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

doi:10.3877/cma.j.issn.2095-9133.2023.03.001

Chinese Journal of Hygiene Rescue(Electronic Edition) ›› 2023, Vol. 09 ›› Issue (03): 129-141. doi: 10.3877/cma.j.issn.2095-9133.2023.03.001

• Consensus and Guideline • Next Articles

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

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 Online:2023-06-18 Published:2023-12-05
Contact: Tianyong Hou, Fei Luo, Peifu Tang, Xinbao Wu, Changqing Zhang, Yingze Zhang

Abstract

Abstract:

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.

Key words: Bone marrow, Bone transplantation, Osteogenesis, Bone substitutes

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.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwsyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9133.2023.03.001

https://zhwsyjdzzz.cma-cmc.com.cn/EN/Y2023/V09/I03/129

Figures/Tables 2

References 122

1	Calori GM，Colombo M，Mazza EL，et al.Incidence of donor site morbidity following harvesting from iliac crest or RIA graft[J]．Injury，2014，45 Suppl 6：S116-S120.
2	Rodríguez-Merchán EC.Bone healing materials in the treatment of recalcitrant nonunions and bone defects[J]．Int J Mol Sci，2022，23(6)：3352.
3	Yasin M，Alisi M，Hammad Y，et al.Treatment of aneurysmal bone cysts by minimally invasive curettage and allogenic bone impaction grafting：mid-to long-term results[J]．Orthop Surg，2022，14(12)：3171-3177.
4	Braly HL，O'Connor DP，Brinker MR.Percutaneous autologous bone marrow injection in the treatment of distal meta-diaphyseal tibial nonunions and delayed unions[J]．J Orthop Trauma，2013，27(9)：527-533.
5	Gross JB，Diligent J，Bensoussan D，et al.Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone：a retrospective study of 45 cases[J]．Biomed Mater Eng，2015，25(1 Suppl)：187-197.
6	张会增，张同润，睢更义，等．断端局部注射治疗骨折术后骨不连的疗效[J]．临床骨科杂志，2020，23(3)：380-383.
7	Schröter S，Ateschrang A，Flesch I，et al.First mid-term results after cancellous allograft vitalized with autologous bone marrow for infected femoral non-union[J]．Wien Klin Wochenschr，2016，128(21-22)：827-836.
8	Kim HJ，Seo I，Shin JY，et al.Comparison of bone healing in open-wedge high tibial osteotomy between the use of allograft bone chips with autologous bone marrow and the use of allograft bone chips alone for gap filling[J]．J Knee Surg，2020，33(6)：576-581.
9	Damron TA，Lisle J，Craig T，et al.Ultraporous β-tricalcium phosphate alone or combined with bone marrow aspirate for benign cavitary lesions：comparison in a prospective randomized clinical trial[J]．J Bone Joint Surg Am，2013，95(2)：158-166.
10	王洪超．同种异体松质骨复合自体红骨髓移植治疗创伤性骨缺损的临床效果评价[J]．中国农村卫生，2019，11(22)：30; 30，33.
11	李波，陈静，阙祥勇，等．大块异体骨联合自体骨髓移植修复股骨上段肿瘤切除后缺损[J]．中国组织工程研究，2012，16(5): 831-834.
12	Johnson RG.Bone marrow concentrate with allograft equivalent to autograft in lumbar fusions[J]．Spine(Phila Pa 1976), 2014，39(9)：695-700.
13	Yang P，Xing J，Chen B，et al.The clinical use of the enriched bone marrow obtained by selective cell retention technology in treating adolescent idiopathic scoliosis[J]．J Orthop Translat，2020，27：146-152.
14	Yousef MAA，La Maida GA，Misaggi B．Long-term radiological and clinical outcomes after using bone marrow mesenchymal stem cells concentrate obtained with selective retention cell technology in posterolateral spinal fusion[J]．Spine (Phila Pa 1976)，2017，42(24)：1871-1879.
15	Shen J，Sun D，Yu S，et al.Radiological and clinical outcomes using induced membrane technique combined with bone marrow concentrate in the treatment of chronic osteomyelitis of immature patients[J]．Bone Joint Res，2021，10(1)：31-40.
16	杨鹏，侯天勇，邢军超，等．骨髓富集骨移植材料在青少年特发性脊柱侧弯矫治中的应用[J]．生物骨科材料与临床研究，2020，17(3)：11-15.
17	张景义，白玉，杨昊飞，等．富集自体骨髓干细胞骨移植治疗早中期股骨头缺血性坏[J]．中华实验外科杂志，2020，37(10)：1915-1918.
18	Jäger M，Herten M，Fochtmann U，et al.Bridging the gap：bone marrow aspiration concentrate reduces autologous bone grafting in osseous defects[J]．J Orthop Res，2011，29(2)：173-180.
19	Hoogervorst P，Campbell JC，Scholz N，et al.Core decompression and bone marrow aspiration concentrate grafting for osteonecrosis of the femoral head[J]．J Bone Joint Surg Am，2022，104 (Suppl 2)：54-60.
20	Kung J，Miller RR，Mackowiak PA.Failure of clinical practice guidelines to meet institute of medicine standards: Two more decades of little, if any, progress[J]．Arch Intern Med，2012，172(21)：1628-1633.
21	Brouwers MC，Kerkvliet K，Spithoff K，et al.The AGREE Reporting Checklist：a tool to improve reporting of clinical practice guidelines[J]．BMJ，2016，352：i1152.
22	Sinclair D，Isba R，Kredo T，et al.World Health Organization guideline development: an evaluation[J]．PLoS One, 2013，8(5)：e63715.
23	Song Y，Alonso-Coello P，Ballesteros M，et al.A reporting tool for adapted guidelines in health care：the RIGHT-Ad@pt checklist[J]．Ann Intern Med，2022，175(5)：710-719.
24	Shea BJ，Grimshaw JM，Wells GA，et al.Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews[J]．BMC Med Res Methodol，2007，7：10.
25	Higgins JP，Altman DG，Gøtzsche PC，et al.The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials[J]．BMJ，2011，343：d5928.
26	Stang A．Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta- analyses[J]．Eur J Epidemiol，2010，25(9)：603-605.
27	Atkins D，Eccles M，Flottorp S，et al.Systems for grading the quality of evidence and the strength of recommendations I：critical appraisal of existing approaches The GRADE Working Group[J]．BMC Health Serv Res，2004，4(1)：38.
28	Li M，Meng Y，Li Y，et al.Multidirectional percutaneous drilling and autologous bone marrow injection for the treatment of femoral diaphyseal nonunions：a prospective interventional study[J]．Ther Clin Risk Manag，2019，15：1003-1011.
29	Singh AK，Shetty S，Saraswathy JJ，et al.Percutaneous autologous bone marrow injections for delayed or non-union of bones[J]．J Orthop Surg (Hong Kong)，2013，21(1)：60-64.
30	Sugaya H，Mishima H，Aoto K，et al.Percutaneous autologous concentrated bone marrow grafting in the treatment for nonunion[J]．Eur J Orthop Surg Traumatol，2014，24(5)：671-678.
31	Sahu RL.Percutaneous autogenous bone marrow injection for delayed union or non-union of long bone fractures after internal fixation[J]．Rev Bras Ortop，2017，53(6)：668-673.
32	Kassem MS.Percutaneous autogenous bone marrow injection for delayed union or non union of fractures after internal fixation[J]．Acta Orthop Belg，2013，79(6)：711-717.
33	王铁翔，夏光麒，袁绍斌，等．自体红骨髓注射治疗骨不连25例体会[J]．吉林医学，2013，34(22)：4510.
34	徐存立，张清波．经皮注射自体红骨髓治疗骨折延迟愈合及不愈合的疗效观察[J]．河北医学，2011，17(11)：1490-1492.
35	刘瑞祥，陈琪，涂江虹，等．自体骨髓经皮注射移植治疗骨不连和骨延迟愈合的临床效果观察[J]．实用临床医药杂志，2013，17(16)：104-105.
36	Lindsey RW，Wood GW，Sadasivian KK，et al.Grafting long bone fractures with demineralized bone matrix putty enriched with bone marrow: pilot findings[J]．Orthopedics，2006，29(10)：939-941.
37	Ateschrang A，Ochs BG，Lüdemann M，et al.Fibula and tibia fusion with cancellous allograft vitalised with autologous bone marrow：first results for infected tibial non-union[J]．Arch Orthop Trauma Surg，2009，129(1)：97-104.
38	Thaler M，Lechner R，Gstöttner M，et al.The use of beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute in posterior lumbar interbody fusion[J]．Eur Spine J，2013，22(5)：1173-1182.
39	王浩．用不同移植材料治疗骨不连或骨折延迟愈合的效果对比[J]．当代医药论丛，2015，13(10)：5-6.
40	李菊明，韦永中，马益民．同种异体骨复合自体骨髓移植治疗肿瘤性骨缺损[J]．中国当代医药，2011，18(21)：206-207.
41	高春阳，张延辉，王清义．同种异体骨复合自体骨髓治疗长骨腔隙性骨缺损[J]．牡丹江医学院学报，2011，32(3)：40-41.
42	Gan Y，Dai K，Zhang P，et al.The clinical use of enriched bone marrow stem cells combined with porous beta-tricalcium phosphate in posterior spinal fusion[J]．Biomaterials，2008，29(29)：3973-3982.
43	Shapiro SA，Kazmerchak SE，Heckman MG，et al.A prospective，single-blind，placebo-controlled trial of bone marrow aspirate concentrate for knee osteoarthritis[J]．Am J Sports Med，2017，45(1)：82-90.
44	Hou T，Li Z，Luo F，et al.A composite demineralized bone matrix--self assembling peptide scaffold for enhancing cell and growth factor activity in bone marrow[J]．Biomaterials，2014，35(22)：5689-5699.
45	Luo K，Mei T，Li Z，et al.A high-adhesive lysine-cyclic RGD peptide designed for selective cell retention technology[J]．Tissue Eng Part C Methods，2016，22(6)：585-595.
46	Tang Y，Luo K，Tan J，et al.Laminin alpha 4 promotes bone regeneration by facilitating cell adhesion and vascularization[J]．Acta Biomater，2021，126：183-198.
47	Tang Y，Luo K，Chen Y，et al.Phosphorylation inhibition of protein-tyrosine phosphatase 1B tyrosine-152 induces bone regeneration coupled with angiogenesis for bone tissue engineering[J]．Bioact Mater，2021，6(7)：2039-2057.
48	Luangphakdy V，Boehm C，Pan H，et al.Assessment of methods for rapid intraoperative concentration and selection of marrow- derived connective tissue progenitors for bone regeneration using the canine femoral multidefect model[J]．Tissue Eng Part A，2016，22(1-2)：17-30.
49	储文祥，干耀恺，赵杰，等．应用干细胞快速筛选富集技术治疗新鲜骨折骨缺损[J]．中华创伤骨科杂志，2018，20(5)：369-375.
50	Petri M，Namazian A，Wilke F，et al.Repair of segmental long-bone defects by stem cell concentrate augmented scaffolds: a clinical and positron emission tomography--computed tomography analysis[J]．Int Orthop，2013，37(11)：2231-2237.
51	Imam MA，Holton J，Ernstbrunner L，et al.A systematic review of the clinical applications and complications of bone marrow aspirate concentrate in management of bone defects and nonunions[J]．Int Orthop，2017，41(11)：2213-2220.
52	Gianakos AL，Sun L，Patel JN，et al.Clinical application of concentrated bone marrow aspirate in orthopaedics：A systematic review[J]．World J Orthop，2017，8(6)：491-506.
53	Seebach C，Henrich D，Meier S，et al.Safety and feasibility of cell-based therapy of autologous bone marrow-derived mononuclear cells in plate-stabilized proximal humeral fractures in humans[J]．J Transl Med，2016，14(1)：314.
54	Chu W，Wang X，Gan Y，et al.Screen-enrich-combine circulating system to prepare MSC/β-TCP for bone repair in fractures with depressed tibial plateau[J]．Regen Med，2019，14(6)：555-569.
55	Lin K，VandenBerg J，Putnam SM，et al.Bone marrow aspirate concentrate with cancellous allograft versus iliac crest bone graft in the treatment of long bone nonunions[J]．OTA Int，2019，2(1)：e012.
56	王昕，干耀恺，赵杰，等．新型骨髓干细胞快速筛选-富集-复合系统治疗四肢骨不连[J]．中华创伤骨科杂志，2018，20(2)：93-98.
57	贾超，喻胜鹏，吴宏日，等．Masquelet技术二期髓内钉固定重建术治疗胫骨感染性骨缺损[J]．局解手术学杂志，2020，29(1)：29-33.
58	傅景曙，汪小华，吴宏日，等．膜诱导技术结合锁定加压钢板外置治疗胫骨感染性骨缺损[J]．中华骨科杂志，2018，38(9)：536-541.
59	中华医学会骨科学分会创伤骨科学组，中华医学会骨科学分会外固定与肢体重建学组，中国医师协会创伤外科医师分会创伤感染专家委员会，等．中国骨折内固定术后感染诊断与治疗专家共识(2018版)[J]．中华创伤骨科杂志，2018，20(11)：929-936.
60	Hernigou P，Dubory A，Homma Y，et al.Single-stage treatment of infected tibial non-unions and osteomyelitis with bone marrow granulocytes precursors protecting bone graft[J]．Int Orthop，2018，42(10)：2443-2450.
61	Hernigou P，Trousselier M，Roubineau F，et al.Local transplantation of bone marrow concentrated granulocytes precursors can cure without antibiotics infected nonunion of polytraumatic patients in absence of bone defect[J]．Int Orthop，2016，40(11)：2331-2338.
62	张泽华，张帅，罗飞，等．同种异体骨植骨联合锁定加压钢板治疗四肢良性骨肿瘤及类瘤病变的随访研究[J]．第三军医大学学报，2014，36(11)：1213-1216.
63	刘畅，乔苏迟，王志伟，等．硫酸钙人工骨联合同种异体骨与单纯人工骨治疗下肢良性骨肿瘤的对比研究[J]．第二军医大学学报，2017，38(12)：1581-1585.
64	Hegde V，Burke ZDC，Park HY，et al.Is core needle biopsy reliable in differentiating between aggressive benign and malignant radiolucent bone tumors？[J]．Clin Orthop Relat Res，2018，476(3)：568-577.
65	D’Amato RD，Memeo A，Fusini F，et al.Treatment of simple bone cyst with bone marrow concentrate and equine-derived demineralized bone matrix injection versus methylprednisolone acetate injections：A retrospective comparative study[J]．Acta Orthop Traumatol Turc，2020，54(1)：49-58.
66	Wang L，Luo D，Wu J，et al.A clinical study on bone defect reconstruction and functional recovery in benign bone tumors of the lower extremity, treated by bone marrow mesenchymal stem cell rapid screening-enrichment-composite system[J]．World J Surg Oncol，2021，19(1)：98.
67	Di Bella C，Dozza B，Frisoni T，et al.Injection of demineralized bone matrix with bone marrow concentrate improves healing in unicameral bone cyst[J]．Clin Orthop Relat Res，2010，468(11)：3047-3055.
68	Tabatabaee RM，Saberi S，Parvizi J，et al.Combining concentrated autologous bone marrow stem cells injection with core decompression improves outcome for patients with early-stage osteonecrosis of the femoral head：A comparative study[J]．J Arthroplasty，2015，30(9 Suppl)：11-15.
69	Hauzeur JP，De Maertelaer V，Baudoux E，et al.Inefficacy of autologous bone marrow concentrate in stage three osteonecrosis：a randomized controlled double-blind trial[J]．Int Orthop，2018，42(7)：1429-1435.
70	Jindal K，Aggarwal S，Kumar P，et al.Core decompression with bone marrow aspirate concentrate in post collapse avascular necrosis of hip：A systematic review and meta-analysis[J]．J Clin Orthop Trauma，2021，17：78-87.
71	Lee K，Goodman SB.Cell therapy for secondary osteonecrosis of the femoral condyles using the Cellect DBM System: a preliminary report[J]．J Arthroplasty，2009，24(1)：43-48.
72	Mao Q，Jin H，Liao F，et al.The efficacy of targeted intraarterial delivery of concentrated autologous bone marrow containing mononuclear cells in the treatment of osteonecrosis of the femoral head：a five year follow-up study[J]．Bone，2013，57(2)：509-516.
73	王志聪，刘谟震，颜超，等．钽棒联合富集骨髓干细胞治疗早期股骨头坏死的近期疗效[J/CD]．中华关节外科杂志：电子版，2013，7(2)：169-174.
74	张蒲，干耀恺，唐坚，等．干细胞技术结合新型可降解材料进行腰椎融合的临床研究[J]．中华外科杂志，2008，46(7)：493-496.
75	闫伟，杨莉，凌梅，等．自体骨髓富集间质干细胞与羟基磷灰石磷酸三钙材料复合在脊柱融合中的应用[J]．中国组织工程研究，2016，20(8)：1075-1080.
76	Feng JT，Yang XG，Wang F，et al.Efficacy and safety of bone substitutes in lumbar spinal fusion: a systematic review and network meta-analysis of randomized controlled trials[J]．Eur Spine J，2020，29(6)：1261-1276.
77	Hart R，Komzák M，Okál F，et al.Allograft alone versus allograft with bone marrow concentrate for the healing of the instrumented posterolateral lumbar fusion[J]．Spine J，2014，14(7)：1318-1324.
78	Hernigou P，Desroches A，Queinnec S，et al.Morbidity of graft harvesting versus bone marrow aspiration in cell regenerative therapy[J]．Int Orthop，2014，38(9)：1855-1860.
79	Hernigou P，Homma Y，Flouzat-Lachaniette CH，et al.Cancer risk is not increased in patients treated for orthopaedic diseases with autologous bone marrow cell concentrate[J]．J Bone Joint Surg Am，2013，95(24)：2215-2221.
80	Hendrich C，Franz E，Waertel G，et al.Safety of autologous bone marrow aspiration concentrate transplantation: initial experiences in 101 patients[J]．Orthop Rev (Pavia)，2009，1(2)：e32.
81	Friedlis MF，Centeno CJ.Performing a better bone marrow aspiration[J]．Phys Med Rehabil Clin N Am，2016，27(4)：919-939.
82	Bowen JE.Technical issues in harvesting and concentrating stem cells (bone marrow and adipose)[J]．PM R，2015，7(4 Suppl)：S8-S18.
83	Ajiboye RM，Eckardt MA，Hamamoto JT，et al.Does age influence the efficacy of demineralized bone matrix enriched with concentrated bone marrow aspirate in lumbar fusions？[J]．Clin Spine Surg，2018，31(1)：E30-E35.
84	Ajiboye RM，Eckardt MA，Hamamoto JT，et al.Outcomes of demineralized bone matrix enriched with concentrated bone marrow aspirate in lumbar fusion[J]．Int J Spine Surg，2016，10：35.
85	Ganguly P，El-Jawhari JJ.The Analysis of in vivo aging in human bone marrow mesenchymal stromal cells using colony-forming unit-fibroblast assay and the CD45^lowCD271⁺phenotype[J]．Stem Cells Int，2019，2019：5197983.
86	Rebolj K，Veber M，Drobnič M，et al.Hematopoietic stem cell and mesenchymal stem cell population size in bone marrow samples depends on patient’s age and harvesting technique[J]．Cytotechnology，2018，70(6)：1575-1583.
87	Siegel G，Kluba T，Hermanutz-Klein U，et al.Phenotype，donor age and gender affect function of human bone marrow-derived mesenchymal stromal cells[J]．BMC Med，2013，11：146.
88	Hernigou P，Beaujean F，Lambotte JC.Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis[J]．J Bone Joint Surg Br，1999，81(2)：349-355.
89	Fathollahi A，Gabalou NB，Aslani S．Mesenchymal stem cell transplantation in systemic lupus erythematous, a mesenchymal stem cell disorder[J]．Lupus，2018，27(7)：1053-1064.
90	Campeau PM，Rafei M，Boivin MN，et al.Characterization of Gaucher disease bone marrow mesenchymal stromal cells reveals an altered inflammatory secretome[J]．Blood，2009，114(15)：3181-3190.
91	Kemp K，Morse R，Wexler S，et al.Chemotherapy-induced mesenchymal stem cell damage in patients with hematological malignancy[J]．Ann Hematol，2010，89(7)：701-713.
92	Piuzzi NS，Hussain ZB，Chahla J，et al.Variability in the preparation，reporting，and use of bone marrow aspirate concentrate in musculoskeletal disorders：A systematic review of the clinical orthopaedic literature[J]．J Bone Joint Surg Am，2018，100(6)：517-525.
93	Hyer CF，Berlet GC，Bussewitz BW，et al.Quantitative assessment of the yield of osteoblastic connective tissue progenitors in bone marrow aspirate from the iliac crest, tibia, and calcaneus[J]．J Bone Joint Surg Am，2013，95(14)：1312-1316.
94	Min WK，Bae JS，Park BC，et al.Proliferation and osteoblastic differentiation of bone marrow stem cells: comparison of vertebral body and iliac crest[J]．Eur Spine J，2010，19(10)：1753- 1760.
95	Otto A，Muench LN，Kia C，et al.Proximal humerus and ilium are reliable sources of bone marrow aspirates for iologic augmentation during arthroscopic surgery[J]．Arthroscopy，2020，36(9)：2403-2411.
96	Vasiliadis AV，Galanis N．Human bone marrow-derived mesenchymal stem cells from different bone sources：a panorama[J]．Stem Cell Investig，2020，7：15.
97	Narbona-Carceles J，Vaquero J，Suárez-Sancho S，et al.Bone marrow mesenchymal stem cell aspirates from alternative sources: is the knee as good as the iliac crest？[J]．Injury，2014，45 Suppl 4：S42-S47.
98	Cavallo C，Boffa A，de Girolamo L，et al.Bone marrow aspirate concentrate quality is affected by age and harvest site[J]．Knee Surg Sports Traumatol Arthrosc，2023，31(6)：2140-2151.
99	吴垠．如何选择合适的骨髓穿刺部位[J]．中国全科医学，2013，16(15)：1443-1444.
100	Hernigou J，Alves A，Homma Y，et al.Anatomy of the ilium for bone marrow aspiration: map of sectors and implication for safe trocar placement[J]．Int Orthop，2014，38(12)：2585-2590.
101	Shapiro SA，Arthurs JR.Bone marrow aspiration for regenerative orthopedic intervention: technique with ultrasound guidance for needle placement[J]．Regen Med，2017，12(8)：917-928.
102	Long JR，Stensby JD，Wiesner EL，et al.Efficacy and safety of bone marrow aspiration and biopsy using fluoroscopic guidance and a drill-powered needle：clinical experience from 775 cases[J]．Eur Radiol，2020，30(11)：5964-5970.
103	Hernigou J，Picard L，Alves A，et al.Understanding bone safety zones during bone marrow aspiration from the iliac crest：the sector rule[J]．Int Orthop，2014，38(11)：2377-2384.
104	D’Souza RS，Li L，Leng S，et al.A three-dimensional computed tomography study to determine the ideal method for fluoroscopically-guided bone marrow aspiration from the iliac crest[J]．Bosn J Basic Med Sci，2021，21(3)：370-377.
105	Stensby JD，Long JR，Hillen TJ，et al.Safety of bone marrow aspiration and biopsy in severely thrombocytopenic patients[J]．Skeletal Radiol，2021，50(5)：915-920.
106	Piuzzi NS，Mantripragada VP，Kwee E，et al.Bone marrow- derived cellular therapies in orthopaedics：Part II：Recommendations for reporting the quality of bone marrow-derived cell populations[J]．JBJS Rev，2018，6(11)：e5.
107	Hernigou P，Homma Y，Flouzat Lachaniette CH，et al.Benefits of small volume and small syringe for bone marrow aspirations of mesenchymal stem cells[J]．Int Orthop，2013，37(11)：2279-2287.
108	Haseler LJ，Sibbitt RR，Sibbitt WL，et al.Syringe and needle size，syringe type，vacuum generation，and needle control in aspiration procedures[J]．Cardiovasc Intervent Radiol，2011，34(3)：590-600.
109	Roger Y，Burmeister L，Hamm A，et al.Heparin anticoagulant for human bone marrow does not influence in vitro performance of human mesenchymal stromal cells[J]．Cells，2020，9(7)：1580.
110	Muschler GF，Boehm C，Easley K．Aspiration to obtain osteoblast progenitor cells from human bone marrow：the influence of aspiration volume[J]．J Bone Joint Surg Am，1997，79(11)：1699-1709.
111	Yandow SM，Van de Velde SK，Siebert J，et al.The influence of aspiration volume on the number of osteoblastic progenitors obtained from bone marrow in children[J]．J Pediatr Orthop，2019，39(7)：382-386.
112	Piuzzi NS，Mantripragada VP，Sumski A，et al.Bone marrow-derived cellular therapies in orthopaedics：Part I: Recommendations for bone marrow aspiration technique and safety[J]．JBJS Rev，2018，6(11)：e4.
113	Mazzotta A，Stagni C，Rocchi M．Bone marrow aspirate concentrate/platelet-rich fibrin augmentation accelerates healing of aseptic upper limb nonunions[J]．J Orthop Traumatol，2021，22(1)：21.
114	Cevolani L，Bianchi G，Costantino E，et al.Minimally invasive treatment of long bone non-unions with bone marrow concentrate, demineralized bone matrix and platelet-rich fibrin in 38 patients[J]．J Tissue Eng Regen Med，2021，15(10)：831-840.
115	Cevolani L，Campanacci L，Sambri A，et al.Is percutaneous injection of bone marrow concentrate, demineralized bone matrix and PRF an alternative to curettage and bone grafting for treating aneurysmal bone cyst？[J]．J Tissue Eng Regen Med，2021，15(3)：269-278.
116	Rocchi M，Del Piccolo N，Mazzotta A，et al.Core decompression with bone chips allograft in combination with fibrin platelet-rich plasma and concentrated autologous mesenchymal stromal cells, isolated from bone marrow: results for the treatment of avascular necrosis of the femoral head after 2 years minimum follow-up[J]．Hip Int，2020，30(2_suppl)：3-12.
117	Houdek MT，Wyles CC，Smith JH，et al.Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study[J]．Bone Jt Open，2021，2(11)：926-931.
118	Lee W，MacDonald J，Prat D，et al.Midfoot joint arthrodesis using compression plate with lag screw augmenting with highly porous β-tricalcium phosphate and bone marrow aspirate concentrate[J]. Foot Ankle Spec, published online October 8，2022.
119	Patty DJ，Nugraheni AD，Ana ID，et al.Dual functional carbonate- hydroxyapatite nanocomposite from Pinctada maxima and egg-white for bone tissue engineering[J]．J Biomater Sci Polym Ed，2022，33(8)：1043-1062.
120	Mohaghegh S，Hosseini SF，Rad MR，et al.3D printed composite scaffolds in bone tissue engineering: A systematic review[J]．Curr Stem Cell Res Ther，2022，17(7)：648-709.
121	Li W，Dai F，Zhang S，et al.Pore size of 3D-printed polycaprolactone/polyethylene glycol/hydroxyapatite scaffolds affects bone regeneration by modulating macrophage polarization and the foreign body response[J]．ACS Appl Mater Interfaces，2022，14(18)：20693-20707.
122	Cui J，Yi Y，Zhang J，et al.Preparation and mechanical properties analysis of porous structure for bone tissue engineering[J]．Biomed Mater Eng，2022，33(6)：465-476.

分级	研究类型	具体描述
高(A)	RCT，质量升高2级的观察性研究	对观察值非常有把握：观察值接近真实值
中(B)	质量降低1级的RCT，质量升高1级的观察性研究	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低(C)	质量降低2级的RCT，观察性研究	对观察值的把握有限：观察值可能与真实值有很大差别
极低(D)	质量降低3级的RCT，质量降低1级的观察性研究，系列病例观察，个案报道	对观察值几乎没有把握：观察值与真实值可能有极大差别

分级	研究类型	具体描述
高(A)	RCT，质量升高2级的观察性研究	对观察值非常有把握：观察值接近真实值
中(B)	质量降低1级的RCT，质量升高1级的观察性研究	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低(C)	质量降低2级的RCT，观察性研究	对观察值的把握有限：观察值可能与真实值有很大差别
极低(D)	质量降低3级的RCT，质量降低1级的观察性研究，系列病例观察，个案报道	对观察值几乎没有把握：观察值与真实值可能有极大差别

推荐强度	具体描述
强推荐	明确显示干预措施利大于弊
弱推荐	利弊不确定或干预措施可能利大于弊
良好实践主张(good practice statement, GPS)	基于非直接证据或专家意见、经验形成的推荐

推荐强度	具体描述
强推荐	明确显示干预措施利大于弊
弱推荐	利弊不确定或干预措施可能利大于弊
良好实践主张(good practice statement, GPS)	基于非直接证据或专家意见、经验形成的推荐

[1]	Wanglin Luo, Chuanjun Yang, Guoxing Xu, Jianguo Yu, Weidong Sun, Wenjuan Yan, Zhi Feng. Meta analysis on implantation of different grafting materials in open wedge high tibial osteotomy [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 818-826.
[2]	Rui Ma, Pei Yang, Run Tian, Chunsheng Wang, Kunzheng Wang. Effect of robot-assisted core decompression and bone grafting fornecrosis of femoral head [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 123-128.
[3]	Kai Liu, Meng Li, Wenchen Ji, Weizhou Yang, Jiantao Liu. Total hip arthroplasty combined with autologous cancellous bone implantation for treatment of femoral neck fractures in elderly patients [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(06): 786-789.
[4]	Yongqing Xu, Luqiao Pu, Chuan Li, Changmeng Shan, Shaoquan Pu, Teng Wang, Wei Lin, Xingbo Cai, Xia Li. Clinical study of femoral head necrosis treated with quadratus femoris-bone flap retaining posterior superior supporting artery [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(06): 664-669.
[5]	Jiwei Zhao, Zhifen Zeng, Honghua Zeng, Meng Zhang, Lingling Li, Zhijie He, Yaowei Zhi. Cytological characteristics of bone marrow in adult patients with sepsis [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2022, 15(01): 14-21.
[6]	Luyue Ding, Wei Liu, Ang Wei, Ruidong Zhang, Tianyou Wang, Linlin Liu, Buolun Zang, Yafeng Wang, Xianliang Wang. Clinical observation of blinatumomabin in the treatment of children with relapsed/refractory CD19-positive B-cell acute lymphoblastic leukemia [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(02): 194-201.
[7]	Yong Li, Yong Quan, Shiyan Fu, Xinze Ran, Hong Tang, Suiyi Liu, Jie Li, Chang Shu, Yonglai Chen, Jing Zhang, Bingbing Yang, Yuhui Hao. Influence of hypoxia on acute radiation injuries in mice [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(04): 299-305.
[8]	Jiawei Zhou, Yingqiu Cui, Zhe Mao, Hongtao Wang. Research progress of bilateral mandibular distraction osteogenesis in the treatment of Pierre Robin sequence [J]. Chinese Journal of Stomatological Research(Electronic Edition), 2021, 15(04): 255-260.
[9]	Chao Xing, Lingqiao Xu, Wenting Liao, Yangpeng Sun, Zhongtai Ye, Zhiguang Zhang. Condyle chondrocytes regeneration promoted by exosomes from bone marrow mesenchymal stem cells [J]. Chinese Journal of Stomatological Research(Electronic Edition), 2021, 15(04): 207-214.
[10]	Lu Zhao, Zheru Zhang, Junqi Jia, Chunlin Zong, Li Jing, Kai Guo, Lei Tian. The experimental study of M2 macrophages inhibiting the transformation of bone marrow mesenchymal stem cells into myofibroblasts after radiation [J]. Chinese Journal of Stomatological Research(Electronic Edition), 2021, 15(04): 198-206.
[11]	Yanqun Zhou, Peng Chen, Zenghui Liu, Jingjing Mao, Yaohe Li. Screening and verifying key genes and signal pathways involved in senescence of bone marrow mesenchymal stem cells in patients with multiple myeloma based on bioinformatics analysis [J]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2022, 12(05): 274-281.
[12]	Yidong Liu, Yufeng Jia, Yan Wang, Yang Liu, Jinyue Ning. Upregulation of Wnt-1 gene expression by soybean isoflavones to promote the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells [J]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2021, 11(05): 292-297.
[13]	Yingming Li, Hua Chen, Yan Wu. The effects of K562 cell-derived exosomes on the hematopoietic and osteogenic gene expressions of bone marrow mesenchymal stem cells [J]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2021, 11(04): 207-214.
[14]	Hui Yang, Lixiang Lu, Jian Yi, Xu Yi. Effects of BMSCs and Bunao No. 1 medicated serum on expression of ICAM-1 and NF200 in mouse hippocampal neurons with oxygen-glucose deprivation [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(01): 100-106.
[15]	Wei Zhang, Ya′nan Wei, Na Han. Bone marrow mesenchymal stem cell-derived exosomes promote peripheral nerve injury recovery [J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(04): 265-271.

Please choose a citation manager

Content to export

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

RichHTML

PDF (PC)

Knowledge

Cited

Abstract

Cite this article

share this article

Figures/Tables 2

References 122

Related Articles 15

Recommended Articles

Metrics

Comments

模态框（Modal）标题

Please choose a citation manager

Content to export

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

RichHTML

PDF (PC)

Knowledge

Cited

Abstract

Cite this article

share this article

Figures/Tables 2

References 122

Related Articles 15

Recommended Articles

Metrics

Comments