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Autogenous

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Autogenous

    Autogenous

    Mar.2007,Volume4,No.3(SerialNo.28)JournalofUS-ChinaMedicalScience,ISSN1548-6648,USA

    AutogenousBoneCombinedBoneMarrowTransplantingforthe

    TreatmentoftheLowerSectorFractureoftheShinbone

    SONGYuguang,YEShu-xin,XIEXiao-ping,JIANGWei

    (YibinSecondPeople"sHospitalAffiliatedtoLuzhouMedicalSchool,Luzhou644000) Abstract:ObjectiveResearchingthecurativeeffectofusingtheautogenousbonecombinedtheautogenous

    marrowtransplantingtotreatthenewly

    fracturedlowersectoroftheshinbone.MethodsTwogroupspatientsin

    ourhospitalwhomwouldbetakentheoperationbecauseofthelowersectorfractureoftheshinbonehavebeen

    dividedfromarandomsamplein42casesfromFebruary2004toFebruary2006,onegroupweretransplanted

    withtheautogenousbonewhiletheinternalfixationsurgerywasdoneatthesartletime,theothergroupwere

    transplantedwiththeautogenousbonecombinedthemarrowwhiletheinternalfixationsurgerywasoperatedat

    thesanletime.TheX

    rayfilmwillbetakenforonetimeineachmonthatleast,andafteronemonthandhalf, three,five,nine,twelvemonthsoftheoperationtheCallusgraydensityintheX

    rayfilmofthetwogroup

    patientswillbeseparatelyanalyzedbythecomputerimageanalysistechniques.ResultsTheanalysisofthe

    Callusgraydensityshows:theCallusgraydensityinthesamesamplegroupwillbeincreasewiththelengthof

    theoperationtime.Comparedinthesameperiod,theCallusgraydensityinthegroupoftheautogenousbone

    combinedwithboneInarrowtransplantingishigherthanthegroupoftheautogenousbonetransplanting.

    Therefore,thereisaconsiderabledifferencebetweenthetwogroupsinCallusgraydensit5andtheheahngtime

    ofthefractureinthegroupoftheautogenousbonecombinedwithbonenlarrowtransplantingisshorterthanthat

    oftheautogenousbonetransplantingwithasignificantdifferencebetweenthem.ConclusionTheresearchshows

    comparedwiththeautogenousbonetransplantingsurgery,theautogenousbonecombinedwithbonemarrow

    transplantingsurgeryisbeRerforthegrowthofthecallusandacceleratesthefracturehealingearlierthanthe

    former.

    Keywords:marrow;autogenousbone;union;freshfracture;imageanalysis INTRoDUCTIoN

    Thefeaturesoftheshankitselfanatomicalstructuredeterminesahigheroccurrencerateofthedelayedunion

    andnonunionoflowersectorfractureoftheshank.Butintherecentyears,theroutineapplicationofthe

    antogenousboneortheallograftbonetransplantingsignificantlydecreasedtheincidencerateofthedelayedunion

    andnonunionoftheboneinthelowersectorfractureoftheshankbone,andahigherincidenceratestillexistsin

    thedelayedunionandnonunionoftheboneafterthesurgeryofthelowersectorfractureoftheshinbone.

    Therefore,fromJanuary2004toApril2006,aconsiderableeffecthasbeenachievedthroughthesurgery

    treatmentoftheautogenousbonecombinedwithboneInarrowtransplantingfor21patientsw

ithafracturebelow

    the1/3shinboneinourhospital,thereportasfollows:

    SONGYu-guang(1973-),male,Master,doctor-in-ch~geofOrthopedicsCenter,YibinSecondPeople'sHospitalAffiliatedto

    LuzhouMcdicalSchool;researchfield:bonefracturewound.

    AutogenousBoneCombinedBoneMarrowTransplantingfortheTreatmentoftheLowerSectorFractureoftheShinbone

    IATERIALSANDMETHODS

    1.GeneralMaterial

    Thereare42casesinthegroupwith31maleand11femalecases.Theageislistedfrom22to33withan

    averageage29yearsold.Thecausesoftheinjuryareallthedirectviolentinjury,ofwhich23casesoftheinjury

    byfalling,12casestrafficbyinjury,and7casesbykinesi

    injury.Allthefracturesbelongtothesimpleocclusion

    tibiafracturewithoutthecombinedinjury;thelocationofthefractureisbelowthe1/3oftheshinbone,withtwo

    typesofthefracturewiththenameofJohnerandWmhs:6casesforB2,12casesforB3,12casesforC1,8cases

    forC2,4casesforC3,ansurgerywasoperatedtoallaftertheinjuriesoccurred. 2.SurgeryMethod

    Allthefracturedpatientsshouldbefirsttreatedbythecalcaneumsbonetractionoperation,after7to10days,

    anoperationofdiscussionandrepositionsshouldbedoneinsequence,thenastainlesssteelplatshouldbeusedto

    fixtheoffsideofthelowersectortheshinbone.Beforethesurgery,allthepatientsshouldberandomlyselected

    intotwogroups,oneisthereferencegroupthatmeanstheautogenousbonetransplantinggroup(3inB2,6inB3,

    6inC1,4inC2,2inC3);theotheristheexperimentgroupmeanstheautogenousbonecombinedwiththebone

    marrowgroup(3inB2,6inB3,6inC1,4inC2,2inc3).Basedonthedifferentconditionsofthetwogroups

    beforethesurgery,firsttheautogenousiliumwillbeiakenasafurtherusefromthepatientinthereferencegroup

    beforethesurgery,andintheexperimentgroup,about20mlredbonemarrowwillbefirsttakenbeforethe

    autogenousiliumactionasafurtheruse.Thesurgerywillbechargedbythesamedoctor,aftertheopening,

    restoration,internalfixation,thebloodfromthewoundwillbeentirelystopped,thenwashedbytheantibiotic,

    andthewoundwillbedriedupwithoutanyliquid.Aftertheoperationofthetwogroups,oneistheautogenous

    iliumbonetransplantingsurgeryinthereferencegroup;theotheristhesurgeryoftheautogenousiliumbone

    combinedwiththebonemarrowintheexperimentgroup(thevolumeofthebonetransplantingintheeachgroup

    isthreegramandthevolumeofthebonemarrowislOm1).Afterthesurgery,thepatientwilltakeantibioticto

    preventtheinfectionandtheX

    rayfilmswillberegularlytakenbythedoctortoobservethegrowthofthecallus. Inordertoreducetheimageerror,aspecialpersonwillbeassignedtochargethisaction. 3.ObservingIndexes

    X

    rayinspection:Eachpatientwillgotothehospitalforaclinicalconsultationmonthlyandthexrayfilmof

    thenormallateralviewofthefracturelocationwillbetakenuntilthecureofthefracturehealing.Theproject

    conditionwillbe50kV,50Ma,withIsexposaltime,andthedistancebetweenthesampleandba

lltubeis70cm.

    Thex

    rayfilmsineachgroupwillbecarefullyread,andtheemergencetimeofthecallousinvariousstages,the

    bonecallouscontentaswellasthedisappearancetimeofthebonefracturelinealsowillbeobserved.Thexray

    filmstakenseparatelyafteroneandhalfmonth,threemonths,fivemonths,ninemonthsand12monthswillbe

    performedbythequantitativeanalysis.Themethodisthatthex

    rayfilmstakenindifferentperiodwillbeinput

    intothecomputerthroughascanner,thenaftergonethroughtheimagetreatingtechnologysystem(madein

    SichuanUniversity,withananalyticsoftwareofthegreyleve1),thesameareaoftheexperimentalbonecallus

    regionwillbemeasuredbythecursor,thenusingthemethodoftheintegrationtocalculatethetotalamountofthe

    callusgreylevelinthedifferentperiod,andallthedataareexpressedwiththemean#_standarderror(X?S).And

    thespssl0.0isadoptedtoconductthestatisticandtexaminationforthedata. 45

    AutogenousBoneCombinedBoneMarrowTransplantingfortheTreatmentoftheLowerSectorFractureoftheShinbone

    RESU1S

    1.ReadingResultsofX-rayFilm

    Aftertheautogenousbonetransplantingsurgery,18patientsofthegroupofautogenousbonetransplanting

    surgeryattainedfollow

    uptreatment.Thefracturelineisclearlyvisibleonemonthlateraftertheautogenousbone transplantingsurgery.6patientsappearnebulouscallusand12patientsdon'thavepartialcallu

s.Thefractureline

    isstillvisibletwomonthslateraftertheautogenousbonetransplantingsurgery.Allpatientsareinvolvedin

    nebulousorshuttle-shapedcallus.Thecallusdensityofthosewhoareinvolvedincallusisincreasedfurther.The

    fracturelineof8patientsdisappears12weekslateraftertheautogenousbonetransplantingsurgeryandthebone

    beginsunion.Thefracturelineofotherpatientsisstillvisiblebutthecallusdensityisincreasedfurther.16weeks

    lateraftertheautogenousbonetransplantingsurgery,allpatients'bonebeginsunionandhasmuchcallus

    surrounded.

    AftertheautogenousbonecombinedwithbonemalTOWtransplanting.20patientsofthegroupofautogenous

    bonecombinedwithbonemalTOWtransplantingattainedfollow

    uptreatment.Onemonthlaterafterthe

    autogenousbonecombinedwithbonemarrowtransplanting,9patients'fracturelineisfuzzyand11ones'clearly

    visible.Partialcloudinesslateralcallusisformed.2patients'fracturelinedisappearsandtheconnectionis

    replacedbyaflatbone8weekslateraftertheautogenousbonecombinedwithbonemarrowtransplanting.The

    other18patients'fracturelineisunconspicuous.16patients'fracturelinedisappearsandtheconnectionis

    replacedbytheflatbone12weekslateraftertheautogenousbonecombinedwithbonemalTOWtransplanting.4

    patients'boneiscoalesced16weeksaftertheautogenousbonecombinedwithbonemalTOWtransplanting.

    2.GrayDensityIntegral,CallusandFractureHealingTime

    Theanalysisresultsofthecallus'sgraydensityindicatethat:thegraydensityofthesamegroupi

sincreased

    withthetimeafterthesurgery;thegraydensityintegralishigherinthegroupoftheautogenousbonecombined

    withbonemalTOWtransplanting.Betweenthetwogroups,thereexistsasignificantdifference.Thehealingtimeof

    thefractureofthegroupofautogenousbonecombinedwithbonemarrowtransplantingisshorterthantheoneof

    thegroupofautogenousbonetransplantingsurgerygroup.Inadditionbetweenthetwogroups,thereexistsa

    significantdifference.

    Table1Graydensity(X:tS)oftwogroups'callusofX-rayfilmaftertheoperationthroughimageanalysis

    DataanalysisisexpressedwithX?

    S:andthespssl0.0isadoptedtoconductthestatisticandtexamination

    forthedata.p<0.05isthedifferencethathasastatisticsignificance. Table2Fracturelinehealingtime(X?S)

    <o.05

    AutogenousBoneCombinedBoneMarrowTransplantingfortheTreatmentoftheLowerSectorFractureoftheShinbone

    DISCUSSION

    Recently,thecomputerimageanalysissystemisrelativelyfrequentlyusedfortheanalysisonthecalluswith

    X

    rayfilm,includingtheanalysisontheimageareaandgraydensity.Itsapplicationmayavoidthesubjectivity

    andrandomnessofreadingX

    rayfilmwitheyes.Thevoluntarybehaviorisakindofobjectiveandreliable nonincursionno

    traumafracturehealingevaluationmethod,inwhichthegraydensityvalueisproportionalto

densityofthecallusontheX

    rayfilm,i.e.Themoredensecallus,thehighergraydensityvalue;morecallus developedontheX

    rayfilm,largerareaofthecallus.Thisarticlesubjectivelyanalyzestheamountofthecallus ofdifferentgroupaftertheoperationwiththismethod.

    Thebloodsupplyatthelowersectoroftheshinboneisweak,mainlyrelyingonthenutrientvesse1.Incase

    lower1/3sectoroftheshinboneisinvolvedinfracture,thenutrientvesselwillbedamagedandlessbloodofthe

    distalfemoralbesupplied.Therefore,thedelayedhealingofthelower1/3sectorfractureandbonenonunionhave

    ahigheroccurrencerate.Theroutineapplicationoftheautogenousbonetransplantingandallograftbone

    implantationreducestheoccurrencerateofthedelayedhealingandbonenonunionofthelowershinbonesector

    obviously.Becauseofthelimitedvolumeofthesofttissueoftheshank,soitcanonlycontainlimitedbone

    transplanting.Inaddition,forotherreasons,theoccurrencerateofthedelayedhealingandbonenonunionofthe

    lowershinbonesectorisstillhigh.Theroutinetreatmentmethodagainstthiskindofbonenonunionisthe

    autogenousbonetransplantingorallograftboneimplantationupontwooperations.Inthisway,theoperationwill

    lastformanytimesandalongtime.Certainly,itisreportedthatthepercutaneousautogenousbonemarrow

    transplantingisadoptedtotreatthebonenonunionandhasattainedgoodeffectsrecently.Nevertheless,the

    operationwiththismethodstilllastsalongtime.Inaddition,becausethesofttissuefilledintheununitedfracture

    sectormakethevolumemarrowlimited.Forthispurpose,weadoptthemethodoftheautogeno

usbonecombined

    theautogenousmarrowtransplantingtotreatthefleshfracture,andhasattainedbeRercurativeeffect,reducing

    theoccurrencerateofthedelayedfracturehealingandbonenonunion.

    Redbonemarrowisakindofconjunctivetissueinthespongybone.Theexperimentandresearchesapprove

    thatthestemcellarintheredbonemarrowmaybedifferentiatedintotheosteoblastandservestheeffectsof

    promotingbonerecovery'.ThefurtherresearchesapprovethatafactorofthemonocyteinthemalTOW

    stimulatesthemesenchymalcellsandmarrowstromacellatthesurroundingofthebloodvesseltoconvertinto

    theosteoblastandchondroblast.Inaddition,themarrowwillinducepartialandsystematicosteogenesisreaction

    afterbeingdamaged.Thisreactionisregulatedbythepeptidproducedbybone,andpromotestheosteocyte

    multiplication,calcificationandcallusincrease.Itsosteogenesishasbeenapprovedbytheanimalexperimentsas

    wellaspatients.Ourresearchcontentsapprovealsothispoint.Moreover,ourresearchisinconformitywiththe

    principleoftissueengineering.

    Thetissueengineeringisanewconcept,whichingrateswiththebasicprinciple,basictechnologiesand

    methodsoftheengineeringscienceandlifesciences.Itisusedtorecoverthetissuedefectandreestablishthe

    functionsoftissueorgans;or,asakindofextraneousdevice,itmaybeusedtoreplacetheorganicfunctionforthe

    purposesoftreatinjuryanddiseases,upgradethesurvivalqualityandextendthelife.Itsthreeelementsinclude

    livingcells(seedcel1),bioactivematerials(cellsupportmaterials)andbioactivefactors.The

marrowweuse

    becomesthecommonseedcel1fortheexistenceofthemesenchymestemcel1.Thedecalcifiedandhydroxyapatic

    arethecommoncellsupportmaterials.Itisreportedthattheexperimentsandclinicalapplicationresearcheson

    theapplicationofmarroworofmarrowcompositeswithartificialbonetransplantingsuchasdecalcifiedand

    47

    AutogenousBoneCombinedBoneMarrowTransplantingfortheTreatmentoftheLowerSectorFractureoftheShinbone

    hydroxyapaticintothebonetotreatthefractureandbonenonunion,thinkthattheearlypostoperativeIIIalTOW

    transplantingmaypreventthebonenonunion,particularlyithasahigherhealingratetotreattheshinbonefracture.

    Itisseldomreportedthattheautogenousboneisusedasthesupportmateria1. Itisalsoseldomreportedthatthe

    autogenousbonecombinedbonemarrowtransplantingwithbothsupportmaterialsandseedcellstotreatthefresh

    fracture.Weespeciallyresearchthatandapprovethattheautogenousboneisagoodcellsupportmateria1.The

    autogenousbonecombinedbonemarrowtransplantingenablesthebonehasbetterosteogenesisabilityand

    promotesthefracturehe~ingthantheautogenousbonetransplanting.ItisakindofeconomicM,practical,safe

    andreliablemethodandappfiedtovariousmedicalinstitutionsatalllevels. 1

    [2

    3

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