Mazzocca Augustus D, McCarthy Mary Beth R, Chowaniec David M, Cote Mark P, Arciero Robert A, Drissi Hicham
University of Connecticut, Department of Orthopaedic Surgery, Farmington, CT 06034, USA.
Am J Sports Med. 2010 Jul;38(7):1438-47. doi: 10.1177/0363546509360924. Epub 2010 Apr 7.
Bone-to-tendon healing in the shoulder can be unpredictable. Biologic augmentation, through the implementation of adult mesenchymal stem cells, may improve this healing process.
The purpose of this study was to (1) arthroscopically obtain bone marrow aspirates from the proximal humerus during rotator cuff repair, (2) purify and concentrate the connective tissue progenitor cells (CTPs) in the operating room efficiently, and (3)confirm these are stem cells through their ability to differentiate into bone cells. We hypothesize that CTPs can be quickly and efficiently isolated from bone marrow during arthroscopic surgery and that these cells are capable of osteogenesis.
Cohort study; Level of evidence, 3; and Descriptive laboratory study.
Bone marrow aspirates were harvested through the anchor tunnel of the humeral head during arthroscopic rotator cuff repair in 23 patients. Twenty-three matched controls were selected from a clinical registry to evaluate for increased incidence of complication. Connective tissue progenitor cells were isolated using 2 accepted methods and compared with a novel, rapid method designed for use in the operating room. Osteogenic potential was assessed by cytochemical and molecular analysis.
Reverse transcription polymerase chain reaction analysis and cellular staining confirmed the osteogenic potential of these CTPs. There was no statistical significant difference in the Single Assessment Numeric Evaluation score (aspirate, 86.3 +/- 10.5; control, 83.6 +/- 15.1; P = .54), range of motion measures (postoperative external rotation: aspirate, 65.0 degrees +/- 20.4 degrees ; control, 62.5 degrees +/- 17.1 degrees ; P = .67; postoperative forward elevation: aspirate, 163.0 degrees +/- 30.6 degrees ; control, 145.7 degrees +/- 41.4 degrees ; P = .12), or postoperative strength measures between groups (median, 5; range, 4-5 in the aspirate group compared with median, 5; range, 4-5 in the control group; P > .05).
Connective tissue progenitor cells can be safely and efficiently aspirated from the proximal humerus using the anchor tunnel created during arthroscopic rotator cuff surgery. These cells may play an important role in cell-based therapies involving rotator cuff repair.
We have established a reliable, reproducible protocol for isolating CTPs in the operating room. These cells may have the potential to enhance the healing process after rotator cuff repair.
肩部骨与肌腱的愈合情况可能难以预测。通过应用成人间充质干细胞进行生物增强，可能会改善这一愈合过程。
本研究的目的是：（1）在肩袖修复过程中通过关节镜从肱骨近端获取骨髓抽吸物；（2）在手术室中高效地纯化和浓缩结缔组织祖细胞（CTP）；（3）通过这些细胞分化为骨细胞的能力来确认它们是干细胞。我们假设在关节镜手术期间可以从骨髓中快速有效地分离出CTP，并且这些细胞具有成骨能力。
队列研究；证据等级：3；以及描述性实验室研究。
在23例患者的关节镜肩袖修复过程中，通过肱骨头的锚定通道获取骨髓抽吸物。从临床登记处选择23例匹配的对照，以评估并发症发生率的增加情况。使用两种公认的方法分离结缔组织祖细胞，并与一种设计用于手术室的新型快速方法进行比较。通过细胞化学和分子分析评估成骨潜能。
逆转录聚合酶链反应分析和细胞染色证实了这些CTP的成骨潜能。单评估数字评价评分（抽吸组，86.3±10.5；对照组，83.6±15.1；P = 0.54）、活动度测量（术后外旋：抽吸组，65.0°±20.4°；对照组，62.5°±17.1°；P = 0.67；术后前屈：抽吸组，163.0°±30.6°；对照组，145.7°±41.4°；P = 0.12）或两组间术后力量测量结果（抽吸组中位数为5；范围为4 - 5，对照组中位数为5；范围为4 - 5；P＞0.05）之间均无统计学显著差异。
使用关节镜肩袖手术期间创建的锚定通道，可以安全有效地从肱骨近端抽吸结缔组织祖细胞。这些细胞可能在涉及肩袖修复的细胞治疗中发挥重要作用。
我们已经建立了一种在手术室中分离CTP的可靠、可重复的方案。这些细胞可能具有增强肩袖修复后愈合过程的潜力。
