نویسندگان

دانشگاه علوم پزشکی مشهد

چکیده

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چکیده
مقدمه: «جوش‌ناخوردگی» (nonunion)، یک عارضة جدی به دنبال شکستگی‌ استخوان‌های بلند است که چالش بزرگی برای جراحان ارتوپد به همراه دارد. این نوع شکستگی‌ها عوارض زیادی به دنبال دارند. فاکتورهای تحریک‌کنندة استخوان‌سازی، همراه با بهبود شرایط مکانیکال محیطی می‎توانند سرعت جوش‌خوردن را افزایش دهند. در این مطالعه، هدف ما درمان جوش‌ناخوردگی به کمک سلول‌های تک‌هسته‌ای به دست آمده از مغز استخوان، BMDMC (bone marrow-derived mononuclear cell) و تغلیظ و کاربرد آن به عنوان منشأ سلول‌های استئوپروژنیتور همراه با فیکساسیون داخلی بود.
مواد و روش‌ها: از نوامبر2010 تا می 2013، 19 بیمار با جوش‌ناخوردگی استخوان، تحت درمان با سلول تک‌هسته‌ای مشتق از مغز استخوان (BMDMC) قرار گرفتند که شامل 15 مرد و 4 زن با متوسط سنی 8/37 سال (18 تا 81 سال) بود. فاصلة زمانی بین تروما تا درمان بین 7 تا 28 ماه (میانگین 4/13 ماه) بود. ابتدا قشرزدایی اطراف محل جوش‌ناخورده انجام شد تا بستر مناسب برای سلول‌های تک‌هسته‌ای ایجاد شود. سپس 2 میلی‌لیتر مغز استخوان تغلیظ شده در محل قرار داده شدکه به صورت مخلوط با چیپس آلوگرافت کورتیکوکنسلوس دمینرالیزه بود. سرعت ترمیم به صورت بالینی و رادیولوژیک هر 4 هفته پیگیری شد.
یافته‌ها: جوش‌خوردن استخوان در 18بیمار از19 بیمار، در طول 06/1 تا 6 ماه با متوسط زمانی 5/3 ماه، به دست آمد. در طول مدت بیهوشی عارضه‌ای نداشتیم و هیچ موردی از عفونت، هماتوم یا درد مزمن در بیماران ایجاد نشد.
نتیجه‌گیری: پیوند مغز استخوان خودی با BMDMC یک درمان منطقی، مؤثر و آسان برای درمان جوش‌ناخوردگی استخوان‌های بلند مثل تیبیا و فمور بعد از فیکساسیون داخلی به شمار می‎رود.
 

کلیدواژه‌ها

عنوان مقاله [English]

Concentrated Autologous Bone Marrow-Derived Mononuclear Cells may have Positive Effect on Treatment of Long Bones Fracture Nonunion

نویسندگان [English]

  • Amin Razi
  • Mohammad taghi Peivandi
  • Ali Birjandinejad
  • Sara Amel Farzad

چکیده [English]

Abstract
Background: Nonunion is a serious complication following long-bone fracture that is known as a therapeutic challenge for surgeons and is associated with significant morbidity. It has been shown that osteogenesis stimulating factors combined with optimization of the mechanical environment could facilitate and accelerate nonunion healing. In this study, we aimed to treat nonunion using autologous bone marrow-derived mononuclear cell (BMDMC) aspirate as a source of osteoprogenitor cells combined with internal fixation.
Methods: From November 2010 to May 2013, 19 cases of nonunion were treated with bone marrow-derived mononuclear cell (BMDMC) grafting, that included 15 males and 4 females with an average age of 37.8 years (range, 18-81 years). The time from injury to therapy was 7 to 28 months, with an average of 13.4 months. At first, decortications were performed around the nonunion site to prepare a suitable bed for bone marrow grafting. Then, 2 ml of bone marrow concentrated cells was applied to the nonunion site in a mixture with partially demineralized cortical cancellous allograft chips. The healing rate in each patient was clinically and radiologically evaluated every 4 weeks.
Results: Bone union was obtained in 18 of the 19 patients during 1.06 to 6 months with an average time of 3.5 months. No complications during anesthesia nor any infection, hematoma or chronic pain at the nonunion site were observed in any patient.
Conclusion: Transplantation of autologous BMDMC aspirate is a reasonable, effective and easy treatment option for tibial and femoral nonunion after internal fixation.
Trial registration: This study has been registrated in ClinicalTrials.gov (https://clinicaltrials.gov).
TRN:NCT01788059
 

کلیدواژه‌ها [English]

  • Keywords: Fracture Ununited
  • Fracture Healing
  • Bone Marrow Cells
  • Bone Marrow Transplantation
  • Bony Callus
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