本文關(guān)鍵詞： 經(jīng)皮自體骨髓移植 兒童 四肢長(zhǎng)骨干骨 延遲愈合 治療 外支架 經(jīng)皮自體骨髓移植 兒童 骨不連 治療　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：第一部分經(jīng)皮自體骨髓治療兒童四肢長(zhǎng)骨干骨折術(shù)后骨延遲愈合目的:探討經(jīng)皮自體骨髓移植治療兒童四肢長(zhǎng)骨干骨折術(shù)后骨延遲愈合的優(yōu)越性、安全性及療效。方法:2006-2014年我院應(yīng)用經(jīng)皮自體骨髓移植治療的四肢長(zhǎng)骨干骨折術(shù)后骨延遲愈合患兒53例(骨折端均穩(wěn)定、無(wú)嚴(yán)重成角和短縮畸形),男性35例,女性18例,年齡1~16歲,平均6.7歲。股骨20例,脛骨12例,肱骨10例,橈骨5例,尺骨5例,單純腓骨1例,均為外傷性骨折術(shù)后骨延遲愈合。按照骨折術(shù)后至第1次骨髓移植的時(shí)間分組,4~6個(gè)月共23例作為A組,6~8個(gè)月共30例作為B組。從髂前上棘處抽吸骨髓穿刺抽取骨髓液5~20m L,平均12.7m L,經(jīng)皮注入到X線(xiàn)定位的骨折延遲愈合處。術(shù)后定期復(fù)查X線(xiàn)片,觀察、比較骨折愈合情況。結(jié)果:本組所有骨折延遲愈合均獲得隨訪,并隨訪至拆除內(nèi)外固定后至少6個(gè)月,最終47例獲臨床愈合,愈合時(shí)間距第1次骨髓移植后3~10個(gè)月,平均5.8個(gè)月。未愈合6例,A組1例,B組5例,骨髓移植2次后骨折處無(wú)明顯骨痂生長(zhǎng),改為其它方法治療。兩組愈合時(shí)間和骨髓注射次數(shù)比較差異均有統(tǒng)計(jì)學(xué)意義(P0.01),兩組最終治愈率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:經(jīng)皮自體骨髓移植治療兒童四肢長(zhǎng)骨干骨折術(shù)后骨延遲愈合是一種操作簡(jiǎn)單、微創(chuàng)、安全、經(jīng)濟(jì)又切實(shí)可行的治療方法,且早期行自體骨髓移植,可加快骨折愈合,縮短療程,值得臨床推廣。第二部分外支架固定及經(jīng)皮自體骨髓移植治療兒童四肢長(zhǎng)骨骨折術(shù)后骨不連目的:探討外支架固定及經(jīng)皮自體骨髓移植治療兒童四肢長(zhǎng)骨骨折術(shù)后骨不連的療效。方法:2005-2014年對(duì)39例四肢長(zhǎng)骨骨折術(shù)后骨不連患兒,采用開(kāi)放性手術(shù)對(duì)骨折斷端肉芽組織及硬化骨切除、髓腔再通、外支架軸向加壓,術(shù)后3~5月有骨延遲愈合傾向者,補(bǔ)充行自體骨髓移植術(shù)進(jìn)行干預(yù)治療。術(shù)后通過(guò)對(duì)骨髓穿刺區(qū)及釘?shù)婪磻?yīng)、骨折愈合、鄰近的關(guān)節(jié)功能恢復(fù)等情況評(píng)估手術(shù)療效。結(jié)果:本組所有骨不連患兒均獲得隨訪,并隨訪至拆除內(nèi)外固定后至少1年。3例患者出現(xiàn)釘?shù)栏腥?經(jīng)積極抗感染及定期換藥后痊愈。2例患兒在行Orthofix單臂外支架固定術(shù)后發(fā)生螺釘松脫導(dǎo)致骨折明顯移位成角,骨不連接,二期更改為Ilizarov環(huán)固定,術(shù)后經(jīng)2次骨髓移植分別于再次術(shù)后9月和11個(gè)月愈合;最終39例均獲臨床愈合,愈合時(shí)間為4~15個(gè)月,平均6.2個(gè)月,末次隨訪時(shí),均無(wú)骨髓穿刺區(qū)及釘?shù)捞弁�、感染或竇道形成,4例患者遺留鄰近關(guān)節(jié)功能部分受限,其余患者均完全恢復(fù)。結(jié)論:外支架對(duì)兒童四肢長(zhǎng)骨骨折術(shù)后骨不連具有良好的固定效果;術(shù)后有骨延遲愈合傾向者,行自體骨髓移植治療,可以加快骨折愈合,減少再次骨不連的風(fēng)險(xiǎn)。因此外支架及經(jīng)皮自體骨髓移植是治療兒童四肢長(zhǎng)骨骨折術(shù)后骨不連的有效辦法。
[Abstract]:Part I Percutaneous autologous bone marrow therapy for delayed bone healing in children with long bone fractures objective: to explore the advantages of percutaneous autologous bone marrow transplantation in the treatment of long bone fractures in children. Methods from 2006 to 2014, 53 children with delayed union of long bone fractures of extremities were treated with percutaneous autologous bone marrow transplantation in our hospital from 2006 to 2014. There were 35 males and 18 females with an average age of 6.7 years. There were 20 cases of femur, 12 cases of tibia, 10 cases of humerus, 5 cases of radius and 5 cases of ulna. Only 1 case of fibula was delayed union of bone after traumatic fracture. 23 cases were divided into 4 ~ 6 months group according to the time from fracture operation to the first time of bone marrow transplantation. From 6 to 8 months, 30 cases were used as group B. the bone marrow fluid was drawn from the anterior superior iliac spine with an average of 12.7 mL. Percutaneous injection of X-ray fixed fracture delayed healing. After the regular review of X-ray films to observe and compare the fracture healing. Results: all the fracture delayed healing were followed up. The patients were followed up until at least 6 months after removal of internal and external fixation, and 47 cases were clinically healed. The healing time was 3 ~ 10 months after the first bone marrow transplantation, with an average of 5.8 months. One case in group A was not healed. In group B, there was no obvious callus growth after bone marrow transplantation. The healing time and times of bone marrow injection were significantly different between the two groups (P 0.01). Conclusion: percutaneous autologous bone marrow transplantation is a simple, minimally invasive and safe method for delayed bone healing after long bone fracture in children. Economic and practical treatment and early autologous bone marrow transplantation can accelerate fracture healing and shorten the course of treatment. The second part is external stent fixation and percutaneous autologous bone marrow transplantation for the treatment of nonunion after long bone fracture in children. Objective: to investigate the effect of external stent fixation and percutaneous autologous bone marrow transplantation in the treatment of nonunion after long bone fracture in children. Methods 39 cases of nonunion after long bone fracture of extremities were treated from 2005 to 2014. Open operation was used to resect granulation tissue and sclerosing bone at fracture end, recanalization of medullary cavity, axial compression of external stent, and delayed healing tendency of bone from 3 to May after operation. The bone marrow was treated with autogenous bone marrow transplantation. The fracture was healed by the reaction of the bone marrow puncture area and the nail canal after the operation. Results: all the children with nonunion were followed up and followed up until at least 1 year after removal of internal and external fixation. After active anti-infection and regular dressing change, 2 cases of children were cured after Orthofix single arm external stent fixation, screw loosening resulted in obvious displacement of the fracture into angle, and the bone was not connected with each other. The second stage was fixed with Ilizarov ring and healed after two bone marrow transplants on September and 11 months respectively. The healing time was 4 ~ 15 months with an average of 6.2 months. At the last follow-up, no pain, infection or sinus formation occurred in the bone marrow puncture area or the nail canal. The left adjacent joint function was partially limited in 4 patients and the other patients recovered completely. Conclusion: the external stent has a good fixation effect on the nonunion of long bone fracture in children after operation. If there is a tendency of delayed bone healing after operation, autogenous bone marrow transplantation can accelerate fracture healing. Therefore, external stent and percutaneous autologous bone marrow transplantation are effective in the treatment of nonunion after long bone fracture in children.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R726.8

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