Öz
Amaç: Kaynamamış kırığı olan hastalarda anterior iliak kanattan alınan kemik iliğinin kırık hattına enjekte edilmesinin kırık kaynamasına etkisi araştırıldı.
Gereç ve Yöntem: Çalışma kliniklerimize müracaat eden kaynamamış kırığı olan ve kemik iliği enjeksiyonu uygulamasını kabul eden bu uygulama ile takip ve tedavi edilen hastaların retrospektif olarak incelenmesi sonucu hazırlandı. Çalışmaya Kasım 2016 Aralık 2019 tarihleri arasında müracaat eden uzun kemik diafiz ve metafiz kırığı kaynamaması olan 13 hastanın 14 kemiği dahil edildi. Hastalara lokal anestezi altında anterior iliak kanattan kemik iliği aspirasyonu yapılarak lokal anestezi altında kırık hattına skopi kontrolünde enjekte edildi. Tüm hastalar aylık olarak ön-arka ve yan grafiler ile izlendi. Enjeksiyon işlemi yedi hastaya üç defa 6 hastanın yedi kaynamamış kırığına 2 defa tekrar edildi.
Bulgular: Toplamda 14 hastanın 11 kırığı kaynadı. Üç kırıkta kaynama elde edilemedi. Kaynama elde edilemeyen kırıklarda boşluk miktarı 2 mm üzerinde idi. Kırık kaynama oranı % 79 olarak bulundu. Hastalara uygulanan ortalama enjeksiyon sayısı 2.5 idi. Tespit tekniği ve kaynamama tipi ile kaynama arasında anlamlı bir ilişki bulunamadı.
Sonuç: Kemik iliği enjeksiyonu kaynamamış uzun kemik kırıkları tedavisinde ucuz etkili ve günübirlik cerrahi uygulaması olarak güvenli bir yöntemdir.
Anahtar Kelimeler
Kemik iliği kaynamama tedavisi günübirlik cerrahi uzun kemik kemik kaynaması
Kaynakça
- Nazar M, Shafiq M, Ahmed A, Ahmad S, Javed S, Aziz A. Autologous percutaneous bone marrow injection in long bone fractures with delayed and nonunion. J Surg Pakistan. 2016;21:23-6.
- Konde SS, Borkar SS, Thosar RS, Allamwar RA, Kamath SP. Role of percutaneous bone marrow injection in non union of fractures. National Journal of Medical Research. 2017;7:135-7.
- Lin K, VandenBerg J, Putnam S M, Parks CD, Spraggs-Hughes A, McAndrew CM et al. Bone marrow aspirate concentrate with cancellous allograft versus iliac crest bone graft in the treatment of long bone nonunions, OTA International. 2019;2:e012.
- Sahu RL. Percutaneous autogenous bone marrow injection for delayed union or non-union of long bone fractures after internal fixation. Rev Bras Ortop. 2017;53:668-73.
- Sonmez M, Durak K, Bi̇lgen O. The results of bone marrow and coral grafts applications in bone restoration. Acta Orthop Traumatol Turc. 2006;30:76-9.
- Pieske O, Wittmann A, Zaspel J, Löffler T, Rubenbauer B, Trentzsch H et al. Autologous bone graft versus demineralized bone matrix in internal fixation of ununited long bones. J Trauma Manag Outcomes. 2009;15:3-11.
- Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, Mineo GV. Incidence of donor site morbidity following harvesting from iliac crest or RIA graft. Injury. 2014;45:116-20.
- Rupp M, Biehl C, Budak M, Thormann U, Heiss C, Alt V. Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations. Int Orthop. 2018;42:247-58.
- Bell A, Templeman D, Weinlein JC. Nonunion of the femur and tibia: an update. Orthop Clin North Am. 2016;47:365-75.
- Agarwal V, Yadav S, Shukla M. Treatment of atrophic non-union fractures by autologous bone marrow aspirate injections: a prospective study. J Bone Joint Dis. 2019;34:17-23.
- Singh AK, Shetty S, Saraswathy JJ, Sinha A. Percutaneous autologous bone marrow injections for delayed or non-union of bones. J Orthop Surg. 2013;21:60-4.
- Sim R, Liang TS, Tay BK. Autologous marrow injection in the treatment of delayed and non-union in long bones. Singapore Med J. 1993;34:412-7.
- Kassem MS. Percutaneous autogenous bone marrow injection for delayed union or non union of fractures after internal fixation. Acta Orthop Belg. 2013;79:711-7.
- Gross JB, Diligent J, Bensoussan D, Galois L, Stoltz JF, Mainard D. Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases. Biomed Mater Eng. 2015;25:187-97.
- Desai P, Hasan SM, Zambrana L, Hegde V, Saleh A, Cohn MR et al. Bone mesenchymal stem cells with growth factors successfully treat nonunions and delayed unions. HSS J. 2015;11:104-11.
- Hernigou P, Mathieu G, Poignard A, Manicom O, Beaujean F, Rouard H. Percutaneous autologous bone-marrow grafting for nonunions. surgical technique. J Bone Joint Surg Am. 2006;2:322-7.
- Hendrich C, Franz E, Waertel G, Krebs R, Jäger M. Safety of autologous bone marrow aspiration concentrate transplantation: initial experiences in 101 patients. Orthop Rev. 2009;10:e32.
Öz
Purpose: The impact on bone union of injecting bone marrow from the anterior iliac crest was examined in patients with non-unions.
Materials and Methods: The present study was prepared following a retrospective study on non-union patients who applied to our clinics who accepted bone marrow injection and were followed up and monitored after the procedure. A total of 14 bones from 13 patients with long bone diaphysis and metaphysis non-union were included in the study from among patients who applied during the dates of November 2016 – December 2019. Bone marrow aspiration from the anterior iliac crest was conducted on the patients under anesthesia which was injected to the fracture line under local anesthesia and fluoroscopy. All patients were monitored on a monthly basis with front-rear and side radiography. The injection operation was conducted three times on seven patients and 2 times on a total of seven non-unions in 6 patients.
Results: A total of 11 unions took place in 14 patients. A union could not be attained in three fractures. The gap was over 2 mm in fractures without union. Fracture union ratio was obtained as 79 %. The mean injection number applied on the patients was 2.5. A statistically significant correlation could not be identified between the fixation method and non-union type and union.
Conclusion: Bone marrow injection is a cheap, effective, easy to use and safe surgical method for the treatment of long bone fractures with non-union.
Anahtar Kelimeler
Bone Marrow non-union treatment out-patient surgery long bone bone union
Kaynakça
- Nazar M, Shafiq M, Ahmed A, Ahmad S, Javed S, Aziz A. Autologous percutaneous bone marrow injection in long bone fractures with delayed and nonunion. J Surg Pakistan. 2016;21:23-6.
- Konde SS, Borkar SS, Thosar RS, Allamwar RA, Kamath SP. Role of percutaneous bone marrow injection in non union of fractures. National Journal of Medical Research. 2017;7:135-7.
- Lin K, VandenBerg J, Putnam S M, Parks CD, Spraggs-Hughes A, McAndrew CM et al. Bone marrow aspirate concentrate with cancellous allograft versus iliac crest bone graft in the treatment of long bone nonunions, OTA International. 2019;2:e012.
- Sahu RL. Percutaneous autogenous bone marrow injection for delayed union or non-union of long bone fractures after internal fixation. Rev Bras Ortop. 2017;53:668-73.
- Sonmez M, Durak K, Bi̇lgen O. The results of bone marrow and coral grafts applications in bone restoration. Acta Orthop Traumatol Turc. 2006;30:76-9.
- Pieske O, Wittmann A, Zaspel J, Löffler T, Rubenbauer B, Trentzsch H et al. Autologous bone graft versus demineralized bone matrix in internal fixation of ununited long bones. J Trauma Manag Outcomes. 2009;15:3-11.
- Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, Mineo GV. Incidence of donor site morbidity following harvesting from iliac crest or RIA graft. Injury. 2014;45:116-20.
- Rupp M, Biehl C, Budak M, Thormann U, Heiss C, Alt V. Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations. Int Orthop. 2018;42:247-58.
- Bell A, Templeman D, Weinlein JC. Nonunion of the femur and tibia: an update. Orthop Clin North Am. 2016;47:365-75.
- Agarwal V, Yadav S, Shukla M. Treatment of atrophic non-union fractures by autologous bone marrow aspirate injections: a prospective study. J Bone Joint Dis. 2019;34:17-23.
- Singh AK, Shetty S, Saraswathy JJ, Sinha A. Percutaneous autologous bone marrow injections for delayed or non-union of bones. J Orthop Surg. 2013;21:60-4.
- Sim R, Liang TS, Tay BK. Autologous marrow injection in the treatment of delayed and non-union in long bones. Singapore Med J. 1993;34:412-7.
- Kassem MS. Percutaneous autogenous bone marrow injection for delayed union or non union of fractures after internal fixation. Acta Orthop Belg. 2013;79:711-7.
- Gross JB, Diligent J, Bensoussan D, Galois L, Stoltz JF, Mainard D. Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases. Biomed Mater Eng. 2015;25:187-97.
- Desai P, Hasan SM, Zambrana L, Hegde V, Saleh A, Cohn MR et al. Bone mesenchymal stem cells with growth factors successfully treat nonunions and delayed unions. HSS J. 2015;11:104-11.
- Hernigou P, Mathieu G, Poignard A, Manicom O, Beaujean F, Rouard H. Percutaneous autologous bone-marrow grafting for nonunions. surgical technique. J Bone Joint Surg Am. 2006;2:322-7.
- Hendrich C, Franz E, Waertel G, Krebs R, Jäger M. Safety of autologous bone marrow aspiration concentrate transplantation: initial experiences in 101 patients. Orthop Rev. 2009;10:e32.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Mart 2022 |
| Kabul Tarihi | 4 Ocak 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 47 Sayı: 1 |
