Hernigou Philippe, Pariat Jacques, Queinnec Steffen, Homma Yasuhiro, Flouzat Lachaniette Charles Henri, Chevallier Nathalie, Rouard Helene
Hopital Henri Mondor, Orthopedic Surgery, Creteil, France,
Int Orthop. 2014 Sep;38(9):1913-21. doi: 10.1007/s00264-014-2285-2. Epub 2014 Feb 9.
The procedure of bone allografting associated with a reinforcement device is widely used for acetabulum revision. However in absence of biologic fixation of the allograft, failure of the reconstruction may occur. We made the hypothesis that it would be possible to load these grafts with bone marrow derived mesenchymal stem cells (MSC) to rescue the osteogenic capacity of an allogenic dead bone and therefore enhance incorporation of allografts with the host bone and decrease the number of failures related to the allograft.
We identified 60 patients who had undergone acetabular component revision for aseptic failure of cemented implants associated with massive periacetabular osteolysis and Paprosky type 3A or 3B classification (without pelvic discontinuity) between 1996 and 2001. The study group of 30 patients received MSCs in the allograft and at the host graft junction. The average total number of MSCs received by each patient was 195,000 cells (range 86,000-254,000 cells). The control group of 30 patients had no MSCs in the allograft. Patients were matched for the size of periacetabular osteolysis (Paprosky type 3A or 3B). We compared the evolution of the allografts and evaluated cup migration and revision of the hips as end points at a minimum of 12 years or until failure.
Better radiographic graft union rates and less allograft resorption were observed with allografts loaded with stem cells. Allograft resorption was significantly decreased in the group with allograft loaded with MSCs (1.2 cm(2) -range 0-2.3 cm(2)-of resorption on radiographs in the group with MSCs; versus 6 cm(2), range 2.1-8.5 cm(2) in the group without MSCs). The rate of mechanical failure was highest (p = 0.01) among the 30 patients with allograft without stem cells (9/30; 30 %) compared with no failures for patients with allograft loaded with stem cells. Revision of the cup was necessary in nine patients in the control group. No revision was performed in the 30 patients of the study group with MSCs.
For acetabular defect reconstruction, loading the allograft with MSCs has resulted in a lower rate of failure as compared with allograft without MSCs.
与强化装置相关的同种异体骨移植手术广泛用于髋臼翻修。然而，在同种异体骨缺乏生物固定的情况下，可能会发生重建失败。我们提出假设，向这些移植物中加载骨髓间充质干细胞（MSC）可以挽救同种异体死骨的成骨能力，从而增强同种异体骨与宿主骨的融合，并减少与同种异体骨相关的失败次数。
我们确定了60例在1996年至2001年间因骨水泥型植入物无菌性失败伴大量髋臼周围骨溶解以及Paprosky 3A或3B型分类（无骨盆连续性中断）而接受髋臼部件翻修的患者。30例患者的研究组在同种异体骨及宿主移植物结合处接受了MSC。每位患者接受的MSC平均总数为195,000个细胞（范围86,000 - 254,000个细胞）。30例患者的对照组在同种异体骨中未使用MSC。患者根据髋臼周围骨溶解的大小（Paprosky 3A或3B型）进行匹配。我们比较了同种异体骨的演变情况，并将髋臼迁移和髋关节翻修作为至少12年或直至失败的终点进行评估。
观察到加载干细胞的同种异体骨具有更好的影像学骨融合率和更少的同种异体骨吸收。加载MSC的同种异体骨组的同种异体骨吸收明显减少（MSC组X线片上的吸收面积为1.2 cm²，范围0 - 2.3 cm²；而未使用MSC的组为6 cm²，范围2.1 - 8.5 cm²）。在30例未使用干细胞的同种异体骨患者中，机械性失败率最高（p = 0.01）（9/30；30%），而加载干细胞的同种异体骨患者未出现失败情况。对照组有9例患者需要进行髋臼翻修。研究组使用MSC的30例患者未进行翻修。
对于髋臼缺损重建，与未使用MSC的同种异体骨相比，向同种异体骨中加载MSC可降低失败率。
