Kitoh Hiroshi, Kitakoji Takahiko, Tsuchiya Hiroki, Katoh Mitsuyasu, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nagoya, Aichi 466-8550, Japan.
Bone. 2007 Feb;40(2):522-8. doi: 10.1016/j.bone.2006.09.019. Epub 2006 Oct 27.
Longer treatment period in distraction osteogenesis (DO) leads to more frequent complications. We developed a new technique of transplantation of culture expanded bone marrow cells (BMC) and platelet rich plasma (PRP) in DO of the long bones. Retrospective comparative study was conducted between the bones treated with and without BMC and PRP in DO to assess the efficacy of this new technique of transplantation. Ninety-two bones (46 patients) that were lengthened in our hospital and followed up until removal of the pins were divided into two groups according to the cell (BMC+PRP) treatment. The BMC-PRP(+) group consisted of 32 bones (14 femora, 18 tibiae) in 17 patients (10 boys and 7 girls), while the BMC-PRP(-) group consisted of 60 bones (25 femora, 35 tibiae) in 29 patients (13 boys and 16 girls). The clinical outcome including the age at operation, amount of length gained, the healing index, the delay in consolidation, and complications were compared between the two groups. The healing between the femoral and the tibial lengthening was also assessed. The average age at operation was 15.8 years in the BMC-PRP(+) group and 15.5 years in the BMC-PRP(-) group. Although there were no significant differences in the age at operation and the length gained between the two groups, the average healing indices of the BMC-PRP(+) group in short stature and in limb length discrepancy were significantly lower than those of the BMC-PRP(-) group (P=0.0019 and P=0.0031, respectively). A delay in consolidation was seen in 45% of the BMC-PRP(-) group but never observed in the BMC-PRP(+) group (P<0.0001). The rate of complications was 23% of the BMC-PRP(-) group and only 6% of the BMC-PRP(+) group (P=0.0406). The femoral lengthening showed significantly faster healing than the tibial lengthening by the BMC and PRP transplantation (P=0.0004) In conclusion, transplantation of BMC and PRP shortened the treatment period and reduced associated complications by accelerating new bone formation in DO.
牵张成骨术（DO）中较长的治疗周期会导致更频繁的并发症。我们开发了一种在长骨DO中移植培养扩增骨髓细胞（BMC）和富血小板血浆（PRP）的新技术。对DO中接受和未接受BMC和PRP治疗的骨骼进行回顾性比较研究，以评估这种新移植技术的疗效。我院92根接受延长并随访至取出钢针的骨骼（46例患者）根据细胞（BMC+PRP）治疗情况分为两组。BMC-PRP（+）组包括17例患者（10名男孩和7名女孩）的32根骨骼（14根股骨，18根胫骨），而BMC-PRP（-）组包括29例患者（13名男孩和16名女孩）的60根骨骼（25根股骨，35根胫骨）。比较两组的临床结果，包括手术年龄、延长长度、愈合指数、骨愈合延迟和并发症情况。还评估了股骨和胫骨延长之间的愈合情况。BMC-PRP（+）组的平均手术年龄为15.8岁，BMC-PRP（-）组为15.5岁。虽然两组的手术年龄和延长长度没有显著差异，但BMC-PRP（+）组在身材矮小和肢体长度差异方面的平均愈合指数显著低于BMC-PRP（-）组（分别为P=0.0019和P=0.0031）。BMC-PRP（-）组45%出现骨愈合延迟，而BMC-PRP（+）组未观察到（P<0.0001）。并发症发生率在BMC-PRP（-）组为23%，在BMC-PRP（+）组仅为6%（P=0.0406）。通过BMC和PRP移植，股骨延长的愈合明显快于胫骨延长（P=0.0004）。总之，BMC和PRP移植通过加速DO中的新骨形成缩短了治疗周期并减少了相关并发症。
