经皮自体骨髓治疗儿童四肢长骨干骨折术后骨延迟愈合

发布时间：2018-02-02 23:19

本文关键词： 经皮自体骨髓移植四肢骨干骨折延迟愈合儿童　出处：《第三军医大学学报》2017年06期 　论文类型：期刊论文

【摘要】：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 m L,平均12.7 m L,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(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。
[Abstract]:Objective to evaluate the advantages of percutaneous autologous bone marrow transplantation (PMT) in the treatment of delayed bone healing after long bone fracture 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. There were 35 males and 18 females with an average age of 6.7 years. The site of fracture included femur (n = 20), tibia (n = 12), humerus (n = 10) and radius (n = 5). Five cases of ulna and one case of fibula were all delayed union of bone after traumatic fracture. 23 cases were divided into group A according to the time of bone marrow transplantation from 4 to 6 months. From 6 to 8 months, 30 cases were used as group B. the bone marrow fluid was extracted from the anterior superior iliac spine by bone marrow puncture with an average of 12.7 mL. X-ray films were taken regularly after operation to observe and compare the fracture healing. Results all the fractures were followed up and followed up to the removal. At least 6 months after external fixation, 47 cases were clinically healed, and the healing time was 3 ~ 10 months after the first bone marrow transplantation, with an average of 5.8 months. There was no obvious callus growth at the fracture site after two bone marrow transplants. 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 feasible treatment and early autologous bone marrow transplantation can accelerate fracture healing and shorten the course of treatment.
【作者单位】：重庆医科大学附属儿童医院骨一科儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室重庆市儿童发育重大疾病诊治与预防国际科技合作基地;
【基金】：国家临床重点专科建设项目[国卫办医函(2013)544] 重庆市卫生和计划生育委员会重点项目[渝卫科教(2013)39号2013-1-029]~~
【分类号】：R726.8
【正文快照】： 大学附属儿童医院骨一科,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地)骨折愈合是一个复杂而连续的动态生理过程,包括以下4个过程:细胞募集、骨诱导、调控、骨传导,需具备适宜的细胞(主要是成骨细胞)环境、足

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