富集骨髓干细胞结合β磷酸三钙在脊柱融合的临床应用

The primary report of clinical application of enriched bone marrow stem cells combining with β-tricalcium phosphate in spine fusion

目的 探索临床应用富集骨髓干细胞技术复合可降解β磷酸三钙（β—TCP）进行脊柱后路融合的新方法。方法 术前抽取患者髂前上棘骨髓血约250ml离心富集，将富含骨髓干细胞的骨髓血复合β—TCP后回植于患者，进行腰椎后路融合29例。临床功能随访，定期X线摄片、CT检查，评定脊柱融合效果。结果 富集后约获骨髓干细胞悬液（38±14）ml用于回植，富集后骨髓血中的有核细胞含量由原来的（14．72±5．33）×10^9／ml增至（44．63±13．89）×10^9／ml，其中骨髓干细胞数增加约8．25倍。富集骨髓血与多孔β—TCP颗粒复合2h后用于脊柱融合植骨替代。初步随访6～14个月，X线、CT观察脊柱融合良好。结论 应用富集骨髓干细胞结合β—TCP材料，作为植骨补充材料用于脊柱融合，可在术中一期应用，β—TCP降解后形成自体的骨融合。富集技术快速安全无副作用，提高了骨髓成骨的有效成分，有利于复合材料成骨，进行脊柱融合。

Objective To observe the clinical results of posterolateral intertransverse process arthrodesis with a new bone substitute： autologous enriched bone marrow stem cells （EBMSCs） hybriding with β tricalcium phosphate（ β- TCP）. Methods About 250 ml bone marrow for each patient had been collected from bilateral anterior superior spines preoperatively. With the enrichment technique, EBMSCs had been collected, then combined with the β-TCP particles, and finally the composite had been placed in the fusion part of the spine, as a bone graft extenders. 29 patients had undergone posterolateral intertransverse process arthrodesis by means of autologous EBMSCs combining with porous β-TCP. Regular follow-up, roentgenograph, CT scanning and physical function examination had been performed for evaluation. Results （ 38± 14） ml had been used for hybrid. The nucleated cells increased from （ 14.72±5.33） × 109/ml originally to （44. 63 ± 13.89） × 109/ml after enrichment; and bone marrow stem cells had in- creased about 8.25 times. The adhesion of stem cells on the internal wall of porous β-TCP could been found after 2 hours incubation. Clinical results were satisfied after 6 - 14 months follow-up. Conclusions The clinical applications of autologous EBMSCs combining with porous β-TCP could be used as a good bone graft extender to apply in the lumbar posterolateral intertransverse fusion without severe side effects. The biomaterial could be replaced finally by new bone formation in 6 months. It is a convenient, effective, and safe method for perioperative usage.