MSCs復合雙相磷酸鈣陶瓷促進脊柱融合相關臨床研究
發(fā)布時間：2018-11-28 19:19
【摘要】：研究背景 脊柱融合術是治療脊柱骨折的主要方式，，普遍采用自體骨移植，但由于自體骨自身的問題和弊端，大大限制了該技術療效的發(fā)揮。因此，研究成活率高、副作用小的人工骨來代替自體骨或異體骨，以修復骨缺損，促進脊柱融合迫在眉睫。此項研究的結(jié)果具有重要的臨床意義。 目的 探討采用人體骨髓間充質(zhì)干細胞（marrow mesenchymal stem cells；MSCs）復合雙相磷酸鈣陶瓷進行脊柱融合治療單節(jié)段胸腰段骨折的療效觀察，為臨床治療方式提供參考。 方法 收集我院自2012年01月至2013年10月間收治的具有至少1年以上完整隨訪資料的50例單節(jié)段胸腰段骨折患者作為研究對象，排除繼發(fā)性骨質(zhì)疏松癥、骨髓增生異常綜合征、糖尿病、凝血功能異常、貧血、感染性疾病等疾病者；心肺肝腎功能嚴重不全者；合并有其它部分骨折者；根據(jù)植骨融合材料的不同分為觀察組（25例）和對照組（25例）。觀察組采用人體骨髓間充質(zhì)干細胞復合雙相磷酸鈣陶瓷進行脊柱融合治療，對照組采用自體髂骨進行脊柱融合治療，所有患者均在椎管內(nèi)麻醉下行后正中入路行后路短節(jié)段椎弓根釘內(nèi)固定術，入選患者均在術前、術后1月、術后3月、術后半年和術后1年進行隨訪，隨訪患者均進行X線及CT檢查，比較兩組患者的圍手術期相關指標及不同時間點Cobb角、椎體前緣高度比、VAS、ODI、手術時間、術中失血量、早期下床時間、住院天數(shù)和臨床療效。 結(jié)果 1.觀察組和對照組一般資料按照手術時間、術中失血量、早期下床時間及住院天數(shù)等指標進行比較，差異有統(tǒng)計學意義（P＜0.05）。 2.兩組患者在術前、術后1月、術后3月、術后半年和術后1年Cobb角進行比較，除術前指標外，兩組數(shù)據(jù)進行比較，差異有統(tǒng)計學意義（P＜0.05）。 3.兩組患者在術前、術后1月、術后3月、術后半年和術后1年椎體前緣高度比進行比較，除術前外，差異有統(tǒng)計學意義（P＜0.05）。 4.兩組患者在術前、術后1月、術后3月、術后半年和術后1年VAS評分進行比較，除術前外，差異有統(tǒng)計學意義（P＜0.05）。 5.兩組患者在術前、術后1月、術后3月、術后半年和術后1年ODI評分進行比較，除術前外，差異有統(tǒng)計學意義（P＜0.05）。 6.所有患者定期隨訪，術后3個月所有患者日常生活自理，所有病例無任何并發(fā)癥。兩組患者術后1年進行下腰背疼痛評分（LBOS），觀察組的優(yōu)良率為88%（22/25），對照組優(yōu)良率為64%（16/25），兩組優(yōu)良率進行比較，差異有統(tǒng)計學意義（P＜0.05）。 結(jié)論 自體富集骨髓間充質(zhì)干細胞聯(lián)合雙相磷酸鈣（BCP）是安全有效的用于骨融合術的植骨替代材料，該技術聯(lián)合內(nèi)固定治療胸腰椎骨折臨的床療效優(yōu)于自體骨移植，具有廣闊的應用前景。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
本文編號：2364025
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
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本文編號：2364025
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