Lee Dong Hoon, Ryu Keun Jung, Kim Jin Woo, Kang Kyung Chung, Choi Young Rak
Department of Orthopaedic Surgery, Severance Hospital, College of Medicine, Yonsei University, 134 Sinchondong, CPO Box 8044, Seoul, Republic of Korea,
Clin Orthop Relat Res. 2014 Dec;472(12):3789-97. doi: 10.1007/s11999-014-3548-3.
During lower limb lengthening, poor bone regeneration is a devastating complication. Several local or systemic applications have been used to promote osteogenesis, and biologic stimulations are gaining attention, but their utility has not been proven in this setting.
QUESTIONS/PURPOSES: In patients undergoing bilateral tibial lengthening, we compared those receiving an osteotomy site injection of autologous bone marrow aspirate concentrate (BMAC) plus platelet-rich plasma (PRP) with those not receiving such an injection in terms of external fixator index (time in external fixation divided by amount of lengthening), full weightbearing index (time until a patient was permitted to do full weightbearing divided by amount of lengthening), four cortical healing indexes (time until each cortical union divided by amount of lengthening), and callus shape and type.
Twenty-two patients (44 tibias) undergoing bilateral tibial lengthening enrolled in this randomized trial. Two patients were excluded, one due to insufficient radiographic evaluation and one who was lost to followup, leaving 20 patients (40 segments) for inclusion. Ten patients (20 segments) received BMAC combined with PRP injection (treatment group) and 10 patients (20 segments) received no injection (control group). All patients underwent stature lengthening for familial short stature with the lengthening over nail technique. Autologous BMAC combined with PRP was injected at the tibial osteotomy site at the end of the index surgery. Mean distraction rates were similar between groups (0.75 mm/day in the treatment group versus 0.72 mm/day in the control group; p = 0.24). Full weightbearing was permitted when we observed radiographic evidence of healing at two cortices; this assessment was made by the surgeon who was blinded to the treatment each patient received. Minimum followup was 24 months (mean, 28 months; range, 24-34 months).
There was no difference in mean external fixator index between groups. However, mean cortical healing indexes (anterior/posterior/medial/lateral) were 1.14/0.81/0.96/0.88 months/cm in the treatment group and 1.47/1.26/1.42/1.22 months/cm in the control group (all p < 0.001), showing faster healing in the treatment group at each cortex. Full weightbearing was permitted earlier in the treatment group than in the control group (index: 0.99 months/cm and 1.38 months/cm, respectively, p < 0.001). Callus shape and type were not different between groups.
Autologous BMAC combined with PRP injection at the osteotomy site helped improve bone healing in distraction osteogenesis of the tibia, although the effect size was small.
Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
在下肢延长过程中，骨再生不良是一种极具破坏性的并发症。已经采用了多种局部或全身应用方法来促进成骨，生物刺激也日益受到关注，但它们在这种情况下的效用尚未得到证实。
问题/目的：在接受双侧胫骨延长的患者中，我们比较了接受截骨部位自体骨髓抽吸浓缩物（BMAC）加富血小板血浆（PRP）注射的患者与未接受此类注射的患者在以下方面的差异：外固定指数（外固定时间除以延长量）、完全负重指数（患者被允许完全负重的时间除以延长量）、四个皮质愈合指数（每个皮质愈合的时间除以延长量）以及骨痂的形状和类型。
22例接受双侧胫骨延长的患者（44条胫骨）纳入了这项随机试验。两名患者被排除，一名是因为影像学评估不足，一名失访，最终纳入20例患者（40个节段）。10例患者（20个节段）接受BMAC联合PRP注射（治疗组），10例患者（20个节段）未接受注射（对照组）。所有患者均采用髓内钉延长技术治疗家族性矮小症。在初次手术结束时，将自体BMAC联合PRP注射到胫骨截骨部位。两组的平均牵张速率相似（治疗组为0.75mm/天，对照组为0.72mm/天；p = 0.24）。当观察到两个皮质有愈合的影像学证据时允许完全负重；这一评估由对每位患者所接受治疗不知情的外科医生进行。最小随访时间为24个月（平均28个月；范围24 - 34个月）。
两组的平均外固定指数无差异。然而，治疗组的平均皮质愈合指数（前/后/内侧/外侧）分别为1.14/0.81/0.96/0.88个月/cm，对照组为1.47/1.26/1.42/1.22个月/cm（所有p < 0.001），表明治疗组每个皮质的愈合更快。治疗组比对照组更早允许完全负重（指数分别为0.99个月/cm和1.38个月/cm，p < 0.001）。两组之间骨痂的形状和类型没有差异。
在截骨部位注射自体BMAC联合PRP有助于改善胫骨牵张成骨中的骨愈合，尽管效应大小较小。
I级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
