Le Nail Louis-Romée, Stanovici Julien, Fournier Joseph, Splingard Marie, Domenech Jorge, Rosset Philippe
Service de Chirurgie Orthopédique et Traumatologique 2, Hôpital Trousseau, Université François-Rabelais de Tours, CHU de Tours, 37044, Tours cedex 09, France.
Int Orthop. 2014 Sep;38(9):1845-53. doi: 10.1007/s00264-014-2342-x. Epub 2014 Apr 13.
Tibial fractures are the most common lower limb fractures. Some criteria such as open fractures and increasing open stage are known to be associated with high delayed union and pseudarthrosis rate. In cases of delayed or nonunion, classical treatment is autologous cancelous bone graft which is associated with high morbidity rate. The ideal treatment would be a percutaneous harvesting and grafting technique. As bone marrow autologous concentrate (BMAC) presents both advantages, we evaluated this technique from 2002 to 2007.
This was a retrospective study of 43 cases of open tibial fractures with initial surgical treatment. The criteria of inclusion were open fracture and nonunion, delayed union or suspicion of delayed union.
In 23 cases (53.5 %) BMAC was successful. The success group had received significantly more CFU-F than the failure group (469 vs 153.10(3), p = 0.013). A threshold of 360.10(3) CFU-F grafted could be established over which there was 100 % success. BMAC done before 110 days after fracture had 47 % success and BMAC done since 110 days after fracture had 73 % success. BMAC success rate decreased with increasing initial fracture skin open stage. There was no BMAC success in cases of a fracture with a remaining gap of more than 4 mm. We had no complications with the technique at the iliac harvesting zone and tibia injection point.
BMAC is a technique that should be considered as one of the different alternatives for management of long-bone delayed and nonunion because of its effectiveness, low complication rate, preservation of bone stock and low cost.
胫骨骨折是最常见的下肢骨折。一些标准，如开放性骨折和开放性程度增加，已知与高延迟愈合和假关节形成率相关。在延迟愈合或不愈合的情况下，传统治疗方法是自体松质骨移植，但该方法的发病率较高。理想的治疗方法是经皮采集和移植技术。由于骨髓自体浓缩物（BMAC）兼具两者的优点，我们在2002年至2007年对该技术进行了评估。
这是一项对43例接受初始手术治疗的开放性胫骨骨折病例的回顾性研究。纳入标准为开放性骨折和不愈合、延迟愈合或疑似延迟愈合。
23例（53.5%）BMAC治疗成功。成功组接受的集落形成单位-成纤维细胞（CFU-F）明显多于失败组（469对153.10³，p = 0.013）。可以确定移植360.10³ CFU-F为阈值，超过该阈值成功率为100%。骨折后110天内进行的BMAC成功率为47%，骨折后110天及以后进行的BMAC成功率为73%。BMAC成功率随初始骨折皮肤开放程度的增加而降低。骨折间隙超过4 mm的病例中BMAC治疗未成功。我们在髂骨采集区和胫骨注射点未出现该技术相关的并发症。
由于其有效性、低并发症率、保留骨量和低成本，BMAC技术应被视为治疗长骨延迟愈合和不愈合的不同选择之一。
