Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics1748910.17816/2311-2905-17489ReviewsОбзорыReviewsReview ArticleUse of multipotent mesenchymal stromal cells as part of bone marrow concentrate in the complex treatment of aseptic necrosis of the femoral head: a systematic reviewИспользование мультипотентных мезенхимальных стромальных клеток в составе концентрата костного мозга в комплексном лечении асептического некроза головки бедренной кости: систематический обзор литературыhttps://orcid.org/0009-0004-8986-7272ZakirovaAlina R.ЗакироваАлина Рамилевна
Russian Federation
alinazakirova30@mail.ruhttps://orcid.org/0000-0002-2789-6172TorgashinAlexander N.ТоргашинАлександр Николаевич
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

dr.torgashin@gmail.comhttps://orcid.org/0000-0002-2726-8758RodionovaSvetlana S.РодионоваСветлана Семеновна
Russian Federation

Dr. Sci. (Med.), Professor

д-р мед. наук, профессор

rod06@inbox.ruNational Medical Research Center of Traumatology and Orthopedics named after N.N. PriorovФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Н.Н. Приорова» Минздрава России11112024181220243041461560403202430072024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-ВекторCopyright ©; 2024,2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journal.rniito.org/jour/article/view/17489

Background. Avascular necrosis of the femoral head (ANFH) is a disabling disease that often leads to hip replacement. Due to the increasing incidence among the young population, various methods of organ-preserving treatment aimed at slowing down the progression of ANFH and preserving the functions of the hip joint have been proposed. Today, there is a lot of controversy and disagreement over the procedure of introducing bone marrow-derived multipotent mesenchymal stromal cells (MMSCs) into the site of osteonecrosis.

The aim of the study — a systematic analysis of the accumulated literature data on the effectiveness, safety, advantages and disadvantages of treating patients with aseptic necrosis of the femoral head by the tunneling method using bone marrow-derived MMSCs, as well as their impact on reducing the risk of disease progression and long-term treatment results.

Methods. A 10-year literature search (2013-2023) was performed in the PubMed, Scopus and eLIBRARY databases. According to our inclusion criteria, the review included 8 high-quality studies that examined the use of MMSCs as part of bone marrow concentrate for the treatment of ANFH.

Results. The surgical outcomes of 368 patients (548 hips) from 8 studies were analyzed. The mean follow-up period was from 24 to 360 months. In most cases, functional indicators improved. In the main group, where mesenchymal stromal cells were used, X-ray progression to the next stage occurred in 31.25% of cases and the need for endoprosthetics was 30.6%; in the comparison group, the progression occurred in 68.75% of cases and the need for endoprosthetics was 69.4 %.

Conclusion. The use of multipotent mesenchymal stromal cells in the complex treatment of ANFH in the early (ARCO I, II, IIIA) stages of the disease can improve the hip joint function, slow down the progression of the disease and reduce the need for endoprosthetics.

Актуальность. Асептический некроз головки бедренной кости (АНГБК) — инвалидизирующее заболевание, которое часто приводит к эндопротезированию тазобедренного сустава. В связи с ростом заболеваемости среди молодого населения были предложены различные методики органосохраняющего лечения, направленные на замедление прогрессирования АНГБК и сохранение функции тазобедренного сустава. На сегодняшний день много споров и разногласий вызывает процедура введения мультипотентных мезенхимальных стромальных клеток костного мозга в очаг остеонекроза.

Цель исследования — систематический анализ накопленных данных литературы посвященных эффективности, безопасности, преимуществам и недостаткам лечения пациентов с асептическим некрозом головки бедренной кости методом туннелизации с использованием мультипотентных мезенхимальных стромальных клеток костного мозга, а также их влиянию на снижение риска прогрессирования заболевания и отдаленные результаты лечения.

Материал и методы. Проведен поиск литературы глубиной 10 лет (2013–2023) в базах данных PubMed, Scopus и eLIBRARY. В соответствии с нашими критериями включения в обзор вошли 8 исследований с высоким уровнем доказательности, в которых в которых изучали применение мультипотентных мезенхимальных стромальных клеток в составе концентрата костного мозга для лечения АНГБК.

Результаты. Были проанализированы результаты хирургического лечения 368 пациентов (548 тазобедренных суставов) из 8 исследований. Средний период наблюдения составил от 24 до 360 мес. В большинстве случаев функциональные показатели улучшились. Рентгенологическое прогрессирование в следующую стадию произошло в 31,25% случаев, потребность в эндопротезировании составила 30,60% в основной группе, где использовали мезенхимальные стромальные клетки, в группе сравнения прогрессирование произошло в 68,75% случаев, потребность в эндопротезировании составила 69,40%.

Заключение. Использование мультипотентных мезенхимальных стромальных клеток в комплексном лечении асептического некроза головки бедренной кости на ранних (I, II, IIIA по ARCO) стадиях улучшает функцию тазобедренного сустава, замедляет прогрессирование заболевания и снижает необходимость в эндопротезировании.

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