经皮自体骨髓治疗儿童四肢长骨干骨折术后骨延迟愈合

目的 探讨经皮自体骨髓移植治疗儿童四肢长骨干骨折术后骨延迟愈合的优越性、安全性及疗效.方法 2006-2014年我院应用经皮自体骨髓移植治疗的四肢长骨干骨折术后骨延迟愈合患儿53例(骨折端均稳定、无严重成角和短缩畸形),男性35例,女性18例,年龄1 ～ 16岁,平均年龄6.7岁.骨折部位:股骨20例,胫骨12例,肱骨10例,桡骨5例,尺骨5例,单纯腓骨1例,均为外伤性骨折术后骨延迟愈合.按照骨折术后至第1次骨髓移植的时间分组,4～6个月共23例作为A组,6～8个月共30例作为B组.从髂前上棘处抽吸骨髓穿刺抽取骨髓液5 ～ 20 mL,平均12.7 mL,经皮注入到X线定位的骨折延迟愈合处.术后定期摄X线片,观察、比较骨折愈合情况.结果 本组所有骨折延迟愈合均获得随访,并随访至拆除内、外固定后至少6个月,最终47例获临床愈合,愈合时间距第1次骨髓移植后3 ～ 10个月,平均5.8个月.未愈合6例,A组1例,B组5例,骨髓移植2次后骨折处无明显骨痂生长,改为其他方法治疗.两组愈合时间和骨髓注射次数比较差异均有统计学意义(P＜0.01),两组最终治愈率比较差异无统计学意义(P＞0.05).结论 经皮自体骨髓移植治疗儿童四肢长骨干骨折术后骨延迟愈合是一种操作简单、微创、安全、经济又切实可行的治疗方法,且早期行自体骨髓移植,可加快骨折愈合,缩短疗程,值得临床推广.

Percutaneous autogenous bone marrow transplantation treats delayed union of diaphyseal fracture in extremity long bone among children

Objective To investigate the effectiveness,advantages,and safety of delayed union of diaphyseal fracture of extremity long bone in children after the treatment with percutaneous autogenous bone marrow transplantation.Methods From 2006 to 2014,53 patients (stable fracture fixation and no serious angular and short deformity) with delayed union of diaphyseal fracture of extremity long bone after operation,including 35 males and 18 females,were enrolled in this study,They were at an age ranged from 1 to 16 years old with a mean age of 6.7 years old.All the cases were traumatic fractures,involving 20 cases of the femur,12 cases of tibia,10 cases of humerus,5 cases of radius,5 cases of ulna,and 1 case of simple fibular.According to the time from the operation to the first bone marrow transplantation,23 patients with the time of 4 ～6 months were assigned as group A,and 30 patients with the time of 6 ～8 months were assigned as group B.The patients were placed by prostration and 5 ～ 20 mL (average 12.7 mL) bone marrow was aspirated from the anterior superior iliac spine.Then the bone marrow was injected into the delayed union site under fluoroscopic control.X-ray filming was used to observe the fracture healing.Results All patients were followed up for at least 6 months after internal and external fixation was removed.Finally 47 cases achieved clinical healing at a mean time of 5.8 months after operation (from 3 months to 10 months).Failure occurred in 6 cases,including 1 case in group A and 5 cases in group B.After 2 injections,no obvious bony callus was observed,and then other treatment was performed.There were statistically significant differences in healing time and the number of injections between the 2 groups (P ＜0.01).The total curative rates of the 2 groups had no statistical significance (P ＞ 0.05).Conclusion Percutaneous autogenous bone marrow transplantation is a simple,safe,minimally invasive,economical and feasible method for the treatment of delayed union of diaphyseal fracture of extremity long bone in children after operation.What is more,the early bone marrow transplantation can accelerate the fracture healing and shorten the course of treatment.