Hernigou Philippe, Guissou Isaac, Homma Yasuhiro, Poignard Alexandre, Chevallier Nathalie, Rouard Helene, Flouzat Lachaniette Charles Henri
Department of Orthopaedic Surgery, Henri-Mondor Hospital, University of Paris, Créteil Cedex, France,
Int Orthop. 2015 Aug;39(8):1639-43. doi: 10.1007/s00264-015-2738-2. Epub 2015 Mar 22.
Clinical studies in diabetic patients have demonstrated that there is a high incidence of complications in distal tibia and ankle fracture treatments. One strategy to mitigate issues with wound healing and infection in diabetic patients is to use a percutaneous technique in which autologous, bone marrow-derived, concentrated cells are injected at the site of non-unions.
Eighty-six ankle non-union in diabetic patients were treated with bone marrow mesenchymal stem cells (BM-MSCs) delivered in an autologous bone marrow concentrate (BMC). Clinical outcomes of the 86 diabetic non-union patients treated with BMC were compared with 86 diabetic matched non-unions treated with a standard bone iliac crest autograft.
Treatment with BMC promoted non-union healing in 70 among 86 diabetic patients (82.1 %) with a low number of complications. Of the 86 diabetic patients treated with iliac bone graft, 53 (62.3 %) had healing; major complications were observed: 5 amputations, 11 osteonecroses of the fracture wound edge and 17 infections.
In diabetic patients with ankle non-unions, treatment with BM-MSCs from bone marrow concentrate may be preferable in view of the high risks of major complications after open surgery and iliac bone grafting, and improved healing rates compared with standard iliac bone autograft treatment.
糖尿病患者的临床研究表明，胫骨干远端和踝关节骨折治疗中并发症的发生率很高。减轻糖尿病患者伤口愈合和感染问题的一种策略是采用经皮技术，即在骨不连部位注射自体骨髓来源的浓缩细胞。
86例糖尿病患者的踝关节骨不连采用自体骨髓浓缩液（BMC）递送的骨髓间充质干细胞（BM-MSCs）进行治疗。将86例接受BMC治疗的糖尿病骨不连患者的临床结果与86例接受标准髂骨自体骨移植治疗的配对糖尿病骨不连患者进行比较。
BMC治疗使86例糖尿病患者中的70例（82.1%）骨不连愈合，并发症较少。在86例接受髂骨移植的糖尿病患者中，53例（62.3%）愈合；观察到主要并发症：5例截肢、11例骨折伤口边缘骨坏死和17例感染。
对于踝关节骨不连的糖尿病患者，考虑到开放手术和髂骨移植后主要并发症的高风险，以及与标准髂骨自体骨移植治疗相比提高的愈合率，采用骨髓浓缩液中的BM-MSCs治疗可能更可取。
