异体皮质人工骨复合物治疗骨折不愈合及骨缺损

背景：异体皮质干燥异体骨为多孔状结构,孔均匀且相互贯通,孔径200μm左右,在形态结构上与人类无机骨极为相似。目的：观察应用骨形态发生蛋白-骨髓间充质干细胞-异体皮质人工骨复合物治疗骨折不愈合及骨缺损的临床效果。方法：选择33例创伤性骨缺损患者,其中男19例,女14例;年龄26-85岁。首先提取患者自体骨髓间充质干细胞,进一步以异体皮质人工骨为支架材料,同时导入骨形态发生蛋白和骨髓间充质干细胞,通过人工合成方式制成骨形态发生蛋白-骨髓间充质干细胞-异体皮质人工骨复合物,植入骨缺损处,每例植入人工骨复合物20-45 g。结果与结论：随访6个月-2.5年,根据Mankin及Komender等对同种异体骨移植结果的评分标准,满意32例,不满意1例。复查X射线片示32例达骨性愈合,其中新鲜骨折愈合时间2-7个月,陈旧性骨折愈合时间4-9个月。同种异体松质骨6-9周开始与自体骨融合爬行替代。1例感染性骨缺损移植后迟发性感染,去除内固定及同种异体骨,置管冲洗、局部稳定后再次植骨愈合,随访2年1个月骨感染未复发;1例钢板松动致骨折未愈合,再次行内固定、自体骨移植后骨折愈合。表明应用骨形态发生蛋白-骨髓间充质干细胞-异体皮质人工骨复合物治疗骨折不愈合及骨缺损无明显不良反应,修复效果良好。

AIIogeneic cortical bone complex for fracture nonunion and bone defects

BACKGROUND： Dried allogeneic cortical bone has a porous structure, with uniform and interconnected holes at an aperture of about 200 pm, and the morphological structure is very similar to human bone. OBJECTIVE： To study the clinical effects of the compound graft of allogeneic cortical bone, bone marrow mesenchymal stem cells and bone morphogenetic protein in the treatment of fracture nonunion and traumatic bone defects. METHODS： Thirty-three patients with traumatic bone defects were enrolled, including 19 males and 14 females, aged 26-85 years. First, autologous bone marrow mesenchymal stem cells were isolated and cultured. Then allogeneic cortical bone as scaffold material was implanted with bone marrow mesenchymal stem cells and bone morphogenetic protein to synthesize allogeneic cortical bone complex that was grafted into bone defects （20-45 g per case）. RESULTS AND CONCLUSION： All the patients were followed up for 6 months to 2.5 years. According to the Mankin and Komender standard evaluation of allogeneic bone transplantation, there were 32 cases with satisfaction and one case with dissatisfaction. The X-ray films at reexamination showed that 32 patients had bone healing, with fresh fracture healing time of 2-7 months and old fracture healing time of 4-9 months. The allogeneic cortical bone complex began to be fused with autologous bone through creeping substitution 6-9 weeks after transplantation. One case, which had delayed infection, had bone union by removing internal fixation,placing irrigating tube and grafting after local stability. During the follow-up of 25 months, no relapse was found. Another case had nonunion because of plate loosening, and received secondary internal fixation and autogenous bone graft. The allogeneic cortical bone complex exhibits no evident side effects and is effective in the treatment of fracture nonunion and traumatic bone defects.