Terapia celular da pseudoartose

Abstract

ObjectiveTo assess the safety and efficiency of cell therapy for pseudarthrosis. Implant of the bone marrow aspirate was compared to mononuclear cells purified extemporaneously using the Sepax® equipment.MethodsSix patients with nonunion of the tibia or femur were treated. Four received a percutaneous infusion of autologous bone marrow aspirated from the iliac crest, and two received autologous bone marrow mononuclear cells separated from the aspirate with the Sepax®. The primary fixation method was unchanged, and the nonunion focus was not exposed. Physical examination and radiographies were performed 2, 4 and 6 months after the treatment by the same physician. After consolidation of the fracture the satisfaction of the patients was estimated using the adapted QALY scale.ResultsNo complications occurred as a result of the referred procedures. Bone consolidation was obtained in all cases within 3 to 24 weeks. The degree of patient satisfaction before and after bone consolidation was assessed, with the average value increasing from two to nine (p=0.0156).ConclusionWe conclude that the proposed method is effective and safe for the treatment of nonunion of long bones regardless of the stabilization method used. Level of Evidence II, Prospective Comparative Study

Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review

“…Nine studies evaluated the use of cBMA in bone healing summarized in Table 4 [ 25 - 33 ]. Eight of nine studies reported on the use of cBMA in either non-union or delayed union.…”

“…One study found a significantly lower number of progenitor cells in patients who did not achieve union as well as a negative correlation between the time needed to obtain union and the concentration of colony forming units in the graft[ 30 ]. Lastly, one study evaluated the efficacy of cBMA in the treatment of open tibia fractures and found adequate bone consolidation and bone callus formation in all patients[ 25 ]. Variation of cBMA application was seen amongst the studies evaluated.…”

“…This finding was also supported by Guimaraes et al[ 28 ] demonstrating that grafts used in patients whom treatment failed contained significantly lower number of total nucleated cells. Bastos Filho et al[ 25 ] compared using cBMA vs whole volume BMA reporting no significant difference in time to union and patient satisfaction score. Although no significant difference was reported, this may be attributed to the small sample size in the cBMA group ( n = 2) and minimal follow up.…”

Intervenção Cirúrgica Tardia em Pseudoartrose Diafisária de Fêmur: Relato de Caso

“…O tratamento invasivo das fraturas aumenta os riscos de perda da vascularização óssea, podendo então gerar também complicações pós-operatórias como a proliferação de infecções no local de fratura. Sendo assim, independente do método utilizado como abordagem, não existe uma alternativa de tratamento apresentando somente benefícios e isenção de riscos [1][2][3]5,13,14 . Neste caso, em breve haverá implantação de outra técnica de osteossíntese, porém, atualmente existem outros tipos de alternativa, como a placa onda.…”

“…Estima-se que aproximadamente 5% de fraturas de ossos longos evoluem para tal, que se associa a sintomas específicos e difícil tratamento clínico [1][2][3][4] . Todavia, constitui um processo grave, capaz de gerar incapacidade em nível severo ou lesão permanente nos pacientes.…”