| Background:Bone defects caused by trauma,bone tumor resection,congenital bone and joint diseases,bone infection and other reasons usually require bone graft materials for repair.Orthopedic operations such as spinal fusion and artificial joint replacement also require a large number of bone graft materials.Traditional bone graft materials such as autogenous bone and allogeneic bone have their own drawbacks.With the use of selective cell retention(SCR)technology,bone marrow was enriched into scaffolds to construct bone graft materials,which provides a new way to promote spinal fusion and repair bone defects.However,the current research about the treatment of clinical diseases with bone marrow-enriched bone graft materials constructed using SCR technology still has some shortcomings,such as small clinical samples,short follow-up period,lack of comparative studies with traditional bone graft materials.Therefore,the effectiveness and security of the clinical application of SCR technology needs to be further validated.Objective:1.To compare the efficacy of allogeneic bone alone and bone marrow-enriched bone graft materials as bone graft fusion materials in scoliosis orthopedic fusion;2.To compare the efficacy of the mixture of allogeneic bone and autologous bone marrow and bone marrow-enriched bone graft materials for the repair of infectious bone defects.Methods:1.Thirty-one patients with adolescent idiopathic scoliosis in our hospital between July 2014 and September 2016 were retrospectively analyzed.The patients were performed posterior spinal fusion with the use of allogeneic bone alone or bone marrow enriched bone graft materials as bone graft fusion materials.According to the different bone graft materials,14 cases were classified into the allogeneic bone alone group(control group),and 17 cases were classified into the bone marrow-enriched bone graft materials group(observation group).Postoperative spinal fusion and deformity correction were evaluated and compared between the two groups by the follow-up methods such as outpatient and telephone.Evaluation and comparison indicators: operation time,intraoperative blood loss,length of hospital stay,correction rate,correction loss,spinal fusion,VAS,ODI,SRS-30,complications.2.Twenty-six patients with infectious bone defects in our hospital between January 2013 and December 2017 were retrospectively analyzed.The patients was performed bone defects repair using the mixture of allogeneic bone and autologous bone marrow and bone marrow-enriched bone graft material as bone graft filling materials.According to the different bone graft materials,13 cases were classified into the mixture of allogeneic bone and autologous bone marrow group(control group),and 13 patients were classified into the bone marrow-enriched bone graft materials group(observation group).Postoperative bone healing and functional recovery were evaluated and compared between the two groups by the follow-up methods such as outpatient and telephone.Evaluation and comparison indicators: operation time,intraoperative blood loss,hospital stay,bone healing time,ADL score,and complications.Results:1.Fourteen patients in the control group were followed up for 50.1 ± 6.5 months,including six males and eight females,with an average age of 14.7 ± 1.3 years.Seventeen patients in the observation group were followed up for 49.9 ± 8.5 months,including eight males and nine females,with an average age of 15.5 ± 2.0 years.There were no significant differences in the operative time,bleeding volume during operation,length of stay,correction rate,and correction loss between the two groups(p > 0.05).The VAS score,ODI score,and SRS-30 score of all patients at the last follow-up were better than those before surgery,but there was no statistical difference between the two groups at preoperatively and the last follow-up(p > 0.05).The fusion rate in the observation group was higher than that in the control group at 6 months after operation.At the last follow-up,the Lenke classification of spinal fusion in the observation group was slightly better than that in the control group.In the observation group,there was 1 case with poor wound healing.No other complications were observed in either gourp.2.Thirteen patients in the control group were followed up for 21.6 ± 10.8 months,including 9 males and 4 females,with an average age of 11.8 ± 4.2 years.Thirteen patients in the observation group were followed up for 24.9 ± 16.3 months,including 10 males and 3 females,with the average age was 11.8 ± 4.1 years.There were no significant differences in bone defects size,operative time,bleeding volume during operation,and hospital stay between the two groups(p > 0.05).The bone healing time in the control group was 5.9 ± 2.1 months,and the bone healing time in the observation group was 4.3 ± 1.3 months.There was a statistical difference in the bone healing time between the two groups(p < 0.05),and the bone healing time of the observation group was shorter than that of the control group.At the last follow-up,the limb function of most of patients recovered to a great extent,but there was no statistical difference between the two groups(p > 0.05).One patient in the control group suffered internal fixation failure due to bone resorption,and bone healing was achieved after another bone graft operation.Conclusions:1.The bone marrow-enriched bone graft material constructed by SCR technology can promote spinal fusion and achieve faster spinal fusion faster than allogeneic bone alone;2.The bone marrow-enriched bone graft material constructed with SCR technology and the mixture of allogeneic bone and autologous bone marrow can achieve satisfactory treatment efficacy in repairing infectious bone defects.However,the bone marrow-enriched bone graft material has a better osteogenesis ability and shorter bone healing time;3.The bone marrow-enriched bone graft material constructed by SCR technology has strong safety,with no obvious complications;4.The use of SCR technology to construct bone marrow-enriched bone graft materials is easy to operate,short in time,and low in bone marrow requirements.It is suitable for clinical promotion and application,particularly for the patients with limited autogenous bone sources. |
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