University Paris East Hôpital Henri Mondor, 94010 Creteil, France.
University Paris East Hôpital Henri Mondor, 94010 Creteil, France.
Injury. 2022 Oct;53 Suppl 2:S26-S33. doi: 10.1016/j.injury.2020.12.007. Epub 2020 Dec 31.
Open fractures are at risk of nonunion; surgeons are reluctant to propose early standard bone grafting after open fractures, preferring to wait in order to adequately assess the facture status of infection. Bone marrow contains mesenchymal stem cells (MSCs) and granulocyte and macrophage precursors identified in vitro as colony forming units-granulocyte macrophage (CFU-GM), both of which have a prophylactic action against infection. We therefore tested the hypothesis that early injection of bone marrow concentrate would be useful in these fractures.
We evaluated a series of 231 patients who had received early percutaneous implantation of bone marrow concentrate (BMC) to treat open fractures (with gap less than 10 mm) that were Gustilo-Anderson Type II or III. The results were compared with those of 67 control (no early graft) patients and with those of 76 patients treated with an early, standard of care, iliac bone graft. All patients were treated with external fixation and were considered to have an aseptic fracture at the time of early grafting, but the actual status of infection was re-assessed at the time of grafting by histology and/or analysis of the aspirate. The bone marrow graft contained after concentration 49,758 ± 21,642 CFU-GM-derived colonies/cc and 9400 ± 1435 MSCs/cc which represents an important increase compared to the level of CFU-GM cells and MSCs present in a standard auto-graft. Healing was evaluated at 9 months.
The rate of unsuspected infections was higher than 15% in the 3 groups. Bone union and removal of external fixation was achieved at 9 months by 50.7% of patients in the Control Group, by 86.8% of patients in the group with a standard bone graft, and by 87.4% of patients in the bone marrow group. A 90% risk reduction (p = 0.005) in the need for an invasive standard bone graft to treat a nonunion and in the risk of infection was observed when bone marrow was proposed as early injection to the treatment of type II or type-III tibial fractures.
Bone marrow concentrate for early grafting in open fractures with limited gap was efficient for healing while decreasing infection.
开放性骨折有发生骨不连的风险；外科医生不愿意在开放性骨折后立即提出标准的骨移植，而是倾向于等待，以便充分评估感染的骨折状态。骨髓中含有间充质干细胞（MSCs）和粒细胞巨噬细胞前体，在体外被鉴定为集落形成单位-粒细胞巨噬细胞（CFU-GM），两者都具有预防感染的作用。因此，我们假设早期注射骨髓浓缩物对这些骨折是有用的。
我们评估了一组 231 名患者，他们接受了早期经皮植入骨髓浓缩物（BMC）治疗开放性骨折（间隙小于 10mm），这些骨折为 Gustilo-Anderson Ⅱ型或Ⅲ型。结果与 67 名对照（无早期移植物）患者和 76 名早期接受标准髂骨移植的患者进行了比较。所有患者均接受外固定治疗，在早期移植时被认为是无菌性骨折，但在移植时通过组织学和/或抽吸分析重新评估感染的实际状态。骨髓移植后浓缩物中含有 49758±21642 CFU-GM 衍生集落/cc 和 9400±1435 MSCs/cc，与标准自体移植物中 CFU-GM 细胞和 MSCs 的水平相比有显著增加。在 9 个月时进行愈合评估。
3 组中未被怀疑的感染率均高于 15%。在对照组中，50.7%的患者、在标准骨移植组中 86.8%的患者和在骨髓组中 87.4%的患者在 9 个月时达到骨愈合和去除外固定。当将骨髓作为早期注射用于治疗Ⅱ型或Ⅲ型胫骨骨折时，与标准骨移植治疗非愈合和感染的风险相比，非愈合和感染的风险降低了 90%（p=0.005）。
在有限间隙的开放性骨折中进行早期移植物骨髓浓缩物对愈合有效，同时减少感染。
