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脐带间充质干细胞植入治疗半椎体缺损的三年随访:先天性脊柱侧凸治疗的生物学方法——病例报告

Umbilical cord-derived mesenchymal stem cells implantation on Hemivertebra defect with three-year follow-up: Biological approach in congenital scoliosis treatment - A case report.

作者信息

Rahyussalim Ahmad Jabir, Nasser Mochammad Kamal, Al As'ady Faiz Muhammad, Kurniawati Tri

机构信息

Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National General Hospital and Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Stem Cells and Tissue Engineering Research Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.

Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Post Graduate Medical Doctor, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

出版信息

Int J Surg Case Rep. 2022 Oct;99:107602. doi: 10.1016/j.ijscr.2022.107602. Epub 2022 Sep 6.

Abstract

INTRODUCTION AND IMPORTANCE

Congenital scoliosis is abnormal vertebral column growth and development during embryogenesis. The most common type of congenital scoliosis is failure of growth which is called as hemivertebra. However, the recent surgical treatment of hemivertebra has several complications especially in young patient. The mesenchymal stem cells (MSCs) have been used to treat several bone problems including bone defect and may be have potential to treat the defect in hemiverterbra. We reported a hemivertebra treated by umbilical cord-derived MSCs (UC-MSCs).

CASE PRESENTATION

A two-year-old boy presented with scoliosis deformity. The mother noticed the patient's deformity when he was 10th month of age as he learned to stand and progressed since then. There were no growth and development problems. On physical examination, the patient appeared to have scoliosis at lumbar level with bending to the right and asymmetry of waist fold with left shoulder depression. Based on X-ray and CT-Scan investigations, the patient was diagnosed with single fully segmented hemivertebra at 3rd lumbar level. 20 × 10 UC-MSCs were implanted into the bone defect of hemivertebra.

CLINICAL DISCUSSION

At three-year follow-up, the X-ray and MRI investigations showed a decrease of Cobb angle and increase of hemivertebra ratio. These findings may be due to improvement of the bone defect, which is consistent with several studies that MSCs have abilities to promote bone formation by maintaining the osteoblast cells and improving vascularization.

CONCLUSION

We found that MSCs therapy for hemivertebra represent a potential therapy to correct scoliosis curvature and prevent further curvature. Further clinical studies are required to investigate the efficacy of this therapy in hemivertebra.

摘要

引言与重要性

先天性脊柱侧凸是胚胎发育过程中脊柱的异常生长和发育。先天性脊柱侧凸最常见的类型是生长发育不全,即半椎体。然而,近期半椎体的手术治疗存在多种并发症,尤其是在年轻患者中。间充质干细胞(MSCs)已被用于治疗包括骨缺损在内的多种骨骼问题,可能具有治疗半椎体缺损的潜力。我们报告了1例采用脐带间充质干细胞(UC-MSCs)治疗的半椎体病例。

病例介绍

一名两岁男孩出现脊柱侧凸畸形。母亲在患儿10个月大开始学站立时注意到其畸形,此后畸形逐渐加重。患儿无生长发育问题。体格检查发现,患者腰部存在脊柱侧凸,向右侧弯曲,腰部褶皱不对称,左肩凹陷。根据X线和CT扫描检查结果,患者被诊断为第3腰椎水平的单一完全分节型半椎体。将20×10的UC-MSCs植入半椎体的骨缺损处。

临床讨论

在三年的随访中,X线和MRI检查显示Cobb角减小,半椎体比例增加。这些结果可能是由于骨缺损得到改善,这与多项研究结果一致,即MSCs具有通过维持成骨细胞和改善血管生成来促进骨形成的能力。

结论

我们发现,MSCs治疗半椎体是一种纠正脊柱侧凸弯曲和预防进一步弯曲的潜在治疗方法。需要进一步的临床研究来探讨这种治疗方法对半椎体的疗效。

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