新型骨髓干细胞快速筛选-富集-复合系统治疗四肢骨不连  

Novel bone marrow stem cell Screen-Enrich-Combine （-Biomaterials） Circulating System for limb bone nonunion

作　　者：王昕[1] 干耀恺[1] 赵杰[1] 储文祥 庄怡富 戴魁戎[1] 孙月华[1] 史定伟[1] 唐坚[1] 

机构地区：[1]上海市骨科内植物重点实验室,上海交通大学医学院附属第九人民医院骨科,200011

出　　处：《中华创伤骨科杂志》2018年第2期93-98,共6页Chinese Journal of Orthopaedic Trauma

基　　金：上海市科学技术委员会西医引导项目（134119a5500）;市级医院新兴前沿技术联合攻关项目（SDHC12016110）;上海申康医院发展中心临床创新三年行动计划（16CR3099B）;上海市第九人民医院临床研究助力计划（JYLJ015）

摘　　要：目的探究利用自主创新研发的骨髓干细胞快速筛选一富集．复合系统制备具有生物活性的植骨材料治疗四肢骨不连的临床有效性及安全性。方法对2013年5月至2015年12月收治的24例四肢骨不连患者资料进行回顾性研究，年龄20～65岁，平均42．8岁；其中股骨骨不连17例，胫骨骨不连4例，桡骨骨不连1例，肱骨骨不连1例，腓骨骨不连1例。所有患者均接受富集骨髓干细胞技术治疗，手术同期采集约80mL骨髓血，通过干细胞快速筛选．富集一复合系统于手术同期制备复合骨髓间充质干细胞的β-磷酸三钙颗粒进行植骨。留取富集前、后的骨髓血液进行干细胞计数，术后1、3、6、9个月摄X线片评估骨愈合情况、愈合时间及相关不良反应。结果每次采集骨髓血耗时平均为13．5min，骨髓干细胞富集效率约81．2％，每例患者植入干细胞平均为（11751±1011）个。所有患者术后获9～48个月（平均19．2个月）随访。截止术后9个月，共22例（91．6％）患者获得临床愈合，2例患者由于植骨尚欠足量而愈合不佳，愈合时间平均为6．5个月。所有患者均未出现植入相关感染及内固定失败，取骨髓血区及植骨区域均未出现明显不良反应。结论利用骨髓干细胞快速筛选．富集一复合系统在术中快速制备生物活性植骨材料可有效治疗四肢骨不连，该方法操作快捷、耗时短、创伤小、成骨能力优良，可避免自体骨移植带来的相关并发症。Objective To evaluate the validity and security of our self-designed bone marrow stem cell Screen-Enrich-Combine （-Biomaterials） Circulating System （SECCS） for bone non-union of limbs. Methods From May 2013 to December 2015, 24 patients with limb non-union were treated at our department. They were aged from 20 to 65 years （mean, 42. 8 years） . Their non-union involved femur in 17 cases, tibia in 4, radius in one, humerus in one and fibula in one. In surgery, 80 mL bone marrow blood was aspirated from the anterior superior iliac spine for rapid preparation of bone substitute （^-TCP） composite with bone marrow stem ceils by SECCS which was then implanted at the non-union locations. The bone marrow blood was collected before and after enrichment for stem cell counts. The bone union, clinical union time and related com- plications were evaluated by follow-up X-rays at 1, 3, 6 and 9 months after surgery. Results Each collection of bone marrow blood took 13.5 minutes on average. The enrichment rate of stem cells was 81.2%. 11,751 ＋ 1, 011 stem cells were implanted per patient on average. All the patients were followed up for 9 to 48 months （mean, 19.2 months） . Twenty-two patients acquired clinical union 9 months after operation and the other 2 suffered from malunion due to insufficient bone implant, yielding a union rate of 91.6% and an average union time of 6. 5 months. No graft infection or internal fixation failure occurred and no severe complications happened at the donor or implant sites. Conclusion The bioactive bone substitute manufactured by our self-designed SECCS can be used as a novel therapy for limb non-union, and this device is moreover characterized with convenience, limited invasion and satisfactory osteogenesis so that complications of autologous bone transplantation can be avoided.

关 键 词：干细胞 骨折 不愈合 四肢 富集 

分 类 号：R687.3[医药卫生—骨科学]