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经皮自体浓缩骨髓移植治疗骨不连

Percutaneous autologous concentrated bone marrow grafting in the treatment for nonunion.

作者信息

Sugaya Hisashi, Mishima Hajime, Aoto Katsuya, Li Meihua, Shimizu Yukiyo, Yoshioka Tomokazu, Sakai Shinsuke, Akaogi Hiroshi, Ochiai Naoyuki, Yamazaki Masashi

机构信息

Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.

出版信息

Eur J Orthop Surg Traumatol. 2014 Jul;24(5):671-8. doi: 10.1007/s00590-013-1369-9. Epub 2013 Nov 26.

Abstract

The purpose of this study was to evaluate the clinical and radiographic treatment effects of percutaneous autologous concentrated bone marrow grafting in nonunion cases and to evaluate the effectiveness of this grafting procedure. We enrolled 17 cases those had atrophic changes due to continuous nonunion for over 9 months after injury and had undergone low-intensity pulsed ultrasound treatment for more than 3 months. The site of nonunion was the femur in 10 cases, the tibia in 5 cases, the humerus in 1 case, and the ulna in 1 case. They underwent percutaneous autologous concentrated bone marrow grafting and continued low-intensity pulsed ultrasound stimulation treatment after grafting. Patients were evaluated using the visual analogue scale for pain at immediately before the procedure, 3, 6, and 12 months after grafting. Plain radiographs of the affected site were taken and evaluated about the healing of the nonunion site at each clinical evaluation. As quantitative assessment, CT scans were undertaken before the procedure and 6 months after grafting. The visual analogue scale pain score was reduced consistently after grafting in all patients. About the healing at the nonunion site, 11 and 13 cases of bone union were observed at 6 and 12 months after grafting. The mean volume of callus formation based on CT images was 4,147 (262-27,392) mm3 total between grafting and 6 months. Percutaneous autologous concentrated bone marrow grafting is an effective procedure for the treatment of patients with nonunion.

摘要

本研究的目的是评估经皮自体浓缩骨髓移植在骨不连病例中的临床和影像学治疗效果,并评估该移植手术的有效性。我们纳入了17例因受伤后持续骨不连超过9个月且已接受低强度脉冲超声治疗3个月以上而出现萎缩性改变的病例。骨不连部位为股骨10例、胫骨5例、肱骨1例、尺骨1例。他们接受了经皮自体浓缩骨髓移植,并在移植后继续进行低强度脉冲超声刺激治疗。在手术前、移植后3个月、6个月和12个月,使用视觉模拟评分法对患者的疼痛进行评估。在每次临床评估时,拍摄患部的X线平片并评估骨不连部位的愈合情况。作为定量评估,在手术前和移植后6个月进行CT扫描。所有患者移植后视觉模拟评分法疼痛评分均持续降低。关于骨不连部位的愈合情况,移植后6个月和12个月分别观察到11例和13例骨愈合。基于CT图像,移植后至6个月期间骨痂形成的平均体积总计为4147(262 - 27392)mm³。经皮自体浓缩骨髓移植是治疗骨不连患者的有效方法。

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