髓芯减压复合自体骨髓间充质干细胞移植治疗股骨头缺血坏死

目的]探讨髓芯减压复合自体骨髓间充质干细胞移植治疗股骨头缺血坏死的临床效果.方法]自2006年11月～2010年4月,62例93髋股骨头缺血坏死患者接受了髓芯减压复合自体骨髓间充质干细胞移植治疗,根据ARCO分期标准:Ⅰ期8例14髋；Ⅱ期47例68髋；Ⅲ期7例11髋.术前常规Harris评分,拍摄髋关节正位、蛙式侧位X线片、CT平扫及MRI.从患者髂前上棘抽取骨髓400ml,分离浓缩中间层骨髓间充质干细胞(2.2±0.3)×109L-1,骨坏死区用6mm空心钻行髓芯减压术后,将浓缩细胞悬液注入.结果]54例71髋获得12个月以上随访,术后4髋改行全髋关节置换术,其余67髋术后Harris评分明显提高(术前平均59.2分,未次随访平均88.3分),差异有统计学意义(P＜0.05).临床成功率为90.1％,影像学成功率为87.3％.MRI术前冠状位脂肪抑制T2WI序列显示股头颈处骨髓水肿32髋,术后水肿均完全消失,消失时间平均10.2个月.结论]髓芯减压复合自体骨髓间充质干细胞移植是治疗ARCO分期Ⅰ～Ⅲ期股骨头缺血坏死安全有效的保头治疗方法.

Treatment of avascular necrosis of the femoral head with core decompression and transplantation of autologous bone marrow mesenchymal stem cells

Objective]To evaluate the clinical effects of core decompression combined with transplantation of autologous bone marrow mesenchymal stem cells to treat avascular necrosis of the femoral head(ANFH).Methods]Between November 2006 and April 2010,62 patients(93 hips) with ANFH were treated with core decompression and transplantation of autologous bone marrow mesenchymal stem cells.According to the system of Association Research Circulation Osseous(ARCO),there were 8 cases(9 hips) of stageⅠ,47 cases(68 hips) of stageⅡ,and 7 cases(11 hips) of stage Ⅲ.All the patients were assessed with Harris score system,X-ray at anteroposterior and frog leg position,CT scan,and MRI.Bone marrow of 400 milliliter was collected from bilateral anterosuperior iliac spine of patients.Bone marrow mesenchymal stem cells were concentrated and cell counting was 2.2±0.3×1010 L-1.Osteonecrosis areas were drilled with the hollow drills of 6 millimeter diameter,and then cell suspension was injected into it.Results]Fifty-four patients(71 hips) were followed up for more than 12 months.Four hips underwent total hip arthroplasty.The average preop Harris score of the other 67 hips was 59.2,and the average postop Harris score at the last follow up was 88.3.Significant difference was found between pre-and postoperative evaluation(P<0.01).Thirty-two hips were demonstrated bone marrow edma(BME) of the femur on STIR-FS-T2WI coronal MRI preoperatively.All of the BME was disappeared postoperatirely and the average time of disappearance was 10.2 months.Conclusion]Core decompression combined with transplantation of autologous bone marrow mesenchymal stem cells is an easy and safe preserving head treatment for stageⅠ~Ⅲ ANFH.