ABSTRACT
Objective: To analyze the effectiveness of percutaneous injection of autologous concentrated bone marrow aspirate (cBMA) combined with platelet-rich plasma (PRP) in the treatment of delayed fracture healing. Methods: A prospective, randomized, controlled, single-blind case study was conducted. Between March 2016 and July 2018, 66 patients who met the inclusion and exclusion criteria for delayed fracture healing but had solid internal fixation of the fracture end were randomly divided into control group (31 cases, treated with percutaneous autogenous bone marrow blood injection) and study group (35 cases, treated with percutaneous autogenous cBMA+PRP injection). General data such as gender, age, body mass index, site of delayed fracture healing, length of bone defect at fracture end, and preoperative radiographic union score for tibia (RUST) showed no significant difference between the two groups ( P>0.05). Before injection, Kirschner wire was used in both groups to stimulate the fracture end and cause minor injury. The fracture healing time, treatment cost, and adverse reactions were recorded and compared between the two groups. Visual analogue scale (VAS) score was used to evaluate pain improvement. The tibial RUST score was extended to the tubular bone healing evaluation. Results: No infection of bone marrow puncture needle eyes occurred in both groups. In the control group, local swelling was obvious in 5 cases and pain was aggravated at 1 day after operation in 11 cases. In the study group, postoperative swelling and pain were not obvious, but 2 cases presented local swelling and pain. All of them relieved after symptomatic treatment. Patients in both groups were followed up, the follow-up time of the control group was 16-36 months (mean, 21.8 months), and the study group lasted 14-33 months (mean, 23.2 months). The amount of bone marrow blood was significantly lower in the study group than in the control group ( t=4.610, P=0.000). The degree of postoperative pain in the study group was less than that in the control group, and the treatment cost was higher than that in the control group. But the differences between the two groups in VAS score at 1 day after operation and treatment cost were not significant ( P>0.05). Fracture healing was achieved in 19 cases (61.3%) in the control group and 30 cases (85.7%) in the study group. The difference in fracture healing rate between the two groups was significant ( χ2=5.128, P=0.024). Fracture healing time and RUST score at last follow-up were significantly better in the study group than in the control group ( P<0.05). At last follow-up, RUST scores in both groups were significantly improved when compared with those before operation ( P<0.05). Conclusion: Autogenous cBMA combined with PRP percutaneous injection can provide high concentration of BMSCs and growth factors, and can improve the fracture healing rate and shorten the fracture healing time better than autogenous bone marrow blood injection.
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Objective To investigate the effect of Celebrex on hemorheology and levels of serum intercelluar adhesion molecule-1 (sICAM-1),serum vascular cell adhesion molecule-1 (sVCAM-1),tumour necrosis factor-α (TNF-α),interleukin-6 (IL-6) in patients with delayed fracture healing.Methods 201 patients with delayed fracture healing in our hospital were randomly divided into observation group (n =101) and control group (n =100).The patients in control group received conventional surgical internal fixation,while patients in observation group received conventional surgical internal fixation combined with Celebrex.The clinical efficacy was observed,while the changes of hemorheology and levels of sICAM-1,sVCAM-1,TNF-α,IL-6 were compared between two groups before and after treatment.Results The effective rate of observation group was 94.1％,which was significant higher than that of control group 70.0％ (P＜0.01).There were no significantly differences between two groups in the indexes of hemorheology and levels of sICAM-1,sVCAM-1,TNF-α,IL-6 before treatment (P＞0.05).The indexes of hemorheology and levels of sICAM-1,sVCAM-1,TNF-α,IL-6 were significantly reduced after treatment,while the decreased degrees of observation group were better than those of control group,with statistically significant difference (P＜0.05).Conclusions Celebrex can improve the indexes of hemorheology,reduce the levels of sICAM-1,sVCAM-1,TNF-α,IL-6 and improve the clinical effect in treatment of delayed fracture healing.It is worth of popularization and application.
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Objective To investigate the clinical study on drynaria injection for delayed healing of fracture patients.Methods 108 patients with fracture delayed union from February 2010 to February 2016 in our hospital were selected and randomly divided into the control group and the experiment group by different treatment,54 cases in each group.The control group were treated by conventional therapy,the experiment group were treated with drynaria rhizome injection on the bases of control group.The total effective rate,serum alkaline phosphatase,NGF and BMP-2 levels were observed and compared after treatment.Results After treatment,the total effective rate of experiment group was higher than control group (P<0.05);After treatment for 7 and 14 days,the serum alkaline phosphatase level of the two groups were significantly increased (P<0.05),and compared with the control group, the serum alkaline phosphatase content of the experimental group was higher (P<0.05);After treatment for 7 and 14 days,the serum NGF and BMP-2 levels of two groups were significantly increased(P<0.05),and compared with the control group,the experimental group was higher than those in the control group.Conclusion Injection of rhizoma drynariae in the treatment of delayed healing of patients with significant effect,increase the levels of serum alkaline phosphatase, serum NGF and BMP-2,promote fracture healing in patients and improve clinical efficacy.
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Objective To investigate the clinical effect of ilium grafting combined with Duhuojishengtang on the delay fracture healing and explore the effect on hemorheology. Methods Eighty patients with delayed fracture healing were randomly divided into two groups. Forty patients in control group were treated by ilium grafting and 40 patients in observation group were treated by ilium grafting combined with Duhuojishengtang. The clinical effect was observed after treatment and indexes of hemorheology were recorded after different treatment time. Results The cure rate of observation group was 62.5%, which was significantly higher than that of control group 35.0%, the effective rate of observation group was 92.5%, which was significantly higher than that of control group 72.5% (P0.05) . After the first, second, third course, the indexes of hemorheology of observation group were better than those of control group, with statistically significant differences (P<0.05) . Conclusions Ilium grafting com-bined with duhuojishengtang can improve the indexes of hemorheology, improve the cure and effective rate and also has high security. It has high clinical value and worth of popularization and application.