Sousa Rui, Babulal Jaime, Amado Paulo
Orthopaedics and Traumatology Department, Unidade Local de Saúde de Viseu Dão-Lafões, Viseu, PRT.
Orthopaedics and Traumatology Department, Unidade Local de Saúde do Médio Ave, Vila Nova de Famalicão, PRT.
Cureus. 2025 Jan 17;17(1):e77578. doi: 10.7759/cureus.77578. eCollection 2025 Jan.
Avascular necrosis (AVN) is characterized by compromised blood supply to bone tissue, often resulting in significant pain and functional impairment. Conservative treatment options for early-stage AVN of the talus are scarce, with non-weight-bearing protocols and hyperbaric oxygen therapy showing limited efficacy. This report presents a potential novel approach to managing non-traumatic AVN of the talus using a combination of adipose-derived stromal vascular fraction (SVF) and platelet-rich plasma (PRP). A 60-year-old male presented with progressive right ankle pain of a two-year evolution. Magnetic resonance imaging (MRI) revealed stage II AVN of the talus with extensive bone infarctions occupying almost all of its volume but with no collapse. A single injection of SVF and PRP was performed after diagnostic arthroscopy, followed by a tailored rehabilitation protocol. The patient experienced significant pain relief, with no further need for analgesics, and was able to return to non-impact sports. At the 18-month follow-up, functional scores showed significant improvement, and MRI showed stable AVN with no evidence of collapse. This report highlights SVF and PRP as a potential effective conservative option for non-traumatic talar AVN.
缺血性坏死（AVN）的特征是骨组织血液供应受损，常导致严重疼痛和功能障碍。距骨早期AVN的保守治疗选择稀缺，非负重方案和高压氧治疗的疗效有限。本报告介绍了一种使用脂肪来源的基质血管成分（SVF）和富血小板血浆（PRP）联合治疗距骨非创伤性AVN的潜在新方法。一名60岁男性出现进行性右踝关节疼痛，病程两年。磁共振成像（MRI）显示距骨II期AVN，广泛的骨梗死几乎占据其全部体积，但无塌陷。在诊断性关节镜检查后进行了一次SVF和PRP注射，随后采用了定制的康复方案。患者疼痛明显缓解，无需再使用镇痛药，并能够恢复非冲击性运动。在18个月的随访中，功能评分显示有显著改善，MRI显示AVN稳定，无塌陷迹象。本报告强调SVF和PRP作为非创伤性距骨AVN的一种潜在有效保守治疗选择。
