浓缩骨髓复合纤维蛋白胶对骨不连的修复  

The clinical application of enriched bone marrow compound with fibrin glue in repairing bone nonunion

作　　者：姚旺祥[1] 朱六龙[1] 徐建生[1] 

机构地区：[1]浙江省杭州市第一人民医院骨科,310006

出　　处：《中华全科医学》2014年第3期350-352,共3页Chinese Journal of General Practice

基　　金：杭州市科技局项目(20080333B05)

摘　　要：目的使用浓缩自体骨髓复合纤维蛋白胶修复骨缺损及骨不连，观察成骨效果并探讨其促进成骨的机制。方法应用浓缩细胞技术取得骨髓有核细胞混合物，与纤维蛋白胶混合后植入16例骨不连及骨缺损患者体内。植入前取复合物行电镜观察、长期培养及细菌学培养。术后定期拍片观察修复效果。结果浓缩后，骨髓中有核细胞数量由（3．2±1．3）×10^6／ml提高至（31．0±3．9）×10^6／ml，细胞集落形成单位由（152±89）／ml浓缩至（531±168）／ml。电镜下见纤维蛋白胶与骨髓有核细胞生物相容性良好，长期培养无致瘤性，细菌学培养阴性。所有患者术后无脂肪栓塞、发热、感染等不良反应发生，无骨髓供区并发症。失访1例，其余患者均得到6～24个月的随访，平均11．6个月。15例中的13例患者骨折治愈，骨折愈合时间3～6个月，平均4．6个月。2例患者骨折不愈合。结论通过浓缩技术可及时、有效的获得足量的骨髓基质干细胞，注射自体浓缩骨髓与纤维蛋白胶}昆合物可修复骨不连及骨缺损。Objective To explore the clinical feasibility of using enriched bone marrow compound with fibrin glue in repairing bone defect or nonunion through injection methods. Methods Enriched bone marrow compound with fibrin glue were implanted in sixteen patients. The outcomes were measured by taking X-ray observation regularly. Before implantation, a compound of enriched bone marrow with fibrin glue were underwent electron microscopy,long-time culture and bacteriological culture. Results The nucleated cells were increased from（3.2 ± 1.3 ） × 10^6/ml to（31.0 ± 3.9 ） × 10^6/ml, colony forming unit were enriched from （152 ± 89 ）/ml to （531 ±168 ）/ml. No bacterial contamination or oncogenieity was observed after long-term culture. Fat embolism ,fever, infection or complication of the donor site were not observed in all patients. All the patients were regularly followed for 6 - 24 months（ average 11.6 months） except one. Clinical and radiological bone union occurred in 13 out of 15 patients within 6 months. The mean union time was 4.6 months （3 -6 months）. Two patients showed no evidence of union and were considered a failure. Conclusion Through enriching methods, a noninvasive technique can acquire sufficient marrow stromal stem cells immediately. The compounds of enriched bone marrow and fibrin glue can repair bone defects or nonunion.

关 键 词：骨髓 骨缺损 骨不连 纤维蛋白组织黏着剂 骨代用品成骨 

分 类 号：R782.2[医药卫生—口腔医学]