自体骨髓间充质干细胞动脉灌注联合局部注射治疗股骨头坏死

背景：细胞水平研究发现,股骨头缺血坏死患者股骨近端成骨细胞增殖能力降低,股骨头内间充质干细胞的数量减少。因此,对股骨头缺血坏死的治疗应在改善血供的同时,还应在坏死区局部补充具有成骨能力的种子细胞。目的：观察自体骨髓间充质干细胞动脉灌注联合局部穿刺注射介入治疗股骨头缺血性坏死的临床疗效。方法：研究组32例股骨头缺血死患者,采用seldinger技术经皮-股动脉穿刺将导管选至股骨头供养动脉,灌注脲激酶30×104U,罂粟硷30mg;然后经旋股内动脉灌注骨髓间充质干细胞悬液10mL,经皮穿刺股骨头坏死区多点注射骨髓间充质干细胞悬液10mL,骨髓间充质干细胞数量为2×107～2×108个。同期对照组34例股骨头缺血死患者,单纯采用动脉溶栓介入治疗进行比较。两组间隔2,4周再进行第2,3次介入治疗,3次为1个疗程。结果与结论：研究组32例患者,股骨头、颈区域狭窄闭塞血管再通,股骨头血管染色区域明显增大,坏死区域逐渐缩小29例;治疗后研究组关节活动度改善程度优于对照组;研究组疼痛缓解有效率为93.8%、临床治愈率为84.4%,均高于对照组。结果显示经动脉溶栓后灌注自体骨髓间充质干细胞,联合经皮穿刺局部多点注射介入治疗股骨头缺血性坏死可以提高疗效、缓解疼痛、改善关节功能。

Arterial perfusion combined with regional injection of autologous bone marrow mesenchymal stem cells for femoral head necrosis

BACKGROUND：Cellular level studies have demonstrated that the proliferative ability of osteoblasts at the proximal end of the femur of patients with femoral head avascular necrosis was decreased,and the number of mesenchymal stem cells（MSCs） was diminished in the femoral head.Therefore,the treatment of femoral head avascular necrosis was done simultaneously when the blood supple was improved.Seed cells with osteogenic ability should be supplemented in the local necrotic region.OBJECTIVE：To observe clinical curative effect of autologous bone marrow MSCs（BMSCs） arterial perfusion in combination with interventional therapy of local puncture injection for treatment of femoral head avascular necrosis.METHODS：In 32 patients with femoral head avascular necrosis in the research group,the catheter was placed on the femoral head to support the artery using seldinger technique via percutaneous-femoral artery puncture.Urokinase 30×104 U and papaverine 30 mg were perfused.10 mL BMSCs suspension was perfused via the medial femoral circumflex artery.10 mL BMSCs suspension was infused via multiple points of percutaneous puncture at the necrotic region of the femoral head.The number of BMSCs was 2×107-2×108.The 34 patients with femoral head avascular necrosis of the concurrent control group were compared using interventional therapy of artery thrombolysis.The second and third interventional therapy was performed with an interval of 2 and 4 weeks,three times as a course,in both groups.RESULTS AND COMCLUSION：Stenosis,occlusion and revascularization were observed in the femoral head and neck regions of 32 patients of the research group.The vessel dying region of the femoral head was obviously enlarged.Necrotic region was gradually shortened in 29 cases.Following treatment,the improvement degree of range of motion was better in the research group than the control group.The effective rate of pain easement was 93.8%,and the clinical recovery rate was 84.4% in the research group,which were greater compared with the control group.Results demonstrated that perfusion of autologous BMSCs in combination with interventional therapy of multiple injection of percutaneous puncture for treatment of femoral head avascular necrosis following artery thrombolysis can elevate curative effect,pain release and improve joint function.