Zhang Pu, Gan Yao-Kai, Tang Jian, Hao Yong-Qiang, Wang You, Sun Yue-Hua, Zhu Zhen-An, Dai Ke-Rong
Department of Orthopaedics, Shanghai Ninth People's Hospital, School of Medicine of Shanghai Jiaotong University, Shanghai 200011, China.
Zhonghua Wai Ke Za Zhi. 2008 Apr 1;46(7):493-6.
To explorer the effectiveness of enriched bone marrow stem cells technique for lumbar fusion.
With the randomization and control principles, 2 graft materials [Enrichment bone marrow mesenchymal stem cells hybridized with beta-tri calcium phosphate (composite graft group), autologous iliac crest bone graft (autograft group)] were compared in posterior lumbar fusion procedures. 56 patients with degenerative disc disease, lumbar instability or spinal stenosis, were included. The volume of cells suspension in pre- and post-enrichment and the number of nucleated cells (NCs) were identified. The number of osteoprogenitor cells was estimated by counting the colony-forming units which express alkaline phosphatase (CFUs/ALP+). Then the efficiency of the enrichment was evaluated. Clinical follow-up with roentgenogram and Oswestry scale scores was performed for outcome evaluation.
(249 +/- 31) ml bone marrow per patient from bilateral iliac crests was aspirated peri-operatively. About (43 +/- 11) ml enriched bone marrow was collected. The number of NCs was concentrated from (15.9 +/- 3.3) x 10(6)/ml to (44.1 +/- 10.8) x 10(6)/ml, CFUs/ALP+ was significantly increased from (118 +/- 86)/ml to(486 +/- 305)/ml. The follow-up was about (26.3 +/- 7.5) months. There was no significant differences in age, gender, disease and fusion segments between the two groups. The fusion rate was 93.3% and 96.2% for composite graft group and autograft group, respectively (chi2 = 0.2146, P = 0.6432). There was no difference in operation time between the two group (t = 0.5243, P = 0.6022), but blood loss in composite graft group was more than that in autograft group (t = 6.4664, P < 0.01). Cell salvage for auto-transfusion could transfuse back half of the blood loss during operation. No hematoma or chronic soreness in the bone marrow donor sites of composite graft group occurred, but a little exudation or moderate swelling in the wound happened in 4 cases which disappeared under medical treatment. Meanwhile, 15.4% patients had hematoma in the iliac bone donor site and 26.9% patients had chronic soreness, but no case had wound problem in autograft group. As for Oswestry scale scores, there was no significant difference between the two groups.
The enrichment technique of autologous bone marrow stem cells can greatly increase the concentration of MSCs. It is a rapid and safe method used peri-operatively. The composite material of enriched MSCs and porous beta-TCP is a good bone substitute in posterior spinal fusion.
探讨富集骨髓干细胞技术用于腰椎融合的有效性。
按照随机对照原则，在腰椎后路融合手术中比较两种移植材料[富集骨髓间充质干细胞与β-磷酸三钙混合（复合移植组）、自体髂骨植骨（自体移植组）]。纳入56例患有退行性椎间盘疾病、腰椎不稳或椎管狭窄的患者。确定富集前后细胞悬液的体积以及有核细胞（NCs）数量。通过计数表达碱性磷酸酶的集落形成单位（CFUs/ALP+）来估算成骨祖细胞数量。然后评估富集效率。采用X线片和Oswestry功能障碍指数评分进行临床随访以评估结果。
术中从双侧髂嵴为每位患者抽取（249±31）ml骨髓。收集到约（43±11）ml富集骨髓。NCs数量从（15.9±3.3）×10⁶/ml浓缩至（44.1±10.8）×10⁶/ml，CFUs/ALP+从（118±86）/ml显著增加至（486±305）/ml。随访时间约为（26.3±7.5）个月。两组在年龄、性别、疾病和融合节段方面无显著差异。复合移植组和自体移植组的融合率分别为93.3%和96.2%（χ² = 0.2146，P = 0.6432）。两组手术时间无差异（t = 0.5243，P = 0.6022），但复合移植组的失血量多于自体移植组（t = 6.4664，P < 0.01）。自体血回输可回输手术中一半的失血量。复合移植组骨髓供区未发生血肿或慢性疼痛，但4例患者伤口有少量渗出或中度肿胀，经治疗后消失。同时，自体移植组15.4%的患者髂骨供区有血肿，26.9%的患者有慢性疼痛，但无一例患者有伤口问题。至于Oswestry功能障碍指数评分，两组之间无显著差异。
自体骨髓干细胞富集技术可大幅提高间充质干细胞浓度。这是一种在手术中使用的快速且安全的方法。富集间充质干细胞与多孔β-TCP的复合材料是后路脊柱融合术中良好的骨替代物。
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