Department of Orthopedic Surgery, College of Medicine, Kyungpook National University, 130, Dongdeok-Ro, Jung-Gu, Daegu, 41944, South Korea.
Department of Orthopedic Surgery, Kyungpook National University Hospital, 130, Dongdeok-Ro, Jung-Gu, Daegu, 41944, South Korea.
Tissue Eng Regen Med. 2024 Aug;21(6):929-941. doi: 10.1007/s13770-024-00647-z. Epub 2024 Jun 14.
Although core decompression (CD) with stem cell for the treatment of osteonecrosis of the femoral head (ONFH) showed promising results in many reports, the efficacy remains uncertain. We aimed to evaluate the efficacy of CD with culture-expanded autologous bone marrow-derived mesenchymal stem cell (BM-MSC) implantation in early stage ONFH.
A total of 18 patients (22 hips) with ONFH who underwent CD with culture-expanded BM-MSC implantation from September 2013 to July 2020 were retrospectively reviewed. The median age was 35.0 years [interquartile range (IQR), 28.5-42.0], and the median follow-up period was 4.0 years (IQR, 2.0-5.3). The median number of MSCs was 1.06 × 10. To evaluate radiographic and clinical outcomes, Association Research Circulation Osseous (ARCO) classifications, Japanese Investigation Committee classification, combined necrotic angle (CNA) visual analogue scale (VAS) and Harris Hip Score (HHS) were checked at each follow-up.
The preoperative stage of ONFH was ARCO 2 in 14 hips and ARCO 3a in 8 hips. The ARCO staging was maintained in 7 hips in ARCO 2 and 4 hips in ARCO 3a. The radiographic failure rate of ARCO 2 and 3a was 14.3 and 50%, respectively. Furthermore, CNA decreased to more than 20° in 6 hips (four were ARCO 2 and two were ARCO 3a).There was no significant difference in the VAS and HHS (P = 0.052 and P = 0.535, respectively). Total hip arthroplasty was performed in 4 hips.
CD with culture-expanded autologous BM-MSCs showed promising results for the treatment of early stage ONFH.
尽管核心减压（CD）联合干细胞治疗股骨头坏死（ONFH）在许多报道中显示出良好的效果，但疗效仍不确定。我们旨在评估 CD 联合培养扩增自体骨髓间充质干细胞（BM-MSC）移植治疗早期 ONFH 的疗效。
回顾性分析 2013 年 9 月至 2020 年 7 月期间因 ONFH 接受 CD 联合培养扩增 BM-MSC 移植的 18 例（22 髋）患者。患者的中位年龄为 35.0 岁[四分位距（IQR），28.5-42.0]，中位随访时间为 4.0 年（IQR，2.0-5.3）。MSCs 的中位数为 1.06×106 个。为评估影像学和临床结果，在每次随访时均检查协会研究循环骨（ARCO）分类、日本调查委员会分类、联合坏死角（CNA）视觉模拟量表（VAS）和髋关节 Harris 评分（HHS）。
ONFH 的术前分期为 ARCO 2 期 14 髋，ARCO 3a 期 8 髋。ARCO 2 期中有 7 髋分期保持不变，ARCO 3a 期中有 4 髋分期保持不变。ARCO 2 期和 3a 期的影像学失败率分别为 14.3%和 50%。此外，CNA 下降超过 20°的有 6 髋（4 髋为 ARCO 2 期，2 髋为 ARCO 3a 期）。VAS 和 HHS 评分无显著差异（P=0.052 和 P=0.535）。4 髋行全髋关节置换术。
CD 联合培养扩增自体 BM-MSCs 治疗早期 ONFH 效果良好。
