Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China.
Department of Gynaecology and Obstetrics, Guiyang First People's Hospital, Guiyang 550000, China.
Orthop Traumatol Surg Res. 2024 Feb;110(1):103417. doi: 10.1016/j.otsr.2022.103417. Epub 2022 Sep 20.
Union of long bone fractures is a complicated biological mechanism affected by numerous systemic and local variables. Disruption of any of these components may result in fracture nonunion. There are various types of clinically available treatment strategies for aseptic nonunion. Both activated platelet plasma and extracorporeal shock waves play important roles in fracture healing. This study aimed to investigate the interaction of platelet-rich plasma (PRP) and extracorporeal shock wave (ESW) in bone healing of nonunion.
PRP and ESW have synergistic effects in treating long bone nonunion.
Between January 2016 and December 2021, a total of 60 patients with established nonunion of a long bone (18 tibias, 15 femurs, 9 humerus, 6 radii, and 12 ulnae) were included in this study, comprising 31 males and 29 females, ranging from 18 to 60 years old. Patients with bone nonunion were separated into two groups: PRP alone (Monotherapy group) and those treated with PRP combined with ESW (Combined treatment group). The two groups were compared to assess the therapeutic benefits, callus development, local problems, bone healing time, and Johner Wruhs functional classification of operated limbs.
Fifty-five patients were followed up, 5 patients were lost to follow-up, two in the PRP group and three in the PRP+ESW group, the follow-up time varied from 6 to 18 months, with an average of 12.7±5.2 months. At 8, 12, 16, 20, and 24 weeks following intervention, the callus score in the monotherapy group was significantly lower than in the combined treatment group (p<0.05). Both groups had no swelling and infection in the soft tissue of the nonunion operation site. In the PRP+ESW group, the fracture union rate was 92.59% and the healing time was 16.3±5.2 weeks. In the PRP group, the fracture union rate was 71.43% and the healing time was 21.5±3.7 weeks. The clinical healing time of the monotherapy group was significantly longer than the combined treatment group (p<0.05). All the nonunion patients with no signs of healing were treated with revision surgery. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the monotherapy group was significantly lower than in the combined treatment group (p<0.05).
PRP combined with ESW has a certain synergistic effect in treating aseptic nonunion after fracture surgery. It can significantly improve the formation of new bone, it is a minimally invasive and effective strategy to treat aseptic nonunion in a clinical setting.
III, retrospective, single-centre, case-control study.
长骨骨折的愈合是一个复杂的生物学机制，受许多全身和局部变量的影响。这些因素中的任何一个受到干扰都可能导致骨折不愈合。对于无菌性不愈合，临床上有多种治疗策略。富血小板血浆（PRP）和体外冲击波在骨折愈合中都起着重要作用。本研究旨在探讨富血小板血浆（PRP）和体外冲击波（ESW）在骨不连愈合中的相互作用。
PRP 和 ESW 在治疗长骨不连方面具有协同作用。
2016 年 1 月至 2021 年 12 月，共有 60 例长骨（18 例胫骨、15 例股骨、9 例肱骨、6 例桡骨和 12 例尺骨）不愈合的患者纳入本研究，包括 31 例男性和 29 例女性，年龄 18-60 岁。骨不连患者分为两组：单独使用 PRP（单独治疗组）和 PRP 联合 ESW 治疗（联合治疗组）。对两组进行比较，评估治疗效果、骨痂形成、局部问题、骨愈合时间和手术肢体的 Johner Wruhs 功能分类。
55 例患者得到随访，5 例失访，PRP 组 2 例，PRP+ESW 组 3 例，随访时间 6-18 个月，平均 12.7±5.2 个月。干预后 8、12、16、20、24 周，单独治疗组的骨痂评分明显低于联合治疗组（p<0.05）。两组均无骨不连手术部位软组织肿胀和感染。在 PRP+ESW 组中，骨折愈合率为 92.59%，愈合时间为 16.3±5.2 周。在 PRP 组中，骨折愈合率为 71.43%，愈合时间为 21.5±3.7 周。单独治疗组的临床愈合时间明显长于联合治疗组（p<0.05）。所有无愈合迹象的骨不连患者均行翻修手术。单独治疗组的Johner-Wruhs 功能分类的优良率明显低于联合治疗组（p<0.05）。
PRP 联合 ESW 治疗骨折术后无菌性不愈合具有一定的协同作用。它可以显著改善新骨的形成，是一种微创有效的治疗无菌性不愈合的策略。
III，回顾性，单中心，病例对照研究。
