Autologous cell therapy of fracture nonunion - cell phenotype as a predictor of outcome

这项研究是关于利用病人吗？拥有干细胞来帮助他们修复骨骼中的缺陷--通常是高能量事故造成的骨折的后果。我们将研究的特定群体是那些接受Ilizarov技术治疗的人，在这种技术中，缺失的骨骼通过使用外部框架(骨运输)逐渐拉伸骨骼上的伤口来再生。这项技术很强大，可以解决原本难以解决的骨丢失问题，但患者一直表示，他们会重视减少在框架内花费的时间。限速步骤之一是修复两个骨骼末端交界处的部位。目前，我们试图通过钻穿它并注入骨髓来加快这一过程。我们将测试是否通过首先培养来自骨髓的干细胞并大量注射它们来实现更好的刺激。我们将使用CT扫描来测量结果，这可以量化骨形成。然而，我们也将研究来自不同患者的干细胞之间的差异，并试图确定导致更活跃的骨形成的特征。这将为我们应该如何制定培养过程中使用的方案提供指导，以便在使用之前优化细胞。这些问题的答案将对接受骨运输的患者有用，但它们也将对其他骨缺损或骨折无法愈合的患者产生影响。

This study is about using patients? own stem cells to help them heal defects in their bones - usually the consequence of fractures sustained in high energy accidents. The particular group we will study are those receiving treatment by the Ilizarov technique, where missing bone is regenerated by gradually stretching a cut in the bone using an external frame(bone transport). This technique is powerful, resolving otherwise intractable problems of bone loss, but patients consistently say they would value a reduction in the time they need to spend in the frame. One of the rate-limiting steps is healing of the site where the two bone ends meet. We currently try to speed this up by drilling across it and injecting bone marrow. We will test whether we achieve better stimulation by first culturing the stem cells from the bone marrow and injecting them in large numbers. We will measure the result using CT scans, which can quantify bone formation. However we will also study the variation between stem cells from different patients and try to identify features that lead to more vigorous bone formation. This will provide guidance as to how we should develop the protocols used in the culture process, to optimise the cells before use. The answers to these questions will be useful to patients undergoing bone transport, but they will also have implications for other patients with bone defects or fractures that will not heal.