中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (22): 3463-3468.doi: 10.3969/j.issn.2095-4344.1270

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials • 上一篇    下一篇

重组人骨形态发生蛋白2、富血小板血浆联合植骨与单纯植骨修复骨缺损的比较

李树源，周琦石，李  悦，陈  超，陈家齐，周宏亮，杨佳宝
  

  1. 广州中医药大学第一附属医院一骨科，广东省广州市  510405
  • 收稿日期:2019-03-25
  • 通讯作者: 周琦石，教授，广州中医药大学第一附属医院一骨科，广东省广州市 510405
  • 作者简介:李树源，男，1991年生，山西省汾阳市人，汉族，广州中医药大学第一临床医学院在读硕士，主要从事创伤骨科研究。
  • 基金资助:

    国家自然科学基金资助项目(81674001)，项目负责人：周琦石

Bone grafting with recombinant human bone morphogenetic protein-2 or autologous platelet-rich plasma versus simple bone grafting for repair of bone defects

Li Shuyuan, Zhou Qishi, Li Yue, Chen Chao, Chen Jiaqi, Zhou Hongliang, Yang Jiabao
  

  1. First Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Received:2019-03-25
  • Contact: Zhou Qishi, Professor, First Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Li Shuyuan, Master candidate, First Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81674001 (to ZQS)

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摘要：

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文题释义：
重组人骨形态发生蛋白2：一种促进骨修复的生长因子，是转化生长因子β超家族的成员，在骨骼中已发现的16种骨形态发生蛋白中，只有重组人骨形态发生蛋白2和7两种成品应用于临床，它们可诱导未分化的骨髓间充质干细胞分化为成骨细胞和成软骨细胞，促进细胞增殖，加速骨愈合。
富血小板血浆：通过自体血离心技术获得的一种高浓度血小板血浆制品，可释放多种对骨愈合和骨再生至关重要的生长因子，特别是血小板衍生生长因子、转化生子因子β、成纤维细胞生长因子、表皮生长因子和其他细胞活素，这些生长因子也可诱导骨髓间充质干细胞分化为成骨细胞，并刺激成骨细胞和软骨细胞的分化、成熟，促进骨再生和修复。
 
 
背景：骨形态发生蛋白2与富血小板血浆均具有促进骨愈合的作用，但将其应用于诱导膜技术的基础研究和临床报道较少。
目的：在诱导膜技术二期手术中，比较重组人骨形态发生蛋白2联合植骨、自体富血小板血浆联合植骨与单纯植骨修复骨缺损的临床效果。
方法：纳入2013年1月至2018年1月广州中医药大学第一附属医院收治的59例骨缺损患者，诱导膜Ⅰ期手术后分3组进行Ⅱ期手术：A组(n=20)进行重组人骨形态发生蛋白2联合自体骨移植治疗，B组(n=21)进行自体富血小板血浆联合自体骨移植治疗，C组(n=18)进行自体骨移植治疗。记录术后并发症发生情况(反复感染、关节僵硬、肌肉萎缩、持续疼痛等)，通过X射线评估骨临床愈合时间与骨痂评分。研究经广州中医药大学第一附属医院伦理委员会许可。
结果与结论：①59例患者均获得随访，随访时间11-40个月；②A组平均骨临床愈合时间为(29.30±4.54)周，B组为(28.71±5.37)周，C组为(35.50±7.37)周，A、B组骨临床愈合时间短于C组(P < 0.05)；③A、B组术后半年的骨痂评分高于C组(9.50±1.43，9.14±0.85，7.83±1.42，P < 0.05)；④A组出现2例深部感染、1例骨质吸收；B组出现1例深部感染、1例遗留膝关节僵硬伴中度疼痛；C组出现4例感染、3例骨质吸收、延迟愈合及1例遗留膝关节僵硬伴肌肉萎缩，A、B组并发症例数少于C组(P < 0.05)；⑤结果表明，将骨形态发生蛋白2或自体富血小板血浆应用于诱导膜技术二期植骨中修复骨缺损，具有骨愈合速度较快、愈合效果良好、术后并发症较少的优势。

关键词: 骨形态发生蛋白, 富血小板血浆, 生物工程材料, 生长因子, 诱导膜, 骨缺损, 植骨, 骨修复

Abstract:

BACKGROUND: Both bone morphogenetic protein-2 and platelet-rich plasma can promote bone healing. However, little is reported on application of bone morphogenetic protein-2 or platelet-rich plasma to induced membrane technique in basic research and clinical studies.  
OBJECTIVE: To investigate the clinical efficacy of bone grafting with recombinant human bone morphogenetic protein-2 or autologous platelet-rich plasma versus simple bone grafting in the repair of bone defects during a phase II surgery using induced membrane technique.
METHODS: 59 patients with bone defects who received treatment in the First Affiliated Hospital of Guangzhou University of Chinese Medicine during January 2013-January 2018 were included in this study. Following phase I surgery with induced membrane technique, these patients were assigned to receive phase II surgery: autologous bone grafting with recombinant human bone morphogenetic protein-2 (group A, n=20), autologous bone grafting with autologous platelet-rich plasma (group B, n=21), autologous bone grafting (group C, n=18). Postoperative complications (recurrent infection, joint stiffness, muscle atrophy, persistent pain, etc.) were recorded. Bone healing time and osteophyte score were evaluated by X-rays. This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, China.
RESULTS AND CONCLUSION: (1) All 59 patients were followed up for 11-40 months. (2) The average bone healing time was (29.30±4.54), (28.71±5.37), and (35.50±7.37) weeks in the groups A, B and C, respectively. The average bone time in the groups A and B was significantly shorter than that in the group C (P < 0.05). (3) At 6 months after surgery, the osteophyte scores in the groups A and B were significantly higher than those in the group C (9.50±1.43, 9.14±0.85, 7.83±1.42, P < 0.05). (4) There were two cases of deep infection and one case of bone resorption in the group A. There was one case of deep infection and one case of residual knee stiffness with moderate pain in the group B. There were four cases of infection, three cases of bone resorption, delayed healing and one case of residual knee stiffness and muscle atrophy in the group C. The number of complications in the groups A and B was significantly less than that in the group C (P < 0.05). (5) The results suggest that application of bone morphogenetic protein-2 or autologous platelet-rich plasma to phase II induced membrane technique for repair of bone defects can accelerate bone healing and obtain encouraging repair efficacy with a few postoperative complications.  

Key words: bone morphogenetic protein, platelet-rich plasma, bioengineering material, growth factor, induced membrane, bone defect, bone graft, bone repair

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