附加侧板联合富血小板血浆治疗股骨骨折髓内固定后骨不连

Auxiliary steel plate combined with platelet rich plasma for the treatment of femoral shaft nonunion after intramedullary nail fixation

目的 回顾性分析附加侧板联合自体单采富血小板血浆(PRP)与更换髓内钉改行钢板固定治疗股骨骨折髓内固定后骨不连的临床疗效。方法 选取2019年6月—2022年6月本院骨科收治的股骨骨折髓内钉固定后骨不连患者30名,其中男26例,女4例;年龄20~58岁,平均为(36.8±7.1)岁。实验组13例患者保留髓内钉,骨折端附加侧板固定,术中自体髂骨混合PRP植于骨缺损部位,术后14d、28d于骨不连部位注射自体PRP 10mL/(人)次。对照组17例患者取出髓内钉,改行锁定加压钢板固定,术中自体髂骨植骨。随访观察比较2组患者围手术期情况和骨折临床愈合情况。结果 30例患者均获得完整随访,随访时间12~33个月,平均(15.2±3.5)个月;两组手术时间(min)、术中出血量(mL)、术后引流量(mL)分别为95.7±47.2 vs.167.6±71.5、292.3±147.2 vs.686.9±238.9、102.8±67.5 vs.166.2±87.3,均有统计学差异(P <0.05),住院时间(d)为10.3±5.2 vs.12.5±6.8,无统计学差异(P>0.05);骨折临床愈合时间(月)为5.36±1.27 vs.7.63±1.57(P <0.05);术后6、9个月时愈合率分别为92.3%(12/13) vs.52.9%(9/17)(P <0.05),100%(13/13) vs.82.4%(14/17)(P>0.05)。结论 附加侧板联合术中及术后使用自体单采PRP治疗股骨骨折髓内固定后骨不连操作简便、术程短、出血少,且愈合快,是可供临床选择的理想治疗方案。

Objective To retrospectively analyze the clinical efficacy of auxiliary steel plate combined with autologous platelet rich plasma(PRP)and replacement of intramedullary nails with steel plate fixation in the treatment of femoral shaft nonunion after intramedullary nail fixation.Methods A total of 30 patients with femoral fracture and bone nonunion after intramedullary nail fixation were selected from the Department of Orthopedics of our hospital from June 2019 to June 2022,including 26 males and 4 females.The average age was(36.8±7.1)years,ranging from 20 to 58 years.In the experimental group of 13 patients,intramedullary nails were retained and the fracture end was fixed with side plates.During the operation,autologous iliac bone mixed PRP was implanted in the bone defect site,and autologous PRP 10 mL/(person)was injected into the bone non-union site 14 d and 28 d after surgery.In the control group,intramedullary nails were removed,and locking compression plates were fixed instead,followed by intraoperative autologous iliac bone grafting.Follow up observation and comparison of perioperative conditions and clinical fracture healing between the two groups of patients were conducted.Results All the 30 patients received complete follow-up for 2~33 months,with an average of(15.2±3.5)months.The operative time(min),intraoperative blood loss(mL)and postoperative drainage volume(mL)of the two groups were 95.7±47.2 vs.167.6±71.5,292.3±147.2 vs.686.9±238.9,and 102.8±67.5 vs.166.2±87.3,respectively,showing significant differences(P<0.05),and the length of hospitalization(d)was 10.3±5.2 vs.12.5±6.8,with no significant difference(P>0.05).The clinical healing time of fractures(month)was 5.36±1.27 vs.7.63±1.57(P<0.05);the healing rates at 6 and 9 months after surgery were 92.3%(12/13)vs.52.9%(9/17)(P<0.05),and 100%(13/13)vs.82.4%(14/17)(P>0.05),respectively.Conclusions Intraoperative and postoperative use of autologous PRP in the treatment of femoral fracture after intramedullary fixation is simple,short,less bleeding,and fast healing,which is an ideal treatment for clinical selection.