porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo13214porozendo-13214Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯCLINICAL GUIDELINESТуннелизация с введением концентрата костного мозга в профилактике прогрессирования асептического некроза головки бедренной костиCore decompression with the introduction of bone marrow aspirate concentrate in prevention of femoral osteonecrosis progressionhttps://orcid.org/0009-0004-8986-7272БайковаА. Р.BaikovaA. R.

Байкова Алина Рамилевна

Москва, 127299, ул. Приорова, 10

Alina R. Baikova, MD

Moscow, Priorov st., 10, 127299

alinazakirova30@mail.ruhttps://orcid.org/0000-0002-2789-6172ТоргашинА. Н.TorgashinA. N.

Торгашин Александр Николаевич, к.м.н.

Москва

Alexander N. Torgashin, MD, Cand. Sci. (Medicine)

Moscow

dr.torgashin@gmail.comhttps://orcid.org/0000-0002-2726-8758РодионоваС. С.RodionovaS. S.

Родионова Светлана Семеновна, д.м.н., профессор

Москва

Svetlana S. Rodionova, MD, PhD, professor

Moscow

rod06@inbox.ruФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Н.Н. Приорова» Минздрава РоссииРоссияPriorov National Medical Research Center of Traumatology and OrthopedicsRussian Federation202524042026284414Copyright © Байкова А.Р., Торгашин А.Н., Родионова С.С., 20262026Байкова А.Р., Торгашин А.Н., Родионова С.С.Baikova A.R., Torgashin A.N., Rodionova S.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/13214Обоснование

Обоснование. Асептический некроз головки бедренной кости (АНГБК) — прогрессирующее заболевание, приводящее к нарушению функции тазобедренного сустава и инвалидности у молодых пациентов. Ранняя диагностика и лечение способствуют замедлению прогрессирования заболевания. Дополнение туннелизации ортобиологическими методиками, такими как введение концентрата костного мозга (ККМ) является одним из современных направлений терапии АНГБК.

Цель

Цель. Сравнительный анализ среднесрочной динамики морфологических изменений по результатам МРТ исследования асептического некроза головки бедренной кости при использовании у пациентов метода изолированной туннелизации и туннелизации с добавлением концентрата костного мозга.

Материалы и методы

Материалы и методы. Проведено одноцентровое интервенционное проспективное нерандомизированное сравнительное исследование для изучения эффективности туннелизации с добавлением концентрата костного мозга (ККМ) для лечения пациентов с асептическом некрозом головки бедренной кости (АНГБК). В исследование было включено 108 пациентов (183 тазобедренных сустава) с АНГБК II-IIIA стадии по классификации ARCO. Пациенты были распределены на основную группу (туннелизация+ККМ) и группу сравнения (туннелизация). Методом оценки динамики АНГБК была МРТ (1,5 Тесла) с анализом морфологической структуры обоих тазобедренных суставов. Период наблюдения 12 месяцев (до лечения, через 3, 6 и 12 месяцев после операции).

Результаты

Результаты. В общей когорте на момент последнего контрольного визита были доступны 100 (92,6%) пациентов для анализа (168 тазобедренных суставов). Через 12 месяцев у пациентов со II стадией до операции в основной группе прогрессирование было в 2 случаях (10,3%), а в группе сравнения — в 18 (48,6%), (р<0,001).

Заключение

Заключение. Туннелизация с ККМ является эффективным методом лечения АНГБК при II стадии ARCO (до коллапса) по сравнению с изолированной туннелизацией в среднесрочном периоде. Эта методика позволяет существенно уменьшить частоту прогрессирования заболевания и снизить необходимость в эндопротезировании тазобедренных суставов.

Background

Background: Osteonecrosis of the femoral head is a progressive disease that can lead to impaired hip function and disability in young patients. Early diagnosis and treatment can help slow the progression of this disease. One of the modern approaches to the treatment of osteonecrosis is core decompression with the introduction of orthobiological products such as bone marrow aspirate concentrate (BMAC).

Aim

Aim: Comparison of the results of magnetic resonance imaging of patients diagnosed with osteonecrosis of the femoral head after using two treatment methods: isolated tunneling and tunneling using bone marrow aspirate concentrate.

Materials and methods

Materials and methods: A prospective cohort non-randomized comparative study was conducted to evaluate the effectiveness of core decompression with the addition of bone marrow aspirate concentrate for the treatment of osteonecrosis of the femoral head. The study involved 108 patients with stages II and IIIA according to the ARCO classification, who were divided into two groups: the main group, which received core decompression withbone marrow aspirate concentrate, and the comparison group, which received only core decompression. The outcome was assessed using MRI (1.5 Tl) to analyze the morphological structure of the hip joints before and after surgery, after 3, 6, and 12 months of follow-up.

Results

Results: In the total sample, at the time of the last control visit, data on 100 (92.6%) patients were available, which made it possible to analyze 168 (91.8%) hip joints. 12 months after surgery, patients with the second stage of the disease in the main group had only two cases of progression (10.3%), while in the comparison group this figure was 18 cases (48.6%), which is significantly higher (p<0.001).

Conclusion

Conclusion: Core decompression with the introduction of bone marrow aspirate concentrate is an effective method of treating osteonecrosis of the femoral head at the ARCO II stage (before collapse) compared with isolated core decompression in the medium term. This method significantly reduces the frequency of disease progression and the need for hip replacement.

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