Guimarães João Antonio Matheus, Duarte Maria Eugenia L, Fernandes Marco B Cury, Vianna Verônica F, Rocha Tito H N, Bonfim Danielle C, Casado Priscila L, do Val Guimarães Isabel C C, Velarde Luis G Coca, Dutra Hélio S, Giannoudis Peter V
National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil.
Injury. 2014 Nov;45 Suppl 5:S7-S13. doi: 10.1016/S0020-1383(14)70013-0.
The aim of this study was to assess the union rates in a series of patients with failed femoral shaft aseptic non-union who were treated with percutaneous concentrated autologous bone marrow grafting. Bone marrow harvesting and cell injection were performed under general anaesthesia in a single surgical procedure. Radiographic union was diagnosed in fractures with a score ≥ 10 according to the radiographic union scale in tibial fractures (RUST) and confirmed by clinical examination. Eight out of 16 patients progressed to consolidation (RUST score ≥ 10). Radiographic evidence of fracture union was observed at an average of 4.75 ± 1.75 months (range 3 to 8 months). All eight patients who did not progress to union within 12 months following the cell grafting procedure had a RUST score ≤ 10 (range 4 to 9). There were no differences in age, number of previous surgeries, duration of nonunion and preoperative RUST score between the patients that developed solid union and those with failed consolidation. However, a relationship between the number of osteoprogenitors injected and the rate of union was noted, 20.2 ± 8.6 × 10(8) versus 9.8 ± 4.3 × 10(8), p<0.005, between the patients with and without union, respectively. The efficacy of percutaneous autologous concentrated bone marrow grafting seems to be related to the number of osteoprogenitors available in the aspirates. Optimisation of the aspiration technique and concentration process is of paramount importance to increase the incidence of a successful outcome.
本研究的目的是评估一系列股骨干无菌性骨不连患者经皮注射浓缩自体骨髓移植后的骨愈合率。骨髓采集和细胞注射在全身麻醉下于单一手术过程中进行。根据胫骨骨折的影像学骨愈合量表（RUST），评分≥10分的骨折被诊断为影像学愈合，并经临床检查确认。16例患者中有8例实现骨愈合（RUST评分≥10）。骨折愈合的影像学证据平均在4.75±1.75个月时出现（范围为3至8个月）。在细胞移植术后12个月内未实现骨愈合的所有8例患者的RUST评分均≤10（范围为4至9）。实现牢固骨愈合的患者与骨愈合失败的患者在年龄、既往手术次数、骨不连持续时间和术前RUST评分方面无差异。然而，观察到注射的骨祖细胞数量与骨愈合率之间存在关联，骨愈合患者与未愈合患者的骨祖细胞数量分别为20.2±8.6×10⁸和9.8±4.3×10⁸，p<0.005。经皮自体浓缩骨髓移植的疗效似乎与抽吸物中可用的骨祖细胞数量有关。优化抽吸技术和浓缩过程对于提高成功结果的发生率至关重要。
