PURPOSE: demonstrate the effectiveness of CEUS (contrast enhanced ultrasound) in evaluating the process of reparative bone regeneration by monitoring angiogenesis around the fracture site in patients with pseudarthrosis who were treated with transplantation of marrow-derived mesenchymal stem cells (MSCs). METHOD AND MATERIAL: The method was used in 14 patients (50% males, mean age 41.7±12.2 years) of the Traumatology Centre of the CTO-Maria Adelaide Hospital in Torino, Italy from february 2009 to february 2011. The researched patients were treated for delayed multifragmentary fracture healing of long bones evolved in pseudoarthrosis. Autologous concentrate of bone marrow stem cells was applied in one session into the area of bone defect. CEUS examination were performed before the gelatinous compound was applied and at one, four and twelve weeks follow up time points, in order to evaluate the physiological formation of new blood vessels. At the end of the study an X-ray was made to confirm the presence of callus. RESULTS: only three patients showed some spare vessels in the fracture site before the treatment. Ecographic signs of neo-vascularization were noted at one week in 12 of 14 patients; a steady increase in vascularity was demonstrated in 12 patients in subsequent tests; repeated measures ANOVA demonstrated statistically significant differences in the extent of vascularization at subsequent follow-up time points (P <0.0001). At the end of the study X-ray examination revealed initial attachment of calcified callus in those patients who demonstrated an increasement of vascularity at CEUS. The other two patients showed no improvement because of the presence of hematoma at the site of inoculation. CONCLUSION: Pseudoarthrosis represents one of the complications in the treatment of bone fractures. In this case a new treatment option is the transplantation of stem cells which stimulate the revascularization, collagen synthesis and bone regeneration. Our results demonstrate that CEUS has a good predictive value on the formation of callus in that it affords the monitoring of the reparative tissue vascularity, reserving the more invasive X-ray at 3 months from stem cells' implantation.
CEUS evaluation in the pseudarthrosis before and after treatment with autologous transplantation of bone marrow stem cells: preliminary results
Biino G;
2011
Abstract
PURPOSE: demonstrate the effectiveness of CEUS (contrast enhanced ultrasound) in evaluating the process of reparative bone regeneration by monitoring angiogenesis around the fracture site in patients with pseudarthrosis who were treated with transplantation of marrow-derived mesenchymal stem cells (MSCs). METHOD AND MATERIAL: The method was used in 14 patients (50% males, mean age 41.7±12.2 years) of the Traumatology Centre of the CTO-Maria Adelaide Hospital in Torino, Italy from february 2009 to february 2011. The researched patients were treated for delayed multifragmentary fracture healing of long bones evolved in pseudoarthrosis. Autologous concentrate of bone marrow stem cells was applied in one session into the area of bone defect. CEUS examination were performed before the gelatinous compound was applied and at one, four and twelve weeks follow up time points, in order to evaluate the physiological formation of new blood vessels. At the end of the study an X-ray was made to confirm the presence of callus. RESULTS: only three patients showed some spare vessels in the fracture site before the treatment. Ecographic signs of neo-vascularization were noted at one week in 12 of 14 patients; a steady increase in vascularity was demonstrated in 12 patients in subsequent tests; repeated measures ANOVA demonstrated statistically significant differences in the extent of vascularization at subsequent follow-up time points (P <0.0001). At the end of the study X-ray examination revealed initial attachment of calcified callus in those patients who demonstrated an increasement of vascularity at CEUS. The other two patients showed no improvement because of the presence of hematoma at the site of inoculation. CONCLUSION: Pseudoarthrosis represents one of the complications in the treatment of bone fractures. In this case a new treatment option is the transplantation of stem cells which stimulate the revascularization, collagen synthesis and bone regeneration. Our results demonstrate that CEUS has a good predictive value on the formation of callus in that it affords the monitoring of the reparative tissue vascularity, reserving the more invasive X-ray at 3 months from stem cells' implantation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
