| ObjectiveThis paper includes two parts: clinical observation and experimental study.By observing platelet-rich plasma(PRP)in the clinical treatment of fracture nonunion,to provide clinical evidence for PRP in the treatment of fracture nonunion.Basic experiments were conducted to investigate the effect of PRP containing Total flavonoids of Rhizoma Drynariae(TFRD)on osteogenic differentiation of rat bone marrow mesenchymal stem cells through SDF-1/CXCR4 pathway,and to explore the potential mechanism of its promotion of osteogenesis and vascularization in bone healing.MethodsA total of 14 patients with fracture nonunion treated with PRP were collected in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2016 to January 2020.General information such as gender,age,fracture site and treatment were collected.Outcome indicators included clinical healing conditions and imaging data were collected,and external callus imaging scoring criteria,fracture line imaging score and bone healing time were obtained according to the imaging data.Basic experiment: rat bone marrow mesenchymal stem cells(MSCs)were extracted and PRP containing TFRD was prepared.The cells were divided into four groups:drug-containing PRP group,drug-containing PRP+AMD3100 group,AMD3100 group and control group.Osteoblasts were induced in each group.CCK-8 was used to detect the proliferation rate of MSCs at day 1,3 and 5,respectively.ALP and alizarin red staining were used to detect the osteogenic ability of MSCs at 7,14 and 21 days.The m RNA expression and protein content of SDF-1,Runx-2,BMP-2 and ALP in MSCs cells were detected by RT-PCR and Western blot.ResultsClinical study: A total of 14 cases of fracture nonunion treated by PRP were collected,including 10 males and 4 females.The mean age was 41.14±15.05 years old(19-64 years old).Fracture nonunion sites: 1 case of radius,8 cases of femur,3 cases of tibia,1 case of humerus,and 1 case of ulna.The average treatment frequency of PRP was1.43±0.62.After treatment,bone healing was achieved in all 14 patients.The mean time of bone healing was 234.64±54.39 days.Imaging score was 4.36±0.48.The follow-up time was 16.14±3.18 months,and the VAS pain score was 1.69±0.67.No complications were observed.Basic research: CCK-8 results showed that PRP containing TFRD could increase the proliferation rate of MSCs(P<0.05),and AMD3100 could inhibit the proliferation of MSCs(P<0.05).ALP and alizarin red staining results showed that PRP containing TFRD could improve the activity of ALP and increase the number of mineralized nodules in MSCs.RT-PCR and Western bloting indicated that PRP containing TFRD could increase the m RNA expression of SDF-1,RUNX-2,BMP-2 and ALP(P<0.05);AMD3100 can inhibit the m RNA and protein expressions of SDF-1,RUNX-2,BMP-2 and ALP in PRP-containing group(P<0.01).ConclusionThrough the clinical case regression study,it is found that PRP has the advantages of simple operation,improving the healing rate and shortening the healing time in the treatment of fracture nonunion disease.By interfering with MSCs,the mechanism of PRP containing osteopractic total flavone in bone healing was investigated,and the effect of PRP containing total flavonoids in bone healing on osteogenic differentiation of rat bone marrow mesenchymal stem cells was preliminarily confirmed through SDF-1/CXCR4 pathway. |
PDF Full Text Request