Abstract：
BACKGROUND: In this study the tibial shaft fracture non unions in diabetes mellitus are evaluated with percutaneous autologous platelet gel supplementation to accelerate union are compared with individually matched control group with autologous iliac crest bone marrow aspirate injection.
METHODS: This present study was carried out on tibial non unions in diabetic patients recruited in an ongoing longitudinal study over a period of 2006 to 2017, treated by one surgeon at one institute, are included in this report. Each of 18 established tibial atrophic, aseptic non unions treated by percutaneous autologous platelets and iliac crest bone marrow aspirate were followed up on regular basis up till 9 months. The healing of non union was assessed clinically by painless full weight bearing and the radiological union was judged by bridging callus formation observed on at least 3 of 4 cortices in anteroposterior and lateral views.
RESULTS: Union was observed in 17 (94.4 %) patients of the autologous platelet group. The average time to union was 9.2 weeks (range 8 to 18 weeks) after percutaneous autologous platelet injection (P < 0.0517) .In the control group, union was observed in 14 (77.8 %) patients (P = 0.672). The average time to union following percutaneous bone marrow injection was 11.6 weeks (range 9 to 28 weeks). The proximal 1/3 shaft non union healed comparatively faster than the distal 1/3 shaft tibia (P ≤ 0.0612). No correlation was observed between the comminuted and non comminuted fracture non union (P = 0.789). A significant correlation was noted as regards the non union healing time duration in patients who were on insulin and oral hypoglycemic drugs (P ≤ 0.001) and also about the total duration of diabetes mellitus in years (P ≤ 0.003).
CONCLUSIONS: This investigation showed that percutaneous autologous platelet gel delivery is sufficient method to obtain union in diabetic tibial fracture non unions, which is less invasive procedure than bone marrow injection. The efficacy of this autologous platelets is once again well established and this study reinforced categorically the previously published report by the author.
METHODS: This present study was carried out on tibial non unions in diabetic patients recruited in an ongoing longitudinal study over a period of 2006 to 2017, treated by one surgeon at one institute, are included in this report. Each of 18 established tibial atrophic, aseptic non unions treated by percutaneous autologous platelets and iliac crest bone marrow aspirate were followed up on regular basis up till 9 months. The healing of non union was assessed clinically by painless full weight bearing and the radiological union was judged by bridging callus formation observed on at least 3 of 4 cortices in anteroposterior and lateral views.
RESULTS: Union was observed in 17 (94.4 %) patients of the autologous platelet group. The average time to union was 9.2 weeks (range 8 to 18 weeks) after percutaneous autologous platelet injection (P < 0.0517) .In the control group, union was observed in 14 (77.8 %) patients (P = 0.672). The average time to union following percutaneous bone marrow injection was 11.6 weeks (range 9 to 28 weeks). The proximal 1/3 shaft non union healed comparatively faster than the distal 1/3 shaft tibia (P ≤ 0.0612). No correlation was observed between the comminuted and non comminuted fracture non union (P = 0.789). A significant correlation was noted as regards the non union healing time duration in patients who were on insulin and oral hypoglycemic drugs (P ≤ 0.001) and also about the total duration of diabetes mellitus in years (P ≤ 0.003).
CONCLUSIONS: This investigation showed that percutaneous autologous platelet gel delivery is sufficient method to obtain union in diabetic tibial fracture non unions, which is less invasive procedure than bone marrow injection. The efficacy of this autologous platelets is once again well established and this study reinforced categorically the previously published report by the author.
摘要：
背景：在这项研究中，通过经皮补充自体血小板凝胶以加速愈合来评估糖尿病患者的胫骨干骨折不愈合，并与单独匹配的对照组进行比较。
方法：本研究是针对2006年至2017年期间正在进行的纵向研究中招募的糖尿病患者的胫骨不愈合进行的，该研究由一家研究所的一名外科医生治疗。包含在本报告中。18个已建立的胫骨萎缩中的每一个，通过经皮自体血小板和髂骨骨髓穿刺液治疗的无菌性非愈合定期随访，直至9个月。通过无痛的完全负重在临床上评估不愈合的愈合情况，并通过在前后和侧向视图中至少在4个皮质中的3个上观察到的桥接骨痂形成来判断放射学愈合。
结果：在自体血小板组17例（94.4%）患者中观察到联合。经皮自体血小板注射后平均愈合时间为9.2周（8至18周）（P<0.0517）。在对照组中，14例(77.8%)患者出现愈合(P=0.672).经皮骨髓注射后的平均愈合时间为11.6周（范围9至28周）。近端1/3轴不连愈合比远端1/3轴胫骨愈合快（P≤0.0612）。粉碎性骨折和非粉碎性骨折不愈合之间无相关性(P=0.789)。在使用胰岛素和口服降糖药的患者中，不愈合愈合时间的持续时间（P≤0.001）以及每年的糖尿病总持续时间（P≤0.003）之间存在显着相关性。
结论：这项研究表明，经皮自体血小板凝胶递送是糖尿病性胫骨骨折不愈合的充分方法，比骨髓注射侵入性小。这种自体血小板的功效再次得到了很好的确立，这项研究明确地加强了作者先前发表的报告。
方法：本研究是针对2006年至2017年期间正在进行的纵向研究中招募的糖尿病患者的胫骨不愈合进行的，该研究由一家研究所的一名外科医生治疗。包含在本报告中。18个已建立的胫骨萎缩中的每一个，通过经皮自体血小板和髂骨骨髓穿刺液治疗的无菌性非愈合定期随访，直至9个月。通过无痛的完全负重在临床上评估不愈合的愈合情况，并通过在前后和侧向视图中至少在4个皮质中的3个上观察到的桥接骨痂形成来判断放射学愈合。
结果：在自体血小板组17例（94.4%）患者中观察到联合。经皮自体血小板注射后平均愈合时间为9.2周（8至18周）（P<0.0517）。在对照组中，14例(77.8%)患者出现愈合(P=0.672).经皮骨髓注射后的平均愈合时间为11.6周（范围9至28周）。近端1/3轴不连愈合比远端1/3轴胫骨愈合快（P≤0.0612）。粉碎性骨折和非粉碎性骨折不愈合之间无相关性(P=0.789)。在使用胰岛素和口服降糖药的患者中，不愈合愈合时间的持续时间（P≤0.001）以及每年的糖尿病总持续时间（P≤0.003）之间存在显着相关性。
结论：这项研究表明，经皮自体血小板凝胶递送是糖尿病性胫骨骨折不愈合的充分方法，比骨髓注射侵入性小。这种自体血小板的功效再次得到了很好的确立，这项研究明确地加强了作者先前发表的报告。
