经皮自体骨髓移植治疗儿童四肢长骨干骨折术后骨不连及骨延迟愈合

发布时间：2018-02-02 01:34

本文关键词： 经皮自体骨髓移植儿童四肢长骨干骨延迟愈合治疗外支架经皮自体骨髓移植儿童骨不连治疗　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：第一部分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6.7岁。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5~20m L,平均12.7m L,经皮注入到X线定位的骨折延迟愈合处。术后定期复查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,改为其它方法治疗。两组愈合时间和骨髓注射次数比较差异均有统计学意义(P0.01),两组最终治愈率比较差异无统计学意义(P0.05)。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。第二部分外支架固定及经皮自体骨髓移植治疗儿童四肢长骨骨折术后骨不连目的:探讨外支架固定及经皮自体骨髓移植治疗儿童四肢长骨骨折术后骨不连的疗效。方法:2005-2014年对39例四肢长骨骨折术后骨不连患儿,采用开放性手术对骨折断端肉芽组织及硬化骨切除、髓腔再通、外支架轴向加压,术后3~5月有骨延迟愈合倾向者,补充行自体骨髓移植术进行干预治疗。术后通过对骨髓穿刺区及钉道反应、骨折愈合、邻近的关节功能恢复等情况评估手术疗效。结果:本组所有骨不连患儿均获得随访,并随访至拆除内外固定后至少1年。3例患者出现钉道感染,经积极抗感染及定期换药后痊愈。2例患儿在行Orthofix单臂外支架固定术后发生螺钉松脱导致骨折明显移位成角,骨不连接,二期更改为Ilizarov环固定,术后经2次骨髓移植分别于再次术后9月和11个月愈合;最终39例均获临床愈合,愈合时间为4~15个月,平均6.2个月,末次随访时,均无骨髓穿刺区及钉道疼痛、感染或窦道形成,4例患者遗留邻近关节功能部分受限,其余患者均完全恢复。结论:外支架对儿童四肢长骨骨折术后骨不连具有良好的固定效果;术后有骨延迟愈合倾向者,行自体骨髓移植治疗,可以加快骨折愈合,减少再次骨不连的风险。因此外支架及经皮自体骨髓移植是治疗儿童四肢长骨骨折术后骨不连的有效办法。
[Abstract]:Part I Percutaneous autologous bone marrow therapy for delayed bone healing in children with long bone fractures objective: to explore the advantages of percutaneous autologous bone marrow transplantation in the treatment of long bone fractures in children. Methods from 2006 to 2014, 53 children with delayed union of long bone fractures of extremities were treated with percutaneous autologous bone marrow transplantation in our hospital from 2006 to 2014. There were 35 males and 18 females with an average age of 6.7 years. There were 20 cases of femur, 12 cases of tibia, 10 cases of humerus, 5 cases of radius and 5 cases of ulna. Only 1 case of fibula was delayed union of bone after traumatic fracture. 23 cases were divided into 4 ~ 6 months group according to the time from fracture operation to the first time of bone marrow transplantation. From 6 to 8 months, 30 cases were used as group B. the bone marrow fluid was drawn from the anterior superior iliac spine with an average of 12.7 mL. Percutaneous injection of X-ray fixed fracture delayed healing. After the regular review of X-ray films to observe and compare the fracture healing. Results: all the fracture delayed healing were followed up. The patients were followed up until at least 6 months after removal of internal and external fixation, and 47 cases were clinically healed. The healing time was 3 ~ 10 months after the first bone marrow transplantation, with an average of 5.8 months. One case in group A was not healed. In group B, there was no obvious callus growth after bone marrow transplantation. The healing time and times of bone marrow injection were significantly different between the two groups (P 0.01). Conclusion: percutaneous autologous bone marrow transplantation is a simple, minimally invasive and safe method for delayed bone healing after long bone fracture in children. Economic and practical treatment and early autologous bone marrow transplantation can accelerate fracture healing and shorten the course of treatment. The second part is external stent fixation and percutaneous autologous bone marrow transplantation for the treatment of nonunion after long bone fracture in children. Objective: to investigate the effect of external stent fixation and percutaneous autologous bone marrow transplantation in the treatment of nonunion after long bone fracture in children. Methods 39 cases of nonunion after long bone fracture of extremities were treated from 2005 to 2014. Open operation was used to resect granulation tissue and sclerosing bone at fracture end, recanalization of medullary cavity, axial compression of external stent, and delayed healing tendency of bone from 3 to May after operation. The bone marrow was treated with autogenous bone marrow transplantation. The fracture was healed by the reaction of the bone marrow puncture area and the nail canal after the operation. Results: all the children with nonunion were followed up and followed up until at least 1 year after removal of internal and external fixation. After active anti-infection and regular dressing change, 2 cases of children were cured after Orthofix single arm external stent fixation, screw loosening resulted in obvious displacement of the fracture into angle, and the bone was not connected with each other. The second stage was fixed with Ilizarov ring and healed after two bone marrow transplants on September and 11 months respectively. The healing time was 4 ~ 15 months with an average of 6.2 months. At the last follow-up, no pain, infection or sinus formation occurred in the bone marrow puncture area or the nail canal. The left adjacent joint function was partially limited in 4 patients and the other patients recovered completely. Conclusion: the external stent has a good fixation effect on the nonunion of long bone fracture in children after operation. If there is a tendency of delayed bone healing after operation, autogenous bone marrow transplantation can accelerate fracture healing. Therefore, external stent and percutaneous autologous bone marrow transplantation are effective in the treatment of nonunion after long bone fracture in children.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8

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