自体富血小板血浆联合骨髓间充质干细胞治疗长骨干骨折术后骨不连

Therapeutic effect of autologous platelet rich plasma combined with bone marrow mesenchymal stem cell transplantation on long shaft fracture bone nonunion

背景:研究显示自体富血小板血浆和骨髓间充质干细胞具有一定的骨修复作用,但临床上少见自体富血小板血浆联合骨髓间充质干细胞治疗长骨干骨不连的研究。目的:对比自体骨髓间充质干细胞及自体富血小板血浆联合骨髓间充质干细胞治疗长骨干骨不连的效果。方法:将47例长骨骨干骨折术后骨不连患者随机分为单一治疗组(n=22)和联合治疗组(n=25),单一治疗组骨折端断注射自体骨髓间充质干细胞,联合治疗组骨折端断注射自体富血小板血浆与自体骨髓间充质干细胞。随访观察两组临床骨折愈合时间、治疗后局部并发症发生情况、患侧肢体功能分级及治疗后3个月的骨痂评分。结果与结论:①临床骨折愈合:联合治疗组临床愈合时间短于单一治疗组[(4.2±1.5),(5.6±1.1)个月,P<0.05]、骨折愈合率高于单一治疗组(92%,86%,P<0.05),骨痂评分高于单一治疗组(2.74±0.36,2.32±0.53,P<0.05);②患肢功能恢复:单一治疗组患侧肢体功能恢复优良率低于联合治疗组(77%,84%,P<0.05);③局部并发症:两组患者骨髓穿刺及治疗局部皮肤无红肿、无感染;④结果表明:自体骨髓间充质干细胞及自体富血小板血浆联合骨髓间充质干细胞移植两种方法治疗长骨干骨折术后骨不连均有一定的疗效,联合治疗的效果更好。

BACKGROUND:Autologous platelet rich plasma and bone marrow mesenchymal stem cells have certain effectson bone repair,but there are rare reports on the clinical treatment of long shaft fracture bone nonunion usingautologous platelet rich plasma combined with bone marrow mesenchymal stem cell transplantation.OBJECTIVE:To investigate the therapeutic effect of autologous platelet rich plasma combined with bone marrowmesenchymal stem cell transplantation on long shaft fracture bone nonunion.METHODS:Forty-seven patients with long shaft fracture bone nonunion were randomly divided into two groups:monotherapy group(n=22)and combination group(n=25).In the monotherapy group,autologous bone marrowmesenchymal stem cell transplantation was performed in the bone nonunion site.In the combination group,autologousplatelet rich plasma combined with bone marrow mesenchymal stem cell transplantation was implemented in the bonenonunion site.Callus score,clinical healing time,local complications and limb function grade were recorded andcompared between the two groups.RESULTS AND CONCLUSION:The healing properties and limb function in the combination group were significantlysuperior to those in the monotherapy group[healing time:(4.2±1.5)vs.(5.6±1.1)months,P<0.05;healing rate:92%vs.86%,P<0.05;callus score:2.74±0.36vs.2.32±0.53,P<0.05;limb function recovery rate:77%vs.84%,P<0.05].Complications like local skin redness or infection were not found in the two groups.In conclusion,both of the twomethods can promote bone healing,but autologous platelet rich plasma combined with bone marrow mesenchymal stemcell transplantation has a better clinical effect on bone healing.