附加侧板联合富血小板血浆治疗股骨骨折髓内固定后骨不连*

doi:10.3969/j.issn.1671-2587.2023.05.012

临床输血与检验 ›› 2023, Vol. 25 ›› Issue (5): 648-653.DOI: 10.3969/j.issn.1671-2587.2023.05.012

附加侧板联合富血小板血浆治疗股骨骨折髓内固定后骨不连^*

周振宇¹, 黄象艳²

¹中国人民解放军联勤保障部队第九六〇医院骨科;
²中国人民解放军联勤保障部队第九六〇医院输血医学科,山东济南 250031

收稿日期:2023-08-15 出版日期:2023-10-20 发布日期:2023-11-20
通讯作者: 黄象艳,主要从事输血检验和临床输血相关研究,（E-mail）xiangyan73@aliyun.com。
作者简介:周振宇,主要从事骨不连、骨髓炎的治疗和PRP在骨科的临床应用等方面研究,（E-mail）90guke@163.com。
基金资助:
*本课题受济南市临床医学科技创新计划（No.202225066）资助

Auxiliary Steel Plate Combined with Platelet Rich Plasma for the Treatment of Femoral Shaft Nonunion after Intramedullary Nail Fixation

ZHOU Zhenyu, HUANG Xiangyan

Department of Orthopaedics, the 960th Hospital of the PLA Joint Logistice Support Force, Jinan 250031

Received:2023-08-15 Online:2023-10-20 Published:2023-11-20

摘要/Abstract

摘要： 目的回顾性分析附加侧板联合自体单采富血小板血浆（PRP）与更换髓内钉改行钢板固定治疗股骨骨折髓内固定后骨不连的临床疗效。方法选取2019年6月—2022年6月本院骨科收治的股骨骨折髓内钉固定后骨不连患者30名,其中男26例,女4例;年龄20~58岁,平均为（36.8±7.1）岁。实验组13例患者保留髓内钉,骨折端附加侧板固定,术中自体髂骨混合PRP植于骨缺损部位,术后14 d、28 d于骨不连部位注射自体PRP 10 mL/（人）次。对照组17例患者取出髓内钉,改行锁定加压钢板固定,术中自体髂骨植骨。随访观察比较2组患者围手术期情况和骨折临床愈合情况。结果 30例患者均获得完整随访,随访时间12~33个月,平均（15.2±3.5）个月;两组手术时间（min）、术中出血量（mL）、术后引流量（mL）分别为95.7±47.2 vs. 167.6±71.5、292.3±147.2 vs. 686.9±238.9、102.8±67.5 vs. 166.2±87.3,均有统计学差异（P<0.05）,住院时间（d）为10.3±5.2 vs. 12.5±6.8,无统计学差异（P>0.05）;骨折临床愈合时间（月）为 5.36±1.27 vs. 7.63±1.57（P<0.05）;术后6、9个月时愈合率分别为92.3%（12/13） vs. 52.9%（9/17）（P<0.05）,100%（13/13） vs. 82.4%（14/17）（P>0.05）。结论附加侧板联合术中及术后使用自体单采PRP治疗股骨骨折髓内固定后骨不连操作简便、术程短、出血少,且愈合快,是可供临床选择的理想治疗方案。

关键词: 富血小板血浆, 股骨干骨折, 髓内固定, 骨不连

Abstract: Objective To retrospectively analyze the clinical efficacy of auxiliary steel plate combined with autologous platelet rich plasma (PRP) and replacement of intramedullary nails with steel plate fixation in the treatment of femoral shaft nonunion after intramedullary nail fixation. Methods A total of 30 patients with femoral fracture and bone nonunion after intramedullary nail fixation were selected from the Department of Orthopedics of our hospital from June 2019 to June 2022, including 26 males and 4 females. The average age was (36.8±7.1) years, ranging from 20 to 58 years. In the experimental group of 13 patients, intramedullary nails were retained and the fracture end was fixed with side plates. During the operation, autologous iliac bone mixed PRP was implanted in the bone defect site, and autologous PRP 10 mL/ (person) was injected into the bone non-union site 14 d and 28 d after surgery. In the control group, intramedullary nails were removed, and locking compression plates were fixed instead, followed by intraoperative autologous iliac bone grafting. Follow up observation and comparison of perioperative conditions and clinical fracture healing between the two groups of patients were conducted. Results All the 30 patients received complete follow-up for 2~33 months, with an average of (15.2±3.5) months. The operative time (min), intraoperative blood loss (mL) and postoperative drainage volume (mL) of the two groups were 95.7±47.2 vs. 167.6±71.5, 292.3±147.2 vs. 686.9±238.9, and 102.8±67.5 vs. 166.2±87.3, respectively, showing significant differences (P<0.05), and the length of hospitalization (d) was 10.3±5.2 vs. 12.5±6.8, with no significant difference (P>0.05). The clinical healing time of fractures (month) was 5.36±1.27 vs. 7.63±1.57 (P<0.05); the healing rates at 6 and 9 months after surgery were 92.3% (12/13) vs. 52.9% (9/17) (P<0.05), and 100% (13/13) vs. 82.4% (14/17) (P>0.05), respectively. Conclusion sIntraoperative and postoperative use of autologous PRP in the treatment of femoral fracture after intramedullary fixation is simple, short, less bleeding, and fast healing, which is an ideal treatment for clinical selection.

Key words: Platelet rich plasma, Femoral shaft fracture, Intramedullary fixation, Bone nonunion

中图分类号:

R457

周振宇, 黄象艳. 附加侧板联合富血小板血浆治疗股骨骨折髓内固定后骨不连^*[J]. 临床输血与检验, 2023, 25(5): 648-653.

ZHOU Zhenyu, HUANG Xiangyan. Auxiliary Steel Plate Combined with Platelet Rich Plasma for the Treatment of Femoral Shaft Nonunion after Intramedullary Nail Fixation[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2023, 25(5): 648-653.

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附加侧板联合富血小板血浆治疗股骨骨折髓内固定后骨不连^*

Auxiliary Steel Plate Combined with Platelet Rich Plasma for the Treatment of Femoral Shaft Nonunion after Intramedullary Nail Fixation

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