Autologous bone marrow stem cell transplant versus autologous iliac bone graft for bone nonunion treatment

Jinguo YUAN; Zhiling ZHOU; Yingfei LIU; Zhenan ZHU

ABSTRACT

BACKGROUND:

The bone marrow stem cell (MSC) transplant treatment have the obvious superiority to tradition graft treatment for bone nonunion, but how to obtain the concentrated and highly effective bone marrow mesenchymal stem cell, as well as the dose-effect relations to fracture healing need further discussions.

OBJECTIVE:

To observe the curative effect of bone nonunion by using autologous MSC transplant treatment, and to compare with autologous iliac bone graft.DESIGN, TIME AND

SETTING:

Randomized controlled analysis was performed from January 1999 to June 2005 in the Affiliated Second Hospital of Hebei Northern College.

PARTICIPANTS:

The admitting 140 patients with humerus and tibia fracture were divided into 2 groups at random, autologous iliac bone graft group and autologous MSC transplant group, with 70 patients in each group.

METHODS:

Under aseptic condition, autologous MSC transplant group received puncture through posterior superior iliac spine, extracting bone marrow 10-20 mL from different spots, separating MSC using the density gradient centrifugation method, and counting as 4×10~9 nucleated cells/mL under the microscope for later use. In the autologous iliac bone graft group, bone fracture end was implanted with the suitable amount of iliac bone, while autologous MSC transplant group with the mixture of decalcified bone matrix and MSC, followed by suture. After the transplantation, external fixation may assist for 4-6 weeks according to the fixed degree of internal fixation.MAIN OUTCOME

MEASURES:

① Bone callus formation and pain conditions in 2 groups at different time points after transplantation. ② Comparison of bone healing time between 2 groups. ③ Adverse events and side effects.

RESULTS:

According to intention-treatment analysis, experimental adopted 140 patients of humerus and tibia fractures, who all entered the final analysis. ① Bone callus formation and pain at different time points post-surgery At 1 month after transplantation, bone callus formation in the fracture end was not obvious in autogenous iliac bone graft group, and could be seen in autologous MSC transplant group, both groups of fractures exhibited tenderness. At 2 months after transplantation, bone callus formation was observed in autogenous iliac bone graft group, fracture tenderness was relieved compared with the previous condition; in autologous MSC transplant group, a large number of bone callus formed, fracture tenderness was not obvious. At 3 months after transplantation, there were a large number of bone callus formations in autogenous iliac bone graft group, with slight fracture tenderness; in the autologous MSC transplant group, continuous bone callus formation appeared, without fracture tenderness. ② Bone healing time The average healing time of autologous MSC transplant group was significantly shorter than autogenous iliac bone graft group [(5.5±1.5), (8.0±2.0) months, P < 0.05]. ③ Adverse events and side effects Except 4 patients had iliac bone pain, all patients during the treatment had no infection and other complications, there were no re-fracture occurred at the follow-up of 8 months.

CONCLUSION:

The autologous MSC transplant treatment of exhibits a short duration and good effect for bone non-union, has obvious advantages over traditional bone graft.