Tissue-Engineered Bone Regeneration for Medium-to-Large Osteonecrosis of the Femoral Head in the Weight-Bearing Portion: An Observational Study.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-01 Epub Date: 2024-09-13 DOI:10.4055/cios23344

Eui-Kyun Park, Bum-Jin Shim, Suk-Young Kim, Seung-Hoon Baek, Shin-Yoon Kim

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引用次数: 0

Abstract

Background: Stem cell therapy for the treatment of osteonecrosis of the femoral head (ONFH) showed promising outcomes. However, ONFH with a large lesion in the weight-bearing portion is a poor prognostic factor and still challenging issue to be solved. We aimed to evaluate the effect of tissue-engineered bone regeneration for this challenging condition to preserve the femoral head.

Methods: A total of 7 patients (9 hips) with ONFH who received osteoblasts expanded ex vivo from bone marrow-derived mesenchymal stem cells (BMdMSCs) and calcium metaphosphate (CMP) as scaffolds from March 2002 to March 2004 were retrospectively reviewed. The median age was 27.0 years (interquartile range [IQR], 23.0-34.0 years), and the median follow-up period was 20.0 years (IQR, 11.0-20.0 years). After culture and expansion of stem cells, we performed core decompression with BMdMSC implantation at a median number of 10.1 ×10⁷ (IQR, 9.9-10.9 ×10⁷). To evaluate radiographic outcomes, the Association Research Circulation Osseous (ARCO) classifications, the Japanese Investigation Committee (JIC) classification, and modified Kerboul combined necrotic angle (mKCNA) were evaluated preoperatively and during follow-up. Clinical outcomes were evaluated by a visual analog scale (VAS) and Harris Hip Score (HHS).

Results: The preoperative stage of ONFH was ARCO 2 in 5 hips and ARCO 3a in 4 hips. The ARCO staging was maintained in 3 hips of ARCO 2 and 4 hips of ARCO 3a. Two hips of ARCO 2 with radiographic progression underwent total hip arthroplasty. According to mKCNA, 2 hips showed medium lesions, and 7 hips showed large lesions. The size of necrotic lesion was decreased in 4 hips (2 were ARCO 2 and 2 were ARCO 3a). There were no significant changes in JIC classification in all hips (type C1: 3 hips and type C2: 6 hips) (p = 0.655). Clinically, there were no significant changes in the VAS and HHS between preoperative and last follow-up (p = 0.072 and p = 0.635, respectively).

Conclusions: Tissue engineering technique using osteoblasts expanded ex vivo from BMdMSC and CMP showed promising outcomes for the treatment of pre-collapsed and early-collapsed stage ONFH with medium-to-large size, mainly located in weight-bearing areas.

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组织工程骨再生治疗中大型股骨头负重部分骨坏死：一项观察性研究

背景：干细胞疗法治疗股骨头坏死（ONFH）取得了良好的疗效。然而，股骨头坏死的承重部分有较大病变是一个不良预后因素，仍是亟待解决的难题。我们的目的是评估组织工程骨再生对这种具有挑战性的情况下保留股骨头的效果：回顾性分析了2002年3月至2004年3月期间接受骨髓间充质干细胞（BMdMSCs）和偏磷酸盐钙（CMP）作为支架体外扩增成骨细胞的7例（9髋）ONFH患者。中位年龄为27.0岁（四分位距[IQR]为23.0-34.0岁），中位随访时间为20.0年（四分位距[IQR]为11.0-20.0年）。干细胞培养和扩增后，我们进行了核心减压术，并植入了BMdMSC，中位数为10.1×107（IQR，9.9-10.9×107）。为了评估放射学结果，我们在术前和随访期间评估了骨性环路研究协会（ARCO）分类、日本调查委员会（JIC）分类和改良Kerboul联合坏死角（mKCNA）。临床结果通过视觉模拟量表（VAS）和哈里斯髋关节评分（HHS）进行评估：结果：5 个髋关节的 ONFH 术前分期为 ARCO 2，4 个为 ARCO 3a。ARCO 2期的3个髋关节和ARCO 3a期的4个髋关节维持了ARCO分期。ARCO 2 中有 2 个出现放射学进展的髋关节接受了全髋关节置换术。根据 mKCNA，2 个髋关节显示中度病变，7 个髋关节显示大面积病变。4 个髋关节（2 个为 ARCO 2，2 个为 ARCO 3a）坏死病灶的大小有所减小。所有髋关节的 JIC 分级均无明显变化（C1 型：3 个髋关节，C2 型：6 个髋关节）（P = 0.655）。在临床上，术前与最后一次随访之间的 VAS 和 HHS 均无明显变化（分别为 p = 0.072 和 p = 0.635）：结论：使用 BMdMSC 和 CMP 在体外扩增的成骨细胞进行组织工程技术治疗主要位于负重区的中大型ONFH塌陷前期和早期塌陷期，显示出良好的疗效。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.