Estudo randomizado da enxertia de plasma rico em plaquetas para consolidação da pseudoartrose da tíbia em relação aos tratamentos convencionais
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Data
2019-04-26
Autores
Franco, Bruno Adelmo Ferreira Mendes
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Pseudoartrose é o termo usado para designar a não consolidação de uma fratura, quando o processo de reparação óssea, por algum motivo deixou de atuar. A falta da união das superfícies ósseas fraturadas decorre da presença de um tecido fibroso ou fibro-cartilaginoso entre as extremidades. Portanto, não há união dos fragmentos de uma fratura, levando à formação de uma pseudocápsula com sinóvia e líquido sinovial. Apesar do desenvolvimento de numerosas técnicas de reparação óssea na cirurgia traumatológica, ainda é bastante desafiador a busca da melhor terapêutica a ser utilizada para o tratamento dos grupos de fraturas que apresentam alterações no processo de consolidação e que culminam em pseudoartrose. Estima-se que cerca de 5 a 10% das fraturas de ossos longos evoluem para a disfunção no processo de consolidação, sendo mais comum na tíbia, fíbula e úmero. Novos métodos de tratamento baseados em biotecnologia têm despertado interesse em todo o mundo. Atualmente existe uma gama heterogênea de biomaterias que podem ser utilizados como facilitadores da consolidação óssea no tratamento das fraturas complexas. Estes biomaterias apesar de não representarem o tratamento principal, auxiliam na consolidação ou estimulação dos fenômenos que envolvem o reparo ósseo. Dentre eles, nos últimos anos diversos estudos têm demonstrado o potencial terapêutico do Plasma Rico em Plaquetas na regeneração de tecidos moles, cartilagem e ósseo. O plasma rico em plaquetas é um concentrado de plaquetas autógenas, obtido através de processo de centrifugação e separação dos elementos do sangue pelo gradiente de densidade das células e demais componentes. O objetivo deste estudo é comparar o desfecho do método tradicional do tratamento das pseudoartroses ou retardo de consolidação da tíbia do adulto, com até 2cm de falha, realizado com o uso de fixador externo, placa e parafuso ou haste intramedular, com o tratamento acrescido da infiltração de Plasma Rico em Plaquetas. Trata-se de um ensaio clínico randomizado, realizado com 123 pacientes de ambos sexos, com faixa etária entre 4 e 103 anos vítimas de fratura. As visitas de acompanhamento ocorreram antes do procedimento e em 1, 3 e 6 meses após a enxertia de PRP, pela equipe de ortopedia. Foram então incluídos neste trabalho 12 pacientes divididos em dois grupos (teste e controle). A maioria dos pacientes eram homens, na fase economicamente produtiva, de baixa escolaridade, com tempo médio de fratura de 14 meses até o tratamento e seguimento de 8 meses. A maioria dos acidentes foram por motocicleta e o material de osteossíntese mais utilizado foi placa e parafuso. Dos indivíduos tratados com PRP 16,7% evoluíram para consolidação da pseudoartrose, 50% desenvolveram pontes ósseas apenas e 33% evoluíram para falha, números pouco expressivos se comparados aos do grupo controle, 16,7%, 16,7% e 66,7% respectivamente. Na nossa amostra obtivemos resultados regulares de melhora clínica e funcional para os pacientes tratados com o PRP, quando comparados a outros estudos que utilizaram técnica semelhante.
Pseudoarthrosis is the term used to designate non-consolidation of a fracture, when the bone repair process for some reason ceased to act. The lack of union of the fractured bone surfaces results from the presence of a fibrous or fibro-cartilaginous tissue between the extremities. Therefore, there is no union of the fragments of a fracture, leading to the formation of a pseudocapsule with synovium and synovial fluid. Despite the development of numerous bone repair techniques in trauma surgery, it is still quite challenging to seek the best therapy to be used for the treatment of fracture groups that present changes in the consolidation process and culminate in pseudoarthrosis. It is estimated that approximately 5 to 10% of the fractures of long bones evolve to the dysfunction in the consolidation process, being more common in the tibia, fibula and humerus. New biotechnology-based treatment methods have attracted interest all over the world. There is currently a heterogeneous range of biomaterials that can be used as facilitators of bone healing in the treatment of complex fractures. These biomaterias, although they do not represent the main treatment, help in the consolidation or stimulation of the phenomena that involve the bone repair. In recent years, several studies have demonstrated the therapeutic potential of Platelet Rich Plasma in the regeneration of soft tissues, cartilage and bone. Platelet-rich plasma is in autogenous platelet concentrate obtained by centrifugation and separation of blood elements by cell density gradient and other components. The objective of this study was to compare the outcome of the traditional method of treatment of pseudoarthroses or delay of consolidation of the adult tibia, with up to 2cm of failure, performed with the use of external fixator, plate and intramedullary screw or nail, with the infiltration of Platelet Rich Plasma. This is a randomized clinical trial of 123 patients of both sexes, aged between 4 and 103 years, victims of fracture. The follow-up visits occurred before the procedure and at 1, 3 and 6 months after the grafting of PRP by the orthopedic team. Twelve patients were divided into two groups (test and control). The majority of the patients were men, in the economically productive phase of low schooling, with an average fracture time of 14 months until treatment and 8 months follow up. Most of the accidents were by motorcycle and the most used osteosynthesis material was plate and screw. Of the individuals treated with PRP, 16.7% developed pseudoarthrosis consolidation, 50% developed bone bridges only, and 33% evolved to failure. These numbers were not significant when compared to the control group, 16.7%, 16.7%, and 66, 7% respectively. In our sample we obtained regular results of clinical and functional improvement for patients treated with PRP, when compared to other studies using a similar technique.
Pseudoarthrosis is the term used to designate non-consolidation of a fracture, when the bone repair process for some reason ceased to act. The lack of union of the fractured bone surfaces results from the presence of a fibrous or fibro-cartilaginous tissue between the extremities. Therefore, there is no union of the fragments of a fracture, leading to the formation of a pseudocapsule with synovium and synovial fluid. Despite the development of numerous bone repair techniques in trauma surgery, it is still quite challenging to seek the best therapy to be used for the treatment of fracture groups that present changes in the consolidation process and culminate in pseudoarthrosis. It is estimated that approximately 5 to 10% of the fractures of long bones evolve to the dysfunction in the consolidation process, being more common in the tibia, fibula and humerus. New biotechnology-based treatment methods have attracted interest all over the world. There is currently a heterogeneous range of biomaterials that can be used as facilitators of bone healing in the treatment of complex fractures. These biomaterias, although they do not represent the main treatment, help in the consolidation or stimulation of the phenomena that involve the bone repair. In recent years, several studies have demonstrated the therapeutic potential of Platelet Rich Plasma in the regeneration of soft tissues, cartilage and bone. Platelet-rich plasma is in autogenous platelet concentrate obtained by centrifugation and separation of blood elements by cell density gradient and other components. The objective of this study was to compare the outcome of the traditional method of treatment of pseudoarthroses or delay of consolidation of the adult tibia, with up to 2cm of failure, performed with the use of external fixator, plate and intramedullary screw or nail, with the infiltration of Platelet Rich Plasma. This is a randomized clinical trial of 123 patients of both sexes, aged between 4 and 103 years, victims of fracture. The follow-up visits occurred before the procedure and at 1, 3 and 6 months after the grafting of PRP by the orthopedic team. Twelve patients were divided into two groups (test and control). The majority of the patients were men, in the economically productive phase of low schooling, with an average fracture time of 14 months until treatment and 8 months follow up. Most of the accidents were by motorcycle and the most used osteosynthesis material was plate and screw. Of the individuals treated with PRP, 16.7% developed pseudoarthrosis consolidation, 50% developed bone bridges only, and 33% evolved to failure. These numbers were not significant when compared to the control group, 16.7%, 16.7%, and 66, 7% respectively. In our sample we obtained regular results of clinical and functional improvement for patients treated with PRP, when compared to other studies using a similar technique.
Descrição
Palavras-chave
Pseudoartrose, Fixação de fratura, Consolidação da fratura, Tíbia, Plasma rico em plaquetas