Lovy Andrew J, Kim Jun S, Di Capua John, Somani Sulaiman, Shim Stephanie, Keswani Aakash, Hasija Rohit, Wu Yangguan, Joseph David, Ghillani Richard
*Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY; †Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY; and ‡Department of Orthopaedic Surgery, Elmhurst Hospital Center, Elmhurst, NY.
J Orthop Trauma. 2017 Jul;31(7):358-362. doi: 10.1097/BOT.0000000000000851.
To evaluate bone marrow aspirate concentrate (BMAC) use in the treatment of AFF.
Retrospective case control.
Level 1 trauma center.
Complete AFF, defined according to American Society of Bone and Mineral Research (ASBMR) criteria, from September 2009 to April 2015 with minimum 1-year follow-up.
Operative treatment with antegrade intramedullary nails. Beginning June 2014, BMAC from the ipsilateral iliac crest was added to all AFFs.
Time to union as determined by a blinded panel of 3 attending orthopaedic surgeons, union rates, complications.
Thirty-five patients with 36 AFFs were reviewed, of which 33 AFFs were included and 11 received BMAC. Alendronate was the most commonly prescribed bisphosphonate, with a similar mean duration of use in controls and BMAC cases (5.6 versus 6 years, P = 0.79). BMAC use significantly decreased time to union (3.5 versus 6.8 months, P = 0.004). Varus malreduction was associated with a significant delay in union (9.7 versus 4.7 months, P = 0.04). Overall, 1 year union rate was 86.2% and nonsignificantly higher in BMAC compared with controls (100.0% versus 77.3%, P = 0.11). Multivariate analysis revealed BMAC and varus malreduction as independent predictors of time to union. There were no complications related to BMAC use.
Our findings support intramedullary nailing of AFFs as an effective treatment option with a low surgical complication rate and highlight the importance of avoiding varus malreduction. BMAC use significantly reduced time to fracture union without an increase in surgical complication rates.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估骨髓抽吸浓缩物（BMAC）在急性股骨骨折（AFF）治疗中的应用。
回顾性病例对照研究。
一级创伤中心。
根据美国骨与矿物质研究学会（ASBMR）标准定义的完全性AFF患者，时间跨度为2009年9月至2015年4月，且至少随访1年。
采用顺行髓内钉进行手术治疗。从2014年6月开始，所有AFF患者均添加同侧髂嵴的BMAC。
由3名骨科主治医生组成的盲法小组确定的骨折愈合时间、愈合率、并发症。
对35例患有36处AFF的患者进行了回顾，其中33处AFF被纳入研究，11例接受了BMAC治疗。阿仑膦酸钠是最常用的双膦酸盐药物，对照组和BMAC治疗组的平均使用时间相似（5.6年对6年，P = 0.79）。使用BMAC显著缩短了骨折愈合时间（3.5个月对6.8个月，P = 0.004）。内翻畸形愈合与骨折愈合的显著延迟相关（9.7个月对4.7个月，P = 0.04）。总体而言，1年时的骨折愈合率为86.2%，BMAC治疗组与对照组相比虽无显著差异，但愈合率略高（100.0%对77.3%，P = 0.11）。多变量分析显示，BMAC和内翻畸形愈合是骨折愈合时间的独立预测因素。未发现与使用BMAC相关的并发症。
我们的研究结果支持采用髓内钉治疗AFF是一种手术并发症发生率低的有效治疗选择，并强调了避免内翻畸形愈合的重要性。使用BMAC显著缩短了骨折愈合时间，且未增加手术并发症发生率。
治疗性三级。有关证据级别的完整描述，请参阅作者指南。
