经皮自体骨髓移植与自体髂骨植骨在胫骨骨折术后不愈合中的应用对比  

Comparison of percutaneous autologous bone marrow transplantation and autologous iliac bone graft in the treatment of postoperative nonunion of tibial fractures

作　　者：张东阳 张桂平 鲜文峰[1] Zhang Dongyang;Zhang Guiping;Xian Wenfeng(WardⅡof Department of Orthopaedics,Nanyang Second People’s Hospital,Nanyang 473000,China)

机构地区：[1]南阳市第二人民医院骨科二病区,南阳473000

出　　处：《中国实用医刊》2023年第11期69-72,共4页Chinese Journal of Practical Medicine

摘　　要：目的比较分析经皮自体骨髓移植与自体髂骨植骨在胫骨骨折术后不愈合中的应用效果。方法抽取2019年4月至2022年4月南阳市第二人民医院收治的胫骨骨折术后不愈合患者53例,按随机数字表法分为对照组(26例)与观察组(27例)。对照组采用自体髂骨植骨,观察组采用经皮自体骨髓移植。比较两组治疗优良率、术后恢复情况(X线片骨折线消失时间、骨折愈合时间)、不同愈合程度骨痂形成时间;比较两组治疗前后骨形成蛋白-2(BMP-2)、胰岛素样生长因子-1(IGF-1)、血管内皮细胞生长因子(VEGF)水平。结果观察组优良率(96.30%,26/27)与对照组(80.77%,21/26)比较差异未见统计学意义(χ^(2)=1.82,P=0.177)。观察组X线片骨折线消失时间、骨折愈合时间短于对照组(P<0.05)。两组少量骨痂、中量骨痂、大量骨痂形成时间比较差异未见统计学意义(P>0.05)。治疗后,观察组BMP-2、IGF-1、VEGF水平高于对照组(P<0.05)。结论经皮自体骨髓移植与自体髂骨植骨对胫骨骨折术后不愈合患者均具有良好治疗效果,但经皮自体骨髓移植能显著增加骨诱导因子表达水平,促进骨折愈合。Objective To compare and analyze the effect of percutaneous autologous bone marrow transplantation and autologous iliac bone graft in the treatment of postoperative nonunion of tibial fractures.Methods A total of 53 patients with nonunion of tibial fractures after surgery treated in Nanyang Second People’s Hospital from April 2019 to April 2022 were selected,and they were divided into control group(26 cases)and observation group(27 cases)by random number table method.The control group was treated by autogenous iliac bone graft,while the observation group was treated by percutaneous autologous bone marrow transplantation.The excellent and good rate,postoperative recovery(fracture line disappearance time in X-ray image and fracture healing time)and callus formation time of different degrees of healing were compared between the two groups.The preoperative and postoperative levels of bone morphogenetic protein-2(BMP-2),insulin-like growth factor-1(IGF-1)and vascular endothelial growth factor(VEGF)were compared between the two groups.Results There was no significant difference in the excellent and good rate between the observation group(96.30%,26/27)and the control group(80.77%,21/26),χ^(2)=1.82,P=0.177.The fracture line disappearance time in X-ray image and fracture healing time of the observation group were shorter than those of the control group(P<0.05).There was no significant difference in the formation time of small amount of callus,medium amount of callus and large amount of callus between the two groups(P>0.05).After treatment,the levels of BMP-2,IGF-1 and VEGF in the observation group were higher than those in the control group(P<0.05).Conclusions Both percutaneous autologous bone marrow transplantation and autologous iliac bone graft have good therapeutic effects on postoperative nonunion of tibial fractures,but percutaneous autologous bone marrow transplantation can significantly increase the expression level of osteoinductive factors and promote fracture healing.

关 键 词：胫骨骨折 不愈合 经皮自体骨髓移植 自体髂骨植骨 

分 类 号：R687.3[医药卫生—骨科学]