自体骨髓移植治疗感染性骨折愈合不良19例临床分析

背景:自体骨髓移植治疗骨折愈合不良已广泛应用于临床,但对于感染性骨折愈合不良采取自体骨髓移植,仍未达成共识.目的:探讨应用自体骨髓移植治疗感染性骨折愈合不良方法及临床效果.设计、时间及地点:回顾性分析,病例来自2001-01/2006-01河北医科大学第三医院骨伤科.对象:感染性骨折愈合不良患者19例,男13例,女6例,年龄18～50岁,平均36岁.胫骨骨折10例,股骨骨折5例,尺骨骨折2例,肱骨骨折2例.骨缺损6例,骨延迟愈合9例,骨不愈合4例.方法:对19例感染性骨折愈合不良患者应用自体骨髓移植治疗,其中12例感染控制后3周应用自体骨髓移植,7例自体骨移植后自体骨髓移植.主要观察指标:自体骨髓移植后定期复查X射线平片,根据骨折端骨痂生长情况,追踪了解骨折愈合进度,并观察副反应.结果:19例患者均获得随访.其中15例骨折愈合,愈合时间为7～20周.除注射时及注射后初期局部有胀痛感外,患者无明显不适症状.5例局部少量渗出,未出现感染复发、移植部位软组织骨化等并发症.骨折未愈合者4例,其原因2例骨缺损大于2cm.1例骨不愈合假关节形成骨折端硬化超过2 cm.1例外固定架松动,更改调整外固定架12周后骨折愈合.3例经再次进行自体髂骨移植后愈合.结论:自体骨髓移植经皮注射于骨愈合不良部位可以诱导成骨,有修复骨折及骨缺损作用,临床应用简单、创伤小、无并发症.尤其适用于感染性骨愈合不良.

Clinical analysis of percutaneous autologous bone marrow transplantation to heal malunion of fracture induced by infections in 19 cases

BACKGROUND: Autologous bone marrow transplantation (ABMT) has been widely used in treatment of the malunion of fracture, but this treatment to cure malunion of fracture induced by infection is still not consistent.OBJECTIVE: To observe the application and clinical outcome of ABUT for the malunion of fracture induced by infection.DESIGN, TIME AND SETTING: A retrospective analysis. The patients were all enrolled at Department of Orthopaedics in the Third Affiliated Hospital of Hebei Medical University from January 2001 to January 2006. PARTICIPANTS: A total of 19 patients with malunion of fracture induced by infection, including 13 males and 6 females aged from 18 to 50 years, with an average of 36. The lesioned site contained fracture of tibia 10, fracture of femur 5, fracture of ulna 2 and fracture of humerus 2. Among them, there were 6 cases with bone defect, 9 cases with bone fracture delayed union and 4 cases with bone fracture disunion.METHODS: Nineteen patients treated with percutaneous ABUT. Among the 19 cases, 12 patients received the transplant 3 weeks after infection was under controlled, and other 8 patients received the transplant following autologous bone transplantation.MAIN OUTCOME MEASURES: After ABMT, all patients were checked using X-ray regularly, the pacing of bone union was traced through observing the growth of callus, and the side reaction was also detected.RESULTS: Totally 19 patients were included in the follow-up visit, and 15 cases of them achieved bony union. Clinical healing time was 7-20 weeks. The patients had no obvious discomforts except local gas pains when injecting and at pristine time after injection. Five patients had a small quantity of exudation. No infection relapse or soft tissue ossification were observed at the injection position. Four patients had not achieved bony union, the reason was that bone defect in 2 patients exceed 2 cm; fracture disunion with pseudoarticulation formatted in one patient, the sclerous broken ends of fractured bone was more than 2 cm; another patient's external fixation displaced, we adjusted it and the bone healed after 12 weeks. Three patients received autoallergic ilium bone transplantation in the second time of operation, the fractured bone got bony union. CONCLUSION: ABMT by percutaneous injection into malunion site can induce ossification, repair bone fracture and bone defects. The clinical application is simple and exhibits small wounds without complications. Especially ABMT is effective for the patient with the malunion of fracture induced by infection.