vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2023.6.CLIN.7vmireaviz-832Research ArticleКлиническая медицинаClinical medicineКонцентрат аутологичных клеток костного мозга в лечении ранних стадий остеонекроза головки бедренной кости (обзор литературы)Autological bone marrow concentrate for the treatment of early stages of femoral head avascular necrosis (literature review)https://orcid.org/0000-0003-4686-7892ПанинМ. А.PaninM. A.

Панин Михаил Александрович Врач травматолог-ортопед отделения ортопедии, Городская клиническая больница № 17; канд. мед. наук, доцент кафедры травматологии и ортопедии, РУДН имени Патриса Лумумбы.

Ул. Волынская, д. 7, Москва, 119620; ул. Миклухо-Маклая, д. 6, Москва, 117198

Mikhail A. Panin - Traumatologist-orthopedist of the Department of Orthopedics, City Clinical Hospital No. 17; Cand. Sci. (Med.), Associate Professor of the Department of Traumatology and Orthopedics, Patrice Lumumba PFUR.

Moscow, 7, Volynskaya str., Moscow, 119620; 6, Miklukho-Maklaya str., Moscow, 117198

panin-mihail@yandex.ruЗагороднийН. В.ZagorodniiN. V.

Загородний Николай Васильевич Д-р мед. наук, профессор, член корреспондент РАМН, заведующий кафедры травматологии и ортопедии, РУДН имени Патриса Лумумбы.

Ул. Волынская, д. 7, Москва, 119620; ул. Миклухо-Маклая, д. 6, Москва, 117198

Nikolay V. Zagorodniy Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Medical Sciences, Head of the Department of Traumatology and Orthopedics, Patrice Lumumba PFUR.

Moscow, 7, Volynskaya str., Moscow, 119620; 6, Miklukho-Maklaya str., Moscow, 117198

Zagorodniy51@mail.ruhttps://orcid.org/0000-0002-7829-2045БойкоА. В.BoikoA. V.

Бойко Андрей Викторович Врач травматолог-ортопед.

Ул. Волынская, д. 7, Москва, 119620

Andrey V. Boyko - Orthopedic traumatologist.

Moscow, 7, Volynskaya str., Moscow, 119620

boiko120393@gmail.comПетросянА. С.PetrosyanA. S.

Петросян Арменак Серёжаевич Канд. мед. наук, заведующий отделением ортопедии.

Ул. Волынская, д. 7, Москва, 119620

Armenak S. Petrosyan - Cand. Sci. (Med.), Head of the Department of Orthopedics, City Clinical

Moscow, 7, Volynskaya str., Moscow, 119620

armenak.p@gmail.comГородская клиническая больница № 17; Российский университет дружбы народов им. Патриса ЛумумбыРоссияCity Clinical Hospital № 17; Peoples' Friendship University of Russia named after Patrice LumumbaRussian FederationГородская клиническая больница № 17РоссияCity Clinical Hospital № 17Russian Federation2023140120241368086Copyright © Панин М.А., Загородний Н.В., Бойко А.В., Петросян А.С., 20242024Панин М.А., Загородний Н.В., Бойко А.В., Петросян А.С.Panin M.A., Zagorodnii N.V., Boiko A.V., Petrosyan A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/832Актуальность

Актуальность. В лечении ранних стадий остеонекроза головки бедренной кости широко применяется декомпрессия очага некроза, которая снижает внутрикостное давление и увеличивает приток крови к головке бедренной кости. Для повышения эффективности декомпрессия очага некроза дополняется использованием различных биоадъювантов, в том числе концентрата аутологичных клеток костного мозга, целесообразность чего активно обсуждается.

Цель систематического обзора: оценка эффективности применения концентрата аутологичных клеток костного мозга при декомпрессии очага некроза в лечении ранних стадий остеонекроза головки бедренной кости по данным литературы.

Материал и методы

Материал и методы. В исследование включены статьи, имеющие клинические данные с полным текстом на английском или русском языках, доступные в сети интернет (базы данных – PubMed и elibrary). Включались статьи, содержащие фактические данные относительно стадии остеонекроза, числа прооперированных головок бедренной кости, применения концентрата аутологичных клеток костного мозга в качестве дополнения к декомпрессии очага некроза, доли неэффективных оперативных вмешательств, после которых потребовалось тотальное эндопротезирование тазобедренного сустава.

Результаты

Результаты. Проведён анализ 16 оригинальных статей (2011–2022 гг.), оценены результаты лечения 1135 головок бедренных костей (892 – с применением концентрата аутологичных клеток костного мозга, 243 – без концентрата аутологичных клеток костного мозга, контрольная группа). Сроки наблюдения за пациентами варьировали от 9 до 120 месяцев, составив в среднем 45 месяцев. При использовании концентрата аутологичных клеток костного мозга необходимость в тотальном эндопротезировании тазобедренного сустава отмечена у 168 из 892 пациентов (18,8 %); при применении декомпрессии очага некроза без концентрата аутологичных клеток костного мозга частота тотальное эндопротезирование тазобедренного сустава составила 27,2 % (р > 0,05). Лишь в 2-х статьях из 16 авторами не признаётся целесообразность применения концентрата аутологичных клеток костного мозга при декомпрессии очага некроза.

Заключение

Заключение. Использование при декомпрессии очага некроза в качестве биоадъюванта концентрата аутологичных клеток костного мозга замедляет прогрессирование остеонекроза. По мнению подавляющего числа авторов, декомпрессия очага некроза с применением концентрата аутологичных клеток костного мозга является высокоэффективной, более значимо снижая интенсивность болевого синдрома и улучшая функцию тазобедренного сустава. Результаты будут более обнадеживающими с дальнейшим развитием регенеративной медицины, которая обеспечит получение новых образцов клеточных препаратов для восстановления структуры костной ткани.

Relevance

Relevance. In the treatment of the early stages of the femoral head osteonecrosis core decompression is widely used, which reduces intraosseous pressure and increases blood flow to the femoral head. To increase the efficiency of the core decompression the use of various bioadjuvants, including concentrate of autologous bone marrow cells is needed, the appropriateness of which is actively discussed.

Purpose of the systematic review: evaluation of the effectiveness of autologous bone marrow cells in core decompression in the treatment of the early stages of the femoral head osteonecrosis according to the literature.

Material and methods

Material and methods. Articles with clinical data in full text in English or Russian available in the Internet (PubMed and elibrary databases) were included in the study. Articles containing actual data on the stage of osteonecrosis, the number of femoral heads operated on, the use of autologous bone marrow cells as an adjunct to the core decompression of the femoral head, the number of ineffective surgical interventions after which total hip arthroplasty was required were included.

Results

Results. Sixteen original articles (2011–2022) were analyzed, and the results of 1135 femoral heads treatment (892 with autologous bone marrow cells, 243 without autologous bone marrow cells, control group) were evaluated. Patient follow-up periods ranged from 9 to 120 months, averaging 45 months. When using autologous bone marrow cells, the need for total hip arthroplasty was observed in 168 of 892 patients (18.8 %); when core decompression was used without autologous bone marrow cells, the rate of total hip arthroplasty was 27.2 % (p > 0.05). Only 2 articles out of 16 authors did not consider autologous bone marrow cells to be reasonable in the core decompression of femoral head.

Conclusion

Conclusion. The use of autologous bone marrow cells concentrate as a bioadjuvant in the core decompression slows the progression of osteonecrosis. According to the overwhelming number of authors, the core decompression using autologous bone marrow cells is highly effective, significantly reducing the intensity of pain syndrome and improving the function of the hip joint. The results will be more encouraging with the further development of regenerative medicine, which will provide new samples of cellular preparations for bone tissue structure restoration.

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The authors declare that there are no conflicts of interest present.