【摘要】 目的 探讨富血小板血浆(platelet-rich plasma, PRP)配合同种异体骨植骨治疗良性骨肿瘤或瘤样病变导致的病理性骨折的临床疗效。方法 2018年3月～2021年3月因良性骨肿瘤或瘤样病变致病理性骨折病人66例，根据治疗方法不同分为3组，A组22例，接受同种异体骨植骨术，B组21例，接受PRP+同种异体骨植骨术，C组23例，接受自体骨植骨术，观察3组病人手术时间、术中出血量、住院时间、病理性骨折临床愈合时间、愈合率、术后3个月X线骨痂评分、血清炎性指标、并发症发生率、术后1个月和3个月健侧和患侧骨代谢值、FMA评分情况。结果 B组病人的手术时间(132.65±20.84)分钟，短于A组的(158.62±23.57)分钟、C组的(156.79±23.36)分钟；B组病人术中出血量为(475.84±68.33)ml,较A组(525.00±73.82)ml、C组(528.39±74.72)ml少，三组病人手术时间、术中出血量对比差异有统计学意义(P<0.05)。三组病人病理性骨折临床愈合时间、术后3个月X线骨痂评分、术后1年骨折愈合率及住院时间比较，差异无统计学意义(P>0.05)。三组病人术后第1、3天血清CRP和IL-6水平均升高，且A、C组高于B组。A、B组有2例病人术后发生免疫排斥反应，1例病人术后切口红肿；C组有2例病人术后发生供骨区持续疼痛，2例切口红肿。3组病人并发症总发生率比较，差异无统计学意义(P>0.05)。与A、C组比较，B组术后1个月和3个月的FMA值显著升高，差异有统计学意义P<0.05),术后3个月，B组患侧骨代谢值显著升高，差异有统计学意义(P<0.05)。结论 PRP联合同种异体骨植骨治疗良性骨肿瘤或瘤样病变导致的病理性骨折可缩短手术时间，减少术中出血量，减轻术后炎症反应，骨愈合效果与自体骨植骨相当，术后并发症较少。更多还原

【Abstract】 Objective To investigate the clinical efficacy of Platelet-rich Plasma(PRP) combined with allogeneic bone transplantation in the treatment of pathological fractures caused by benign bone tumors or tumor-like lesions.Methods Patients with pathological fractures caused by benign bone tumors or tumor-like lesions in the orthopedic department of our hospital from March 2018 to March 2021 were retrospectively analyzed.The operation time, intraoperative blood loss, hospital stay, clinical healing time, healing rate and postoperative X-ray callus score, serum inflammatory index, and the incidence of complications of group A(Patients who received PRP + allogeneic bone transplantation, n=21) and group B(Patients who received autologous bone transplantation, n=23) were observed and compared.The bone metabolism value and FMA score between the healthy side and the affected side at 1 month and 3 months after operation were compared.Results The operation time of the group B(132.65±20.84) min was shorter than that of group A(158.62±23.57) min and group C(156.79±23.36) min, and the intraoperative blood loss(475.84±68.33)ml was less than that of group A(525.00±73.82) ml and group C(528.39±74.72) ml(all P<0.05).The clinical healing time of pathological fractures X-ray callus score at 3 months after operation, fracture healing rate at 1 year after operation and hospital stay had no significant differences in 3 groups(P>0.05).The levels of serum CRP and IL-6 in 3 groups were increased on the 1st and 3rd day after the operation(all P<0.05).The levels of serum CRP and IL-6 in the group A and C were higher than those of group B.In group A and B,2 patients had postoperative immune rejection, and 1 patient had postoperative incision redness and swelling.In group C,2 patients had persistent pain in the donor site after surgery, and 2 patients had incision redness and swelling.There was no significant difference in the total incidence of complications in 3 groups(P>0.05).Compared with the groupA and C,the FMA value of group B increased significantly at 1 st and 3 rd month after operation(all P<0.05). 3 months after operation, the bone metabolism value of the affected side was significantly increased(P<0.05).Conclusion PRP combined with allogeneic bone transplantation in the treatment of pathological fractures caused by benign bone tumors or tumor-like lesions can shorten the operation time, reduce the amount of intraoperative blood loss and postoperative inflammatory reaction, and the bone healing effect is similar to that of autogenous bone transplantation, with less postoperative complications.更多还原