Treatment Of Nonunion And Delayed Union Of Diaphseal Fracture Of Extremity Long Bone In Children After Operation Treated With Percutaneous Autogeous Bone Marrow Transplantation

PART? DELAYED UNION OF DIAPHSEAL FRACTURE OF EXTREMITY LONG BONE IN CHILDREN AFTER OPERATION TREATMENT WITH PERCUTANEOUS AUTOGEOUS BONE MARROW TRANSPLANTATIONObjective: To investigate the effectiveness,advantages,and safety of delayed union of diaphyseal fracture of extremity long bone in children after the treatment with percutaneous autogeous bone marrow transplantation.Methods: From 2006 to 2014,53 patiens(stable fracture fixation and no serious angular and short deformity)with delayed union of diaphyseal fracture of extremity long bone after operation,including 35 males and 18 females,were enrolled in this study,They were at an age anged from 1 to 16 years old with a mean age of 6.7 years old,All the cases were traumatic fractures,involving 20 cases of femur,12 cases of tibia,10 cases of humerus,5 cases of radius,5 cases of ulna,1 case of simple fibular.According to the time from the operative to the first bone marrow transplantion,23 patients with the time of 4~6 months were assigned as group A,and 30 patients with the time of 6 ~8 months were assigned as group B.The patients were placed by prostration and 5~20 ml(average 12.7ml)bone marrow was aspirated from the anterior superior iliac spine.then the bone marrow was injected into the delayed union site under fluoroscopic control.X-ray filming was used to observe the fracture healing.Results: All patients were followed up at least 6 months after internal and external fixation was removed.Finally 47 case achieved clinical healing at a mean time of 5.8 months after operation(from 3 to 10 months).Failure occurred in 6 cases,including 1 case in group A and 5 cases in group B.After 2 injections,no obvious bony callus was observed,and then other treatment was performed.There were statistically significant differences in healing time and the number of injections between the two groups(P<0.01).The total curative rates of the two groups had no statistical significance(P>0.05).Conclusion: Percutaneous autogeous bone marrow transplantation is a simple,safe,minimally invasive,economical and feasible method for the treatment of delayed union of diaphyseal fracture of extremity long bone in children after operation.What is more,the early bone marrow transplantation can accelerate the fracture healing and shortened the course of treatment.PART? TREATMENT OF LONG BONE'S NONUNION IN CHILDREN AFTER OPERATION WITH EXTERNAL FIXTION SYSTERM AND PERCUTANEOUS AUTOGEOUS BONE MARROW TRANSPLANTATION TREATEDObjective: To investigate the curative effect of treatment of long bone's nonunion in children after operation with external fixation system and percutaneous autogeous bone marrow transplantation.Methods: From 2005 to 2014,39 cases of patients with nonunion of long bone's fractures after operation external fixation system and percutaneous autogeous bone marrow transplantation,treated by perforating marrow antrum,excising the scar and ossified tissue in fracture,and injection of autologous bone marrow for these patients with delayed union tendency at 2-3months after reoperation.The therapeutic effect of the treatment after operation was been evaluated by wound healing,reaction in the area of pin track and bone marmw aspiration,fracture healing,and recovery of adjacent joinf function.Results: All patients were followed up at least 1 year after internal and external fixation removed.3 patients occurred pin-track infection but controlled by anti-infection and periodic dressing change.2 patient with displacement and nounion caused by loose of screws after Orthofix unilateral external fixation,which were replaced by the Ilizarov circular external fixation in the secondary operation,reached clinical heal at 9,11 months after operation and two autologous bone marrow transplantation.Finally 39 case reached clinical healing at a mean time of 6.2 months after operation(from 4 to 15 months).Pain,infection and sinus tract in the area of bone marrow aspiration were not detected.The functional recovery of adjacent joints was excellent in most cases,only 4 cases remained partially limited function.Conclusion: External fixation can have good curative efficacy in the treatment of postoperative nonunion of long bone fracture.Injection of autologous bone marrow for these patients with delayed union tendency after reoperation can accelerate fracture healing and decreases the risk of reoperation.Therefore,it is effective that the treatment of long bone's nonuion in children after operation with external fixation system and percutaneous autogeous bone marrow transplantation.