浓缩自体骨髓移植治疗非创伤性股骨头坏死的临床研究

目的探讨富含单个核细胞的浓缩骨髓血移植治疗非创伤性股骨头坏死的临床疗效。方法应用自体骨髓血浓缩技术，在术中完成骨髓血采集、含有骨髓基质干细胞（BMSCs）的骨髓浓集，通过细针多孔减压手术回植入股骨头坏死区，治疗非创伤性股骨头坏死45例（59髋），男36例，女9例；年龄16—56岁，平均37．5岁，其中根据国际骨循环学会（ARCO）分期，Ⅰ期2髋，Ⅱ期48髋，ⅢA期9髋，激素性20例（29髋），酒精性18例（22髋），特发性7例（8髋）。对浓集集前后包含BMSCs的骨髓单个核细胞（BMMCs）计数，分析年龄、性别、病种对BMMCs的影响；平均随访27．64个月（12—40个月），结合Harris评分和影像学检查综合评定临床疗效。结果平均抽取骨髓血（126±15）ml，经浓集后BMMCs数量从（12．23±3．2）×10^6／ml增加到了（35．23±12）×10^6／ml。BMMCs细胞数量与年龄，病因和性别有一定相关性，酒精性患者要多于激素性患者，40岁以上患者细胞数量降低。临床总体成功率为79．66％（影像学有效率为76．27％），其中Ⅰ期100％，U期87．5％，ⅢA期成功率44％，激素性坏死患者预后较差。Harris评分手术前后比较有统计学意义（P〈0．05）。结论富含单个核细胞的浓缩骨髓血移植技术是一种快速、简便、安全的临床细胞治疗手段，与髓心减压技术一起可以有效缓解各期的股骨头坏死患者症状，并在一定程度上防止股骨头塌陷或进展。

The clinical research on treatment for nontraumatic osteonecrosis of the femoral head with the implantation of concentrated autologous bone marrow

Objective To study the implantation of the concentrated autologous bone marrow containing mononuelear cells in necrotic lesion of the femoral head and to determine the etfeet of the method. Methods The study included 4. 5 patients （59 hips, nine females, 36 males, mean age 37.50 years; ranging from 16 to 56 years） with stage Ⅰ -Ⅲ A nontraumatic avascular necrosis of the femoral head according to the system of the Association Research Circulation Osseous. Concentrated bone marrow （30 - 50 ml） containing mononuelear cells were obtained from the iliac crest of patient with the Cell Processor System. Concentrated bone marrow was injected through a core decompression channel into the femoral head. The outcome was determined by the Harris hip score, progression in radiographic stages, and the need for hip replacement. The mean follow-up time was 27.64 months （range 12 to 40 months）. Results Pre-and postoperative evaluations showed that the mean Harris hip score increased from 71 to 83. Clinically the overall success rate was 79. 66%, and hip replacement was done in seven of 59 hips （ 11.86% ）. Radiologieally, 14 of 59 hips exhibited femoral head collapse or narrowing of the coxofemoral joint space, and the overall failure rate was 23.73%. The number of bone marrow mononuelear cells （ BMMCs ） increased from （12.23 ± 3.2） × 10^6/ml pre-concentration to （35.23 ±12） × 10^6/ml post-concentration. Conclusions The implantation of concentrated autologous bone marrow containing mononuclear cells relieve.s hip pain, and prevents the progression of osteonecrosis. Therefore, it may be a treatment of choices particularly in stage Ⅰ - Ⅱ nontraumatic osteonecrosis of the femoral head.