| 1.Evaluation of the effect of platelet-rich plasma in promoting fracture healing Objective:Clarify the effect of local injection of platelet-rich plasma(PRP)on promoting fracture healing,and provide a guarantee for the practicability of applying it to treat fracture nonunion.Methods:A retrospective analysis of 61 patients with long bone shaft fractures treated in our hospital from January 2015 to December 2016 with slow healing(callus and fracture line imaging score ≤ 3 points)3 months after surgery,including 26 males and 35 females Cases were 27 to 61 years old,with an average age of(51.5±7.1)years.Patients were divided into PRP group(28 cases)and observation group(33 cases)according to whether or not local PRP was injected.Review X-rays monthly to observe fracture healing,record the time to achieve bone healing standards,record the callus and fracture line imaging scores and visual analogue scale(visual analogue scale)6 months and 9 months from the first operation,VAS).The data was statistically processed by spss.17 software,and the results of the two processing methods were compared.Results: There was no statistically significant difference between the two groups of patients in general information(gender,age,fracture site,cause of injury),callus and fracture line imaging scores,and VAS scores at the time of inclusion in the study(P>0.05).All 61 patients were followed up for 9-14 months,with an average of(11.41±1.30)months.The fractures of the two groups of patients were healed without adverse reactions.The average bone healing time of patients in the PRP group was(10.9±0.9)months,which was shorter than the average healing time of the observation group [(11.8±1.4)months],and the difference was statistically significant(P>0.05).The imaging scores of callus and fracture line at 6 and 9 months after the first operation were[(4.3±0.8)points,(6.8±1.3)points] in the PRP group were higher than those in the observation group [(3.1±0.8)points,(5.3±0.8)points],the differences were statistically significant(P<0.05).The VAS scores at 6 months and 9 months after the first operation,[(4.3±1.1)points,(1.5±0.8)points] in the PRP group were lower than those in the observation group [(5.0±0.7)points,(2.2±1.0))Points],the difference was statistically significant(P<0.05).2.Evaluation of the effect of PRP in adjuvant treatment of nonunion of tibial shaft fractures after operationObjective:Compare the effect of PRP combined with surgery and surgery alone for the treatment of nonunion of tibial shaft fractures,and compare the corresponding fracture repair laboratory indicators to explore more effective treatment methods for fracture nonunion.Methods:Collected from January 2017 to January 2020,30 cases of nonunion patients with tibial shaft fractures after continuous income in our hospital,13 males and 17 females,aged 27-63 years old,with an average of(51.4±8.4)years old,according to two The secondary operation methods were divided into PRP combined operation group with16 cases and operation group with 14 cases.On the day of surgery(before surgery)and at2,4,8 and 12 weeks after surgery,blood samples were taken from the two groups of patients to determine the levels of osteocalcin(OCN)and bone Alkaline Phosphatase(bone Alkaline Phosphatase)in their blood.The contents of BAP)and β-C-terminal telopeptide Ⅰ collagen(β-CTx)were determined,and the contents of the two groups of patients at different periods were compared.The PRP concentration of 3 injections in the PRP combined operation group was measured.Observe the healing of the surgical incisions of the two groups,regularly review the x-rays,and perform the callus and fracture line imaging scores and VAS scores on the two groups at 3,6 and 9 months after the operation,and record that the two groups have reached the clinical fracture The time of healing standard and bone healing standard was statistically processed by spss.17 software,and the results of the two surgical methods were compared.Results:There was no statistically significant difference between the two groups of patients in preoperative general information(gender,age,cause of injury,and type of fracture nonunion)and the VAS score at the time of inclusion in the study(P>0.05).Thirty patients were followed up after the operation.The follow-up time was 9-14 months,with an average of(12.10±1.40)months.The fractures of the two groups were healed without adverse reactions.1.PRP injection concentration: The PRP injection concentration in the PRP combined operation group was(1198.02±195.04)×109 /L,which was(5.43±1.28)times the concentration of autologous PLT(platelets,PLT).2.Biochemical marker detection results: The OCN content of the two groups reached the peak at 4 weeks after surgery,and the content of the PRP combined operation group at 2and 4 weeks [(25.95±1.94)ng/ml,(31.49±2.01)ng/ml] was higher than that in the operation group [(19.58±2.95)ng/ml,(24.66±2.14)ng/ml],the difference was statistically significant(P<0.05);BAP levels in the two groups were 4,4,and 4,respectively.The peak value was reached at 8 weeks,and the content of PRP combined operation group[(73.94±10.17)u/l,(77.63±7.69)u/l,(72.88±7.05)u/l] was higher at 2,4,and 8 weeks In the operation group [(66.64±7.29)u/l,(67.43±6.16)u/l,(68.14±5.05)u/l],the difference was statistically significant(P<0.05);the content of β-CTx in the two groups was in It reached the peak at 4 weeks after operation,and the content of PRP combined operation group was always higher than that of operation group,the difference was statistically significant(P<0.05).3.Incision and fracture healing: 2 out of 16 patients in the PRP combined operation group had incisions healed at grade B,the healing rate of incisions at grade A was 87.5%(14/16),and 5 of the 14 patients in the operation group were grade B.Healing,the incision grade A healing rate was 64.3%(9/14);the clinical healing time and bone healing time of the PRP combined operation group were shorter than those of the operation group,and the difference was statistically significant(P<0.05).4.Postoperative imaging score and VAS score: The callus and fracture line imaging scores of patients in the PRP combined surgery group were higher than those in the surgery group at 3,6,and9 months after surgery.The VAS scores were lower than those in the surgery group,and the differences were statistically significant(P<0.05).Conclusion:1.Local injection of PRP can promote the healing of long bone shaft fractures of the extremities without adverse reactions.It can be used as a good way to promote fracture healing.2.PRP combined with surgery to treat nonunion of tibial shaft fractures is better than surgical treatment alone.It has the advantages of short healing time and fewer adverse reactions to the incision.It is a good way to treat nonunion fractures.3.PRP injection therapy can promote the increase of the levels of bone formation markers OCN,BAP and bone resorption marker β-CTx in the blood of patients,which is helpful to the study of the mechanism of PRP treatment of fracture nonunion and clinical prognosis judgment. |
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