Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas 77204-6015, USA.
J Orthop Trauma. 2013 Sep;27(9):527-33. doi: 10.1097/BOT.0b013e31828bf077.
To report the outcomes of percutaneous autologous bone marrow injection for nonunion or delayed union of the distal tibial metaphysis in patients with prior plating.
Consecutive case series.
Tertiary center.
Eleven consecutive patients (aged 24-51 years) were referred to us with a nonunion or delayed union of the distal tibial metaphysis after open reduction and internal fixation (plates and screws) at the time of fracture. The average time from initial injury to nonunion or delayed union and bone marrow treatment was 8 months (range, 3-20 months).
A total of 40-80 mL of bone marrow aspirated from the posterior iliac crest and injected in and around the nonunion or delayed union site under fluoroscopic guidance.
Healing at the injury site was evaluated using clinical and radiographic criteria, including computed tomography. Measures included American Academy of Orthopaedic Surgeons Lower Limb Core Scale (LLCS), Brief Pain Inventory, and Short Form 12 Physical Component Summary.
Nine of the 11 patients attained bony union within 6 months of bone marrow injection. Six of these 9 patients who were followed-up an average of 4.4 years (range, 1.3-8.2 years) after the injection reported significant (P < 0.05) improvements in Lower Limb Core Scale (59.9-89.7), pain intensity (2.9-1.7), pain interference (4.6-2.3), and Short Form 12 Physical Component Summary (29.5-46.6) and 5.6 years improvement in quality-adjusted life years.
Percutaneous autologous bone marrow injection is a minimally invasive, safe, and inexpensive treatment option for distal metaphyseal tibial nonunions or delayed unions after internal fixation and should be considered when the retained hardware seems to be intact and stable.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
报告经皮自体骨髓注射治疗骨折切开复位内固定（钢板和螺钉）后胫骨远端干骺端骨不连或延迟愈合的结果。
连续病例系列。
三级中心。
11 例连续患者（年龄 24-51 岁）因开放性复位和内固定（钢板和螺钉）后胫骨远端干骺端骨不连或延迟愈合而被转诊给我们。从初次损伤到骨不连或延迟愈合和骨髓治疗的平均时间为 8 个月（范围，3-20 个月）。
在透视引导下，从髂后嵴总共抽吸 40-80 毫升骨髓，并注入骨不连或延迟愈合部位及其周围。
使用临床和影像学标准（包括计算机断层扫描）评估损伤部位的愈合情况。测量包括美国矫形外科医师学会下肢核心量表（LLCS）、简明疼痛量表和 12 项简短健康调查问卷物理成分概括。
11 例患者中有 9 例在骨髓注射后 6 个月内获得骨性愈合。在这 9 例中有 6 例在注射后平均随访 4.4 年（范围，1.3-8.2 年），报告了下肢核心量表（59.9-89.7）、疼痛强度（2.9-1.7）、疼痛干扰（4.6-2.3）和 12 项简短健康调查问卷物理成分概括（29.5-46.6）显著改善（P<0.05），质量调整生命年提高了 5.6 年。
经皮自体骨髓注射是一种微创、安全、经济的治疗方法，适用于内固定后胫骨远端干骺端骨不连或延迟愈合，当保留的内固定物看起来完整且稳定时应考虑使用。
治疗性 IV 级。有关证据水平的完整描述，请参见作者说明。
