Osteoking Combination With Percutaneous Autogenous Bone Cement Injection For Management Of Bone Nonunion:an Experimental Research And Preliminary Clinical Application

Objective:To explore an innovation in the treatment of bone nonunion through an experimental research and preliminary clinical application by percutaneous autogenous bone cement injection and Osteoking.Methods:The right radius of75New Zealand white rabbits were osteotomised and a defective bony nonunion was created for10weeks. Five rabbits were randomly selected and killed,and nonunion was confirmed by radiography and histology. Others were randomly divided into four groups:Group A (experimental group) received both Osteoking and percutaneous autogenous bone cement injection; group B were only dealed with autologous bone cement graft only; group C were only treated with Osteoking and group D had no treatment. Moreover, the sample was observed by X-ray, histology, ALP and bone mineral density testing.at4,8,12weeks.From November2011to June2012, twelve patients with long bone nonunion were treated with Osteoking and autologous bone cement injection, including eight males and four females, aged25-55years old. The time from injury to therapy was12-23months,(average16months). The distance of bone defect was3-12mm (average6mm). Eleven patients were treated by internal fixation (seven patients by plate, four patients by intramedullary nail), and one patient was treated by external fixation. The X-ray films were taken at1day,1,3,6months after treatment to observe fracture union.Results:At12weeks, there were identical lamellar and medullary cavity recanalization in group A and no significant difference between normal and new bone. A lot of solid bony callus were formed in group B and C, but callus arrangement was irregular. Part of the medullary cavity was recanalized. In group D, nonunion area was still filled with fibroblastic and connective tissure. Bone nonunion area in group A was repaired more rapidly than group B and C through ALP testing and X-ray (P<0.05). BMD testing showed that at12weeks, BMD of group A was significantly higher than that of group B and C (P<0.01), indicating that ossification quality of group A was superior to group B and C.All twelve patients were followed up for6months. Eleven patients achieved union between3.5and6months (average4.5months) without any complications with one patient nonunion at the last follow-up.Conclusion:Osteoking and percutaneous autologous bone cement injection could obviously promote nonunion repairing, and the ossification quality of new bone were superior to those which only dealed with autologous graft and Osteoking. Preliminary clinical results were satisfactory.