背景：骨髓基质干细胞具有较强的成骨潜能，属于当前组织工程中最为理想的种子细胞。但是，临床上未见将骨髓基质干细胞植入良性骨肿瘤和瘤样病变的研究。 目的：探讨体内灌注诱导骨髓基质干细胞方法，研究骨髓基质干细胞在良性骨肿瘤和瘤样病变患者中的临床治疗效果。 方法：将65例良性骨肿瘤和瘤样病变患者根据治疗措施不同分为单纯植骨组(n=30)和骨髓基质干细胞组(n=35)。单纯植骨组采用生理盐水混合同种异体骨进行30 min浸泡，并植入骨缺损部位。骨髓基质干细胞组根据植骨量从每一位患者身上抽取20-40 mL骨髓，分化、纯化，培养获得骨髓基质干细胞，经过体内灌注方法诱导工程骨，并植入骨缺损部位。 结果与结论：①在倒置相差显微镜下，灌注的骨髓细胞悬液中细胞为圆球形，但是细胞大小不一。细胞灌注最初培养皿造血细胞较多。随着培养时间的延长，可见分布在贴壁梭形细胞及悬浮红细胞，细胞多为圆形、三角形；②两组患者治疗后均进行1-12个月随访，患者术后均为甲级愈合。骨髓基质干细胞组患者感染率、愈合时间显著低于单纯植骨组；③结果提示体内灌注诱导骨髓基质干细胞构建组织工程骨效果理想，能促进血供的重建，将骨髓基质干细胞构建组织工程骨运用于良性骨肿瘤和瘤样病变中能够促进骨融合和骨缺损愈合，具有较高的临床应用价值。%BACKGROUND:Bone marrow stromal stem cels have a strong osteogenic potential, which are currently the most ideal seed cels for tissue engineering. However, there is no clinical report on the treatment of benign bone tumors and tumor-like lesions using bone marrow stromal stem cel transplantation. OBJECTIVE: To investigate thein vivo perfusion method of inducing bone marrow stromal stem cels, and the clinical effects of bone marrow stromal stem cels on benign bone tumors and tumor-like lesions. METHODS: Sixty-five cases of benign bone tumors and tumor-like lesions were divided into three groups according to the different treatments: bone graft group (n=30) and bone marrow stromal stem cels group (n=35). In the bone graft group, alogeneic bone was soaked in normal saline for 30 minutes, and then implanted into the bone defect site. In the bone marrow stromal stem cels group, 20-40 mL of bone marrow from each patient was extracted to isolate, purify and culture bone marrow stromal stem cels that were then perfused into the bone defect site. RESULTS AND CONCLUSION:Under the inverted phase contrast microscope, the perfused cels appeared as a spherical shape, with different sizes. Initialy, there were more hematopoietic cels in the perfusion cel culture. With the extension of the culture time, adherent spindle cels and suspended red blood cels appeared, which were mostly round and triangular. Al the patients were folowed up for 1-12 months and healed wel after surgery. Compared with the bone graft group, infection rate and healing time were both lower in the bone marrow stromal cel group. To conclude, in vivo perfusion of bone marrow stromal stem cels used for construction of tissue-engineered bone promotes blood supply reconstruction and bone healing in patients with benign bone tumors and tumor-like lesions, which is of high clinical values.
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