Goodman Stuart B
Departments of Orthopaedic Surgery and Bioengineering, Stanford University, Stanford, CA, USA.
Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA, 94063, USA.
Int Orthop. 2018 Jul;42(7):1705-1709. doi: 10.1007/s00264-018-3830-1. Epub 2018 Feb 12.
Core decompression is a surgical procedure that is capable of salvaging the patient's own natural joint, if the operation is performed in the early stages of osteonecrosis, in which the articular surface has not collapsed. The addition of concentrated cells, aspirated from the iliac crest, to the core tract has been shown to enhance the viability of the femoral head, although large, prospective, randomized, blinded multicentre studies are lacking. The rationale for adding these cells to the core decompression tract is to provide osteoprogenitor and vascular progenitor cells to the area of decompressed dead bone, in order to facilitate tissue regeneration and repair. It has become increasingly evident that vast discrepancies exist in different series in regard to the criteria for patient selection, the surgical technique of core decompression, the methods for harvesting, processing, and injecting the cells, and the methodology for determining success or failure in a specific patient cohort. This paper reviews the salient points relevant to the treatment of osteonecrosis by core decompression with addition of concentrated iliac crest aspirates and poses important questions regarding the future successful application of this technique.
髓芯减压术是一种外科手术，如果在股骨头坏死的早期阶段、关节面尚未塌陷时进行该手术，能够挽救患者自身的天然关节。尽管缺乏大型、前瞻性、随机、双盲多中心研究，但已表明向髓芯通道中添加从髂嵴抽取的浓缩细胞可提高股骨头的存活率。将这些细胞添加到髓芯减压通道的基本原理是为减压的坏死骨区域提供骨祖细胞和血管祖细胞，以促进组织再生和修复。越来越明显的是，在不同系列研究中，在患者选择标准、髓芯减压的手术技术、细胞采集、处理和注射方法以及特定患者队列中判断成功或失败的方法等方面存在巨大差异。本文回顾了与添加浓缩髂嵴抽吸物的髓芯减压治疗股骨头坏死相关的要点，并提出了有关该技术未来成功应用的重要问题。
