Avascular necrosis (AVN) is a severe complication of immunosuppressant therapy or chemotherapy. A beneficial AVN therapy with core decompression (CD) and intraosseous infusion of mesenchymal stromal cells (MSCs) has been described in adult patients, but there are only few data on MSC applications in pediatric and young adult patients (PYAP). Between 2006 and 2015, 14 AVN lesions of 10 PYAP (6 females) with a median age of 16.9 years (range 8.5–25.8 years) received CD and intraosseous application of autologous MSCs. Data of these patients were analyzed regarding efficacy, safety, and feasibility of this procedure as AVN therapy and compared with a control group of 13 AVN lesions of 11 PYAP (5 females) with a median age of 17.9 years (range 13.5–27.5 years) who received CD only. During the follow-up analysis [MSC group: median 3.1 (1.6–5.8) years after CD; CD group: median 2.0 (1.5–8.5) years after CD], relative lesion sizes (as assessed by magnetic resonance imaging) compared with the initial lesion volume, were significantly lower (P < 0.05) in the MSC group (volume reduction to a median of 18.5%) when compared with the CD group (58.0%). One lesion in the MSC group comprised a complete remission. Size progression was not observed in either group. Clinical improvement (pain, mobility) was not significantly different between the two groups. None of the patients experienced treatment-related adverse effects. CD and additional MSC application was regarded safe, effective, feasible, and superior in reducing the lesion size when compared with CD only. Prospective, randomized clinical trials are needed to further evaluate these findings.

中文翻译：

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在类固醇或化疗后小儿患者和年轻成人无血管坏死的小儿患者和年轻人中，自体间充质基质细胞骨内施用后的长期结果。

血管坏死（AVN）是免疫抑制剂治疗或化学疗法的严重并发症。在成年患者中已经描述了一种有益的AVN治疗，其具有核心减压（CD）和骨内输注间充质基质细胞（MSC），但关于MSC在儿科和年轻成年患者（PYAP）中应用的数据很少。在2006年至2015年之间，有10例PYAP的14例AVN病变（6例女性），年龄中位数为16.9岁（范围8.5-25.8岁），接受了CD并在骨内应用了自体MSC。分析了有关这些患者作为AVN疗法的有效性，安全性和可行性的数据，并与中位年龄为17.9岁（范围13.5–27.5岁）的11个PYAP的13个AVN病变的对照组（5名女性）进行了比较。仅收到CD的人。在随访分析中[MSC组：中位数3.1（1.6-5。8）CD之后的几年；CD组：CD后中位2.0（1.5-8.5）年]，相对病变大小（通过磁共振成像评估）与初始病变体积相比显着降低（ 与CD组（58.0％）相比，MSC组的P <0.05）（中位数减少至18.5％）。MSC组中的一个病变完全缓解。两组均未观察到大小进展。两组之间的临床改善（疼痛，活动性）无显着差异。没有患者经历与治疗相关的不良反应。与仅CD相比，CD和附加MSC的应用被认为是安全，有效，可行的，并且在减小病变大小方面优越。需要进一步的随机临床试验来进一步评估这些发现。