Maslennikov Serhii, Kozhemyaka Maksym, Golovakha Maksym
Department of Traumatology and Orthopedics, Zaporizhzhya State Medical and Pharmaceutical University, Zaporozhye, Ukraine.
Prz Menopauzalny. 2025 Jun;24(2):137-142. doi: 10.5114/pm.2025.152148. Epub 2025 Jun 17.
Delayed fracture union is a common complication in orthopedic practice, particularly in patients with osteoporosis. Advances in regenerative medicine, including mesenchymal stem cells (MSCs) within the stromal-vascular fraction, have introduced novel therapeutic approaches to address this challenge. This case describes a patient with postmenopausal osteoporosis and a congenital anomaly of the left lower limb who sustained a proximal tibial fracture with fragment displacement. Osteoporosis therapy was initiated, and the fracture was managed using external fixation and compression. Despite an improvement in bone mineral density over an eight-month period, radiographic assessment revealed no evidence of fracture union. Consequently, local administration of MSCs combined with needling at the fracture site was performed, followed by a series of autologous concentrated plasma (ACP) injections. Within three months, radiographic signs of bone callus formation were observed, ultimately leading to complete fracture union six months after the initiation of regenerative therapy. Although the limited number of cases in our clinic prevents definitive conclusions regarding the primary contributing factor in fracture healing, existing literature suggests that the mobilization of endogenous resources at the fracture site in high concentrations promotes tissue regeneration. This process is further facilitated by physical activity and adjunctive pharmacological treatment. Regenerative therapy integrating MSCs and ACP-derived growth factors represents a promising adjunctive approach for managing fracture complications in patients with systemic osteoporosis. This strategy has the potential to enhance bone healing while potentially delaying or even avoiding the need for more invasive surgical interventions.
骨折延迟愈合是骨科临床常见的并发症，在骨质疏松患者中尤为常见。再生医学的进展，包括基质血管成分中的间充质干细胞（MSCs），为应对这一挑战引入了新的治疗方法。本病例描述了一名患有绝经后骨质疏松症和左下肢先天性异常的患者，其胫骨近端骨折并伴有骨折块移位。开始进行骨质疏松治疗，并采用外固定和加压处理骨折。尽管在八个月期间骨密度有所改善，但影像学评估显示没有骨折愈合的迹象。因此，在骨折部位进行了间充质干细胞局部给药并结合针刺治疗，随后进行了一系列自体浓缩血浆（ACP）注射。三个月内观察到骨痂形成的影像学迹象，最终在再生治疗开始六个月后实现了骨折完全愈合。尽管我们诊所的病例数量有限，无法就骨折愈合的主要促成因素得出明确结论，但现有文献表明，高浓度动员骨折部位的内源性资源可促进组织再生。体育活动和辅助药物治疗进一步促进了这一过程。整合间充质干细胞和ACP衍生生长因子的再生治疗是一种有前景的辅助方法，用于管理全身性骨质疏松患者的骨折并发症。该策略有可能促进骨愈合，同时有可能延迟甚至避免更具侵入性的手术干预的需要。
