自体骨髓移植、体外冲击波以及石膏固定治疗胫骨疲劳骨折的比较

背景：疲劳骨折是部队训练常见伤,目前多以保守治疗为主,愈合时间长,功能恢复差,尚无明确的治疗方案。 目的：比较体外冲击波、自体骨髓移植以及石膏固定治疗3种方法对疲劳骨折愈合的促进作用。方法：将临床确诊为疲劳骨折Ⅱ型的30例男性士兵,随机分为3组：①体外冲击波组：在CT定位下以疲劳骨折断裂带中心点为冲击点,单次治疗。②自体骨髓移植组：取髂前上棘下部或髂后上棘骨板较厚的部位骨髓3~5 mL注入疲劳骨折断端,单次治疗。③石膏固定组：采用休息,固定,口服活血化淤药物的方法治疗。3组分别于治疗后第2,4,6,8周依照X线影像学及功能恢复标准判定骨折愈合情况。结果与结论：根据X射线结果,体外冲击波组与自体骨髓移植组在治疗后第8周时骨折愈合效果差异无显著性意义,但二者均优于石膏固定组(P < 0.05)。功能恢复观察结果显示,体外冲击波组优于自体骨髓移植组,自体骨髓移植组优于石膏固定组。提示体外冲击波治疗是一种促进疲劳骨折愈合的有效方法。关键词：冲击波;疲劳骨折;愈合;骨髓移植;固定;治疗doi:10.3969/j.issn.1673-8225.2012.09.042

Autologous bone marrow transplantation and extracorporeal shock wave as well as plaster fixation for the treatment of tibial fatigue fracture

BACKGROUND: Fatigue fracture is common injuries in military training. To date, the therapy of the injuries is mainly conservative with the characters of long healing time, poor functional recovery and there is no specific treatment for the fatigue facture.OBJECTIVE: To compare the effect of extracorporeal shock wave (ESW), autologous bone marrow transplantation (ABMT) and plaster fixation treatment (PFT) on the healing of fatigue fracture in order to seek for the best therapy．METHODS: Thirty male patients with tibial fatigue fracture type Ⅱ in hospital were randomly divided into three groups: ① ESW group, positioned by the CT, took the fatigue fracture center as the impact point and gave a single treatment. ② ABMT group, took the bone marrow 3-5 mL from lower part of anterior superior iliac spine or the thicker part of posterior inferior iliac spine and injected it in the fatigue fracture ends and gave a single treatment. ③ PFT group, the patients were treated with rest, fixation of the fracture and took blood activating medicine. The fracture healing conditions of three groups were evaluated according to the X-ray imaging and functional recovery standard at the 2nd, 4th, 6th and 8th weeks after treatment, respectively.RESULTS AND CONCLUSION: According to X-ray results, the difference of fracture healing was not significant in ESW group and ABMT group at 8 weeks after treatment and both of which were better than PFT group (P < 0.05). Functional recovery observation results showed that ESW group is better than ABMT, which is still better than PFT group. ESW treatment is an effective mean in the healing of fatigue fractures.