MSCs复合双相磷酸钙陶瓷促进脊柱融合相关临床研究

发布时间：2018-11-28 19:19

【摘要】：研究背景脊柱融合术是治疗脊柱骨折的主要方式，，普遍采用自体骨移植，但由于自体骨自身的问题和弊端，大大限制了该技术疗效的发挥。因此，研究成活率高、副作用小的人工骨来代替自体骨或异体骨，以修复骨缺损，促进脊柱融合迫在眉睫。此项研究的结果具有重要的临床意义。目的探讨采用人体骨髓间充质干细胞（marrow mesenchymal stem cells；MSCs）复合双相磷酸钙陶瓷进行脊柱融合治疗单节段胸腰段骨折的疗效观察，为临床治疗方式提供参考。方法收集我院自2012年01月至2013年10月间收治的具有至少1年以上完整随访资料的50例单节段胸腰段骨折患者作为研究对象，排除继发性骨质疏松症、骨髓增生异常综合征、糖尿病、凝血功能异常、贫血、感染性疾病等疾病者；心肺肝肾功能严重不全者；合并有其它部分骨折者；根据植骨融合材料的不同分为观察组（25例）和对照组（25例）。观察组采用人体骨髓间充质干细胞复合双相磷酸钙陶瓷进行脊柱融合治疗，对照组采用自体髂骨进行脊柱融合治疗，所有患者均在椎管内麻醉下行后正中入路行后路短节段椎弓根钉内固定术，入选患者均在术前、术后1月、术后3月、术后半年和术后1年进行随访，随访患者均进行X线及CT检查，比较两组患者的围手术期相关指标及不同时间点Cobb角、椎体前缘高度比、VAS、ODI、手术时间、术中失血量、早期下床时间、住院天数和临床疗效。结果 1.观察组和对照组一般资料按照手术时间、术中失血量、早期下床时间及住院天数等指标进行比较，差异有统计学意义（P＜0.05）。 2.两组患者在术前、术后1月、术后3月、术后半年和术后1年Cobb角进行比较，除术前指标外，两组数据进行比较，差异有统计学意义（P＜0.05）。 3.两组患者在术前、术后1月、术后3月、术后半年和术后1年椎体前缘高度比进行比较，除术前外，差异有统计学意义（P＜0.05）。 4.两组患者在术前、术后1月、术后3月、术后半年和术后1年VAS评分进行比较，除术前外，差异有统计学意义（P＜0.05）。 5.两组患者在术前、术后1月、术后3月、术后半年和术后1年ODI评分进行比较，除术前外，差异有统计学意义（P＜0.05）。 6.所有患者定期随访，术后3个月所有患者日常生活自理，所有病例无任何并发症。两组患者术后1年进行下腰背疼痛评分（LBOS），观察组的优良率为88%（22/25），对照组优良率为64%（16/25），两组优良率进行比较，差异有统计学意义（P＜0.05）。结论自体富集骨髓间充质干细胞联合双相磷酸钙（BCP）是安全有效的用于骨融合术的植骨替代材料，该技术联合内固定治疗胸腰椎骨折临的床疗效优于自体骨移植，具有广阔的应用前景。
[Abstract]:Background Spinal fusion is the main method for the treatment of spinal fractures. Autologous bone transplantation is widely used. However, due to the problems and disadvantages of autogenous bone, the effectiveness of this technique is greatly limited. Therefore, it is urgent to study artificial bone with high survival rate and low side effect to replace autogenous bone or allogeneic bone in order to repair bone defect and promote spinal fusion. The results of this study are of great clinical significance. Objective to observe the therapeutic effect of bone marrow mesenchymal stem cell (marrow mesenchymal stem cells;MSCs) combined with biphasic calcium phosphate ceramics in the treatment of single segment thoracolumbar fracture. Methods from January 2012 to October 2013, 50 patients with single segmental thoracolumbar fracture admitted to our hospital from January 2012 to October 2013 were included in the study, and secondary osteoporosis was excluded. Myelodysplastic syndrome, diabetes, abnormal coagulation, anemia, infectious diseases and other diseases; Patients with severe insufficiency of heart, lung, liver and kidney were divided into observation group (25 cases) and control group (25 cases) according to different materials of bone graft fusion. The observation group was treated with bone marrow mesenchymal stem cells combined with biphasic calcium phosphate ceramics, while the control group was treated with autogenous iliac bone fusion. All the patients were treated with posterior short segmental pedicle screw fixation via posterior median approach under intraspinal anesthesia. All the patients were followed up before, 1 month, 3 months, 6 months and 1 year after operation, and all the patients were followed up before operation, 1 month after operation, 3 months after operation, 6 months after operation and 1 year after operation. All the patients were examined by X-ray and CT. The relative indexes of perioperative period, Cobb angle at different time points, the ratio of anterior height of vertebral body, the time of VAS,ODI, operation, the amount of blood lost during operation and the time of early getting out of bed were compared between the two groups. Length of stay and clinical efficacy. Result 1. The general data of the observation group and the control group were compared according to the time of operation, the amount of blood loss during operation, the time of getting out of bed early and the days of hospitalization, etc. The difference was statistically significant (P < 0.05). 2. The Cobb angle was compared between the two groups before operation, 1 month, 3 months, 6 months after operation and 1 year after operation. There was a significant difference between the two groups except preoperative indexes (P < 0. 05). 3. There were significant differences between the two groups (P < 0.05) before operation, 1 month after operation, 3 months after operation, 6 months after operation and 1 year after operation (P < 0.05). 4. There were significant differences in VAS scores between the two groups (P < 0. 05) before operation, 1 month, 3 months, 6 months after operation and 1 year after operation (P < 0. 05). 5. There were significant differences in ODI scores between the two groups (P < 0. 05) before operation, 1 month, 3 months, 6 months after operation and 1 year after operation (P < 0. 05). 6. All patients were followed up regularly, and 3 months after operation, all patients took care of themselves, and no complications were found in all cases. The excellent and good rates of (LBOS), group and control group were 88% (22 / 25) and 64% (16 / 25), respectively. The difference was statistically significant (P < 0.05). Conclusion Autologous enrichment of bone marrow mesenchymal stem cells combined with biphasic calcium phosphate (BCP) is a safe and effective substitute for bone graft for bone fusion. This technique combined with internal fixation is superior to autologous bone graft in the treatment of thoracolumbar fractures. It has broad application prospect.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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