<Case Report>Percutaneous Autologous Bone Marrow Transplantation for Nonunion of the Femur

Abstract

Percutaneous bone marrow injections were performed on 7 nonunions of the femur. There were 6 hypervascular nonunions and one avascular nonunion. Two nonunions presented with active infections. One other patient had a history of infection which had subsided. One nonunion received the injection twice. After the site of nonunion was curetted and the bone surface was scored, 150 ml of bone marrow aspirated from the iliac bone was injected. Complete union occurred in 4 patients within 9 months; all of them were uninfected hypervascular nonunions following intramedullary nail fixation. One nonunion with a bone defect united partially leaving a 1×1 cm defect. The two infected femoral nonunions failed to unite . The results show that percutaneous autologous bone marrow injection for femoral nonunions can be considered for uninfected hypervascular nonunions following intramedullary nail fixation. In these cases, stimulation of healing processes of fracture leading to consolidation can be expected from bone marrow injection. However, femoral nonunion with an active infection and loss of fixation is considered to be a contraindication for this technique.

7例の大腿骨偽関節症例に対して経皮的自家骨髄移植を施行した. Weber の分類法で, 7例中6例は hypervascular nonunion, 1例は avascular nonunion であった. 2例は感染を合併しており, 他の2例は感染の既往があった. 方法として, 経皮的に偽関節部の一部を掻爬し, 腸骨から吸引した骨髄 150 ml を直ちに注入した. 1例には2回の自家骨髄注入を行った. 髄内釘手術後の, 感染を合併していなかった4例に9ヵ月以内に骨癒合が得られたが, 感染のあった2例では癒合が得られなかった. この結果から, 髄内釘施行後の感染の徴候を示さない大腿骨偽関節例に対して, 経皮的自家骨髄移植は, より侵襲の少ない有用な治療方法と考えられた.