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中华卫生应急电子杂志 ›› 2023, Vol. 09 ›› Issue (03) : 129 -141. doi: 10.3877/cma.j.issn.2095-9133.2023.03.001

共识与指南

自体骨髓富集骨修复技术临床应用专家共识(2023版)
中华医学会骨科学分会, 邢军超, 毕龙, 陈林, 董世武, 高梁斌, 侯天勇(), 侯志勇, 黄伟, 靳慧勇, 李岩, 李忠海, 刘鹏, 刘曦明, 罗飞(), 马锋, 沈杰, 宋锦璘, 唐佩福(), 吴新宝(), 徐宝山, 许建中, 徐永清, 颜滨, 杨鹏, 叶青, 殷国勇, 于腾波, 曾建成, 张长青(), 张英泽(), 张泽华, 赵枫, 周跃, 朱芸, 邹俊   
  1. 400038 重庆,陆军军医大学第一附属医院
    710032 陕西西安,空军军医大学第一附属医院
    400042 重庆,陆军军医大学大坪医院
    400038 重庆,陆军军医大学
    510120 广东广州,中山大学附属第二医院
    050051 河北石家庄,河北医科大学第三医院
    400016 重庆,重庆医科大学附属第一医院
    615012 四川凉山,解放军63790部队医院
    710077 陕西西安,西安医学院第二附属医院
    116011 辽宁大连,大连医科大学附属第一医院
    430012 湖北武汉,解放军中部战区总医院
    750002 宁夏回族自治区银川,宁夏回族自治区人民医院
    400015 重庆,重庆医科大学附属口腔医院
    100853 北京,中国人民解放军总医院
    100035 北京,北京积水潭医院
    300329 天津,天津医院
    650118 昆明,解放军联勤保障部队第九二○医院
    518025 广东深圳,深圳市第二人民医院
    111010 辽宁辽阳,陆军第七十九集团军医院
    530003 广西南宁,武装警察部队广西总队医院
    210029 江苏南京,江苏省人民医院
    266003 山东青岛,青岛大学医学院附属医院
    610041 四川成都,四川大学华西医院
    201306 上海,上海市第六人民医院
    362000 福建泉州,解放军联勤保障部队第九一○医院
    400037 重庆,陆军军医大学第二附属医院
    408099 重庆涪陵,重庆大学附属涪陵医院
    215006 江苏苏州,苏州大学附属第一医院
  • 收稿日期:2022-10-10 出版日期:2023-06-18
  • 通信作者: 侯天勇, 罗飞, 唐佩福, 吴新宝, 张长青, 张英泽
  • 基金资助:
    重庆英才项目(cstc2022ycjh-bgzxm0104); 军队后勤重大项目(AWS17J004-02-07); 陆军装备综合研究科学研究项目(LJ20222Z060059)

Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair(version 2023)

Chinese Orthopaedic Association, Junchao Xing, Long Bi, Li Chen, Shiwu Dong, Liangbin Gao, Tianyong Hou(), Zhiyong Hou, Wei Huang, Huiyong Jin, Yan Li, Zhonghai Li, Peng Liu, Ximing Liu, Fei Luo(), Feng Ma, Jie Shen, Jinlin Song, Peifu Tang(), Xinbao Wu(), Baoshan Xu, Jianzhong Xu, Yongqing Xu, Bin Yan, Peng Yang, Qing Ye, Guoyong Yin, Tengbo Yu, Jiancheng Zeng, Changqing Zhang(), Yingze Zhang(), Zehua Zhang, Feng Zhao, Yue Zhou, Yun Zhu, Jun Zou   

  1. First Affiliated Hospital of Army Medical University, Chongqing 400038, China
    First Affiliated Hospital of Air Force Medical University, Xi’an 710032, China
    Daping Hospital, Army Medical University, Chongqing 400042, China
    Army Medical University, Chongqing 400038, China
    Second Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
    Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
    First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
    PLA 63790 Military Hospital, Liangshan 615012, China
    Second Affiliated Hospital of Xi’an Medical College, Xi’an 710077, China
    First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
    General Hospital of Central War Zone of PLA, Wuhan 430012, China
    People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, China
    Stomatological Hospital of Chongqing Medical University, Chongqing 400015, China
    General Hospital of PLA, Beijing 100853, China
    Beijing Jishuitan Hospital, Beijing 100035, China
    Tianjin Hospital, Tianjin 300329, China
    920th Hospital of PLA Joint Logistics Support Force, Kunming 650118, China
    Shenzhen Second People’s Hospital, Shenzhen 518025, China
    Army 79th Group Military Hospital, Liaoyang 111010, China
    Armed Police Force Guangxi General Hospital, Nanning 530003, China
    Jiangsu Provincial People’s Hospital, Nanjing 210029, China
    Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, China
    West China Hospital of Sichuan University, Chengdu 610041, China
    Shanghai Sixth People’s Hospital, Shanghai 201306, China
    910th Hospital of PLA Joint Logistics Support Force, Quanzhou 362000, China
    Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
    Fuling Hospital of Chongqing University, Fuling 408099, China
    First Affiliated Hospital of Suzhou University, Suzhou 215006, China
  • Received:2022-10-10 Published:2023-06-18
  • Corresponding author: Tianyong Hou, Fei Luo, Peifu Tang, Xinbao Wu, Changqing Zhang, Yingze Zhang
引用本文:

中华医学会骨科学分会, 邢军超, 毕龙, 陈林, 董世武, 高梁斌, 侯天勇, 侯志勇, 黄伟, 靳慧勇, 李岩, 李忠海, 刘鹏, 刘曦明, 罗飞, 马锋, 沈杰, 宋锦璘, 唐佩福, 吴新宝, 徐宝山, 许建中, 徐永清, 颜滨, 杨鹏, 叶青, 殷国勇, 于腾波, 曾建成, 张长青, 张英泽, 张泽华, 赵枫, 周跃, 朱芸, 邹俊. 自体骨髓富集骨修复技术临床应用专家共识(2023版)[J]. 中华卫生应急电子杂志, 2023, 09(03): 129-141.

Chinese Orthopaedic Association, Junchao Xing, Long Bi, Li Chen, Shiwu Dong, Liangbin Gao, Tianyong Hou, Zhiyong Hou, Wei Huang, Huiyong Jin, Yan Li, Zhonghai Li, Peng Liu, Ximing Liu, Fei Luo, Feng Ma, Jie Shen, Jinlin Song, Peifu Tang, Xinbao Wu, Baoshan Xu, Jianzhong Xu, Yongqing Xu, Bin Yan, Peng Yang, Qing Ye, Guoyong Yin, Tengbo Yu, Jiancheng Zeng, Changqing Zhang, Yingze Zhang, Zehua Zhang, Feng Zhao, Yue Zhou, Yun Zhu, Jun Zou. Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair(version 2023)[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2023, 09(03): 129-141.

由创伤、骨感染等原因造成的骨缺损临床十分常见且治疗困难,通常需要骨移植材料进行修复。目前临床常用的骨移植材料主要包括自体骨、同种异体骨、异种骨、人工合成材料等,而自体骨以外的骨移植材料均存在不同程度的成骨活性不足。骨髓中含有干细胞、细胞因子等利于成骨的有效成分,基于高效骨髓利用的骨髓富集骨修复技术应运而生,其核心理念是将自体骨髓中具有促成骨作用的细胞和细胞因子浓聚于支架材料,快速构建为具有高成骨活性的骨移植材料。但该技术的临床适用范围、应用方法、安全性、有效性等尚缺乏科学指导和应用规范。为此,由中华医学会骨科学分会牵头,依据循证医学方法制订了《自体骨髓富集骨修复技术临床应用专家共识(2023版)》,主要从常用自体骨髓促进骨修复临床技术特点、自体骨髓富集骨修复技术适用范围、安全性和应用注意事项等方面提出相应的推荐意见,为规范该技术的临床应用提供指导。

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair (version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

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表2 自体骨髓富集骨修复技术临床应用专家共识的推荐强度分级
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