Imam Mohamed A, Holton James, Ernstbrunner Lukas, Pepke Wojciech, Grubhofer Florian, Narvani Ali, Snow Martyn
Department of Trauma and Orthopaedics, Faculty of Medicine, Suez Canal University, Circular road, Ismailia, Egypt.
The Royal Orthopaedic Hospital, Birmingham, UK.
Int Orthop. 2017 Nov;41(11):2213-2220. doi: 10.1007/s00264-017-3597-9. Epub 2017 Aug 13.
Fracture healing encompasses a succession of dynamic multifactorial metabolic events, which ultimately re-establishes the integrity of the biomechanical properties of the bone. Up to 10% of the fractures occurring annually will need additional surgical procedures because of impaired healing. The aim of this article is to review the current literature regarding the use of bone marrow aspirate concentrate (BMAC) and its effectiveness in the management of bone defects.
We have included all published clinical literature investigating the development, techniques and applications of BMAC. Language, design and risk of bias did not deter the initial inclusion of any study. Our search was exclusively limited to studies involving human subjects. A PRISMA compliant search was carried out as published in 2009. This included the online databases: PubMed, EMBASE, clinical trial.gov and the Cochrane library from 1960 to the end of May 2015. MeSH terms used included: "Bone" AND "Marrow" AND "Aspirate" AND "Concentrate" AND "Bone Defects" AND "NONUNION". Eligible studies were independently appraised by two authors using the Critical Appraisal Skills Program checklist. For the purpose of narrative review, relevant studies were included irrespective of methodology or level of evidence.
Thirty-four of the 103 (48 PubMed and 55 EMBASE) results yielded by the preliminary search were included. Exclusions included three duplicate records, six letters, 17 non-orthopaedics related studies and four records irrelevant to our search topic. The CASP appraisal confirmed a satisfactory standard of 31 studies. They all had clearly defined objectives, were well designed and conducted appropriately to meet them. The published studies reported the use of BMAC in non-union and fracture healing (15 studies), bone defects (nine studies), spine fusion (two studies), distraction osteogensis (two studies) and complications related to the use of BMAC (seven studies).
Stem cells found in BMAC have the potential to self-renew, undertake clonal expansion and differentiate into different musculoskeletal tissues. The commercial processing of BMAC needs to be optimized in order to achieve a consistent end product, which will provide predicable and translatable results. The future potential of cell characterization in order to determine the optimum cell for repair/regeneration of bone also needs to be explored.
Systematic Review of minimum level IV studies.
骨折愈合包含一系列动态的多因素代谢事件，最终重新建立骨骼生物力学特性的完整性。每年发生的骨折中，高达10%由于愈合受损而需要额外的外科手术。本文的目的是综述关于使用骨髓抽吸浓缩物（BMAC）及其在骨缺损治疗中的有效性的当前文献。
我们纳入了所有已发表的研究BMAC的开发、技术和应用的临床文献。语言、设计和偏倚风险均不影响对任何研究的初步纳入。我们的检索仅限于涉及人类受试者的研究。按照2009年发表的PRISMA指南进行检索。这包括在线数据库：PubMed、EMBASE、clinicaltrial.gov和Cochrane图书馆，检索时间范围为1960年至2015年5月底。使用的医学主题词包括：“骨”、“骨髓”、“抽吸物”、“浓缩物”、“骨缺损”和“骨不连”。符合条件的研究由两位作者使用批判性评估技能计划清单进行独立评估。为了进行叙述性综述，无论方法或证据水平如何，相关研究均被纳入。
初步检索得到的103项结果（48项来自PubMed，55项来自EMBASE）中有34项被纳入。排除的包括3条重复记录、6封信件、17项与骨科无关的研究以及4条与我们检索主题无关的记录。CASP评估确认31项研究的标准令人满意。它们都有明确界定的目标，设计良好且实施得当以实现这些目标。已发表的研究报告了BMAC在骨不连和骨折愈合（15项研究）、骨缺损（9项研究）、脊柱融合（2项研究）、牵张成骨（2项研究）以及与BMAC使用相关的并发症（7项研究）中的应用。
BMAC中发现的干细胞具有自我更新、进行克隆扩增并分化为不同肌肉骨骼组织的潜力。需要优化BMAC的商业加工以获得一致的最终产品，从而提供可预测和可转化的结果。还需要探索细胞表征在确定用于骨修复/再生的最佳细胞方面的未来潜力。
IV级最低水平的系统综述。
