同种异体骨复合自体红骨髓移植治疗关节周围骨折

doi:10.3969/j.issn.2095-4344.2013.48.020

中国组织工程研究 ›› 2013, Vol. 17 ›› Issue (48): 8419-8428.doi: 10.3969/j.issn.2095-4344.2013.48.020

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇下一篇

同种异体骨复合自体红骨髓移植治疗关节周围骨折

孔志刚，陈永宝，孙磊

河北医科大学第三医院骨伤科，河北省骨科生物力学重点实验室，河北省石家庄市 050051

出版日期:2013-11-26 发布日期:2013-11-26
通讯作者: 孔志刚，河北医科大学第三医院骨伤科，河北省骨科生物力学重点实验室，河北省石家庄市 050051
作者简介:孔志刚，男，1962年生，1984年河北医科大学毕业，教授，硕士生导师。
基金资助:
河北省卫生厅科研基金资助项目(20090417)*

Allograft cancellous bone combined with autologous red marrow for treatment of periarticular fractures

Kong Zhi-gang, Chen Yong-bao, Sun Lei

Department of Orthopedics, the Third Affiliated Hospital of Hebei Medical University, Hebei Orthopaedic Biomechanics Laboratory, Shijiazhuang 050051, Hebei Province, China

Online:2013-11-26 Published:2013-11-26
Contact: Kong Zhi-gang, Professor, Master’s supervisor, Department of Orthopedics, the Third Affiliated Hospital of Hebei Medical University, Hebei Orthopaedic Biomechanics Laboratory, Shijiazhuang 050051, Hebei Province, China kzg2005@tom.com
About author:Kong Zhi-gang, Professor, Master’s supervisor, Department of Orthopedics, the Third Affiliated Hospital of Hebei Medical University, Hebei Orthopaedic Biomechanics Laboratory, Shijiazhuang 050051, Hebei Province, China kzg2005@tom.com
Supported by:
the Scientific and Technological Research Program of Hebei Provincial Health Bureau, No. 20090417*

摘要/Abstract

摘要：

背景：关节周围骨折复位后常出现骨缺损，需进行植骨填充骨缺损以早期支撑关节面以防止关节面塌陷及移位。同种异体骨是治疗骨缺损的移植材料，但成骨能力差。自体红骨髓有成骨能力，但同种异体骨复合自体红骨髓移植治疗关节周围骨折的临床效果有待评定。
目的：采用锁定板固定、同种异体骨复合自体红骨髓移植治疗关节周围骨折的临床效果。
方法：纳入河北医科大学第三医院骨伤科治疗关节周围骨折患者43例。采用切开解剖复位关节面、将红骨髓与同种异体骨颗粒复合体植于骨缺损处，植骨完成后常规解剖锁定板内固定。胫骨平台骨折采用内侧、外侧或双侧锁定板固定。桡骨远端骨折采用背侧或掌侧锁定板固定，胫骨远端骨折采用胫骨远端内侧或外侧板锁定内固定。
结果与结论：患者43例共随访12个月至6年，平均4.3年。X射线片及CT复查结果显示，43例患者达骨性愈合，塌陷骨折复位良好。其中新鲜骨折愈合时间2-6个月，平均4个月；陈旧骨折愈合时间3-7个月，平均5.5个月。植骨后43例患者无明显免疫排斥反应，2例患者切口渗液较多，经换药2周愈合。切口感染患者1例，经引流换药4周伤口愈合，随访4年1个月至今感染未复发。根据Mankin和Komender标准评定，同种骨移植满意患者40例，占93%；不满意患者3例，占7%。结果证实，在锁定板支撑固定下，异体松质骨与自体红骨髓复合体移植治疗周围关节骨折可以起到近期支撑作用，防止关节面塌陷及骨折移位，并为关节周围骨折骨缺损提供骨重建材料，远期可以达到骨折愈合的目的。

关键词: 骨关节植入物, 骨与关节临床实践, 骨科内固定物, 骨折内固定, 同种异体松质骨, 自体红骨髓, 移植, 骨折, 关节, 内固定, 锁定板, 骨缺损, 切开复位, 创伤和损伤, 省级基金

Abstract:

BACKGROUND: Bone defects often occur after the reduction of periarticuar fractures, and bone grafting is required to fill bone defects, thereby to make the early support of articular surface and prevent the collapse and shift of the articular surface. Allograft cancellous bone is the transplant material for the treatment of bone defects, but its osteogenesis ability is poor. Autologous red marrow has osteogenesis ability. Therapeutic efficiency of allograft cancellous bone combined with autologous red marrow for periarticular fractures is still yet to be assessed.
OBJECTIVE: To study clinical effect of locking plate fixation and allograft cancellous bone combined with autologous red marrow in the treatment of periarticular fractures.
METHODS: Forty-three cases of periarticular fractures were incorporated into the Orthopaedics Department of the Third Hospital of Hebei Medical University. After cutting the articular surface anatomically, composite particles of the red marrow and allograft cancellous bone were implanted into bone defects, and then, an anatomic locking plate was used. Medial lateral or bilateral locking plate was used for tibial plateau fractures. Dorsal or volar locking plate was used for distal radius fractures, and distal tibial medial or lateral locking plate was used for distal tibial fractures.
RESULTS AND CONCLUSION: Forty-three patients were followed up for 12 months to 6 years, an average of 4.3 years. X-ray films and CT scans review showed that 43 patients’ collapse fracture all reached bony union. Fresh fracture healing time was 2-6 months, an average of 4 months; the healing time for old fracture was 3- 7 months, an average of 5.5 months. After bone grafting, 43 patients all had no significant immune rejection, two cases showed more wound exudates, and the wound was healed by dressing after 2 weeks. One case had wound infection, the wound was healed after 4 weeks of draining and dressing, and the infection had no recurrence following up for 4 years and 1 month. Forty patients were satisfied with bone grafting, accounting for 93%, and three cases dissatisfied, accounting for 7%, based on Mankin and Komender’s standard assessment. The results confirmed that allograft cancellous bone combined with autologous red marrow transplantation can play a supporting role in treating periarticular fractures to prevent the collapse of the articular surface and fracture displacement, and to provide reconstruction materials for periarticular defects. Its long-term goal is fracture healing.

Key words: bone marrow transplantation, biocompatible materials, bones of lower extremity, graft rejection, tibial fractures

中图分类号:

R318

孔志刚，陈永宝，孙磊. 同种异体骨复合自体红骨髓移植治疗关节周围骨折[J]. 中国组织工程研究, 2013, 17(48): 8419-8428.

Kong Zhi-gang, Chen Yong-bao, Sun Lei. Allograft cancellous bone combined with autologous red marrow for treatment of periarticular fractures[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(48): 8419-8428.

图/表（结果） 2

Quantitative analysis of participants

Forty-three cases were involved with complete follow-up data, and all of them entered the result analysis, with no withdrawal.

The follow-up results of the patients receiving the locking plate fixation and transplantation of allogeneic bone combined with autologous red marrow

Forty-three cases were followed up for 12 months to 6 years, average 4.3 years, and the fractures were all healed (Table 2).

Forty-three patients were followed up for 12 months to 6 years, an average of 4.3 years. The review of X-ray and CT showed that the collapse fracture reset well, and all fractures healed after allograft bone composite and autologous bone marrow transplantation. As shown in Figure 1, the fresh fracture healing time was 2-6 months, an average of 4 months; the old fracture healing time was 3 to 7 months, an average of 5.5 months.

Fusion condition of bone graft and the host bone

Evaluation criteria of X-ray radiography for bone fusion between the graft and the host bone^[12]: the bone graft and the host bone get fused well, which is defined as fracture healing; the bone graft and the host bone are not fused, which is defined as nonunion; the transplant bone is absorbed > 30%, which is defined as transplanted bone resorption; the bone mineral density around the transplantation bone decreases, which is defined as osteoporosis; the bone mineral density around the transplantation bone increases, which is defined as osteosclerosis. Results found that the fresh fracture healing time was 2-6 months, an average of 4 months; the old fracture healing time was 3 to 7 months, an average of 5.5 months.

Evaluation of bone graft adverse reactions

There was no obvious immune rejection in the 43 patients. Five patients got fever (tibia platform fracture in three cases, distal tibial fractures in two cases), the heating time was 2-5 days, and the highest temperature was 38.5 ℃. After treatment with antipyretic-analgesic drugs and physical cooling, the temperature dropped to normal, and the incisions of the patients with fever had no redness, heat, pain and infection. Blood routine examination showed that there was no rise of white blood cells and neutrophils.

There are two cases of serious incision drainage, and bacterial culture of incision shows no bacterial growth. The wound was healed after 3 weeks of dressing change. For one case of tibia platform fracture incision infection (Escherichia coli), antibiotics were used for

1 week, and the wound was healed after 4 weeks of drainaging and dressing change. There was no infection recurrence so far according to the follow-up of 4 years and 1 month.

Suture removal was one in 40 patients at 12-14 days after surgery and all incisions got first intention.

According to the scoring criteria of the result of allograft taken by Mankin^[13] and Komender^[14], the results were classified as: (1) Satisfaction: incision is healed well after fixation; presence of transient fever and a small amount of effusion; X-ray shows no absorption of graft bone; fracture is completely healed; no tumor recurrence; limb local strength and function return to normal or mildly limited, no pain, normal daily activities recover without complications. (2) Dissatisfaction: apparent rejection, a large number of effusion, wound delayed union or fistula formation; X-ray shows all bone graft absorbed ahead of time; local pain, limited daily activities; complications such as infection and nonunion, or tumor recurrence, bone graft taken out, even amputation. Finally, according to the results of 43 patients, 40 cases were satisfied with the bone allograft, accounted for 93%; three cases were not satisfied, accounting for 7%.

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引言

Bone defects often occur after the reduction of periarticuar fractures, and bone grafting is required to fill bone defects, so as to make the early support of articular surface and prevent the collapse and shift of the articular surface. Bone defects of 10 mm × 6 mm × 6 mm are repaired by bone grafting^[1], and autologous bone graft is the best method to fill bone defects. Although the osteogenesis effect of autogenous grafts is strong, but autologous cancellous bone quantity is limited. The soft tissue is cut with big trauma, and the graft can bring some complications to patients. The simple artificial bone due to the inactive

cells shows no ideal effects. The clinical application of hydroxyapatite bone material and bone growth factors is expensive, and it remains to be further clinical study^[2].

Allogeneic bone has the same considerable strength as autologous bone, which is a commonly used as materials filling bone defects. Allogeneic bone after a deep frozen and gamma ray irradiation can destroy cell surface antigen and produce good histocompatibility, which is, therefore, considered as immunogenicity implant^[3]. Separate dry allograft bone transplantation requires a long creeping substitution process. The longer time of fixation leads to a less osteogenesis ability than the autogenous bone. Previous studies used autologous bone marrow transplantation to treat fracture nonunion^[4-5]. Many basic and clinical studies have confirmed that the bone marrow has the abundant ability of bone induction and bone autograft, and the bone marrow can promote the fracture healing and bone defect repairing. Autologous red marrow with osteogenetic activity is the first to be combined with bone grafting. The advantages of pure red marrow transplantation are safe, simple operation, low cost and small trauma. Pure red marrow transplantation can get better treatment effect in treatment of fracture delayed union and nonunion. Bone marrow has certain liquidity. Due to a lack of cell carrier, a bone marrow transplant alone is easy to spread after implantation and the active cells from the bone marrow are easy to loss. It cannot be effectively concentrated in the implant site, and also cannot provides mechanical stability, which, therefore, reducing the osteogenesis effect.

Burwell et al ^[6-7] made the animal experiments that fresh iliac without bone marrow was soaked in an autologous red marrow. This fresh compound autograft was transplanted into muscle, and the result showed that the compound has the same ostegenesis ability as the common iliac bone. Chinese scholars used cancellous allograft composite with autologous red marrow to treat comminuted fractures, bone defects and bone nonunion^[8-9]. Allogenic decalcified bone matrix combined with autologous red marrow was used to treat bone defects after shaving the benign bone tumor. Yin et al ^[10] used allogeneic bone materials combined with autologous concentrate red marrow to treat benign bone tumors and tumor lesions. The transplant boundaries blur and disappear time of the group of compound red marrow was shorter than that of the group of pure allograft, and the bone mineral density was also higher in the former group. Purpose of bone grafting into joint fracture is to implement bone reconstruction on the basis of mechanical support, by autologous crawling to reach fracture healing. Bone graft materials should have certain mechanical strength, can provide mechanical support and disperse stress from inside and outside, and to a certain extent, can allow early exercise muscle contraction diastole and passive flexion and extension after fixation.

Research has shown that locking compression plate has obvious advantages proved by multi-center clinical research^[11]. The locking screw angularly fixed in comminuted fracture and osteoporosis has good tensile resistance and anchor force, to prevent loosening of internal fixation. As a carrier of the bone marrow, allograft bone has a good histocompatibility. Small pieces of cancellous bone as carriers are combined with bone marrow to make composite bone graft materials. Full use of the active osteogenesis ability of bone marrow can just cover the shortage of allograft bone graft on osteogenesis ability. Allogeneic cancellous bone and autologous red marrow have the same holding power that can support early joint functional exercise. The active osteogenesis ability of bone marrow contributes to realize the reconstruction of bone defects as early as possible. This kind of packing material plays a role in bone conduction, bone induction and osteogenesis. The therapeutic outcome of allograft cancellous bone combined with autologous red marrow in the treatment of periarticular fractures is the problem of attention.

Here, 43 cases of periarticular fractures were treated with locking plate fixation and allograft cancellous bone combined with autologous red marrow. The effect was satisfied as follows.

材料方法

Design

A retrospective case analysis.

Time and setting

The study was completed from June 2006 to January 2011 in the Orthopedics and Traumatology of the Third Affiliated Hospital of Hebei Medical University.

Subjects

Totally 43 patients included 25 males and 18 females, aged 19-68 years with an average of 40 years. There were 18 cases of tibial plateau fractures, 17 cases of distal radius fractures, and eight cases of distal tibial fractures. Of all the 43 cases, 22 cases were confirmed as having fresh fractures, and 21 as having old fractures. Time from fresh fractures to surgery after injury was 5-12 days, an average of 8 days. Time from old fractures to surgery after injury was 1-5.5 months, an average of 2.5 months (Table 1).

Diagnostic criteria: X-ray CT confirmed periarticular fractures.

Inclusion criteria: (1) Patients suffering from periarticular fractures with surgical treatment indications; (2) no serious disease of internal medicine and immune system; (3) informed consent for treatment scheme was obtained.

Exclusion criteria: (1) History of serious disease of internal medicine or surgery and infectious diseases, and surgical contraindications; (2) open fractures; (3) allergic constitution, and immune system disease.

Materials

Locking compression plate (LCP) manufactured by Shandong Weigao Orthopedic Device Co., Ltd. is used to lock epiphyseal end and has different specifications and models to choose according to the position and damage degree of fractures. All allogeneic cancellous bone is freeze-dried cancellous bone provided by Shanxi Osterorad Biomaterial Co., Ltd.

Methods

Preparation of autologous red marrow and allograft bone composite

Red marrow was extracted from the iliac bone with a needle and mixed with allogeneic cancellous bone, 2.5 to 5.0 mL for each puncture point. Multipoint puncture to extract bone marrow could be used to ensure the enough concentration of the bone marrow. 10 g cancellous particles were mixed with 10 mL red marrow, for about 5 minutes, and red marrow and allogeneic bone particles could be solidified into a complex.

Reduction, fixation and bone graft in the treatment of periarticular fractures

Brachial plexus anesthesia and spinal canal anesthesia were used for upper limb fractures and lower limb fractures, respectively, to reposition the collapse of articular surface and make the joint surface and the fracture obtain anatomical reposition. Autologous red marrow and allograft bone composite was embedded in bone defects to support the joint surface, in order to prevent the shift again. Bone mass for allogeneic bone graft was 25 to 55 g, an average of 30 g. Normal anatomic locking plate was used for internal fixation after the completion of bone grafting.

Tibial plateau fractures, for example, chose anteromedial or anterolateral incision of the knee joint. If the tibia platform collapsed, joint capsule incision was made at the bottom of the meniscus. The knee varus or valgus was made during the operation, showing the articular surface with meniscus retractor to reveal the collapse of the tibial platform. The presence of meniscus injuries and anterior cruciate ligament rupture was detected. An incision was made 2.0 cm below the tibial plateau, and the periosteum screwdriver was inserted below the collapse to support the collapse and restore smooth joint surface. The allogeneic bone was implanted into the space, and autologous ilium bone or allogeneic bone graft was implanted into the bone defect area followed by lateral fixation with L shape locking plate and medial fixation with T type locking plate. The articular fracture line was revealed if no collapse of the tibial platform. Extra-articular reduction was instead of cutting joint capsule. C-arm X-ray machine was used for observing reduction of the fractures. If reduction was satisfied, the fracture was fixated. For old tibia plateau fracture, it ought to resect the bone surrounding the collapse of plateau, and then the articular surface open reduction was done. The incision size of old fractures should match the size of platform collapse. Medial, lateral, or bilateral locking plate fixation could be chosen for tibial plateau fracture according to the location, severity and comminuted degree. For distal radius fractures, dorsal or volar locking plate fixation was preferred. For distal tibial fractures, distal tibial medial or lateral plate internal fixation with locking was selected. Reliable internal fixation without external fixation is beneficial to early joint activities. After fixation, drugs for dehydration and detumescence were taken and the affected limbs were lifted up to abandon external fixation. Guidance for joint activities should be done as soon as possible.

The project implementers ought to be clinical directors who have been trained and have the qualification of engaging in bone and joint fractures surgical technique work.

X-ray evaluation of fracture healing and fusion level of bone graft with the host bone

Patients were required to review X-ray plain film when fracture was fixed for 2, 4, 6, 8, 10, 12, 14, 16 weeks, and then X-ray examination was done once a month. According to the degree of bone defect healing, we tracked process of fracture healing. Evaluation criteria of X-ray radiography for bone fusion between the graft and the host bone^[12]: the bone graft and the host bone get fused well, which is defined as fracture healing; the bone graft and the host bone are not fused, which is defined as nonunion; the transplant bone is absorbed > 30% , which is defined as transplanted bone resorption; the bone mineral density around the transplantation bone decreases, which is defined as osteoporosis; the bone mineral density around the transplantation bone increases, which is defined as osteosclerosis.

Main outcome measures

Temperature change after the bone graft; seepage and infection of incision, immunological rejection, fracture healing, fusion level of bone graft with the host bone.

讨论

Anatomical reduction and bone grafting for supporting and fixation is the principle to treat periarticular fractures

Periarticular fractures include intra-articular fractures which involving the articular surface and metaphysic fractures near to the joint. Fractures often involve the articular surface. The reduction of articular surface fracture is more strict than normal. Its treatment purpose is not only the healing of the fracture itself, more important is to restore good joint function on the basis of fracture healing. Anatomical repositioning, padded support fixed and bone graft is the principle which needs to be followed in the fixation of periarticular fractures, which is also the essential condition of joint function recovery^[15]. Anatomical reduction means the fracture involving articular surface, which needs opening reduction for resetting the shifted articular surface, in order to maximize the recovery of joint surface smooth, and to prevent or delay the occurrence of traumatic arthritis. Studies have shown that when the collapse of tibial plateau articular surface is 3 mm or more, joint contact pressure increases obviously; when the collapse is 1.5 mm or less, joint contact pressure has no obvious change^[16]. Compressive stress increase per unit area is one of the important reasons leading to degeneration of articular cartilage, eventually causing the occurrence of traumatic arthritis. Because of periarticular fracture displacement, bone loss, osteoporosis and other reasons, it is difficult to achieve strong fixation like long bone fixation, especially in old fractures. But the important guarantee of articular function recovery is the smooth of articular surface and the whole structure recovery of metaphysics, so the goal of fixation in this area is the overall support. In the present study, anatomic locking plate fixation was used, which was suitable for the morphology of periarticular fractures, especially suitable for fixation of periarticular cancellous bone, which provides reliable support for articular fixation^[17-18]. After achieving anatomical reduction of articular surface fractures, a larger anatomical reattachment of bone defects often forms which requires Ⅰ phase bone grafting and the purpose of grafting is to support the articular surface which has been reset, and to ensure the restored articular surface has no longer displacement and subsidence during articular rehabilitation exercise. Bone reconstruction materials are used for defects to reach the goal of fracture healing. The grafting can ensure early rehabilitation exercise and provide conditions to restore the articular function to the maximal extent. In our study, all of cases were grafted with allograft cancellous bone combined with autologous red marrow after fracture reset and fixed by anatomic locking plate, achieving a reliable support fixed effect. There were no patients experiencing articular surface subsidence, fracture displacement, and loosening of internal fixation. The method effectively prevented the articular adhesion, stiffness, and the occurrence of traumatic arthritis.

How to choose the graft material after reduction of articular fractures

The purpose of grafting for the reset periarticular fracture is to make the early support of articular surface and fractures, and to prevent articular surface subsidence and fracture displacement during articular functional exercise. The forward goal is to provide reconstruction materials for fracture healing, and to allow the early functional exercise under the fixed support for preventing complications, such as articular adhesion and stiffness. Autogenous bone is the ideal bone graft material^[19]. It has osseous, bone induction, bone conductibility and complete biocompatibility. But autologous bone mass is limited, and complications such as hematoma, infection, and pain can happen when extracting bone tissue. An additional incision is made for resection of iliac bone, which increases blood loss and the fixed time, thereby aggravate damage to patients^[20-21]. So the clinical application of autologous bone is limited by a lot and a planting bone material is required to replace autologous bone grafts clinically. There are two conditions for alternative materials of autologous bone grafts as ideal materials for periarticular fractures. The first is the strength of supporting to the reset articular surface and fracture, and the second is that the material has the same structure and osteogenesis as autologous bone. The alternative material is used to fill bone defects in recent to support reset articular surface and fractures, and the long-term effect is to heal fracture as bone reconstruction materials. Allogeneic bone has rich sources, and possesses the same structure and support with autologous bone, which can be chosen according to defect size and shape. Jerosch et al ^[22] observed the mechanical properties of freeze-dried bone, and found that the bending strength of freeze-dried bone after rehydration was reduced by 5%-100% than fresh bone, the rotation strength decreased by 61% and the compressive strength had no obvious change or slight increase. Small pieces of freeze-dried allograft bone have been used as common bone graft materials^[23-24]. During the preparation process of freeze-dried cancellous allograft, allograft bone after lyophilization irradiation is freeze-dried to reduce antigenicity, improve the success rate after fixation and reduce complications such as infection^[24]. The process also kills many living cells, and abates the osteogenesis ability, thereby leading to a longer healing time of allograft than autogenous bone. Allograft materials that are simply placed to fill bone defects only provide and maintain a growth space for bone regeneration with no osteogenesis. The osteogenesis ability of autologous bone marrow can be made up the shortage of allograft bone.

Periarticular fracture is cancellous bone fracture, and the healing of cancellous bone is different from that of tubular bone. Due to a lack of local periosteum, it cannot undertake membrane in osteogenesis, and hematoma surrounding the fracture ends is small, so its endochondral ossification effect is weak, and its fracture healing mainly depends on the osteogenesis of bone marrow^[25]. Therefore, the bone marrow plays a vital role in the healing of periarticular fractures. Some scholars^[27]use concentrated bone marrow progenitor cells to treat tibial fracture nonunion but the effect is not satisfactory. Treatment of bone defect and bone fracture nonunions with autologous red marrow graft gets better clinical effects^[27-28]. The graft material of periarticular fractures in addition to the osteogenesis effect still needs to have considerable strength that can support joint surface and fractures in the short term, and prevent articular surface subsidence and fracture displacement during joint functional exercise. Autologous marrow transplantation needs a closed complete space in order to make bone marrow fluid or transplants clot in bone defects. Pure liquid of autologous red marrow will lose in transplant parts for bone defects which are an open space for periarticular fractures. Because of brittle the autologous red marrow clot is hard to fill bone defects, cannot support reset articular surface, and holds no large space for bone defects. Simple autologous red marrow transplantation obviously cannot achieve requirements of reconstruction materials for periarticular fractures. Autologous bone marrow cannot separately be the transplant material to fill bone defects, and it needs a planting bone material as a carrier to keep the autologous red marrow in bone defects. Allograft cancellous bone is the right material. Freeze-dried allograft cancellous bone has the same structure, considerable support strength, bone conduction and bone induction with autograft bone. In spite of the lack of osteogenesis of allogenic bone, the osteogenesis ability of bone marrow can make it good.

Osteogenesis effect of composite transplantation of autologous red marrow and allogeneic cancellous bone

Freeze-dried small piece or granule of cancellous allograft bone that has porous and mesh structure, and is good for nutrients penetrate can provide good carrier and adsorption materials for bone marrow cells. Complex of allograft cancellous bone particles and autologous red marrow is convenient for clinical application. Cao’s experiments shows that the growth and proliferation capacity of osteoblast from bone marrow stem cells can normally grow and proliferate in allogeneic freeze-dried bone scaffold, and freeze-dried allograft bone particles have good cell compatibility^[29]. Animal experiments have confirmed that allograft cancellous bone combined with bone marrow stem cell transplantation has better healing effect on bone defects than simple allograft^[30]. Clinical application of allograft cancellous bone and autologous red marrow complex has received satisfactory results on the bone defect treatment^{[10, 31-33]}. The complex of cancellous bone allograft and autologous red marrow as the filling material has the bone conduction, bone induction and osteogenesis effect. Our findings shows that fracture healings were seen in all the 43 patients with fractures after treatment with the complex of cancellous allograft bone and autologous red marrow as a fill material. It receives the same effect as autologous bone graft. Immune rejection and delayed infection are the common complications of allograft, foreign proteins antigenicity of allogeneic bone allograft is stronger, immunogenicity of allograft can be reduced by deep freezing, freeze drying, decalcification, degreasing and deproteinization to keep the bone induction capacity. In this study, the 43 cases had no obvious immune rejection response and adverse reactions. At present, heterogeneous cancellous bone to repair bone defects is the development direction of bone defect treatment as well^[34]. The tissue-engineered bone, which uses natural or synthetic materials as scaffold, cells themselves as the center, growth factor as the promoter of growth and differentiation, is becoming a research hotspot^[35-36].

To sum up, under the support of locking plate fixation, cancellous bone allograft combined with autologous red marrow transplantation for treatment of periarticular fractures can provide short-term support, prevent joint surface subsidence and fracture displacement, provide bone reconstruction materials for periarticular fractures and bone defects, and achieve the goal of fracture healing.

同种异体骨复合自体红骨髓移植治疗关节周围骨折

Allograft cancellous bone combined with autologous red marrow for treatment of periarticular fractures

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