扩髓交锁髓内钉固定-骨皮质钻孔-自体骨移植治疗萎缩性骨干骨不连的临床研究

目的分析萎缩性骨干骨不连的原因，探讨采用扩髓交锁髓内钉固定-骨皮质钻孔-自体骨移植进行治疗的效果。方法对19例长管状骨萎缩性骨干骨不连的患者，采用扩髓交锁髓内钉固定-骨皮质钻孔-自体骨移植的方法进行治疗。结果经6。34个月的随访，骨折全部愈合，关节功能明显改善，愈合时间18周至8个月，平均22周。结论扩髓交锁髓内钉固定-骨皮质钻孔-自体骨移植是治疗萎缩性骨干骨不连的理想方法。治疗的关键在于扩髓、合适直径交锁髓内钉、锁定、折段皮质有限微钻孔、将收集的骨泥与自体骨条复合移植。     

Bone marrow transplantation in adolescents

This paper reviews bone marrow transplantation in adolescents. The primary indications for bone marrow transplantation are malignancies, usually relapsed lymphomas or acute/chronic leukemias. Autologous bone marrow transplantation is used as a high-dose consolidation therapy in some solid tumor patients with varied success. Peripheral blood stem cells are a feasible source of autologous stem cells in adolescents. The process of stem cell transplantation and the complications are the same in adolescents as in younger children and adults. Adolescents face the same biologic barriers to allogeneic transplant (minimal residual disease, availability of donor), but may also face more problems with their insurance status. The psychological and social aspects of bone marrow transplantation during adolescence are unique to their developmental stage. With appropriate medical, nursing, and psychosocial support, bone marrow transplantation offers cure for the adolescent with high-risk disease.     

肝炎病毒感染与骨髓移植

肝炎病毒感染是亚洲人包括中国的特殊感染问题，肝炎病毒感染与骨髓移植之间的关系尚不很明确。笔者通过对１０６例骨髓移植患者乙型、丙型肝炎病毒感染及其与临床结果的综合分析，发现骨髓移植后患者乙型、丙型肝炎病毒感染率分别为７／１０６（６．６％）、６５／１０６（６１．３％），乙型、丙型肝炎病毒活动均可致轻到中度肝功能上升，１例ＨＢＶ、ＨＣＶ混合感染患者因急性肝功能衰竭死亡，但无论乙型或丙型肝炎病毒感染均不影响骨髓的植活，亦不导致急、慢性移植物抗宿主病及肝静脉阻塞综合征发病率上升，因而肝炎病毒感染并非骨髓移植禁忌症，但肝炎病毒感染的防治仍是我们面临的一重大课题。人类重组干扰素可防治丙型肝炎病毒活动，笔者对此进行了初步探讨。     

自体骨髓干细胞移植治疗早期脊髓损伤疗效观察

目的 观察自体骨髓干细胞移植治疗早期脊髓损伤的近期有效性和安全性.方法 2007年11月至2009年8月间山东聊城市脑科医院神经外科收治早期脊髓损伤患者51例.移植组24例患者通过蛛网膜下腔注射方式行自体骨髓干细胞移植,选择同时期入院但未行干细胞移植患者作为对照组.分别于移植前、移植后1、3、6月对两组患者进行运动、感觉功能评定（AISA评分）.同期随访血常规、凝血机制、生化全项、肿瘤标记物.结果 51例患者进入结果分析.移植后1个月,两组患者均有不同程度的运动、感觉功能回复;移植后3个月,移植组感觉功能恢复与对照组差异有统计学意义（P〈0.05）;移植后6个月,移植组运动、感觉功能恢复均与对照组差异有统计学意义（P〈0.05）.随访各项血液检查结果未出现明显异常.结论 自体骨髓干细胞移植治疗早期脊髓损伤安全且近期内疗效确定,远期疗效尚待进一步观察.     

超声消融联合干细胞移植治疗糖尿病动脉硬化闭塞症疗效观察

目的观察血管内超声消融联合自体骨髓干细胞移植治疗糖尿病下肢动脉硬化闭塞症的疗效。方法选择2010年1月-2012年12月确认的糖尿病下肢动脉硬化闭塞症患者46例作为研究对象。采用切开显露股动脉或经皮穿刺插入超声消融导管，在血管造影监视下进行血管内超声消融，随后将干细胞悬浊液注射于缺血小腿肌肉内。结果46例患者术后冷、凉感觉得到改善，跛行距离增加，踝肱指数提升（P〈0．05）。结论血管内超声消融联合自体骨髓干细胞移植治疗糖尿病下肢动脉硬化闭塞症是一种安全、有效的方法。     

骨髓单个核细胞移植治疗慢性心力衰竭的疗效观察

目的 探讨自体骨髓单个核细胞移植治疗慢性心力衰竭患者的可行性.方法 人选慢性心力衰竭患者80例,分为骨髓细胞移植组(48例)和标准药物治疗组(32例).骨髓细胞移植组将骨髓单个核细胞悬液在冠状动脉造影时经导管注入冠状动脉内.标准药物治疗组仅采用常规治疗.用超声心动图、血浆脑钠肽(BNP)和单光子发射计算机断层扫描(SPECT)比较两组治疗前后心功能指标和心肌灌注缺损区面积.结果 骨髓细胞移植组和标准药物治疗组治疗前LVEF分别为(42.1±5.8)%、(43.9±6.7)%,术后1年随访分别为(54.1±4.8)%、(49.8±7.7)%;治疗前BNP分别为(699±101)ng/L、(687±95)ng/L,随访分别为(305±78)ng/L、(3994-89)ng/L;治疗前心肌灌注缺损面积分别为(26.8±8.6)%、(26.3±6.5)%,随访分别为(15.8±4.3)%、(20.5±7.8)%,两组随访比较差异均有统计学意义;骨髓细胞移植组术中和术后均无并发症发生.结论 骨髓单个核细胞移植治疗慢性心力衰竭患者安全可行,术后能改善心功能及心肌血流灌注.     

Prenatal and postnatal transplantation of hematopoietic stem cells in children with primary immunodeficiency

Primary immunodeficiencies are inherited diseases characterized by impaired immune responses. In case of severe impairment of immunity bone marrow transplantation is the only therapeutic option. The molecular defect is known for several primary immunodeficiencies allowing prenatal diagnosis. This paper summarizes the clinical experience treating these pathologies by bone marrow transplantation.     

Hematopoietic stem-cell transplantation in aplastic anemia

Severe aplastic anemia is a rare syndrome characterized by bone marrow failure with cytopenias and hypocellular bone marrow biopsy (usually 10-15%), without blasts or myelodysplasia. The first choice treatment for these patients is allogeneic bone marrow transplantation from a sibling matched for HLA-A, HLA-B and HLA-DR. Unfortunately only 30% of patients have an HLA-matched sibling (a 25% chance per sibling). The alternative treatment for severe aplastic anemia for the rest of the patients (70%) is immunosuppression with antithymocyte globuline and cyclosporine. The evolution of bone marrow transplantation since 1970's has been positive in terms of survival and transplant success (initial overall survival 43% vs. 90% lately, and graft rejection of 29% vs. 4%). The favorable outcome of bone marrow transplantation for severe or very severe aplastic anemia is due to: the use of conditioning with antithymocyte globuline and cyclophosphamide, the use of graft-vs.-host disease prophylaxis with short curse methotrexate and cyclosporine and the use of filtrated and irradiated blood products. For those patients without an HLA-matched related donor the first treatment to use is the immunosuppression with antithymocyte globuline and cyclosporine. Another option emerged in the late 80's is the unrelated bone marrow transplantation, with survival hardly half of the HLA-identical related bone marrow transplants. In our country, the first allogeneic bone marrow transplant was done in the Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, in a patient with aplastic anemia, making possible to perform this procedure safely in our country.     

膝上外侧动脉骨皮瓣游离移植修复肢体复合组织缺损

目的探讨膝上外侧动脉骨皮瓣游离移植修复肢体复合组织缺损的l晦床效果。方法以大腿外侧正中为轴心线,股骨外上髁上约4cm处为中心,在髌骨外侧缘向近端延长线、股二头肌后缘、髌骨上缘区域内,根据受区需要设计和切取膝上外侧动脉为蒂的骨皮瓣。选择与受区动脉顺行或逆行端侧或端端吻合。修复前臂、手、小腿、足部外伤后骨缺损、局限性骨髓炎并软组织缺损15例,骨瓣面积7．2cm×4cm～3cm×1cm;皮瓣面积12cm×6cm～3cm×3cm。结果15例游离移植骨皮瓣均成活,创面未再发感染,3—4个月骨瓣与受区骨骼愈合。修复后伤肢外观满意。结论膝上外侧动脉骨皮瓣游离移植是修复肢体复合组织缺损的理想方法之一。     

自体骨髓基质干细胞移植对大鼠脊髓损伤的疗效

[目的]观察自体骨髓基质干细胞(bone marrow stromal cells,BMSCs)移植对大鼠脊髓损伤(SCI)的治疗效果。[方法]体外分离纯化大鼠骨髓基质干细胞,取46例Wistar大鼠采用改良的Allen’s装置在T11水平制成大鼠脊髓损伤模型,随机分成基质干细胞(MSCs)移植组(n=23)和对照组(n=23),分别于术后1、4周通过BBB评分观察大鼠SCI后功能的恢复情况。[结果]术前所有大鼠BBB评分均为21分,脊髓损伤后为0分,所有大鼠神经功能缺损症状随着时间的推移都有不同程度的减轻。两组术后4周时BBB评分均较术后1周时高,差异有统计学意义(P﹤0.05)。移植组术后1、4周时BBB评分均高于对照组,差异有统计学意义(P﹤0.05)。[结论]BMSCs移植有助于大鼠脊髓损伤后的修复重建和功能恢复。     

Bone loss at the proximal femur and reduced lean mass following liver transplantation: a longitudinal study.

The longevity of recipients of liver transplant may be compromised by spinal osteoporosis and vertebral fractures. However, femoral neck fractures are associated with a higher morbidity and mortality than spine fractures. As there is little information on bone loss at this clinically important site of fracture, the aim of this study was to determine whether accelerated bone loss occurs at the proximal femur following transplantation. Bone mineral density and body composition were measured at the femoral neck, lumbar spine and total body, using dual x-ray absorptiometry in 22 men and 19 women, age 46 +/- 1.4 y (mean +/- SEM) before and at a mean of 19 mo after surgery (range 3-44). Results were expressed in absolute terms (g/cm2) and as a z score. Before transplantation, z scores for bone mineral density were reduced at the femoral neck (-0.47 +/- 0.21 SD), trochanter (-0.56 +/- 0.19 SD), Ward's triangle (-0.35 +/- 0.14 SD), lumbar spine (-0.76 +/- 0.13 SD), and total body (-0.78 +/- 0.15 SD) (all P < 0.01 to < 0.001). Following transplantation, bone mineral density decreased by 8.0 +/- 1.7% at the femoral neck (P < or = 0.01) and by 2.0 +/- 1.2% at the lumbar spine (P < or = 0.05). Total weight increased by 12.2 +/- 2.3%, lean mass decreased by 5.7 +/- 1.4%, while fat mass increased from 24.1 +/- 2.0% to 35.1 +/- 1.8% (all P < or = 0.001). Patients with end-stage liver disease have reduced bone mineral density. Liver transplantation is associated with a rapid decrease in bone mineral density at the proximal femur, further increasing fracture risk and a reduction in lean (muscle) mass, which may also predispose to falls. Prophylactic therapy to prevent further bone loss should be considered in patients after liver transplantation.     

骨髓单个核细胞移植治疗慢性心力衰竭的疗效观察

目的探讨自体骨髓单个核细胞移植治疗慢性心力衰竭患者的可行性。方法入选慢性心力衰竭患者80例，分为骨髓细胞移植组（48例）和标准药物治疗组（32例），骨髓细胞移植组将骨髓单个核细胞悬液在冠状动脉造影时经导管注入冠状动脉内。标准药物治疗组仅采用常规治疗。用超声心动图、血浆脑钠肽（BNP）和单光子发射计算机断层扫描（SPECT）比较两组治疗前后心功能指标和心肌灌注缺损区面积。结果骨髓细胞移植组和标准药物治疗组治疗前LVEF分别为（42．1±5．8）％、（43．9±6．7）％，术后1年随访分别为（54．1±4．8）％、（49．8±7．7）％；治疗前BNP分别为（699±101）ng／L、（687±95）ng／L，随访分别为（305±78）ng／L、（399±89）ng／L；治疗前心肌灌注缺损面积分别为（26．8±8．6）％、（26．3±6．5）％，随访分别为（15．8±4．3）％、（20．5±7．8）％，两组随访比较差异均有统计学意义；骨髓细胞移植组术中和术后均无并发症发生。结论骨髓单个核细胞移植治疗慢性心力衰竭患者安全可行，术后能改善心功能及心肌血流灌注。     

Granulocyte-macrophage progenitor cells in allogenic bone marrow transplantation: correlation of progenitor cell content and regeneration in the graft

The amount of granuloid macrophage progenitors (CFU-GM) was studied in 16 donor bone marrows used for allogenic bone marrow transplantation in the National Institute of Haematology and Blood Transfusion between January, 1984 and January, 1988. In 10 bone marrow transplanted patients long-term follow up of bone marrow CFU-GM regeneration was carried out. Graft sizes were the following: 2.91 +/- 0.62 X 10(8)/kg body weight nucleated cells and 19.2 +/- 14 X 10(4)/kg body weight (CFU-GM. Preinfusion procedures (centrifugation and resuspension) did not alter CFU-GM content of the grafts. Separation of nucleated cells with hydroxyethylstarch, applied for ABO mismatched donor bone marrow, however, resulted in a 30 per cent loss in CFU-GM. Since higher than threshold graft-sizes for successful engraftment were used, no linear correlation between graft size and speed of granulocyte and platelet recovery was found. Significant difference between regeneration kinetics of bone marrow CFU-GM of patients transplanted for CML or AML and ALL was observed: in AML and ALL patients normal bone marrow CFU-GM level was found 4 to 6 months after transplantation, while in CML patients CFU-GM level approached the lower limit of the normal value only 10 to 14 months after transplantation. Granulocyte and thrombocyte recovery of CML patients showed a significant delay when compared to transplanted AML and ALL patients.     

大段同种异体骨移植重建膝关节

目的研究大段冷冻同种异体骨移植股骨远近骨缺损的重建膝关节疗效。方法2005年～2007年应用大段异体骨治疗股骨远端严重毁损病例7例,其中均为开放性股骨远端骨缺损,异体股骨远端移植后采用钢板内固定。结果本组随访6～18个月,平均12个月。因早期负重活动异体骨塌陷钢板断裂1例,所有病例均未发生术后感染。X线片显示1～3个月开始出现骨痂生长。平均愈合时间7个月。结论坚强的内固定、足量的抗生素及避免过早负重是保证大段异体骨移植手术成功的重要条件。     

Limiting access to allogeneic bone marrow transplantation in five European countries: what can we learn about implicit rationing?

BACKGROUND: Allogeneic bone marrow transplantation is a complex procedure exemplifying a class of new and emerging treatment modalities involving advanced medical technologies with high costs. OBJECTIVES: To collect available data on volume of allogeneic bone marrow transplantation in five European countries for the period 1990-1994. To assess the opinion of selected physicians on whether they felt that patients that would have benefited from a transplant actually received a transplant in the same period. To assess their opinion on possible reasons for limited access. METHOD: Literature review and mailed self-administered questionnaire to the responsible physician at 76 transplant centres in Denmark, Germany, The Netherlands, Norway, and the UK. RESULTS: Substantial geographical differences in transplantation rates between the five countries studied. For adult patients 62.5% of the respondents felt that there was limited access to allogeneic bone marrow transplantation in the period. For children, the corresponding figure was 37.5%. The reasons for limited access cited most frequently were scarcity of facilities or transplant beds, scarcity of donors, and inadequate referral practices.     

大段同种异体骨移植重建膝关节

目的研究大段冷冻同种异体骨移植股骨远近骨缺损的重建膝关节疗效。方法2005年～2007年应用大段异体骨治疗股骨远端严重毁损病例7例,其中均为开放性股骨远端骨缺损,异体股骨远端移植后采用钢板内固定。结果本组随访6～18个月,平均12个月。因早期负重活动异体骨塌陷钢板断裂1例,所有病例均未发生术后感染。X线片显示1～3个月开始出现骨痂生长。平均愈合时间7个月。结论坚强的内固定、足量的抗生素及避免过早负重是保证大段异体骨移植手术成功的重要条件。     

器官移植患者的营养支持

器官移植患者的营养支持关系到移植器官的功能。近年来，本所将营养支持已应用于肝移植、肾移植、胰腺移植、小肠移植、骨髓移植、联合器官移植和多器官移植的患者身上，提高了手术成功率，治愈了术后严重并发症。营养支持分为移植前期、围手术期和移植后期进行。各期应按病情特点进行合理的肠外与肠内营养支持，做到个体化。谷氨酰胺、生长激素等特殊营养素对危重器官移植患者具有代谢调理和免疫调理作用。     

自体骨髓干细胞在心肌梗死后不同阶段移植对心功能影响的实验研究

目的自体骨髓干细胞移植在观察心肌梗死(心梗)后不同时期的组织学及心脏功能的变化,探讨骨髓干细胞移植的最佳时机。方法将36只雄性青紫兰兔随机分成6组,每组6只:即时移植组(A组),即时对照组(A1),2周后移植组(B组),2周后对照组(B1组),4周后移植组(C组),4周后对照组(C1组)。用液氮冷冻法制成心梗模型。将经5-氮杂胞苷(5-aza)诱导过的骨髓干细胞,于心梗形成后的即时、2周和4周,注射入心梗区。4周后。分别使用M型超声心动图和在体心功能检测系统,检测左心室射血分数(EF)、左室短轴缩短率(FS)、左室收缩压最大变化速率(dp/dt m ax)、收缩末期内径(LVSD)、左室舒张末期内径(LVDD)。结果即时移植的治疗组与对照组比较,左心室射血分数(EF)、左室短轴缩短率(FS)、左室收缩压最大变化速率(dp/dtm ax)、左室收缩末期内径(LVSD)、左室舒张末期内径(LVDD)在治疗组与对照组相比无明显的变化(P>0.05)。4周后治疗组与对照组相比,EF、FS、dp/dtm ax、LVSD、LVDD也无明显变化(P>0.05)。2周后治疗组与对照组、即时治疗组、4周后治疗组相比,EF、FS、dp/dtm ax、LVSD、LVDD有明显的改善(P<0.05)。结论心梗后第2周进行骨髓干细胞移植,可有效的减轻心室扩张,改善心功能。     

自体骨髓单个核细胞经冠状动脉移植治疗扩张型心肌病1例报告

目的观察自体骨髓单个核细胞经冠状动脉移植治疗扩张型心肌病的可行性及临床效果。方法原发性扩张型心肌病1例,心功能NYHA Ⅳ级。抽取患者骨髓,用密度梯度法分离骨髓单个核细胞,经左、右冠状动脉分别直接注入经分离自体骨髓单个核细胞,术后观察及随访患者症状,心功能,心血管事件。结果术中和术后未见不良影响,无新发严重心律失常,心功能稳定。术后第三天患者因咽痛干咳伴发热6 小时,第五天出院,运动能力增加。结论自体骨髓单个核细胞经冠状动脉移植治疗扩张型心肌病技术简单, 安全,对患者创伤小,短期观察对患者未见不良影响,而运动能力增加,长期效果有待随访观察。