Células-tronco mesenquimais alógenas derivadas de tecido adiposo nas osteossínteses minimamente invasivas na tíbia de cães
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Data
2019-03-12
Autores
Franco, Guilherme Galhardo [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
O tratamento das fraturas, especialmente aquelas causadas por traumas de alta energia, permanece como grande desafio ao cirurgiões médicos e veterinários. A busca por terapias adjuvantes, assim como técnicas que possam aprimorar os índices de sucesso, é fundamental na minimização das potenciais complicações. O objetivo desse estudo foi avaliar a reparação óssea após a realização da técnica de osteossíntese minimamente invasiva com placa (MIPO) associada à aplicação percutânea, no foco de fratura, de células-tronco mesenquimais alógenas derivadas de tecido adiposo (CTM-AD), em fraturas de tíbia de cães e posteriormente, comparar com a aplicação percutânea de concentrado de medula óssea autóloga. Foram utilizados 29 cães que apresentaram fraturas completas e fechadas da tíbia, as quais foram tratadas com MIPO e aplicação percutânea, no foco de fratura, de 3 milhões de CTM-AD alógenas ou 2 mL de concentrado de medula óssea autóloga (MO). Os exames radiográficos foram realizados no momento imediato após a cirurgia e 15, 30, 60, 90 e 120 dias pós-operatórios e avaliados quanto à aposição dos fragmentos, presença de desvios angulares, evolução da união óssea e complicações. A análise dos resultados dos 20 cães do grupo CTM-AD mostrou que a aposição dos fragmentos foi boa em 60% dos casos, adequada em 35% dos casos e inaceitável em 5% dos casos. O tempo médio de união clínica radiográfica foi de 28 ± 12,8 dias. Em 60% dos casos foi observada reação periosteal moderada, demonstrando organizada atividade osteogênica no foco de fratura com 15 dias de pós-operatório. Somente em 1 caso (5%) ocorreram desvios angulares moderados após a fixação da fratura, porém sem repercussões clínicas. Complicações menores incluíram seroma (5%) e soltura de um parafuso (10%), e complicações maiores incluíram a inserção do parafuso mais proximal no espaço articular do joelho (10%). Em relação à comparação entre as CTM-AD e MO, o tempo mediano de união radiográfica entre os grupos foi similar (30 dias). Entretanto, na escala de união radiográfica (RUST) das radiografias de 30 dias de pós-operatório, o grupo CTM-AD apresentou escore final médio superior (p<0,05). Conclui-se que a associação da terapia celular com CTM-AD alógena e MIPO se mostrou uma alternativa viável, eficaz e segura em promover a reparação óssea em fraturas não articulares de tíbia em cães.
Treating fractures, especially those caused by high energy trauma, remains a major challenge to medical and veterinary surgeons. Adjuvant therapies as well as techniques that can improve success rates are fundamental at minimizing potential complications. The aim of this study was to evaluate bone healing after minimally invasive plate osteosynthesis (MIPO) associated with percutaneous application, in the fracture site, of allogenic adipose derived mesenchymal stem cells (AD-MSC), in the tibia of dogs, and then, to compare with an application of autologous bone marrow concentrate (BMC). Twenty-nine dogs with complete and closed tibial fractures were used, which were treated with MIPO and percutaneous application of 3 million allogeneic AD-MSC or 2 mL of autologous BMC. Radiographic examinations were performed immediately after surgery and 15, 30, 60, 90 and 120 postoperatively. Fragments apposition, angular and rotational deviations, bone union evolution and complications were evaluated. Apposition was considered good in 60% of cases, adequate in 35% and unacceptable in 5%. The mean radiographic union time was 28 ± 12.8 days. In 60% of the cases, a moderate periosteal reaction was observed, showing organized osteogenic activity at the fracture site 15 days postoperatively. In only 1 case (5%), moderate angular deviations occurred after fracture fixation, but without clinical issues. Minor complications included seroma (5%) and a screw pullout (10%), and major ones included an insertion of the most proximal screw in the joint space of the knee (10%). Regarding the comparison between AD-MSC and BMC, median time of radiographic union between groups was similar (30 days). However, in the radiographic union scale (RUST) of the 30th day postoperative radiographs, the CTM-AD group had a superior final mean score (p <0.05). In conclusion, the association of cell therapy with AD-MSC and MIPO seems to be a feasible and effective alternative to improve bone healing in non-articular tibial fractures in dogs. Keywords: percutaneous application, dog, bone healing, fracture, biological osteosynthesis, cell therapy.
Treating fractures, especially those caused by high energy trauma, remains a major challenge to medical and veterinary surgeons. Adjuvant therapies as well as techniques that can improve success rates are fundamental at minimizing potential complications. The aim of this study was to evaluate bone healing after minimally invasive plate osteosynthesis (MIPO) associated with percutaneous application, in the fracture site, of allogenic adipose derived mesenchymal stem cells (AD-MSC), in the tibia of dogs, and then, to compare with an application of autologous bone marrow concentrate (BMC). Twenty-nine dogs with complete and closed tibial fractures were used, which were treated with MIPO and percutaneous application of 3 million allogeneic AD-MSC or 2 mL of autologous BMC. Radiographic examinations were performed immediately after surgery and 15, 30, 60, 90 and 120 postoperatively. Fragments apposition, angular and rotational deviations, bone union evolution and complications were evaluated. Apposition was considered good in 60% of cases, adequate in 35% and unacceptable in 5%. The mean radiographic union time was 28 ± 12.8 days. In 60% of the cases, a moderate periosteal reaction was observed, showing organized osteogenic activity at the fracture site 15 days postoperatively. In only 1 case (5%), moderate angular deviations occurred after fracture fixation, but without clinical issues. Minor complications included seroma (5%) and a screw pullout (10%), and major ones included an insertion of the most proximal screw in the joint space of the knee (10%). Regarding the comparison between AD-MSC and BMC, median time of radiographic union between groups was similar (30 days). However, in the radiographic union scale (RUST) of the 30th day postoperative radiographs, the CTM-AD group had a superior final mean score (p <0.05). In conclusion, the association of cell therapy with AD-MSC and MIPO seems to be a feasible and effective alternative to improve bone healing in non-articular tibial fractures in dogs. Keywords: percutaneous application, dog, bone healing, fracture, biological osteosynthesis, cell therapy.
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Palavras-chave
Aplicação percutânea, Cão, Consolidação óssea, Osteossíntese biológica, Terapia celular