Camarena Adrian, Kang Lillian, Mirando Anthony J, Augustine Emily, McMillian Najerie S, Stinson Natasha C, Agarwal Suresh M, Becker Matthew L, Hilton Matthew J, Fernandez-Moure Joseph S
From the Department of Surgery (A.C., L.K., S.M.A., J.S.F.-M.), Duke University Medical Center; Department of Orthopedic Surgery (A.J.M., M.J.H.), Duke University School of Medicine; Division of Trauma, Acute, and Critical Care Surgery (N.S.M., S.M.A., J.S.F.-M.), Duke University Medical Center; and Department of Chemistry (E.A., N.C.S., M.L.B.), Department of Mechanical Engineering and Materials Science (E.A., N.C.S., M.L.B.), Department of Biomedical Engineering (E.A., N.C.S., M.L.B.), Department of Orthopedic Surgery (E.A., N.C.S., M.L.B.), and Department of Cell Biology (M.J.H.), Duke University, Durham, North Carolina.
J Trauma Acute Care Surg. 2024 Dec 1;97(6):884-890. doi: 10.1097/TA.0000000000004441. Epub 2024 Sep 6.
Rib fractures are a common traumatic injury affecting more than 350,000 patients a year. Early stabilization has shown to be effective in reducing pulmonary complications. Platelet-rich plasma (PRP) is a growth factor-rich blood product known to improve soft tissue and bone healing. We hypothesized that the addition of PRP to a rib fracture site would accelerate callus formation and improve callus strength.
Platelet-rich plasma was isolated from pooled Lewis rat blood and quantified. Thirty-two Lewis rats underwent fracture of the sixth rib and were treated with 100 μL PRP (1 × 10 6 platelets/μL) or saline. At 2 weeks, ribs were harvested and underwent a 3-point bend, x-ray, and microcomputed tomography, and callus sections were stained with 4',6-diamidino-2-phenylindole and Alcian blue and picrosirius red. At 6 weeks, ribs were harvested and underwent a 3-point bend test, x-ray, microcomputed tomography, and Alcian blue and picrosirius red staining.
At 2 weeks, PRP increased callus diameter (9.3 mm vs. 4.3 mm, p = 0.0002), callus index (4.5 vs. 2.1, p = 0.0002), bone volume/total volume (0.0551 vs. 0.0361, p = 0.0024), cellularization (2,364 vs. 1,196, p < 0.0001), and cartilage (12.12% vs. 3.11%, p = 0.0001) and collagen (6.64% vs. 4.85%, p = 0.0087) content compared with controls. At 6 weeks, PRP increased fracture callus diameter (5.0 mm vs. 4.0 mm, 0.0466), callus index (2.5 vs. 2.0, p = 0.0466), BV/TV (0.0415 vs. 0.0308, p = 0.0358), and higher cartilage (8.21% vs. 3.26%, p < 0.0001) and collagen (37.61% vs. 28.00%, p = 0.0022) content compared with controls. At 6 weeks, PRP samples trended toward improved mechanical characteristics; however, these results did not reach significance ( p > 0.05).
Rib fractures are a common injury, and accelerated stabilization could improve clinical outcomes. Platelet-rich plasma significantly increased callus size, calcium deposition, and cartilage and collagen content at 2 and 6 weeks and trended toward improved strength and toughness on mechanical analysis at 6 weeks compared with controls, although this did not reach significance. These findings suggest that PRP may be a useful adjunct to accelerate and improve fracture healing in high-risk patients.
肋骨骨折是一种常见的创伤性损伤，每年影响超过35万名患者。早期固定已被证明可有效减少肺部并发症。富血小板血浆（PRP）是一种富含生长因子的血液制品，已知可促进软组织和骨愈合。我们假设在肋骨骨折部位添加PRP会加速骨痂形成并提高骨痂强度。
从汇集的Lewis大鼠血液中分离并定量富血小板血浆。32只Lewis大鼠接受第六肋骨骨折，并接受100μL PRP（1×10⁶血小板/μL）或生理盐水治疗。在2周时，采集肋骨并进行三点弯曲、X线和微型计算机断层扫描，骨痂切片用4',6-二脒基-2-苯基吲哚、阿尔辛蓝和苦味酸天狼星红染色。在6周时，采集肋骨并进行三点弯曲试验、X线、微型计算机断层扫描以及阿尔辛蓝和苦味酸天狼星红染色。
在2周时，与对照组相比，PRP增加了骨痂直径（9.3mm对4.3mm，p = 0.0002）、骨痂指数（4.5对2.1，p = 0.0002）、骨体积/总体积（0.0551对0.0361，p = 0.0024）、细胞化程度（2364对1196，p < 0.0001）以及软骨（12.12%对3.11%，p = 0.0001）和胶原蛋白（6.64%对4.85%，p = 0.0087）含量。在6周时，与对照组相比，PRP增加了骨折骨痂直径（5.0mm对4.0mm，p = 0.0466）、骨痂指数（2.5对2.0，p = 0.0466）、骨体积分数（0.0415对0.0308，p = 0.0358）以及更高的软骨（8.21%对3.26%，p < 0.0001）和胶原蛋白（37.61%对28.00%，p = 0.0022）含量。在6周时，PRP样本的力学特性有改善趋势；然而，这些结果未达到显著水平（p > 0.05）。
肋骨骨折是一种常见损伤，加速固定可改善临床结果。与对照组相比，富血小板血浆在2周和6周时显著增加了骨痂大小、钙沉积以及软骨和胶原蛋白含量，并且在6周时力学分析显示强度和韧性有改善趋势，尽管未达到显著水平。这些发现表明PRP可能是加速和改善高危患者骨折愈合的有用辅助手段。
