超选择性动脉干细胞移植治疗创伤性股骨头缺血性坏死的研究

目的研究自体骨髓干细胞（BMsC）移植对创伤性股骨头坏死患者缺血状态的改善程度和治疗效果。方法选取2004年8月-2008年12月期间127例139髋成人创伤性股骨头坏死患者，应用自体BMSC移植治疗。治疗方法：分别采集127例患者骨髓各200～300ml，采用Ficoll密度梯度离心法分离单个核细胞；流式细胞仪测定CD34＋和CD133＋在所分离出的干细胞悬液中的含量。将单个核细胞用生理盐水制备成悬液10～20ml。采用数字减影血管造影技术（DSA）行超选择性股骨头供血动脉内干细胞移植术。按世界骨循环研究学会（ARCO）对骨坏死分期，自身前后对照观察疗效。移植后第3、6、12、24个月，根据髋关节Harris评分评价疗效，移植术后6个月通过复查患者股骨头供血动脉DSA观察其是否有新血管形成，每隔6个月采用影像学方法观察股骨头形态学变化。结果（1）临床疗效：对接受自体BMSC移植治疗的127例患者随访3。24个月（平均18．3个月），其中髋关节疼痛缓解患者111例（占患者总数的87．6％），髋关节功能改善患者107例（占患者总数的84．3％），行走间距延长患者109例（占患者总数的85．9％）；（2）影像学检查：干细胞移植术后6个月，127例患者中随访到24例患者行股骨头供血动脉DSA检查后，显示供血动脉较移植前明显增多、增粗，血流速度增快；12～24个月后36例患者股骨头区骨质病变获得改善。结论超选择性动脉干细胞移植方法简便、安全有效，对因缺血导致坏死的股骨头无再次损伤，能够有效地治疗创伤性缺血股骨头坏死。

The treatment outcome of ischemia condition in Trauma necrosis of femoral head by Super-selective arterial stem cells transplantation

Objective To observe the curative effects of bone marrow stem cell (BMSC) transplantations on the trauma avascular necrosis of femoral head. Methods Totally 127 patients (139 coxae) treated by BMSC transplantations were enrolled from July 2004 to December 2008. Treatment methods: 127 patients were collected 200 ~ 300 ml bone marrow, respectively. Mononuclear cells were separated by Ficoll density gradient centrifugation, then we detected the content of CD34+ and CD133+ in the separated stem cells suspension with flow cytometry. Mononuclear cells were dissolved into 10 - 20 ml of single-cell suspension with saline. Stem cells were transplanted into Femoral artery by digital subtraction angiography (DSA). The osteonecrosises were classed to different stages according to the ARCO. Control group were desired as themselves before and after treatment. 3, 6, 12, 24 months after transplantation, we evaluated the treatment outcomes according to Harris score of hip. The patients were checked once again to observe the formation of neovascularization by DSA. And The patients were observed the changes of pattern with image every other 6 months. Results ⑴Treatment outcomes: the 127 patients who accepted BMSC translation treatment were follow-up after 3 - 24 months (mean was 18.3 months), the patients of hip joint pain relieved were 111 cases (these take up 87.6% in total patient), the patients of joint functions improved and walking distance extended were 107 cases (these take up 84.3% in total patient) and 109 cases (these take up 85.9% in total patient), respectively; ⑵Imaging: compared with before treatment, the calibers thickened; vessels increased and blood velocity quickened of femoral head blood-supply artery were observed in 24 patients after 6 months checked by DSA, the reduced areas of femoral head necrosis in 36 patients indicated the new bone formation between 12 and 24 months. Conclusion The stem cell transplantation is convenient, safe and effective in the treatment with no adverse reaction, and can be considered as a new therapy of trauma avascular necrosis of femoral head.