Nandeesh Nagaraj H, Janardhan Kiranmayee, Subramanian Vignesh, Ashtekar Abhishek Bhushan, Srikruthi Nandagiri, Koka Prasad S, Deb Kaushik
Department of Orthopedics and Neurology, LIVE 100 Hospital, Bangalore, India.
Department of Regenerative Medicine, LIVE 100 Hospital, Bangalore, India.
J Stem Cells. 2016;11(3):135-148.
Avascular Necrosis (AVN) of hip is a devastating condition seen in younger individuals. It is the ischemic death of the constituents of the bone cartilage of the hip. The femoral head (FH) is the most common site for AVN. It results from interruption of the normal blood flow to the FH that fits into the hip socket. Earlier studies using autologous bone marrow stem cell concentrate injections have shown encouraging results with average success rates. The current study was designed to improve significantly the cartilage regeneration and clinical outcome.
Total of 48 patients underwent autologous bone marrow stem cell and activated platelet-rich plasma derived growth factor concentrate (PRP-GFC) therapy for early and advanced stages AVN of femoral head in a single multi-specialty center. The total treatment was divided into three phases. In the phase I, all the clinical diagnostic measurements such as magnetic resonance imaging (MRI), computed tomography (CT) etc. with respect to the AVN patients and bone marrow aspiration from posterior iliac spine from the patients were carried out. In the phase II, isolation of stem cells and preparation from the patients were performed. Subsequently, in phase III, the stem cells and PRP- GFCs were transplanted in the enrolled patients.
Ninety three percent of the enrolled AVN patients showed marked enhancement in the hip bone joint space (more than 3mm) after combined stem cells and PRP-GFC treatment as evidenced by comparison of the pre- and post-treatment MRI data thus indicative of regeneration of cartilage. The treated patients showed significant improvement in their motor function, cartilage regrowth (3 to 10mm), and high satisfaction in the two-year follow-up.
Combination of stem cell and PRP-GFC therapy has shown promising cartilage regeneration in 45 out of 48 patients of AVN. This study clearly demonstrates the safety and efficacy of this treatment. Larger numbers of patients need to be evaluated to better understand the efficacy of the combined stem cell and PRP-GFC therapy on AVN patients.
髋关节缺血性坏死（AVN）是一种在年轻人中出现的严重病症。它是髋关节骨软骨成分的缺血性死亡。股骨头（FH）是AVN最常见的部位。它是由于流入髋关节窝的股骨头正常血流中断所致。早期使用自体骨髓干细胞浓缩液注射的研究已显示出令人鼓舞的结果，平均成功率较高。本研究旨在显著改善软骨再生和临床结果。
在一个单一的多专科中心，共有48例患者接受了自体骨髓干细胞和活化的富含血小板血浆衍生生长因子浓缩液（PRP-GFC）治疗股骨头早期和晚期AVN。整个治疗分为三个阶段。在第一阶段，对AVN患者进行所有临床诊断测量，如磁共振成像（MRI）、计算机断层扫描（CT）等，并从患者的后髂嵴进行骨髓抽吸。在第二阶段，从患者中分离并制备干细胞。随后，在第三阶段，将干细胞和PRP-GFC移植到入组患者中。
联合干细胞和PRP-GFC治疗后，93%的入组AVN患者髋关节骨间隙明显增宽（超过3mm），治疗前后MRI数据对比证明了这一点，表明软骨再生。在两年随访中，接受治疗的患者运动功能、软骨再生（3至10mm）有显著改善，满意度较高。
干细胞和PRP-GFC联合治疗在48例AVN患者中的45例显示出有希望的软骨再生。本研究清楚地证明了这种治疗的安全性和有效性。需要评估更多患者，以更好地了解干细胞和PRP-GFC联合治疗对AVN患者的疗效。
