富血小板血浆复合自体松质骨移植的生物重建治疗陈旧性腕舟状骨骨不连的临床效果分析

目的 观察富血小板血浆（platelet-rich plasma, PRP）复合自体松质骨移植治疗腕舟状骨骨不连的近期临床效果。方法 收集中国人民解放军联勤保障部队第989医院自2019年6月至2021年6月期间收治的30例陈旧性腕舟状骨骨不连的患者作为研究对象，按照随机数表分为观察组和对照组。观察组（15例）采用PRP复合自体松质骨移植的生物重建方法，对照组（15例）采用只采用自体松质骨移植并内固定的手术方式。对比两组的手术时间、住院时间、骨折愈合情况、骨痂等级评分、腕关节功能评估及术后并发症。结果 术后30例患者均得到随访，随访周期为12个月。观察组骨折愈合率为93.3%，对照组骨折愈合率为66.7%，两组比较差异具有统计学意义（P＜0.05）。观察组的手术时间为（1.83±0.23）h，对照组的手术时间为（1.73±0.30）h，两组比较差异无统计学意义（P＞0.05）；观察组骨折愈合时间［（16.54±0.74）周］少于对照组［（20.70±4.73）周］，术后住院时间［（14.27±2.43） d］少于对照组［（19.53±6.29） d］，两组比较差异具有统计学意义（P＜0.05）。观察组术后4、8、12周骨痂等级评分比较优于对照组，两组比较差异具有统计学意义（P＜0.05）；观察组术后16周骨痂等级评分比较优于对照组，两组比较差异无统计学意义（P＞0.05）。数据显示术后6个月，观察组的Mayo评分高于对照组，VAS评分低于对照组，两组比较差异具有统计学意义（P＜0.05）；术后12个月，两组间Mayo评分及VAS评分比较，差异无统计学意义（P＞0.05）。观察组术后并发症共2例，对照组术后并发症共6例，两组比较差异具有统计学意义（P＜0.05）。结论 富血小板血浆（PRP）复合自体松质骨移植治疗腕舟状骨骨不连可促进腕舟状骨骨折愈合，减少手术相关并发症，利于腕关节功能恢复，近期临床效果较好。

Clinical results of platelet-rich plasma combined with autologous cancellous bone graft in the treatment of old navicular osteonecrosis of the wrist

Objective To observe the recent clinical results of platelet-rich plasma (PRP) combined with autologous cancellous bone graft in the treatment of osteonecrosis of the navicular bone of the wrist.Methods Thirty patients with obsolete carpal navicular bone nonunion admitted to 989 Hospital of Joint Service Support Force of Chinese PLA from June 2019 to June 2021 were collected as study subjects and randomly divided into observation group and control group according to a random number table. The observation group (15 patients) used PRP combined with autologous cancellous bone graft for bioreconstruction, and the control group (15 patients) used only autologous cancellous bone graft with internal fixation. The operative time, hospital stay, fracture healing, bone scab grade score, wrist function assessment and postoperative complications of the two groups were compared.Results All 30 patients were followed up after the operation with a follow-up period of 12 months. The fracture healing rate was 93.3% in the observation group and 66.7% in the control group, and the difference between the two groups was statistically significant (P<0.05). The mean operative time was (1.83±0.23) h in the observation group and (1.73±0.30) h in the control group, there was no statistical difference between the two groups (P>0.05). The mean fracture healing time was (16.54±0.74) weeks in the observation group and (20.70±4.73) weeks in the control group, the differences between the two groups were statistically significant(P<0.05). The mean postoperative hospitalization time was (14.27±2.43) d in the observation group and (19.53±6.29) d in the control group, and the differences between the two groups were statistically significant (P<0.05). The bone scab grade score at 4, 8, 12 weeks postoperatively in the observation group were better than that in the control group, the differences between the two groups were statistically significant (P<0.05); the bone scab grade score at 16 weeks postoperatively in the observation group were better than that in the control group, but there was no statistical difference between the two groups (P>0.05). The Mayo score at 6 months postoperative in the observation group was better than that in the control group, and the VAS score was lower than that in the control group, the differences between the two groups were statistically significant (P<0.05); at 12 months after operation, there was no significant difference between the two groups. The postoperative complications were 2 cases in the observation group and 6 cases in the control group, the differences between the two groups were statistically significant (P<0.05).Conclusion Platelet-rich plasma (PRP) combined with autologous cancellous bone grafting for carpal navicular bone nonunion can promote carpal navicular fracture healing, reduce surgery-related complications, and facilitate functional recovery of the wrist joint, with good recent clinical results.