摘要
目的:探索通过自体骨髓富集的间质干细胞复合羟基磷灰石/磷酸三钙作为植骨材料进行脊柱融合的新方法。方法:①观察对象:选择2005-01/2006-02建湖县人民医院骨科收治的胸腰椎骨折均采用后路椎弓根钉系统复位及固定患者48例。②实验分组:根据植骨融合材料不同随机分为2组,干细胞+复合材料组24例,男13例,女11例;年龄25～49岁。自体髂骨移植组24例,男15例,女9例;年龄26～50岁。③实验干预:采自体骨髓通过密度梯度离心得到富集的间质干细胞悬液与羟基磷灰石磷酸三钙复合2h后作为植骨材料。干细胞+复合材料组采用骨髓间质干细胞复合羟基磷灰石磷酸三钙移植;自体髂骨移植组采用自体髂骨移植。④实验评估:对所有患者脊柱融合情况、临床疗效、伤椎复位后高度丢失等进行比较分析,评定脊柱融合效果。结果:术后随访12个月,48例患者全部进入结果分析。①骨髓富集的有效性:富集前后骨髓间质细胞浓度达到8倍。②临床疗效:干细胞+复合材料组所有病例取髓处疼痛术后1周消失,均未发生感染。自体髂骨移植组术后3个月取骨处仍有疼痛。所有病例无感染和内固定松动断裂等并发症。两组术后12个月LBOS评分优良率干细胞+复合材料组71%(17/24),自体髂骨移植组79%(19/24)。③脊柱融合情况:术后随访6个月以上的患者X射线、检查均示有良好的脊柱融合,两组在术后3个CT月移植物密度降低并可见双侧薄层融合块,术后6个月双侧可见整块新生骨或单侧大块新生骨。按Lenke字母分级法融合分级,两组均无C、级融合。④Cobb角测量结果:伤椎复位后高度丢失干细胞+复合材料组平均为2.38°D,自体髂骨移植组平均为2.42°。结论:通过自体骨髓富集的间质干细胞复合羟基磷灰石磷酸三钙应用于胸腰椎骨折后外侧融合可取得与自体髂骨移植同等的临床疗效,是一种安全可靠,简便有效的植骨替代材料。
AIM： To investigate the clinical results of spine fusion with the autologous enriched bone marrow mesenchymal stem cells （EBMSCs） combined with hydroxyapatite （HA）/tricalcium phosphate （TCP）. METHODS： ①Between January 2005 and February 2006, 48 patients who underwent pedicle screw instrumentation for treating thoracolumbar fractures were selected.②According to different bone substitutes, the cases were randomly divided into two groups： Group A was autologous EBMSCs plus composite material （n=24,13 males, and 11 females; aged 25 to 49 years）; Group B was autologous iliac crest bone graft （n=24,15 males, and 9 females; aged 26 to 50 years）.③Autologous EBMSCs suspension was obtained by gradient-centrifugation method, then combined with HA/TcP for 2 hours to serve as bone graft extenders. In the group A, autologous EBMSCs cultured with HA/TcP were used as bone substitute; In group B, autologous iliac crest bone harvested was used as a bone graft extenders. ④Spine fusion healing, clinical effects and correction loss of two groups were compared to assess spine fusion extent. RESULTS： Forty-eight cases were all involved in the result analyses after a 12 months post-operative follow-up.①Effectiveness of marrow enrichment： The concentration of MSCs increased 8 times after enrichment. ②ln group A, pain in the location of harvested marrow diminished in 1 week after operation without infection; In group B, pain in the location of harvested iliac crest bone still remained in 3 months after operation. There was no complication such as infection, internal instrumentation loosening or breakage. LBOS scores showed that the excellent rate in the group A was 71% （17/24）, and group B was 79% （19/24）. ③Spinal fusion outcomes： X-ray and CT scanning indicated that spine fusion in all cases were good after a more than 6 months follow-up. The density of grafting substitutes was decreased and bilateral thin fusion phenomenon was observed in 3 months, moreover, unilateral or bilateral autologous blocks of bone mass were found in 6 months after operation. According to Lenke letter grades, there was no C or D grade spinal fusion. ④Cobb angles＇ outcomes： Mean degree of correction loss in group A was 2.38°, and group B was 2.42°. CONCLUSION： Autologous EBMSCs combined with HA/TcP is safe, simple and effective as a graft material for posterolateral spine fusion in treating thoracolumbar fractures, and has the same clinical effect as that of autologous iliac crest bone graft.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第28期5536-5539,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
江苏省医学科技发展基金资助项目(H200558)~~
