Kurniawan Aryadi, Ivansyah Muhammad Deryl, Dilogo Ismail Hadisoebroto, Hutami Witantra Dhamar
Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, 10430, Indonesia.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2881-2888. doi: 10.1007/s00590-023-03511-3. Epub 2023 Mar 6.
Most patients with congenital pseudoarthrosis of tibia (CPT) do not have promising outcomes despite multiple attempts using conventional surgeries. The combination of umbilical cord-derived mesenchymal stem cells and conditioned medium (secretome) contains major components pivotal for the enhancement of fracture healing. The purpose of this study was to address fracture healing in CPT cases that were treated using the combined implantation of umbilical-cord mesenchymal stem cells (UC-MSCs) and secretome.
From 2016 to 2017, six patients with CPT who were treated by one senior pediatric orthopedic consultant at a single center (3 girls and 3 boys; mean age of 5.8 years) were included in this case series. A combined procedure including resection of hamartomatous fibrotic tissue, implantation of MSCs and secretome, and fixation using a locking plate and screws was performed. Patients were followed up for a mean of 29 months. Leg-length discrepancy, refracture rate, functional outcome, and radiological outcomes were assessed preoperatively, immediately postoperatively and at the final follow-up.
Five out of 6 (83%) of the patients experienced primary union. One patient experienced refracture; however, 8 months later, after another implantation and reconstruction were performed, union eventually occurred. Significant functional improvement was achieved after at least 1 year of follow-up.
This case series suggests that the combination of secretome and UC-MSCs is a potential treatment for CPT, it highlights the efficacy of the combined procedure in treating CPT and in achieving satisfying results. A larger number of subjects and longer follow-up are required for further study.
尽管多次尝试采用传统手术治疗，但大多数先天性胫骨假关节（CPT）患者的预后并不理想。脐带间充质干细胞与条件培养基（分泌组）的组合包含对促进骨折愈合至关重要的主要成分。本研究的目的是探讨采用脐带间充质干细胞（UC-MSCs）与分泌组联合植入治疗CPT病例的骨折愈合情况。
2016年至2017年，本病例系列纳入了由一位资深小儿骨科顾问在单一中心治疗的6例CPT患者（3名女孩和3名男孩；平均年龄5.8岁）。实施了一项联合手术，包括切除错构瘤性纤维化组织、植入间充质干细胞和分泌组，并使用锁定钢板和螺钉进行固定。对患者进行了平均29个月的随访。在术前、术后即刻和最终随访时评估腿长差异、再骨折率、功能结果和影像学结果。
6例患者中有5例（83%）实现了一期愈合。1例患者发生了再骨折；然而，8个月后，在再次进行植入和重建后，最终实现了愈合。至少随访1年后，功能有显著改善。
本病例系列表明，分泌组与UC-MSCs的联合是CPT的一种潜在治疗方法，它突出了联合手术在治疗CPT及取得满意结果方面的疗效。进一步研究需要更多的受试者和更长时间的随访。
