Avaliação clínica e por ressonância magnética do tratamento da osteonecrose da cabeça umeral com implante de células mononucleares da medula óssea em pacientes com doença falciforme
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Data
2019-04-25
Autores
Faleiro, Thiago Batista
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Universidade Estadual Paulista (Unesp)
Resumo
O termo Doença Falciforme (DF) é utilizado para definir hemoglobinopatias nas quais pelo menos uma hemoglobina (Hb) anormal é a hemoglobina S (HbS). Essa alteração provoca distorção dos eritrócitos, fazendo-os tomar a forma de “f c ” ou “ - ”. No Brasil, cerca de 700 a 1.000 pessoas portadoras de DF nascem anualmente e na Bahia uma em cada 650 crianças nascidas vivas apresentam a patologia. A DF cursa com complicações ósteo-articular em 80% dos casos e uma das mais frequentes e graves é a osteonecrose. Os métodos de tratamento atualmente disponíveis não são capazes de garantir bons resultados clínicos para este grupo de pacientes. Além disso, a evolução natural da doença em pacientes não tratados é de piora progressiva. Diante disso, traçou-se como objetivo avaliar o resultado clínico e radiológico do tratamento com implante autólogo de células mononucleares da medula óssea em pacientes com osteonecrose da cabeça umeral secundária a Doença Falciforme. Foi realizado um estudo prospectivo, experimental, com avaliação antes e após o implante das células mononucleares na cabeça umeral; participaram deste estudo 6 pacientes adultos, portadores sintomáticos de necrose avascular. Os resultados do estudo demonstraram que os resultados do implante autólogo de células mononucleares foram excelentes, promovendo melhora da mobilidade, dor e função articular. A amplitude de todos os movimentos avaliados apresentou melhora em relação ao pré operatório com ganho estatisticamente significante nos movimentos de flexão, extensão e rotação externa. Além disso, o Shoulder Pain and Disability Index (SPADI) apresentou melhora estatisticamente significativa nos dois domínios avaliados (dor e incapacidade) em todos os pacientes. Outro aspecto importante foi a melhora observada nos exames de ressonância realizados 01 ano após a cirurgia quando comparados com os realizados no pré operatório. Conclui-se pelo estudo que a terapia com células mononucleares autólogas é segura e eficaz para promover melhora clínica e nos exames de ressonância.
The term sickle cell disease (SCD) is used to define hemoglobinopathies in which the at least one hemoglobin (Hb) is abnormal hemoglobin S (HbS). This relationship causes distortion of the erythrocytes, making it take a form of "sickle" or "half-moon". In Brazil, about 700 to 1,000 people with SCD are born annually and in Bahia one out of every 650 communities born alive have a pathology. SCD is complicated with osteoarticular disease in 80% of cases and one of the most frequent is osteonecrosis. The treatment available are not able to promote good clinical results for this group of patients. Moreover, the natural evolution of the disease is characterized by progressive worsening. Therefore, the objective is to evaluate the clinical and radiological results of the treatment with autologous bone marrow mononuclear cell implantation in patients with osteonecrosis of the humeral head secondary to Sickle Cell Disease. We developed a prospective, experimental study with evaluation and post-implantation of mononuclear cells in the humeral head; 6 adult patients, symptomatic carriers of avascular necrosis, participated in the study. The results of the study demonstrated that the results of autologous mononuclear cell implantation were excellent, promoting improved mobility, pain and functional function. The breadth of all efforts is improved in terms of performance with the statistically significant gain in terms of flexibility, stretch and external velocity. In addition, the Index of Pain and Disability in the Shoulder (SPADI) was updated in all patients. Another important aspect was an improvement in the resonance tests performed 1 year after surgery when compared with those performed in the preoperative period. It is concluded by the study that mononuclear cells are safe and effective in improving their clinical capacity and in the resonance examinations.
The term sickle cell disease (SCD) is used to define hemoglobinopathies in which the at least one hemoglobin (Hb) is abnormal hemoglobin S (HbS). This relationship causes distortion of the erythrocytes, making it take a form of "sickle" or "half-moon". In Brazil, about 700 to 1,000 people with SCD are born annually and in Bahia one out of every 650 communities born alive have a pathology. SCD is complicated with osteoarticular disease in 80% of cases and one of the most frequent is osteonecrosis. The treatment available are not able to promote good clinical results for this group of patients. Moreover, the natural evolution of the disease is characterized by progressive worsening. Therefore, the objective is to evaluate the clinical and radiological results of the treatment with autologous bone marrow mononuclear cell implantation in patients with osteonecrosis of the humeral head secondary to Sickle Cell Disease. We developed a prospective, experimental study with evaluation and post-implantation of mononuclear cells in the humeral head; 6 adult patients, symptomatic carriers of avascular necrosis, participated in the study. The results of the study demonstrated that the results of autologous mononuclear cell implantation were excellent, promoting improved mobility, pain and functional function. The breadth of all efforts is improved in terms of performance with the statistically significant gain in terms of flexibility, stretch and external velocity. In addition, the Index of Pain and Disability in the Shoulder (SPADI) was updated in all patients. Another important aspect was an improvement in the resonance tests performed 1 year after surgery when compared with those performed in the preoperative period. It is concluded by the study that mononuclear cells are safe and effective in improving their clinical capacity and in the resonance examinations.
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Palavras-chave
Osteonecrose, Anemia falciforme, Terapia baseada em transplante de células e tecidos