application of autologous mesenchymal stem cells, a randomized clinical trial
(Dental Traumatology 2017; 33: 38–44) 原文作者姓名： Guadalupe Castillo-Cardie
通訊作者學校： Western National Medical Center, Mexico 報告者姓名(組別)： 陳彥融 (L 組)
報告日期： 2017/7/6 內文：
Background and Aim
Autologous mesenchymal stem cells (AMSCs) transplantation is proposed as an alternative to conventional graft treatment to improve bone regeneration.
The aim was to evaluate the effectiveness of AMSCs application in mandibular fractures to reduce regeneration time and increase bone quality.
Facial Injury result in fractures in mandible Common age:30+
Frequent fracture: Condyle, contralateral symphysis
Diagnostic tool: Panoramic X ray, Towne’s projection, oblique projection Computed Tomography, Clinical analysis
If not treated properly, the soft tissue rapidly adopts the shape of the underlying bones which are displaced. hinder the restoration of original form of face once the acute phase has ended
⸫ It is fundamental to accomplish early alignment of the facial skeleton
Only those fractures which are not displaced, stable and with no objective changes in occlusion, can be treated conservatively with soft diet, absolute joint rest and expectant attitude.
Management:
1. Closed reduction (Intermaxillary fixation) 2. Open reduction and internal fixation (ORIF) Internal fixation:
1. Non-resorbable material: Miniplates and mono- or bi-cortical screws 2. Resorbable material: Polylactic and polyglycolic acid implants
inflammatory response reported in patient with DM.
The stem cells obtained from adipose tissue have the capacity to differentiate into chondrocytes and osteogenic cells, and they can be placed in bone defects.
The expansion of these cells can be performed in vitro using various osseous morphogenetic proteins.
Materials and methods
Single-blind randomized clinical trial
17-59 years old male patients without chronic degenerative diseases, active smoking, collagen disorders, signs of infection
Study group(n=10): Application of AMSCs and ORIF Control group(n=10): Fracture reduction only
Imaging study: Pano+CT of healthy bone, site of fracture, repaired bone 4 weeks after surgery, repaired bone 12 weeks after surgery
Data analysis: Image Processing and Analysis IMAGE J VERSION 1.43 software Panoramic radiography units were expressed in Voxels, and the CT units were expressed as Hounsfield Units
Statistical analysis: By SPSS statistical software (version 20)
Harvest of AMSCs
Obtained from adipose tissue (50 cc) 24 h before the surgery Collagenase 0.1%
Centrifuged 2.400 RCF during 10 min Suspension medium:
15ml Dulbecco’s Modified Eagle Medium low glucose, supplemented with foetal bovine serum (FBS) 10% + antibiotic
Harvest in a carbon dioxide 5% 37 °C incubator, AMSCs adhere to the walls (usually at the bottom) of the bottle of culture separable and extractable
The processing of 50 cc of adipose tissue can result in approximately 1 x 107 to 6 x 108 cells with more than 90% viability
Result
The study group had a mean age of 31.2 ± 6.3 years, and the control group mean age was 29.7 ± 7.2 years. All patients are male. Left mandible angle fracture is more common in this study.
Bone quality measured at week 4 were (SG vs CG)
108.82 ± 3.4 vs 93.92 ± 2.6 (P = 0.000) using panoramic radiography (13.69% higher) 123 ± 4.53 vs 99.72 ± 5.72 (P = 0.000) using computed tomography. (18.93% higher) At week 12, the measurements were (SG vs CG)
153.53 ± 1.83 vs 101.81 ± 4.83 (P = 0.000) using panoramic radiography (33.68%
higher)
165.4 ± 4.2 vs 112.9 ± 2.0 (P = 0.000) using tomography (32.36% higher)
At week 12, the levels obtained using CT images (165.4 ± 4.2) were 36.48% higher compared to normal bone reaching an earlier return to daily activity.
Discussion
1.This study demonstrated AMSCs derived from adipose achieving an ossification rate 2.4 times higher than the conventional treatment for mandibular fractures.
2. Adipose tissue-derived stem cells demonstrate several advantages over those obtained from bone marrow
a) less invasive harvesting procedure
b) higher number of stem cell progenitors from an equivalent tissue harvested c) increased proliferation and differentiation capacities
d) better angiogenic and osteogenic properties in vivo
that application without scaffold could be effective.
6. Quarto et al. described the use of bone marrow stromal cells to treat three patients with large bone defects. They reported that a composite prepared with osteogenically enhanced MSCs and their extracellular matrix had an unprecedented capacity for the repair of critical bone defects of murine femora. The result data is similar to this study, with a 32.36% higher value in SG in week 12.
7. Bone regeneration is frequently delayed in patients with active smoking or alcoholism, and there is a reduction in the number of progenitor cells.
8. Park et al. reported one case of a patient with mandibular reconstruction with autologous human bone marrow mesenchymal stem cells and autogenous bone graft.
The patient recovered masticatory function and did not require microanastomosis to provide blood supply to the grafted bone.
9. As in the present study, this case showed favourable results with AMSCs but future studies need to be conducted in larger populations to confirm the benefits of this treatment option
Conclusion
The present results support the effectiveness of AMSCs application in the treatment of mandibular fractures to improve bone regeneration. An advantage of taking AMSCs directly from the patient’s adipose tissue is the minimally invasive nature of the procedure associated with more than 90% viability of the cells that translates into an improvement and acceleration of bone healing and a faster recovery time.
題號 題目 1 What is the indication for open reduction?
(A) Continued displacement of the bony segments (B) Unfavorable fracture
(C) Patient want earlier return and without IMF (D) All of the above
答案 ( D)
出處：Contemporary Oral and Maxillofacial Surgery 4th Edition p503-504
題號 題目
2 In open reduction surgery, what is the general approach to anterior symphysis fracture and posterior mandible angle fracture respectively?
(A) extra-oral / extra-oral (B) intra-oral / intra-oral (C) extra-oral / intra-oral (D) intra-oral / extra-oral 答案
( D)
出處：Contemporary Oral and Maxillofacial Surgery 4th Edition p504
