Percutaneous autologous bone-marrow grafting for nonunions. Surgical technique.
Percutaneous autologous bone-marrow grafting for nonunions. Surgical technique.
复制标题
经皮自体骨髓移植治疗骨不连。
DOI：
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发表时间：
2006
期刊：
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通讯作者：
H. Rouard
中科院分区：
文献类型：
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作者：
P. Hernigou;G. Mathieu;A. Poignard;O. Manicom;F. Beaujean;H. Rouard
背景
从髂骨中抽取的骨髓含有可用于骨不连愈合的祖细胞。然而，关于获得骨修复所必需的这些细胞的数量和浓度，可用的信息很少。本研究的目的是评估移植治疗骨不连的祖细胞的数量和浓度、移植后骨痂的体积和临床愈合率。
方法
从两个髂骨前部抽出骨髓，集中在细胞分离器上，然后注入60个未感染的胫骨萎缩性骨不连。每一例骨不连患者均接受相对恒定体积的20厘米(3)的浓缩骨髓。通过计算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个月进行的扫描来确定矿化骨形成的体积。
结果
浓缩前平均(和标准差)为612+/-134个祖细胞/厘米(3)(范围为12-1224个/厘米(3))，浓缩后平均为2579+/-1121个祖细胞/厘米(3)(范围为60-6120个/厘米(3))。平均每个骨不连内注入51×10(3)个成纤维细胞集落形成单位。53例患者骨愈合，植入骨不连的骨髓中含有1500个祖细胞/厘米(3)，平均总共有54,962+/-17,431个祖细胞。未愈合的7例患者骨不连部位的祖细胞浓度(634+/-187个/cm~(3))和植入的祖细胞总数(19,324+/-6843个)均显著低于骨愈合组(P=0.001和P<0.01)。骨折愈合后4个月计算机断层扫描测得的矿化骨痂体积为0.8~5.3 cm(3)，平均3.1 cm(3)。4个月时矿化骨痂的体积与移植物内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。愈合所需时间与移植物中成纤维细胞集落形成单位的浓度呈负相关(p=0.04)。
结论
经皮自体骨髓移植是治疗萎缩性胫骨骨干骨不连的一种安全有效的方法。然而，其疗效似乎与移植物中的祖细胞数量有关，在没有浓缩的情况下，从髂骨提取的骨髓中可获得的祖细胞数量似乎不是最理想的。
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/cm(3) (range, 60 to 6120 progenitors/cm(3)) after concentration. An average total of 51 x 10(3) 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.