采用培养扩增的骨髓细胞和富含血小板血浆移植治疗软骨发育不全/低软骨发育不全患者下肢的牵张成骨术。

Distraction osteogenesis of the lower extremity in patients with achondroplasia/hypochondroplasia treated with transplantation of culture-expanded bone marrow cells and platelet-rich plasma.

作者信息

Kitoh Hiroshi, Kitakoji Takahiko, Tsuchiya Hiroki, Katoh Mitsuyasu, Ishiguro Naoki

机构信息

Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan.

出版信息

J Pediatr Orthop. 2007 Sep;27(6):629-34. doi: 10.1097/BPO.0b013e318093f523.

DOI:10.1097/BPO.0b013e318093f523

PMID:17717461

Abstract

BACKGROUND

Longer treatment period in distraction osteogenesis (DO) of the lower extremity leads to more frequent complications. We have developed a new technique of transplantation of culture-expanded bone marrow cells (BMCs) and platelet-rich plasma (PRP) during DO to accelerate new bone formation. To assess the efficacy of this cell therapy, retrospective comparative study was conducted between the bones treated with BMC and PRP and the bones treated without BMC and PRP during DO in patients with achondroplasia (ACH) and hypochondroplasia (HCH).

METHODS

Fifty-six bones in 20 patients (ACH, 16; HCH, 4) that were lengthened in our hospital were divided into 2 groups. Twenty-four bones (femora, 12; tibiae, 12) in 11 patients (boys, 7; girls, 4) were treated with BMC and PRP transplantation (BMC-PRP group), whereas 32 bones (femora, 14; tibiae, 18) in 9 patients (boys, 3; girls, 6) did not undergo additional cell therapy (control group). The parameters, including the age at operation, the increase in length, and the healing index, were compared between the 2 groups. The clinical outcome was also compared between the femoral and tibial lengthenings.

RESULTS

Bone marrow cells (average number, +/- SD, 3.2 +/- 1.37 x 10 cells) and PRP (average platelet concentration +/- SD, 2.36 +/- 0.57 x 10 cells/muL) were transplanted. Although there were no significant differences in the age at operation and the length gained between the 2 groups, the average healing index of the BMC-PRP group (27.1 +/- 6.89 d/cm) was significantly lower than that of the control group (36.2 +/- 10.4 d/cm) (P = 0.0005). The femoral lengthening showed significantly faster healing than did the tibial lengthening in the BMC-PRP group (P = 0.0092).

CONCLUSIONS

Transplantation of BMC and PRP shortened the treatment period by accelerating new bone regeneration during DO of the lower extremity in patients with ACH and HCH, especially in the femoral lengthening.

摘要

背景

下肢牵张成骨术（DO）治疗周期延长会导致并发症更频繁发生。我们研发了一种在DO过程中移植培养扩增的骨髓细胞（BMCs）和富血小板血浆（PRP）的新技术，以加速新骨形成。为评估这种细胞治疗的疗效，对软骨发育不全（ACH）和软骨发育低下（HCH）患者在DO期间接受BMC和PRP治疗的骨骼与未接受BMC和PRP治疗的骨骼进行了回顾性比较研究。

方法

将我院20例患者（ACH 16例；HCH 4例）的56根延长骨分为2组。11例患者（男孩7例；女孩4例）的24根骨（股骨12根；胫骨12根）接受了BMC和PRP移植（BMC-PRP组），而9例患者（男孩3例；女孩6例）的32根骨（股骨14根；胫骨18根）未接受额外的细胞治疗（对照组）。比较两组的手术年龄、长度增加量和愈合指数等参数。还比较了股骨和胫骨延长的临床结果。

结果

移植了骨髓细胞（平均数量，±标准差，3.2±1.37×10⁶个细胞）和PRP（平均血小板浓度±标准差，2.36±0.57×10⁹个细胞/μL）。虽然两组的手术年龄和延长长度没有显著差异，但BMC-PRP组的平均愈合指数（27.1±6.89天/cm）显著低于对照组（36.2±10.4天/cm）（P = 0.0005）。在BMC-PRP组中，股骨延长的愈合明显快于胫骨延长（P = 0.0092）。