effective in treating the patients with postoperative nonunion of tibia fracture.