Voss Andreas, McCarthy Mary Beth, Singh Hardeep, Beitzel Knut, DiVenere Jessica, Cote Mark P, Hoberman Alexander R, Nowak Michael, Imhoff Andreas B, Mazzocca Augustus D
Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.
Arthroscopy. 2017 Jun;33(6):1167-1174.e1. doi: 10.1016/j.arthro.2016.12.013. Epub 2017 Feb 7.
To evaluate the number of connective tissue progenitor cells (CTPs) and nucleated cells obtained during bone marrow aspiration (BMA) from the proximal humerus using either a fenestrated or a nonfenestrated trocar and determine differences in varying amounts of aspiration volume. The first hypothesis was that the number of CTPs extracted with the fenestrated trocar would be greater due to its potential to extract more cells through its fenestrations. The second hypothesis was that using consecutive aspirations with either trocar would provide a consistent number of CTPs and nucleated cells throughout the aspiration with no significant decrease of cells at the end.
Patients were eligible for inclusion if they underwent primary or revision arthroscopic rotator cuff surgery, were between 18 and 75 years of age, and signed the informed consent. Between January 2011 and September 2013, 24 patients underwent BMA from the proximal humerus during arthroscopic surgery. They were grouped according to which of 3 different trocars were used for aspiration: (1) nonfenestrated, (2) fenestrated trocar A, and (3) fenestrated trocar H. Four consecutive 12 mL double syringes were used for each aspiration: 1 (0-12 mL), 2 (12-24 mL), 3 (24-36 mL), and 4 (36-48 mL). One milliliter was removed from each syringe (nonconcentrated BMA). The remainder of the BMA was then spun using a centrifuge. BMA and concentrated BMA were brought to the laboratory, counted for nucleated cells (million cells/mL BMA) and cultured for 7 days to obtain colony-forming units (CTPs/million cells).
No significant differences were observed in tubes 1 to 4 in the number of nucleated cells in the nonconcentrated and concentrated BMA using the nonfenestrated trocar compared with the fenestrated trocars A and H (all P > .05), except for concentrated BMA tube 3 (P = .014) and tube 4 (P = .003). Nonconcentrated and concentrated BMA from tubes 1 to 4 had a significantly higher CTP prevalence using the nonfenestrated trocar compared with the fenestrated trocars A and H (all P < .05). Most of the times the first tube of each aspiration showed a significantly greater amount of cells and a greater CTP prevalence compared with tubes 2, 3, and 4.
Aspiration from the proximal humerus with the nonfenestrated trocar during BMA was associated with higher prevalence of CTPs, suggesting that more CTPs can be obtained using a nonfenestrated trocar. Furthermore, CTPs can be obtained through all consecutive aspirations with a greater amount in the first tubes.
Level II, prospective comparative study.
评估使用有孔或无孔套管针从肱骨近端进行骨髓穿刺（BMA）时获得的结缔组织祖细胞（CTP）和有核细胞数量，并确定不同抽吸量的差异。第一个假设是，由于有孔套管针有潜力通过其孔提取更多细胞，因此用有孔套管针提取的CTP数量会更多。第二个假设是，使用任一套管针连续抽吸，在整个抽吸过程中会获得一致数量的CTP和有核细胞，且最后细胞数量不会显著减少。
符合以下条件的患者可纳入研究：接受初次或翻修关节镜下肩袖手术，年龄在18至75岁之间，并签署知情同意书。2011年1月至2013年9月期间，24例患者在关节镜手术期间从肱骨近端进行了BMA。根据用于抽吸的3种不同套管针将他们分组：（1）无孔，（2）有孔套管针A，和（3）有孔套管针H。每次抽吸使用四个连续的12 mL双筒注射器：1（0 - 12 mL）、2（12 - 24 mL）、3（24 - 36 mL）和4（36 - 48 mL）。从每个注射器中取出1 mL（非浓缩BMA）。然后将剩余的BMA用离心机离心。将BMA和浓缩BMA送至实验室，计数有核细胞（百万细胞/mL BMA），并培养7天以获得集落形成单位（CTP/百万细胞）。
与有孔套管针A和H相比，使用无孔套管针时，非浓缩和浓缩BMA中第1至4管的有核细胞数量在第3管浓缩BMA（P = 0.014）和第4管浓缩BMA（P = 0.003）除外的情况下无显著差异（所有P > 0.05）。与有孔套管针A和H相比，使用无孔套管针时，第1至4管的非浓缩和浓缩BMA的CTP患病率显著更高（所有P < 0.05）。大多数情况下，每次抽吸的第一管与第2、3和4管相比显示出显著更多的细胞数量和更高的CTP患病率。
BMA期间使用无孔套管针从肱骨近端抽吸与更高的CTP患病率相关，这表明使用无孔套管针可获得更多CTP。此外，通过所有连续抽吸均可获得CTP，且第一管中的数量更多。
II级，前瞻性比较研究。
