严重复合组织缺损皮瓣修复术后应用自体脂肪干细胞构建组织工程骨重建骨支架

Clinical application of tissue engineering bone loaded with adipose derived stem cells after flap reconstruction in the treatment of composite tissue defects

目的探讨严重复合组织缺损皮瓣修复术后采用自体脂肪干细胞（ADSCs）复合脱钙骨支架构建组织工程骨重建骨支架的临床疗效。方法2013年4月至2015年6月．共收治创伤性骨皮肤复合组织缺损的患者9例，男7例，女2例，年龄20～58岁，平均43岁。一期选择腹壁下动脉穿支（DIEP）皮瓣修复创面皮肤及软组织缺损。同时采用皮瓣修薄时切除的多余脂肪组织，经体外培养获取ADSC。并诱导向成骨细胞转化，然后复合同种异体脱钙骨支架构建组织工程骨。二期将制备完成的组织工程骨回植体内重建骨支架．并同时行皮瓣修薄整形术。术后进行随访。结果术后9例随访12～36个月．平均18个月。截至末次随访．5例胫骨中下段骨缺损者新骨生长明显．均已达到临床愈合标准．可完全负重行走。1例肱骨中段骨缺损患者新生正常骨组织长人．骨干横截面的2／3以上已恢复连续性。1例肱骨和1例桡骨骨缺损者已达骨性愈合。1例颅骨缺损患者CT显示有大量新骨生长。结论应用自体ADSC。构建组织工程骨联合穿支皮瓣为治疗复合组织缺损中合并骨骼大块缺如的患者开辟了一条新的途径．具有取材便利、不产生新的供区损伤、疗效可靠和操作安全等诸多优点。

Objective To investigate the clinical efficacy of using the tissue engineering bone loaded with adipose derived stem cells （ADSCs）and perforator flap in the treatment of composite tissue defects. Methods From April, 2013 to June, 2015, there were 9 cases of traumatic bone and skin composite tissue defects, including 7 males and 2 females, with an averaged age of 43 years old. The ADSCs were isolated, induced and co-cultured with dem- ineralized bone scaffold. The tissue engineering bone and deep inferior epigastric artery perforator （DIEP） flap were adopted for reconstruction of composite tissue defects. Results All 9 patients were followed up for 12-36 months, averaged of 18 months. The bone growth was obviously for 5 cases with bone defects at the middle and lower part of the tibia. They tolerated full weight bearing walking. One case of middle humeral bone defect demonstrated normal bone tissue growth, and the 2/3 of cross section had been restored. One case of humeral bone defect and 1 case of ra- dial bone defect reached bone union. The remaining 1 with skull defect showed new bone growth, but it had not yet achieved complete bone healing. Conclusion The combination of tissue engineering bone and perforator flap is a minimally invasive, easy accessible and effective method for reconstruction of composite tissue defects.