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"Тrauma" Том 17, №2, 2016

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Autotranspantation Native Marrow at Defective Fracture Consolidation

Authors: Movchan O.S., Olifirenko O.I. - National Medical Academy of Postgraduate Education named after P.L. Shupyk, Kyiv, Ukraine

Categories: Traumatology and orthopedics

Sections: Clinical researches

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Summary

В даній роботі поданий попередній досвід лікування 44 пацієнтів з ознаками порушення консолідації переломів кісток, які перебували на стаціонарному лікуванні в період з 2013 по 2015 р. Вивчено етіопатогенетичні фактори порушення репаративних процесів при переломах. Відпрацьована методика проведення автотрансплантації нативного кісткового мозку, індукованого кристалічним хімотрипсином, у хворих з ознаками сповільненої консолідації й незрощення переломів кісток. Продемонстрована висока клінічна ефективність та технічна простота виконання запропонованої методики.

В данной работе представлен предварительный опыт лечения 44 пациентов с признаками нарушения консолидации переломов костей, находившихся на стационарном лечении в период с 2013 по 2015 г. Изучены этиопатогенетические факторы нарушения репаративных процессов при переломах. Отработана методика проведения аутотрансплантации нативного костного мозга, индуцированного кристаллическим химотрипсином, у больных с признаками замедленной консолидации и несращения переломов костей. Продемонстрирована высокая клиническая эффективность и техническая простота выполнения предложенной методики.

This work presents previous experience in treating 44 patients with signs of defective consolidation of fractures, who were hospitalized in the period from 2013 to 2015. The etiopathogenetical factors of reparative processes failure in fractures have been studied. There was mastered the method of autotransplantation of native bone marrow induced with crystalline chymotrypsin in patients with signs of delayed consolidation and nonunion fractures. There was demonstrated a high clinical efficiency and technical simplicity of the proposed method.


Keywords

порушення остеогенезу, сповільнена консолідація, кістковий мозок, кристалічний хімотрипсин.

нарушение остеогенеза, замедленная консолидация, костный мозг, кристаллический химотрипсин.

defective osteogenesis, delayed consolidation, bone marrow, crystalline chymotrypsin.

Introduction

Post-traumatic violation of bone regeneration in treating patients with fractures, especially in the light of the increased frequency of high-energy trauma and injuries in general, is an actual problem of orthopedics and traumatology. The last decade, both in Ukraine and in the world, according to official statistics, traumatism, among the general morbidity of population, is on the fourth place with the growth dynamics. According to the data from different authors, the number of patients with violation of fracture healing, ranges from 15.5% to 27%. It should be noted, that the problem of reparative processes violation because of injury, can occur independently of using one or the other of surgical treatment methods, and their initial cause can be the whole complex of factors. The introduction of new methods of osteogenesis stimulation and improvement of treatment outcomes were our milestones in conducting this work.

Materials and Methods

A retrospective analysis of case histories and prospective follow-up of 44 patients with violation of fracture healing was carried out. All patients were aged from 20 to 70 years. By gender 77.5% men and 22.5% women. The majority of patients (65.9%) belonged to the socially active, able-bodied population group. In some patients (38.6%) was observed violations of consolidation as a result of high-energy trauma. Vascular disorders were found in 15.9% of patients. In the great majority of patients (79.5%), delay of bone consolidation could be connected with the presence of multi-fragment fracture. For all patients, who received standard complex treatment, we applied the technique of autotransplantation of the native bone marrow induced with crystalline chymotrypsin, which was developed and implemented by V.Y.Zorya.

The first stage of puncture stimulation of osteogenesis with the native bone marrow induced with crystalline chymotrypsin was made on the day before of the skin test for sensitivity to crystalline chymotrypsin. An allergic reaction was observed only in one patient, so he has not been selected for the study. So, the installation of 1-2 needles of Kasyrskiy or injection needles with the thickness of the 15 gauge into the gap between the fragments was carried out under sterile conditions, based on X-ray pictures and palpation, if necessary, X-ray control was performed.

Collecting of the bone marrow puncture was performed with the puncture needle MCN22 with the thickness of 15Gv under sterile conditions from the iliac crest, but at first the syringe was filled with the 20-40 mg of crystalline chymotrypsin. Considering that one access leads to deterioration of the qualitative composition of the bone marrow during the aspiration of its significant amount - the target amount was 5 ml. Then the received mixture of the native bone marrow with chymotrypsin was injected into the fracture zone through pre-set needles, areas of punctures were sealed with aseptic dressings.

The research results

We have not found inflammatory, purulent, allergic or other complications in the short term of follow-up that suggests the safety of this method for the patient’s health. Among the technical complexities of the method is worth noting that in some cases tissue concretion between the fragments interferes injection, requiring considerable effort to enter the total amount of graft.

X-ray monitoring was conducted during 4-6 weeks after stimulation, in which was revealed the formation of callus, with its subsequent compaction and consolidation of the fracture. In general, during the treatment of post-traumatic disorders of the bone regeneration with puncture administration of the autologous bone marrow induced with crystalline chymotrypsin, we obtained the following results: consolidation was occurred in all cases of slow fracture healing in 34 patients (100%), in cases of unhealed fractures in 9 of 10 patients (90.0 %), overall in 43 of 44 patients (97.7%). The question of this osteogenesis stimulation requires further studies and comparative analysis, with possible further extension of indications.

Conclusions

1) Autotransplantation of the native bone marrow at violation of fractures consolidation stimulates reparative regeneration and contributes to fracture healing.

2) Method of sampling and introduction of the bone marrow punctate is characterized by technical simplicity of implementation and is minimally invasive procedure that indicates the possibility of implementing it in the clinical practice, taking into account further improvement and study of long-term results of research.

3) In the complex treatment with the additional osteogenesis stimulation with the native bone marrow induced with crystalline chymotrypsin of 44 patients with impaired fracture consolidation - consolidation was achieved in 43 cases (97.7%) and complications were not found, that suggests safety and efficacy of the methodology.


Bibliography

1. Андрейчин В.А., Білінський П.І. Системний аналіз оперативного методу лікування діафізарних переломів і фактори впливу на репаративну регенерацію // Травма. — 2014. — № 6.

2. Анкін М.Л., Шмагой В.Л. Значимість патогенетичного підходу та обсягу реостеосинтезу в лікуванні порушень консолідації переломів діафіза кісток гомілки // Травма. — 2015. — № 2.

3. Горидова Л.Д., Дедух Н.В. Репаративная регенерация кости в различных условиях // Травма. — 2009. — № 1.

4. Зоря В.И., Ярыгин Н.В., Азарян Г.Р. и др. Пат. 2195216 от 17.11.00. Способ ускоренного сращения костных отломков.

5. Камінська М.О., Дігтяр В.А., Харитонюк Л.М., Садовенко О.Г. Лікування посттравматичних порушень репаративної регенерації переломів кісток у дітей // Травма. — 2012. — № 2.

6. Климовицький В.Г. Симпозіум «Переломи, що не зрослися, та хибні суглоби» / Климовицький В.Г. // Травма. — 2012. — № 4. — 166-174.

7. Климовицкий В.Г., Черныш В.Ю. Частота замедленной консолидации переломов у пострадавших разных возрастных групп и влияние на нее остеотропной терапии // Травма. — 2011. — № 3.

8. Корж Н.А. Репаративная регенерация кости: современный взгляд на проблему / Корж Н.А., Дедух Н.В. // Ортопедия, травматология и протезирование. — 2006. — № 1 — С. 77-89.

9. Лациник Н.В. Влияние трипсинизации костного мозга на эффективность образования колоний фибробластов в монослойных культурах / Н.В. Лациник, С.Ю. Сидорович, А.Я. Фриденштейн // Бюллетень эксперим. биологии и медицины. — 1981. — Т. 92, № 9. — С. 356-358.

10. Лациник Н.В., Горская Ю.Ф., Грошева А.Г. и др. Содержание стромальных колониеобразующих клеток (КОКф) в костном мозге мышей и клональная природа образуемых ими колоний фибробластов // Онтогенез. — 1986. — Т. 17, № 1. — С. 27-35.

11. Фриденштейн А.Я., Чайлахян Р.К., Герасимов Ю.В. Пролиферативные и дифференциальные потенции скелетогенных костномозговых колониеобразующих клеток // Цитология. — 1986. — Т. 28, № 3. — С. 341-349.

12. Weber B.G., Cech O. Pseudarthrosen. Pathophysiologie, biomechanik, therapie, ergebnisse. — Bern-Stuttgart-Wien: Hans Huber, 1973. — 237 p.

13. Thomas P. Rüedi, Richard E. Buckley, Christopher G. Morgan. AO Principles of fracture management. — 2nd expended edition by AO published. — 2007. — Р. 10-25, 504-520.

14. Giannoudis F. Enhancement of fracture healing with the diamond contept: The role of the biological chamber / F. Giannoudis // Injury. — 2011. — 42. — P. 1191-1193.

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