骨髓间充质干细胞、血小板凝胶和体外冲击波联合应用治疗骨不连

Combination of bone marrowmesenchymal stem cells,platelet gel and extrocorporeal shock wave on bone regeneration

目的观察血小板凝胶(PG)和体外冲击波(ESW)对骨髓间充质干细胞(BMSCs)治疗骨不连的影响,确定骨不连治疗的最佳方案。方法制备Wistar大鼠萎缩性骨不连模型125只,随机分为骨不连组、BMSCs组、BMSCs+PG组、BMSCs+ESW组和BMSCs+PG+ESW组,每组25只,并给予相应的治疗。治疗后第4、8周行显微CT和X线检测,第8周处死大鼠对骨折端行组织学染色分析。结果 X线结果显示,BMSCs+PG+ESW组骨折愈合率明显高于其他各组(P<0.05)。显微CT结果显示,BMSCs+PG+ESW组正向成骨指标骨体积分数、骨小梁厚度和骨小梁数量均高于其他各组(P<0.05),负向成骨指标骨小梁间隙和骨表面积体积比均低于其他各组(P<0.05)。组织形态学检测结果显示,BMSCs+PG+ESW组成骨细胞数量、血管数量和新骨面积分数均高于其他各组(P<0.05)。结论血小板凝胶和体外冲击波均可增强BMSCs治疗骨不连的疗效;三因素联合应用效果优于双因素和单因素。

Objective To evaluate whether platelet gel（ PG） and extracorporeal shock wave（ ESW） could enhance the effect of bone marrowmesenchymal stem cell（ BMSCs） in the treatment of nonunion and to select the best therapy on bone regeneration. Methods A total of 125 atrophic nonunion models of rats were established and randomly divided into 5 groups with 25 animals in each group： nonunion group,BMSCs group,BMSCs ＋ PG group,BMSCs ＋ ESW group,and BMSCs ＋ PG ＋ ESW group. Bone regeneration was evaluated via X-ray and micro-CT 4 and 8 weeks after treatment. All rats were sacrificed for histological analysis in week 8. Results X-ray images showed that the ratio of bone union in BMSCs ＋ PG ＋ ESW group was the highest（ P〈0. 05）. Micro-CT showed that BMSCs ＋ PG ＋ ESW group contained significantly larger bone volume fraction,thicker and higher number of bone trabecular,and smaller ratio of bone surface / bone volume compared with the other 4 groups（ P〈0. 05）. Histomorphometry showed that the BMSCs ＋ PG ＋ ESW group had the largest number of osteoblasts,vascular buds and bone areas fraction among all groups（ P〈0. 05）. Conclusion PG and ESW can enhance the effect of BMSCs on bone regeneration. Combination of BMSCs,PG and ESW can produce better results than the combination of two items and monotherapy.