Percutaneous autologous bone-marrow grafting for nonunions - Influence of the number and concentration of progenitor cells
Percutaneous autologous bone-marrow grafting for nonunions - Influence of the number and concentration of progenitor cells
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DOI：
10.2106/jbjs.d.02215
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发表时间：
2005-07-01
影响因子：
5.3
通讯作者：
Rouard, H
中科院分区：
文献类型：
--
作者：
Hernigou, P;Poignard, A;Rouard, H
背景：从髂嵴抽取的骨髓含有祖细胞，可用于骨不连的骨愈合。然而，关于获得骨修复所需的这些细胞的数量和浓度的可用信息很少。本研究的目的是评估祖细胞的数量和浓度，移植治疗骨不连，骨痂体积移植后获得的，和临床愈合率。方法：骨髓被吸出两个髂前嵴，集中在一个细胞分离器，然后注射到60个非感染性萎缩性骨不连的胫骨。每例骨不连接受相对恒定体积的20 cm（3）浓缩骨髓。通过计数成纤维细胞集落形成单位来估计移植的祖细胞的数量。通过比较术前计算机断层扫描和注射后4个月进行的扫描，确定矿化骨形成的体积。吸出物平均含有612 +/- 134个祖细胞/cm（3）（范围，12至1224个祖细胞/cm（3））和浓缩后平均2579 1121个祖细胞/cm（3）（范围，60至6120个祖细胞/cm（3））。每个骨不连平均注射51 x 103个成纤维细胞集落形成单位。53名患者获得了骨愈合，注射到这些患者骨不连处的骨髓含有> 1500个祖细胞/cm 3，平均总数为54，962 +/-17，431个祖细胞。7名未获得骨愈合的患者的骨不连部位注射的祖细胞浓度（634 +/- 187个祖细胞/cm 3）和总数（19，324 +/- 6843）均显著低于获得骨愈合的患者（分别为p = 0.001和p < 0.01）。在4个月时，通过计算机断层扫描测量愈合患者的矿化骨痂体积，范围为0.8至5.3 cm（3）（平均3.1 cm（3））。四个月时矿化愈伤组织的体积与移植物中成纤维细胞集落形成单位的数量（p = 0.04）和浓度（p = 0.01）呈正相关。有一个负相关的时间之间需要获得愈合和成纤维细胞集落形成单位的浓度在移植物（p = 0.04）。结论：经皮自体骨髓移植是一种有效和安全的方法治疗萎缩性胫骨骨干骨不连。然而，其疗效似乎与移植物中的祖细胞数量有关，并且在缺乏浓缩的情况下，从髂嵴抽吸的骨髓中可用的祖细胞数量似乎低于最佳水平。
Background: Bone marrow aspirated from the iliac crest contains progenitor cells that can be used to obtain bone-healing of nonunions. However, there is little available information regarding the number and concentration of these cells that are necessary to obtain bone repair. The purpose of this study was to evaluate the number and concentration of progenitor cells that were transplanted for the treatment of nonunion, the callus volume obtained after the transplantation, and the clinical healing rate.Methods: Marrow was aspirated from both anterior iliac crests, concentrated on a cell separator, and then injected into sixty noninfected atrophic nonunions of the tibia. Each nonunion received a relatively constant volume of 20 cm(3) of concentrated bone marrow. The number of progenitor cells that was transplanted was estimated by counting the fibroblast colony-forming units. The volume of mineralized bone formation was determined by comparing preoperative computerized tomography scans with scans performed four months following the injection.Results: The aspirates contained an average (and standard deviation) of 612 +/- 134 progenitors/cm(3) (range, 12 to 1224 progenitors/cm(3)) before concentration and an average of 2579 1121 progenitors/cm3 (range, 60 to 6120 progenitors/cm(3)) after concentration. An average total of 51 x 103 fibroblast colony-forming units was injected into each nonunion. Bone union was obtained in fifty-three patients, and the bone marrow that had been injected into the nonunions of those patients contained > 1500 progenitors/cm(3) and an average total of 54,962 +/- 17,431 progenitors. The concentration (634 +/- 187 progenitors/cm(3)) and the total number (19,324 +/- 6843) of progenitors injected into the nonunion sites of the seven patients in whom bone union was not obtained were both significantly lower (p = 0.001 and p < 0.01, respectively) than those in the patients who obtained bone union. The volume of the mineralized callus measured at four months on the computerized tomography scans of the patients who had union ranged from 0.8 to 5.3 cm(3) (mean, 3.1 cm(3)). There was a positive correlation between the volume of mineralized callus at four months and the number (p = 0.04) and concentration (p = 0.01) of fibroblast colony-forming units in the graft. There was a negative correlation between the time needed to obtain union and the concentration of fibroblast colony-forming units in the graft (p = 0.04).Conclusions: Percutaneous autologous bone-marrow grafting is an effective and safe method for the treatment of an atrophic tibial diaphyseal nonunion. However, its efficacy appears to be related to the number of progenitors in the graft, and the number of progenitors available in bone marrow aspirated from the iliac crest appears to be less than optimal in the absence of concentration.