Department of Pediatric Orthopedics and Traumatology "Gaetano Pini" Orthopedic Institute Milan, Italy.
J Biol Regul Homeost Agents. 2020 Jul-Aug;34(4 Suppl. 3):431-440. Congress of the Italian Orthopaedic Research Society.
Congenital pseudoarthrosis of the tibia (CPT) is a rare disease characterised by the onset of bone anomalies or fractures, leading to deformities in paediatric patients. The aetiology of this pathology is unknown. The main theories include the presence of hamartomatous tissue related to Neurofibromatosis type 1, vascularisation deficit of the periosteum and alterations in the numbers and functions of the osteoblasts and osteoclasts in loco. Surgical treatment generally requires multiple operations during the patient's childhood and adolescence. The best outcomes seem to occur when using intramedullary nailing, vascularised fibular transplant and external fixation with the Ilizarov technique. The purpose of this paper is to evaluate the effectiveness of in-situ injections of Bone Marrow Aspirate Concentrate (BMAC) as an adjuvant therapy for congenital pseudoarthrosis of the tibia in patients treated with external fixation and that of radiographic healing over time compared to external fixation treatment alone. We performed a retrospective review of clinical and radiographic records of patients affected by CPT and treated in the Paediatric Orthopaedics and Traumatology Department of the Gaetano Pini Orthopaedic Institute with in-situ injections of bone marrow aspirate concentrate (BMAC) on the pseudoarthrosis site, in addition to pseudoarthrosis site excision and application of circular external fixator frame in compression (Group A). The time needed to reach the radiological consolidation of the resection site was recorded and compared to that needed for patients treated with only pseudoarthrosis site excision and application of circular external fixator frame in compression (Group B). There is a statistically relevant improvement of healing time in patients affected by congenital pseudoarthrosis of the tibia treated with external fixation and bone marrow aspirate concentrate compared to patients affected by the same pathology treated with external fixation only. Injection of MSC in the pseudoarthrosis site after focus removal in combination with circular external fixation achieves faster bone healing compared with external fixation only, and the lower refracture percentage may be associated with the better quality and structure of the new bone. However, it would be desirable to have a longer followup to determine if the results of the BMC as adjuvant therapy will hold up over time.
先天性胫骨假关节（CPT）是一种罕见的疾病，其特征在于骨骼异常或骨折的发作，导致儿科患者出现畸形。这种病理的病因尚不清楚。主要理论包括存在与神经纤维瘤病 1 型相关的错构组织、骨膜的血管化不足以及局部成骨细胞和破骨细胞的数量和功能改变。手术治疗通常需要在患者的儿童和青少年时期进行多次手术。使用髓内钉、带血管腓骨移植和伊利扎洛夫技术的外固定似乎可以获得最佳效果。本文旨在评估在接受外固定治疗的患者中，骨髓抽吸浓缩物（BMAC）原位注射作为辅助治疗先天性胫骨假关节的有效性，并评估其与单纯外固定治疗相比随时间推移的放射学愈合情况。我们对在 Gaetano Pini 骨科研究所的小儿矫形和创伤科接受骨髓抽吸浓缩物（BMAC）原位注射治疗的 CPT 患者的临床和影像学记录进行了回顾性分析，除了在假关节部位切除并应用环形外固定架加压（A 组）。记录达到切除部位放射学愈合所需的时间，并与仅切除假关节部位和应用环形外固定架加压的患者（B 组）进行比较。与仅接受外固定治疗的患者相比，接受外固定和骨髓抽吸浓缩物治疗的先天性胫骨假关节患者的愈合时间有统计学显著改善。与单纯外固定相比，在去除病灶后在假关节部位注射 MSC 并结合环形外固定可实现更快的骨愈合，较低的再骨折率可能与新骨的质量和结构更好有关。然而，为了确定 BMC 作为辅助治疗的结果是否会随着时间的推移而保持，还需要进行更长时间的随访。
