Zhai Lei, Ma Xin-Long, Jiang Chuan, Zhang Bo, Liu Shui-Tao, Xing Geng-Yan
Department of Orthopaedic Surgery, The General Hospital of Tianjin Medical University, Tianjin 300052, P. R. China.
Department of Orthopaedic Surgery, Tianjin Hospital, Hexi District, Tianjin 300211, P. R. China.
Indian J Orthop. 2016 Sep;50(5):543-550. doi: 10.4103/0019-5413.189602.
Currently, the available treatments for long bone nonunion (LBN) are removing of focus of infection, bone marrow transplantation as well as Ilizarov methods etc. Due to a high percentage of failures, the treatments are complex and debated. To develop an effective method for the treatment of LBN, we explored the use of human autologous bone mesenchymal stems cells (hBMSCs) along with extracorporeal shock wave therapy (ESWT).
Sixty three patients of LBN were subjected to ESWT treatment and were divided into hBMSCs transplantation group (Group A, 32 cases) and simple ESWT treatment group (Group B, 31 cases).
The patients were evaluated for 12 months after treatment. In Group A, 14 patients were healed and 13 showed an improvement, with fracture healing rate 84.4%. In Group B, eight patients were healed and 13 showed an improvement, with fracture healing rate 67.7%. The healing rates of the two groups exhibited a significant difference ( < 0.05). There was no significant difference for the callus formation after 3 months treatment ( > 0.05). However, the callus formation in Group A was significantly higher than that in the Group B after treatment for 6, 9, and 12 months ( < 0.05).
Autologous bone mesenchymal stems cell transplantation with ESWT can effectively promote the healing of long bone nonunions.
目前,长骨不愈合(LBN)的现有治疗方法包括清除感染灶、骨髓移植以及伊里扎洛夫方法等。由于失败率较高,这些治疗方法复杂且存在争议。为了开发一种有效的长骨不愈合治疗方法,我们探索了使用人自体骨髓间充质干细胞(hBMSCs)联合体外冲击波疗法(ESWT)。
63例长骨不愈合患者接受ESWT治疗,并分为hBMSCs移植组(A组,32例)和单纯ESWT治疗组(B组,31例)。
治疗后对患者进行12个月的评估。A组中,14例患者愈合,13例有改善,骨折愈合率为84.4%。B组中,8例患者愈合,13例有改善,骨折愈合率为67.7%。两组的愈合率存在显著差异(<0.05)。治疗3个月后骨痂形成无显著差异(>0.05)。然而,治疗6、9和12个月后,A组的骨痂形成明显高于B组(<0.05)。
自体骨髓间充质干细胞移植联合ESWT可有效促进长骨不愈合的愈合。