Introduction

Union of long bone fractures is a complicated biological mechanism affected by numerous systemic and local variables. Disruption of any of these components may result in fracture nonunion. There are various types of clinically available treatment strategies for aseptic nonunion. Both activated platelet plasma and extracorporeal shock waves play important roles in fracture healing. This study aimed to investigate the interaction of platelet-rich plasma (PRP) and extracorporeal shock wave (ESW) in bone healing of nonunion.

Hypothesis

PRP and ESW have synergistic effects in treating long bone nonunion.

Methods

Between January 2016 and December 2021, a total of 60 patients with established nonunion of a long bone (18 tibias, 15 femurs, 9 humerus, 6 radii, and 12 ulnae) were included in this study, comprising 31 males and 29 females, ranging from 18 to 60 years old. Patients with bone nonunion were separated into two groups: PRP alone (Monotherapy group) and those treated with PRP combined with ESW (Combined treatment group). The two groups were compared to assess the therapeutic benefits, callus development, local problems, bone healing time, and Johner Wruhs functional classification of operated limbs.

Results

Fifty-five patients were followed up, 5 patients were lost to follow-up, two in the PRP group and three in the PRP + ESW group, the follow-up time varied from 6 to 18 months, with an average of 12.7 ± 5.2 months. At 8, 12, 16, 20, and 24 weeks following intervention, the callus score in the monotherapy group was significantly lower than in the combined treatment group (p < 0.05). Both groups had no swelling and infection in the soft tissue of the nonunion operation site. In the PRP + ESW group, the fracture union rate was 92.59% and the healing time was 16.3 ± 5.2 weeks. In the PRP group, the fracture union rate was 71.43% and the healing time was 21.5 ± 3.7 weeks. The clinical healing time of the monotherapy group was significantly longer than the combined treatment group (p < 0.05). All the nonunion patients with no signs of healing were treated with revision surgery. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the monotherapy group was significantly lower than in the combined treatment group (p < 0.05).

Conclusion

PRP combined with ESW has a certain synergistic effect in treating aseptic nonunion after fracture surgery. It can significantly improve the formation of new bone, it is a minimally invasive and effective strategy to treat aseptic nonunion in a clinical setting.

Level of evidence

III, retrospective, single-centre, case-control study.

中文翻译：

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自体富血小板血浆联合体外冲击波治疗长骨干无菌性骨不连的协同作用

介绍

长骨骨折愈合是一个复杂的生物学机制，受众多系统和局部变量的影响。这些组件中任何一个的破坏都可能导致骨折不愈合。临床上有多种类型的无菌性骨不连治疗策略。活化的血小板血浆和体外冲击波在骨折愈合中都发挥着重要作用。本研究旨在探讨富血小板血浆（PRP）和体外冲击波（ESW）在骨不连骨愈合中的相互作用。

假设

PRP和ESW治疗长骨骨不连具有协同作用。

方法

2016 年 1 月至 2021 年 12 月期间，共有 60 名已确定长骨骨不连的患者（18 根胫骨、15 根股骨、9 根肱骨、6 根桡骨和 12 尺尺骨）纳入本研究，其中男性 31 名，女性 29 名，年龄不等18岁至60岁。骨不连患者分为两组：单独使用 PRP（单一治疗组）和使用 PRP 联合 ESW 治疗的患者（联合治疗组）。对两组进行比较，以评估治疗效果、愈伤组织发育、局部问题、骨愈合时间以及手术肢体的 Johner Wruhs 功能分类。

结果

55例患者获得随访，5例失访，PRP组2例，PRP  +  ESW组3例，随访时间6～18个月，平均12.7  ±  5.2几个月。干预后8、12、16、20和24周时，单药治疗组愈伤组织评分显着低于联合治疗组（p  <  0.05）。两组骨不连手术部位软组织均未出现肿胀和感染。PRP  +  ESW组骨折愈合率为92.59%，愈合时间为16.3  ±  5.2周。PRP组骨折愈合率为71.43%，愈合时间为21.5  ±  3.7周。单一治疗组的临床治愈时间明显长于联合治疗组（p  <  0.05）。所有没有愈合迹象的骨不连患者均接受了修复手术。单药治疗组患肢Johner-Wruhs功能分级优良率显着低于联合治疗组（p  <  0.05）。

结论

PRP联合ESW治疗骨折术后无菌性骨不连具有一定的协同作用。它可以显着改善新骨的形成，是临床上治疗无菌性骨不连的一种微创且有效的策略。

证据级别

III、回顾性、单中心、病例对照研究。