METHOD OF TREATING ASEPTIC NECROSIS OF FEMORAL HEAD USING OSTEOTROPIC AND VASCULAR THERAPY IN COMBINATION WITH TUNNELLING OF LESIONS AND INTRODUCTION OF AUTOLOGOUS BONE MARROW CONCENTRATE Russian patent published in 2024 - IPC A61B17/56 A61K31/59 A61K33/06 A61K33/10 A61K31/675 A61K31/5377 A61K31/4545 A61K31/727 A61K35/28 A61P19/08 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for treating aseptic necrosis of the femoral head using osteotropic and vascular therapy in combination with tunnelling of foci and introduction of an autologous bone marrow concentrate. In the preoperative period, aseptic necrosis of the femoral head is localized by magnetic resonance imaging. 14–21 days before the beginning of the surgical treatment, an osteotropic therapy is performed by administering active metabolites D in the form of alfacalcidol in dose of 0.5–1.0 mcg once a day and intake of calcium carbonate in dose of 800–1,000 mg per day, prescribing a single intravenous drop-by-drop introduction to a patient as an antiresorptive preparation of zoledronic acid in dose of 5 mg, prescribing oral administration of rivaroxaban 10 mg once a day or taking apixaban 2.5 mg twice a day. Administration of rivaroxaban or apixaban is stopped three days before the beginning of the surgical treatment. At the same time, the patient is prescribed an orthopaedic mode of unloading the joints by walking on crutches for 14–21 days before the surgical treatment. 14–21 days after the beginning of the osteotropic therapy, the stage of the disease and the absence of collapse of the femoral head are determined by multilayer spiral computed tomography. Stage of surgical treatment is performed by performing bone marrow aspiration from an upper posterior iliac spine in amount of 100–150 ml under aseptic conditions under local anaesthesia using a needle for trepanobiopsy and attaching 50 ml of a syringe with heparin in amount of 500 units of heparin per 1 ml of bone marrow, prepared bone marrow in 50 ml test tubes is centrifuged with visual control at 400 g for 2 minutes for 2 to 6 times to fractionation with erythrocyte sedimentation to level of 25–30 ml, which are removed from the bottom of each test tube using syringe with 18G needle. Remaining material of each test tube is centrifuged at 700–1,000 g for 10-15 minutes, followed by removal of the surface layer of plasma using a syringe with a needle, preventing sediment aspiration. Remaining bone marrow aspirate concentrate from the test tubes is collected using long 18G needle into two 10 ml syringes in amount of 5–7 ml in each syringe. With the patient lying on a healthy side, the osteonecrosis focus of the femoral head is tunnelled under the control of an electro-optical converter using pins and a drill with diameter of 3.2–3.5 mm and the prepared bone marrow concentrate is introduced using a trepan biopsy needle into each osteonecrosis focus in amount of 5–7 ml. Performing suturing and aseptic dressing, postoperative walking on crutches for 6 weeks. Osteotropic therapy of the patient is continued for one year after the end of the surgical treatment by taking active metabolites D in the form of alfacalcidol in dose of 0.5–1.0 mcg once a day and taking calcium carbonate in dose of 800–1,000 mg a day, the patient continues to take rivaroxaban in dose of 10 mg orally once a day or apixaban in dose of 2.5 mg twice day for 9–10 weeks after the end of the surgical treatment.

EFFECT: method provides reducing the level of injuries with simultaneous reduction of the intensity of resorption, stimulating the regeneration of osteogenesis, reduced time of bone mass recovery with simultaneous improvement of patient’s quality of life due to osteotropic and vascular therapy combined with foci tunnelling and introduction of autologous bone marrow concentrate.

1 cl, 3 ex