Hernigou Philippe, Dubory Arnaud, Homma Yasuhiro, Flouzat Lachaniette Charles Henri, Chevallier Nathalie, Rouard Helene
Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France.
Int Orthop. 2018 Oct;42(10):2443-2450. doi: 10.1007/s00264-017-3687-8. Epub 2017 Nov 13.
Infected non-unions present a clinical challenge, especially with risk of recurrent infection. Bone marrow contains granulocyte precursors identified in vitro as colony forming units-granulocyte macrophage (CFU-GM) have a prophylactic action against infection. We therefore tested the hypothesis that bone marrow concentrated granulocytes precursors added to a standard bone graft could decrease the risk of recurrence of infection when single-stage treatment of infected tibial non-unions is performed with bone graft.
During a single-stage procedure 40 patients with infected tibial non-union received a spongious bone graft supercharged with granulocytes precursors after debridement (study group). A control group (40 patients) was treated in a single stage with local debridement and standard bone graft obtained from the iliac crest. The antibiotic therapy protocol was the same (60 days) in the two groups. CFU-GM progenitors were harvested from bone marrow aspirated on the opposite iliac crest of the site where the cancellous bone was obtained. Union (radiographs and CT scan), a recurrence of clinical infection, and need for subsequent surgery were evaluated.
Thirty-eight (95%) patients who received graft supercharged with granulocytes precursors achieved successful union without recurrence of infection during the seven-year follow-up versus 28 (70%) control patients; for the control group the mean graft resorption volume was 40%, while no bone graft resorption was found for the study group.
Supercharging the cancellous bone graft with bone marrow granulocytes precursors protect the site of infected non-union from recurrence of infection and bone resorption of the graft.
感染性骨不连是一项临床挑战，尤其是存在反复感染的风险。骨髓中含有在体外被鉴定为集落形成单位-粒细胞巨噬细胞（CFU-GM）的粒细胞前体，其对感染具有预防作用。因此，我们检验了这样一个假设，即在对感染性胫骨骨不连进行单阶段植骨治疗时，向标准骨移植材料中添加骨髓浓缩粒细胞前体可降低感染复发的风险。
在单阶段手术过程中，40例感染性胫骨骨不连患者在清创后接受了富含粒细胞前体的松质骨移植（研究组）。对照组（40例患者）接受单阶段局部清创和取自髂嵴的标准骨移植治疗。两组的抗生素治疗方案相同（60天）。CFU-GM祖细胞从获取松质骨部位对侧髂嵴抽取的骨髓中采集。评估骨愈合情况（X线片和CT扫描）、临床感染复发情况以及后续手术需求。
在七年随访期间，38例（95%）接受富含粒细胞前体移植的患者实现了成功骨愈合且无感染复发，而对照组为28例（70%）；对照组的平均植骨吸收量为
