纤维蛋白胶复合自体骨髓与人工骨促进脊柱融合的现状与展望

背景:如何利用纤维蛋白胶的黏合性在术中复合自体骨髓与人工骨来提高脊柱融合的成功率,值得进一步研究。目的:综述纤维蛋白胶的研究背景、成分、作用原理及理化特性,纤维蛋白胶及自体骨髓复合人工骨在脊柱融合中应用的现状。方法:由第一作者检索1994/2010CNKI系列数据库及PubMed数据库有关纤维蛋白胶的研究背景、成分、作用原理及理化特性,纤维蛋白胶在构建组织工程骨及修复骨缺损中的应用,自体骨髓复合人工骨移植在修复骨缺损中的应用,脊柱融合中植骨方法应用等方面的文献。结果与结论:自体骨髓复合人工骨移植修复骨缺损在临床取得了较好的疗效,因此在脊柱融合中利用自体骨髓复合人工骨来提高脊柱融合率应该是可行的方案,但以往自体骨髓混合人工骨的过程相对简单,又由于自体骨髓流动性大,注射后容易流失,明显降低了自体骨髓的成骨作用。因此设想在临床手术中,利用纤维蛋白胶的黏合特性将自体骨髓与人工骨黏合在一起,植入脊柱关节突、横突部位,充分发挥骨髓的最大成骨作用,这将是临床一个提高脊柱融合率的简易、快速、有效的方法,有待进一步的深入研究。

Fibrin sealant combined with autologous bone marrow and artificial bone to promote spine fusion

BACKGROUND: How to use the adhesion of fibrin glue to combine with autologous bone marrow and artificial bone to increase the success rate of spinal fusion in surgery, it is worthy of further study. OBJECTIVE: To review the research background, composition, function theory, physical and chemical properties of fibrin glue, the present of fibrin glue, autologous bone marrow combined with artificial bone in spinal fusion. METHODS: China Knowledge Resources Library-CNKI Series Database (1994 to 2010) and PubMed database were retrieved by the first author for literatures concerning the research background, composition, function theory and physical and chemical properties of fibrin glue, the application of fibrin glue in bone tissue engineering and repairing bone defects, the application of autologous bone marrow graft combined with artificial bone transplantation in repairing bone defects, the application of bone graft methods of spinal fusion. RESULTS AND CONCLUSION: Autologous bone marrow graft combined with artificial bone repairing bone defects achieved good clinical efficacy. Therefore, it should be a feasible solution which using autologous bone marrow combined with artificial bone to increase spinal fusion rate in spinal fusion. However, the process of autologous bone marrow combined with artificial bone was relatively simple in the past. Because of a large fluidity of autologous bone marrow, it lost easily after injection, and reduced its bone formation function. Therefore, it is envisaged in clinical surgery that the adhesion properties of fibrin glue were used to adhere autologous bone marrow and artificial bone together, implant it in spinal zygapophysial joints and transverse process and make full use of its largest bone formation function. This will be a simple, fast and effective clinical way for increasing spinal fusion rate. It needs to be further researched.