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目的探讨经皮自体骨髓移植治疗儿童四肢长骨干骨折术后骨延迟愈合的优越性、安全性及疗效。方法 2006-2014年我院应用经皮自体骨髓移植治疗的四肢长骨干骨折术后骨延迟愈合患儿53例(骨折端均稳定、无严重成角和短缩畸形),男性35例,女性18例,年龄1~16岁,平均年龄6.7岁。骨折部位:股骨20例,胫骨12例,肱骨10例,桡骨5例,尺骨5例,单纯腓骨1例,均为外伤性骨折术后骨延迟愈合。按照骨折术后至第1次骨髓移植的时间分组,4~6个月共23例作为A组,6~8个月共30例作为B组。从髂前上棘处抽吸骨髓穿刺抽取骨髓液5~20 m L,平均12.7 m L,经皮注入到X线定位的骨折延迟愈合处。术后定期摄X线片,观察、比较骨折愈合情况。结果本组所有骨折延迟愈合均获得随访,并随访至拆除内、外固定后至少6个月,最终47例获临床愈合,愈合时间距第1次骨髓移植后3~10个月,平均5.8个月。未愈合6例,A组1例,B组5例,骨髓移植2次后骨折处无明显骨痂生长,改为其他方法治疗。两组愈合时间和骨髓注射次数比较差异均有统计学意义(P<0.01),两组最终治愈率比较差异无统计学意义(P>0.05)。结论经皮自体骨髓移植治疗儿童四肢长骨干骨折术后骨延迟愈合是一种操作简单、微创、安全、经济又切实可行的治疗方法,且早期行自体骨髓移植,可加快骨折愈合,缩短疗程,值得临床推广。
Objective To investigate the superiority, safety and efficacy of percutaneous autologous bone marrow transplantation in the treatment of delayed union of long bones of limbs in children. Methods Fifty-three children with delayed union of long bone trunk fractures treated with percutaneous autologous bone marrow transplantation in our hospital from 2006 to 2014 were randomly divided into three groups: stable fracture with no serious angulation and malformation, 35 males and 18 females Cases, aged 1 to 16 years, mean age 6.7 years. Fracture sites: 20 cases of femur, 12 cases of tibia, 10 cases of humerus, 5 cases of radius, 5 cases of ulna and 1 case of simple fibula. All of them were delayed union of traumatic fracture. According to the time after fracture to the first bone marrow transplantation group, 4 to 6 months, a total of 23 cases as A group, 6 to 8 months, a total of 30 cases as a group B. From the anterior superior iliac spine suction bone marrow aspiration 5 ~ 20 m L, an average of 12.7 m L, percutaneous injection of X-ray positioning of the fracture delayed healing. Regular X-ray film after surgery to observe and compare the fracture healing. Results All the fractures healed in this group were followed up and were followed up for at least 6 months after the internal and external fixation. Finally, 47 cases were clinically cured. The healing time ranged from 3 to 10 months after the first bone marrow transplantation, with an average of 5.8 months month. 6 cases did not heal, 1 case in group A, 5 cases in group B, no significant callus growth at fracture after 2 times of bone marrow transplantation, and changed to other methods. There was significant difference between the two groups in the healing time and the frequency of bone marrow injection (P <0.01). There was no significant difference in the final cure rate between the two groups (P> 0.05). Conclusion Percutaneous autologous bone marrow transplantation for the treatment of long bone fracture of limbs in children with delayed union is a simple, minimally invasive, safe, economical and feasible treatment. Early autologous bone marrow transplantation can speed up fracture healing and shorten the course of treatment , It is worth clinical promotion.