组织工程肋骨移植修复胸壁巨大缺损  

HUGE THORACIC WALL DEFECT REPAIRED BY TISSUE ENGINEERED BONE TRANSPLANTATION

作　　者：杨志明[1] 赵雍凡[2] 解慧琪[1] 黄富国[1] 刘欣[2] 李涛[1] 

机构地区：[1]华西医科大学附属第一医院骨科,成都610041 [2]华西医科大学附属第一医院胸外科,成都610041

出　　处：《中国修复重建外科杂志》2000年第6期365-368,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家重点基础研究发展规划! (973) :组织工程的基本科学问题 (G19990 5 430 8);国家自然科学基金!重点项目 (39830 10 0 )

摘　　要：目的　应用组织工程技术构建的肋骨和带蒂皮瓣移位修复 1例 2 5岁女性患者胸壁巨大韧带样纤维瘤切除后 ,合并软组织、肋骨缺损的早期效果。方法　经髂骨穿刺抽取骨髓组织 ,按 Houghton法分离培养骨髓基质干细胞 ,经定向诱导分化为成骨样细胞 ;用同种异体肋骨经去细胞、去抗原、部分脱钙和冻干处理 ,制成保存天然框架的生物衍生骨支架 ,将 5× 10 6 /ml骨髓基质干细胞与骨支架材料联合培养 6天 ;待完整切除肿瘤后 ,用膈肌瓣修复胸膜腔 ,组织工程肋骨修复 3根肋骨 ,同侧带蒂侧腹壁皮瓣移位修复胸壁软组织缺损。结果　手术经过顺利 ,伤口 期愈合。术后 3个月随访 ,植入组织工程肋骨在体内逐渐发育成成熟肋骨 ,心肺功能显著改善。结论　应用自体骨髓基质干细胞构建的组织工程肋骨在个体化治疗中显示了优越性。Objective A rare huge desmoplastic fibroma on thoracic wall in 1 female case of 25 years old was resected, and the accompanying huge thoracic wall defect, ribs and soft tissues were repaired by tissue engineered bone and pedicled flap. The paper aims to explore the clinical results of early stage after operation. Methods Autogeneic bone marrow stromal cells (MSC) were obtained from bone marrow puncture of iliac bone and isolated and cultured according to the Houghton's methods, MSC were directively induced and differentiated to osteoblasts. Allogeneic ribs were made to the bio-derived bone scaffold materials after treatment of decell, deantigen, decalcification and dry freezing. 5×10 6/ml MSC were cocultured with the bio-derived bone for 6 days in vitro. After intact resection of tumor, the diaphragm flap was applied to repair pleural cavity, the three defect ribs were repaired by tissue engineered bone and the soft tissue defect was repaired by transfer of pedicled ipsilateral abdominal flaps. Results The patient recovered well with first intention. Followed up for 3 months, tissue engineered ribs were matured in vitro and the heart and pulmonary functions were improved markedly. Conclusion The tissue engineered bone constructed by autogeneic MSC is advantageous in individual treatment.

关 键 词：组织工程 胸壁肿瘤 胸壁巨大缺损 肋骨移植 修复 

分 类 号：R734.405[医药卫生—肿瘤] R655.1[医药卫生—临床医学]