MSCs复合双相磷酸钙陶瓷促进腰椎骨折患者脊柱融合

Mesenchymal Stem Cells Combined with Biphasic Calcium Phosphate Ceramics Promotes Spinal Fusion in Patients with Vertebral Fractures

目的:探索自体骨髓间充质干细胞(Mesenchymal stem cells,MSCs)复合双相磷酸钙陶瓷(Biphasic calcium phosphate ceramics,BCP)在腰椎骨折患者脊柱融合中的应用。方法:收集我院住院腰椎骨折患者50例,随机分为两组:MSCs复合BCP组和自体髂骨组。MSCs复合BCP组中,体外分离培养患者自体MSCs,复合BCP材料后共聚焦显微镜观察细胞和材料复合生长状况;然后回植于胸腰椎体骨折处,采用后路腰椎椎体间融合术(PLIF),钛合金椎弓根钉棒系统作脊柱内固定。自体髂骨组中,用患者自体髂骨代替BCP骨移植物。术前、术后1、3、6、12个月行X线和CT检查,同时采用Lenke字母分级评价脊柱融合情况,LBOS评分评价临床疗效,Cobb角评价患者伤椎复位效果。结果:两组患者术后6个月Lenke字母分级法表明两组患者均为A、B级,无C、D级;LBOS评分表明MSCs复合BCP组的优良率为68%(17/25),自体髂骨组优良率为76%(19/25);Cobb角结果表明两组伤椎复位效果良好。所有数据两组差异无明显统计学意义(P>0.05)。结论:MSCs复合BCP材料是一种优良的促进脊柱融合方法,可替代自体髂骨移植。

Objective： To explore the effect of autologous mesenchymal stem cells （MSCs） combined with biphasic calcium phosphate ceramics （BCP） for spinal fusion in patients with vertebral fractures. Methods： Fifty patients with vertebral fractures were collected from our hospital and randomly divided into two groups, MSCs ＋ BCP group and autologous iliac group. In group of MSCs ＋ BCP, MSCs were isolated and cultured in vitro, then were seeded into BCP materials and observed under confocal microscope; next, the composite materials were replanted into the site of vertebral fracture with posterior lumbar interbody fusion （PLIF） and fixed with titanium pedicle screw system. In autologous iliac group, the materials were replaced by ilium. All patients were detected with X-ray and CT preoperative and postoperative 1, 3, 6 and 12 months. The spinal fusion was evaluated with Lenke letter grades, the clinical efficacy was evaluated by LBOS scores and Cobb angles. Results： Six months after surgery, Lenke letter grades showed that there was no C or D grade of spinal fusion. LBOS scores showed that the excellent rate was 68 % in group MSCs ＋ BCP （17/25） and 76 % in autologous iliac group （19/25）. Cobb angles＇ outcome showed that the correction loss was small in both groups. All data showed no statistically difference （P〉0.05）. Conclusions： MSCs combined with BCP was an excellent method to promote spinal fusion, which could be used to replace autologous bone graft.