组织工程化干细胞联合PRP在骨不连中的临床应用(1)
摘 要：目的 比较骨不连患者采用组织工程干细胞联合PRP和常规开放固定+有效植骨治疗的临床疗效。方法 将骨不连患者43例分为治疗组22例和对照组21例，治疗组患者采用组织工程化干细胞联合PRP移植治疗，对照组采用开放内固定+有效植骨治疗。比较患者两组手术时间、出血量、住院费用、住院时间、切口愈合等级、有无取自体骨等相关指标。结果 随访9～15个月后，治疗组骨折愈合率为86.36%，对照组骨折愈合率为85.70%，组间比较，差异无统计学意义(P>0.05)；在手术时间、出血量、住院费用、住院时间方面，对照组均高于治疗组，差异有统计学意义(P<0.05)；切口愈合方面，对照组有2例患者出现Ⅱ级愈合，治疗组患者均为Ⅰ级愈合；有无取自体骨：治疗组无一例取自体骨，对照组均取自体骨。结论 组织工程化干细胞联合PRP可作为一种有效的治疗骨不连的方法，较常规手术方法更微创，操作更简便，损伤小，节约经济，减少住院时间，未来可作为治疗骨不连的一种有效的方法。
关键词：组织工程；间充质干细胞；富含血小板血浆；骨不连
, http://www.100md.com
中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.12.020
文章编号：1006-1959(2018)12-0065-04
Abstract：Objective To compare the clinical efficacy of tissue-engineered stem cells combined with PRP and conventional open fixation+effective bone grafting in patients with non-union.Methods 43 patients with nonunion were divided into treatment group(22 cases)and control group(21 cases).The treatment group patients were treated with tissue-engineered stem cells combined with PRP transplantation，and the control group was treated with open internal fixation+effective bone grafting.The two groups of patients were compared for operative time，blood loss，hospitalization costs，length of stay，incision healing grade，and whether autologous bone was taken or not.Results After 9 to 15 months of follow-up，the fracture healing rate was 86.36% in the treatment group and 85.70% in the control group.There was no significant difference between the two groups(P>0.05)；The operative time，blood loss，hospitalization costs，and length of hospital stay were higher in the control group than in the treatment group，the difference was statistically significant (P<0.05).In wound healing，two patients in the control group had grade II healing，and all patients in the treatment group had grade I healing；Whether or not autologous bone was taken：No autologous bone was used in the treatment group，and autologous bone was used in the control group.Conclusion Tissue-engineered stem cells combined with PRP can be used as an effective method for the treatment of bone non-union，which is more minimally invasive，easier to operate，less damaged，economical，and less time spent in hospital.The future can be used as an effective treatment for non-union.
, 百拇医药
Key words：Tissue-engineered；Mesenchymal stem cells；Platelet-rich plasma；Non-union
骨不連一直以来是困扰骨科医师的难题[1]，临床上常见的方法是开放手术，取自体骨或同时更换内固定方式[2]，因其手术创伤较大，出血较多，费用高，取自体骨骨副损伤等，一直不被患者所接受。近年来随着干细胞、生物材料学及组织工程技术的发展，使干细胞和PRP(platelet-rich plasma)移植治疗骨不连的研究逐渐成为骨科领域研究的热点[3]。既往都采用单一方法治疗骨不连，效果较好但仍存在失败病例，间充质干细胞具有向成骨细胞分化的能力、PRP中的TGF因子家族有促进干细胞成骨转化和局部血管化的生物学效应，如能联合二者对骨不连进行治疗，理论上有增加疗效的功能，且在本研究中我们使血浆成分凝胶化，使血浆转换为可吸收生物材料而负载干细胞和PRP中的生长因子成分，形成组织工程化干细胞-PRP凝胶，避免了局部注入的干细胞和PRP流失的弊端，固化和增加了二者在局部发挥更大的生物学效应，文章总结兴义市人民医院骨创伤科近4年来组织工程化干细胞联合PRP治疗骨不连的手术，比较了两种手术的临床疗效及相关指标。, http://www.100md.com(赵宝平 叶川 江深河 武成兴 谢大伟 李江龙 刘志伟 许明友 付红军)
关键词：组织工程；间充质干细胞；富含血小板血浆；骨不连
, http://www.100md.com
中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.12.020
文章编号：1006-1959(2018)12-0065-04
Abstract：Objective To compare the clinical efficacy of tissue-engineered stem cells combined with PRP and conventional open fixation+effective bone grafting in patients with non-union.Methods 43 patients with nonunion were divided into treatment group(22 cases)and control group(21 cases).The treatment group patients were treated with tissue-engineered stem cells combined with PRP transplantation，and the control group was treated with open internal fixation+effective bone grafting.The two groups of patients were compared for operative time，blood loss，hospitalization costs，length of stay，incision healing grade，and whether autologous bone was taken or not.Results After 9 to 15 months of follow-up，the fracture healing rate was 86.36% in the treatment group and 85.70% in the control group.There was no significant difference between the two groups(P>0.05)；The operative time，blood loss，hospitalization costs，and length of hospital stay were higher in the control group than in the treatment group，the difference was statistically significant (P<0.05).In wound healing，two patients in the control group had grade II healing，and all patients in the treatment group had grade I healing；Whether or not autologous bone was taken：No autologous bone was used in the treatment group，and autologous bone was used in the control group.Conclusion Tissue-engineered stem cells combined with PRP can be used as an effective method for the treatment of bone non-union，which is more minimally invasive，easier to operate，less damaged，economical，and less time spent in hospital.The future can be used as an effective treatment for non-union.
, 百拇医药
Key words：Tissue-engineered；Mesenchymal stem cells；Platelet-rich plasma；Non-union
骨不連一直以来是困扰骨科医师的难题[1]，临床上常见的方法是开放手术，取自体骨或同时更换内固定方式[2]，因其手术创伤较大，出血较多，费用高，取自体骨骨副损伤等，一直不被患者所接受。近年来随着干细胞、生物材料学及组织工程技术的发展，使干细胞和PRP(platelet-rich plasma)移植治疗骨不连的研究逐渐成为骨科领域研究的热点[3]。既往都采用单一方法治疗骨不连，效果较好但仍存在失败病例，间充质干细胞具有向成骨细胞分化的能力、PRP中的TGF因子家族有促进干细胞成骨转化和局部血管化的生物学效应，如能联合二者对骨不连进行治疗，理论上有增加疗效的功能，且在本研究中我们使血浆成分凝胶化，使血浆转换为可吸收生物材料而负载干细胞和PRP中的生长因子成分，形成组织工程化干细胞-PRP凝胶，避免了局部注入的干细胞和PRP流失的弊端，固化和增加了二者在局部发挥更大的生物学效应，文章总结兴义市人民医院骨创伤科近4年来组织工程化干细胞联合PRP治疗骨不连的手术，比较了两种手术的临床疗效及相关指标。, http://www.100md.com(赵宝平 叶川 江深河 武成兴 谢大伟 李江龙 刘志伟 许明友 付红军)