Dilogo Ismail Hadisoebroto, Primaputra Muhammad Rizqi Adhi, Pawitan Jeanne Adiwinata, Liem Isabella Kurnia
Consultant of Orthopaedic Trauma and Reconstruction, Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell Medical Technology, Integrated Service Unit, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell and Tissue Engineering Research Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Resident of Orthopaedic Surgery, Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Int J Surg Case Rep. 2017;34:11-16. doi: 10.1016/j.ijscr.2017.03.002. Epub 2017 Mar 6.
Non-union due to large bone loss often causes significant long-term morbidity. We incorporate the use of allogeneic umbilical cord-derived mesenchymal stem cells (UC-MSCs) as part of the diamond concept of regenerative medicine in a case of infected non-union fracture.
We reported a 54-year-old female patient presenting with pain on the right thigh. She was previously diagnosed with a closed fracture of the right femoral shaft and underwent four surgeries before finally being referred to Dr. Cipto Mangunkusumo General Hospital with infected non-union of the right femoral shaft. The patient was treated with a combination of UC-MSCs, bone morphogenetic protein-2 (BMP-2), Hydroxyapatite (HA), and mechanical stabilization using Masquelet Technique. The combination of allogeneic MSCs, BMP2, HA, and Masquelet Technique was successful in creating new bone with no apparent side effects.
Bone loss might be caused by external factors (true defects), or structural loss of the existing bone. The combination of allogeneic UC-MSCs, BMP-2, HA and an induced membrane technique pioneered by Masquelet allowed for faster regeneration process and more optimal bone healing. This paper aims to assess and compare the result of such procedures with the previous four surgeries done to the patient, which did not yield satisfactory results.
The application of allogeneic UC-MSC, BMP-2, HA and Masquelet technique as proposed in the diamond concept is a viable method in treating critical-sized bone defect and provides an effective way to overcome non-union caused by large defect.
由于大量骨质流失导致的骨不连常常会引发严重的长期并发症。在一例感染性骨不连骨折病例中，我们将同种异体脐带间充质干细胞（UC-MSCs）的应用纳入再生医学的钻石概念之中。
我们报告了一名54岁女性患者，其右大腿疼痛。她之前被诊断为右股骨干闭合性骨折，在最终被转诊至西托·曼古库苏莫综合医院时，已因右股骨干感染性骨不连接受了四次手术。该患者接受了UC-MSCs、骨形态发生蛋白-2（BMP-2）、羟基磷灰石（HA）的联合治疗，并采用Masquelet技术进行机械稳定固定。同种异体间充质干细胞、BMP2、HA与Masquelet技术的联合成功地生成了新骨，且无明显副作用。
骨质流失可能由外部因素（真性缺损）或现有骨骼的结构丧失引起。同种异体UC-MSCs、BMP-2、HA与Masquelet首创的诱导膜技术相结合，实现了更快的再生过程和更理想的骨愈合。本文旨在评估并比较该治疗方法与此前对该患者进行的四次未取得满意效果的手术的结果。
钻石概念中所提出的同种异体UC-MSC、BMP-2、HA与Masquelet技术的应用是治疗临界尺寸骨缺损的可行方法，为克服由大缺损导致的骨不连提供了有效途径。
