Boyette Melissa Y, Herrera-Soto Jose A
Department of Pediatric Orthopedics, Arnold Palmer Hospital for Children, 83 W Columbia St, Orlando, FL 32806, USA.
Orthopedics. 2012 Jul 1;35(7):e1051-5. doi: 10.3928/01477447-20120621-20.
Nonunion of fractures or osteotomies in the pediatric population is rare. The gold standard for the treatment of nonunions involves harvesting autologous iliac crest bone graft and sometimes internal fixation, which are invasive procedures. The purpose of this study was to evaluate the effectiveness of pulsed electromagnetic field on a non-united fracture or osteotomy in the pediatric population. A retrospective study was performed on all patients at the authors' institution who used pulsed electromagnetic field as part of their treatment for nonunion or delayed union. Success of the initial nonunion treatment was defined as complete union of the fracture or osteotomy site. Two types of treatment were administered once delayed bone healing was identified: pulsed electromagnetic field alone or pulsed electromagnetic field plus an adjunct treatment. Twenty-one patients were included; 8 osteotomies and 14 fractures developed a nonunion. Average patient age was 11.7 years. Average age for patients who healed with the initial treatment was 10.7 years, whereas nonhealers had an average age of 14 years. Eighty-nine percent of osteotomy nonunions healed with their first management. Fifty-seven percent of fracture nonunions healed at the first attempt. The use of pulsed electromagnetic field is a good option for the initial treatment of pediatric nonunions, especially for patients who develop nonunions secondary to osteotomies. Adding bone marrow aspiration improves the outcomes and is minimally invasive compared with autologous iliac crest bone graft, with no complications.
小儿骨折或截骨不愈合的情况较为罕见。治疗不愈合的金标准包括采集自体髂嵴骨移植，有时还需要内固定，这些都是侵入性手术。本研究的目的是评估脉冲电磁场对小儿骨折或截骨不愈合的有效性。对作者所在机构所有使用脉冲电磁场作为治疗不愈合或延迟愈合一部分的患者进行了回顾性研究。初始不愈合治疗的成功定义为骨折或截骨部位完全愈合。一旦确定骨愈合延迟，就会给予两种治疗方式：单独使用脉冲电磁场或脉冲电磁场加辅助治疗。纳入了21名患者；8例截骨和14例骨折出现了不愈合。患者平均年龄为11.7岁。初始治疗愈合的患者平均年龄为10.7岁，而未愈合者的平均年龄为14岁。89%的截骨不愈合在首次治疗时愈合。57%的骨折不愈合在首次尝试时愈合。对于小儿不愈合的初始治疗，使用脉冲电磁场是一个不错的选择，尤其是对于因截骨导致不愈合的患者。与自体髂嵴骨移植相比，添加骨髓抽吸可改善治疗效果且微创，无并发症。
