开放性胫骨缺损富血小板血浆复合游离骨块回植

Replantation of free bone fragments combined with platelet-rich plasma for bone defect secondary to open tibial fractures

摘要:

［目的］探讨开放性胫骨缺损富血小板血浆复合游离骨块回植的手术技术和初步临床效果。［方法］对 15 例开放性胫骨骨缺损患者采用富血小板血浆复合游离骨块回植治疗。一期急症行清创手术，取出较大的游离骨块，用外固定架固定胫骨骨折，骨缺损处用抗生素骨水泥填充，将取出的游离骨块寄养于同侧大腿中段股直肌与股外侧肌之间，术后抗感染对症治疗。 创面愈合且无明显感染迹象后行二期手术，去除外固定架，改用钢板固定骨折，将寄养骨块取出后用咬骨钳咬碎成微粒状后与富血小板血浆（platelet-rich plasma, PRP）混合回植于骨缺损处。［结果］15 例患者均获得随访。随访时间 12~24 个月，术后无感染病例，骨折均顺利骨性愈合，愈合时间 10~15 个月。［结论］开放性胫骨缺损富血小板血浆复合游离骨块回植，具有操作简单，疗效可靠等优点，是治疗开放性骨缺损的一种简便有效方法。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of free-bone- fragment replantation com- bined with platelet-rich plasma in the second stage for bone defect secondary to open tibial fractures. [Methods] A total of 15 patients re- ceived free-bone- fragment replantation combined with platelet-rich plasma in the second stage for bone defect secondary to open tibial fractures. In the first-stage operation, the fractures were fixed by an external fixator after a thorough debridement, the bone defect was filled with antibiotic bone cement, while the free bone fragments were implanted into the muscle space between the rectus femoris and vastus late- ralis on ipsilateral middle thigh. After the wound healed without obvious signs of infection, the second-stage operation was performed. After the external fixator was removed, the tibial fracture was fixed internally with a bridge plate. The free bone fragments fostered on the thigh were harvested and crushed into granules by rongeur forceps, and then mixed with platelet-rich plasma (platelet-rich plasma, PRP) , im- planted back into the bone defect. [Results] All the 15 patients were followed up for 12~24 months. No infection happened in anyone of them after operation, whereas all the patients had fractures healed smoothly in 10~15 months. [Conclusion] The free-bone- fragment re- plantation combined with platelet-rich plasma in the second stage proves a simple and effective treatment for bone defect secondary to open tibial fractures.