Porter Ryan M, Liu Fangjun, Pilapil Carmencita, Betz Oliver B, Vrahas Mark S, Harris Mitchel B, Evans Christopher H
Center for Molecular Orthopedics, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Orthop Res. 2009 Jan;27(1):42-9. doi: 10.1002/jor.20715.
Intramedullary nailing preceded by canal reaming is the current standard of treatment for long-bone fractures requiring stabilization. However, conventional reaming methods can elevate intramedullary temperature and pressure, potentially resulting in necrotic bone, systemic embolism, and pulmonary complications. To address this problem, a reamer irrigator aspirator (RIA) has been developed that combines irrigation and suction for reduced-pressure reaming with temperature modulation. Osseous particles aspirated by the RIA can be recovered by filtration for use as an autograft, but the flow-through is typically discarded. The purpose of this study was to assess whether this discarded filtrate has osteogenic properties that could be used to enhance the total repair potential of aspirate. RIA aspirate was collected from five patients (ages 71-78) undergoing hip hemiarthroplasty. Osseous particles were removed using an open-pore filter, and the resulting filtrate (230 +/- 200 mL) was processed by Ficoll-gradient centrifugation to isolate mononuclear cells (6.2 +/- 5.2 x 10(6) cells/mL). The aqueous supernatant contained FGF-2, IGF-I, and latent TGF-beta1, but BMP-2 was below the limit of detection. The cell fraction included culture plastic-adherent, fibroblastic cells that displayed a surface marker profile indicative of mesenchymal stem cells and that could be induced along the osteogenic, adipogenic, and chondrogenic lineages in vitro. When compared to outgrowth cells from the culture of osseous particles, filtrate cells were more sensitive to seeding density during osteogenic culture but had similar capacity for chondrogenesis. These results suggest using RIA aspirate to develop improved, clinically expeditious, cost-effective technologies for accelerating the healing of bone and other musculoskeletal tissues.
对于需要稳定固定的长骨骨折，先进行髓腔扩髓再行髓内钉固定是当前的标准治疗方法。然而，传统的扩髓方法会升高髓腔内的温度和压力，可能导致骨坏死、全身栓塞和肺部并发症。为了解决这个问题，已开发出一种扩髓冲洗吸引器（RIA），它将冲洗和吸引相结合，用于减压扩髓并调节温度。RIA吸出的骨颗粒可通过过滤回收用作自体移植物，但冲洗液通常被丢弃。本研究的目的是评估这种丢弃的滤液是否具有成骨特性，可用于增强吸出物的整体修复潜力。从五名接受半髋关节置换术的患者（年龄71 - 78岁）中收集RIA吸出物。使用开孔过滤器去除骨颗粒，所得滤液（230±200 mL）通过Ficoll梯度离心法处理以分离单核细胞（6.2±5.2×10⁶个细胞/mL）。水性上清液中含有FGF - 2、IGF - I和潜伏性TGF - β1，但BMP - 2低于检测限。细胞部分包括贴壁于培养塑料的成纤维细胞，其表面标志物谱表明为间充质干细胞，并且在体外可沿成骨、成脂和成软骨谱系诱导分化。与骨颗粒培养的贴壁生长细胞相比，滤液细胞在成骨培养期间对接种密度更敏感，但软骨形成能力相似。这些结果表明，可利用RIA吸出物开发改进的、临床快速且经济高效的技术，以加速骨和其他肌肉骨骼组织的愈合。
