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中国骨科临床与基础研究杂志 2017年第2期9卷 122-122页

作者： gianakos al Yasui Y Fraser EJ 白朝晖夏远军

对于小的距骨软骨损伤，首选骨髓刺激（bonemarrowstimulation，BMS）技术进行治疗，临床报道其疗效显著。BMS的目的在于清除不稳定的软骨及其下层的坏死骨，用锥或克氏针在软骨下骨板上钻孔，以连通其与软骨下骨髓腔。本研究旨在通过Mi... 详细信息

对于小的距骨软骨损伤，首选骨髓刺激（bonemarrowstimulation，BMS）技术进行治疗，临床报道其疗效显著。BMS的目的在于清除不稳定的软骨及其下层的坏死骨，用锥或克氏针在软骨下骨板上钻孔，以连通其与软骨下骨髓腔。本研究旨在通过Micro-CT评估技术，观察应用BMS技术不同直径钻孔装置对距骨形态学变化、微环境干扰以及骨髓与软骨下骨髓腔接触范围等的影响。

关键词：软骨下骨骨髓腔 CT评价刺激技术距骨骨软骨损伤形态学变化 BMS

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Current management of talar osteochondral lesions

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World Journal of Orthopedics 2017年第1期8卷 12-20页

作者： Arianna L gianakos Youichi Yasui Charles P Hannon John G Kennedy Department of Orthopedic Surgery 2~(nd) Jersey City Medical Center Department of Foot and Ankle Hospital for Special Surgery Department of Orthopaedic Surgery 2~(nd) Teikyo University School of Medicine 2~(nd) Department of Orthopaedic Surgery Rush University Medical Center (C.P.H.)

Osteochondral lesions of the talus(OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation(BMS), or replacement procedures, such as autologous osteochondral transplantation(AOT). Reparative procedures are generally indicated for OLT although shortand medium-term results have been reported, longterm studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures.

关键词： Osteochondral lesions of talus Comprehensive review Diagnosis Bone marrow stimulation Autologous autograft transfer Biologics

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Clinical application of concentrated bone marrow aspirate in orthopaedics:A systematic review

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World Journal of Orthopedics 2017年第6期8卷 491-506页

作者： Arianna L gianakos Li Sun Jay N Patel Donald M Adams Frank A Liporace Division of Orthopedic Surgery Department of Orthopedic SurgeryJersey City Medical Center-RWJ Barnabas Health

AIM To examine the evidence behind the use of concentrated bone marrow aspirate(c BMA) in cartilage, bone, and tendon repair; establish proof of concept for the use of cB MA in these biologic environments; and provide the level and quality of evidence substantiating the use of cB MA in the clinical *** We conducted a systematic review according to PRISMA guidelines. EMBASE, MEDLINE, and Web of Knowledge databases were screened for the use of cB MA in the repair of cartilage, bone, and tendon repair. We extracted data on tissue type, cB MA preparation, cB MA concentration, study methods, outcomes, and level of evidence and reported the results in tables and *** A total of 36 studies met inclusion/exclusion criteria and were included in this review. Thirty-one of 36(86%) studies reported the method of centrifugation and preparation of cB MA with 15(42%) studies reporting either a cell concentration or an increase from baseline. Variation of c BMA application was seen amongst the studies evaluated. Twenty-one of 36(58%) were level of evidence Ⅳ, 12/36(33%) were level of evidence Ⅲ, and 3/36(8%) were level of evidence Ⅱ. Studies evaluated full thickness chondral lesions(7 studies), osteochondral lesions(10 studies), osteoarthritis(5 studies), nonunion or fracture(9 studies), or tendon injuries(5 studies). Significant clinical improvement with the presence of hyaline-like values and lower incidence of fibrocartilage on T2 mapping was found in patients receiving cB MA in the treatment of cartilaginous lesions. Bone consolidation and time to bone union was improved in patients receiving cB MA. Enhanced healingrates, improved quality of the repair surface on ultrasound and magnetic resonance imaging, and a decreased risk of re-rupture was demonstrated in patients receiving cB MA as an adjunctive treatment in tendon repair. CONCLUSION The current literature demonstrates the potential benefits of utilizing c BMA for the repair of cartilaginous lesions, bo

关键词： Concentrated bone marrow aspirate Bone Cartilage Osteochondral lesion Osteoarthritis Tendon

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Current concepts on osteonecrosis of the femoral head

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World Journal of Orthopedics 2015年第8期6卷 590-601页

作者： Joaquin Moya-Angeler Arianna L gianakos Jordan C Villa Amelia Ni Joseph M Lane Hospital for Special Surgery

It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. Thelack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging(MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures(FHSP) and femoral head replacement procedures(FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated.

关键词： Osteonecrosis Femoral head Conservative treatment Core decompression Stem cells Total hip arthroplasty

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