Department of Medicine, Medical College, Al Muthanna University, Samawah, Iraq.
Department of Surgery, Medical College, Kufa University, Kufa, Iraq.
J Med Life. 2023 Jan;16(1):76-90. doi: 10.25122/jml-2022-0342.
The study aimed to assess the effectiveness of autologous hematopoietic bone marrow and concentrated growth factor (CGF) transplantation and core decompression in patients with avascular necrosis of the femoral head (ANFH). We performed a single-center prospective study on 31 patients with non-traumatic early-stage (stage I to III) ANFH based on the 1994 classification of the Association Research Circulation Osseous (ARCO). The patients were subjected to bone marrow aspiration from the posterior iliac crest, separation, and concentration of growth factors from the bone marrow aspirate, core decompression of the femoral head, and injection of hematopoietic bone marrow and CGFs into the necrotic lesion. Patients were evaluated using the visual analogue scale, the WOMAC questionnaire, and X-ray and MRI examinations of the hip joints before, at 2, 4, and 6 months after the intervention. Patients had a mean age of 33 years (range 20-44 years), 19 (61%) of them being male and 12 (39%) females. The presentation of the disease was bilateral in 21 patients and unilateral in 10 patients. The main cause of ANFH was steroid treatment. The mean VAS and WOMAC scores were 48.37 (SD: 14.67) out of 100, and the mean VAS pain score was 50.83 out of 100 (SD: 20.46), respectively, before transplant. This value significantly improved to 22.31 (SD 12.12) of 100, and the mean VAS pain score was 21.31 of 100 (SD: 20.46) (P=0.04). MRI showed a significant improvement (P=0.012). Our results suggest that autologous hematopoietic bone marrow and CGFs transplantation with core decompression have a beneficial effect in early-stage ANFH.
本研究旨在评估自体造血骨髓和浓缩生长因子（CGF）移植联合核心减压术治疗股骨头坏死（ANFH）的疗效。我们对 31 例非创伤性早期（I 期至 III 期）ANFH 患者进行了单中心前瞻性研究，这些患者基于 1994 年的 Association Research Circulation Osseous（ARCO）分类。患者接受了从髂后嵴进行骨髓抽吸、从骨髓抽吸物中分离和浓缩生长因子、股骨头核心减压以及将造血骨髓和 CGF 注射到坏死病变部位的治疗。通过视觉模拟评分（VAS）、WOMAC 问卷以及髋关节 X 线和 MRI 检查对患者进行评估，评估时间分别为干预前、干预后 2、4 和 6 个月。患者的平均年龄为 33 岁（范围 20-44 岁），其中男性 19 例（61%），女性 12 例（39%）。21 例患者为双侧病变，10 例为单侧病变。ANFH 的主要病因是类固醇治疗。移植前，VAS 和 WOMAC 评分的平均得分为 48.37（SD：14.67）和 100，VAS 疼痛评分的平均得分为 50.83（SD：20.46），100 分。该值显著改善至 100 分中的 22.31（SD 12.12），VAS 疼痛评分的平均得分为 100 分中的 21.31（SD：20.46）（P=0.04）。MRI 显示出显著的改善（P=0.012）。我们的结果表明，自体造血骨髓和 CGF 移植联合核心减压术对早期 ANFH 具有有益的效果。
