Oliver Kristin, Awan Tariq, Bayes Matthew
Bluetail Medical Group, Columbia and St Louis, Missouri, USA.
Family Medicine/Sports Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Orthop J Sports Med. 2017 Aug 29;5(8):2325967117724398. doi: 10.1177/2325967117724398. eCollection 2017 Aug.
Bone marrow concentrate (BMC) is growing in popularity as an alternative treatment option in orthopaedics. The regenerative capacity of BMC has been linked to the number of mesenchymal stem cells (MSCs) present in the graft at the time of its clinical application. MSC counts in bone marrow aspirate (BMA) are affected by harvest technique, but controversy exists over which aspiration method optimizes cellular yield while taking patient comfort and risk into consideration.
To compare a single- versus multiple-site bone marrow aspiration technique to determine which would generate a sufficient volume of high-quality BMA for concentration into a BMC graft. The level of pain experienced by the patient was monitored, since patient comfort should be included in the determination of a safe and effective aspiration technique.
Controlled laboratory study and cohort study; Level of evidence, 2.
BMC samples from 6 patients were sent to an outside source for laboratory analysis. All 6 participants underwent bilateral bone marrow aspiration. Each patient received both techniques at the posterior iliac crest: one side underwent a multiple-site aspiration technique, and the contralateral side underwent a single-site technique with needle redirection. BMA and BMC samples were analyzed for concentrations white blood cells, total nucleated cells, red blood cells, neutrophils, and hematopoietic stem cells. One BMC sample was cultured, and MSC analysis was performed via flow cytometry. All patients underwent monitoring of pain scores during and after the procedure through a visual analog pain scale at 24 hours, 72 hours, and 7 days after BMA.
No significant difference was found between the cell ratios of the single- and multiple-site groups. Both aspiration techniques were found to provide ample colony-forming units without a marked difference in appearance. Additionally, no significant difference was found between groups with regard to MSC numbers. Pain during and 24 hours after the procedure was significantly greater with the multiple-site method than the single-insertion method.
The single-insertion method produced final cellular concentrations and culture results that were not significantly different from those of a multiple-insertion method. Additionally, the single-insertion site technique was significantly less painful to the patient at the time of the procedure as well as 24 hours after aspiration.
The results of this study indicated that a high-quality bone marrow aspirate is possible with a single-stick aspiration method.
骨髓浓缩物（BMC）作为骨科的一种替代治疗选择，越来越受到欢迎。BMC的再生能力与临床应用时移植物中存在的间充质干细胞（MSC）数量有关。骨髓抽吸物（BMA）中的MSC计数受采集技术影响，但在考虑患者舒适度和风险的同时，哪种抽吸方法能优化细胞产量仍存在争议。
比较单点与多点骨髓抽吸技术，以确定哪种技术能产生足够体积的高质量BMA用于浓缩成BMC移植物。监测患者的疼痛程度，因为在确定安全有效的抽吸技术时应考虑患者的舒适度。
对照实验室研究和队列研究；证据等级，2级。
将6例患者的BMC样本送至外部机构进行实验室分析。所有6名参与者均接受双侧骨髓抽吸。每位患者在髂后嵴均接受两种技术：一侧采用多点抽吸技术，对侧采用单点技术并重新定向穿刺针。对BMA和BMC样本进行白细胞、总核细胞、红细胞、中性粒细胞和造血干细胞浓度分析。对一个BMC样本进行培养，并通过流式细胞术进行MSC分析。所有患者在BMA后24小时、72小时和7天通过视觉模拟疼痛量表对手术期间和术后的疼痛评分进行监测。
单点组和多点组的细胞比例无显著差异。两种抽吸技术均能提供充足的集落形成单位，外观无明显差异。此外，两组间MSC数量无显著差异。多点法在手术期间和术后24小时的疼痛明显大于单点法。
单点法产生的最终细胞浓度和培养结果与多点法无显著差异。此外，单点穿刺技术在手术时以及抽吸后24小时对患者的疼痛明显较轻。
本研究结果表明，单针抽吸法可获得高质量的骨髓抽吸物。
