自体骨髓干细胞移植治疗激素性股骨头坏死

目的观察自体骨髓干细胞移植治疗激素性股骨头坏死的临床效果。方法52例激素性股骨头缺血性坏死患者经使用rhG-CSF进行骨髓干细胞动员后,第2天进行骨髓干细胞采集,在数字减影血管造影术（DSA）下行股动脉穿刺,导管超选择至闭孔动脉及旋股内外侧动脉,将干细胞悬液缓慢匀速注入动脉内;干细胞移植后随访观察患者髋关节疼痛程度、性质及持续时间变化,行走间距及步态变化,髋关节外展及内旋功能变化;6个月后行股骨头供血动脉造影术。结果52例患者随访12个月,髋关节疼痛有不同程度缓解67％,关节功能改善29．7％,行走间距延长32．5％。干细胞移植术后6个月,10例患者行股骨头供血动脉数字减影血管造影检查,均显示旋股内动脉,旋股外动脉及闭孔动脉管径增粗,新生血管增多,血流速度增快,与移植前血管造影相比较,股骨头血液供应明显改善。治疗中均未发生严重的并发症和不良反应。结论自体骨髓干细胞移植治疗激素性股骨头坏死方法简便,安全有效,适合Ⅰ-Ⅲ期早、中期股骨头坏死的患者。     

自体骨髓基质细胞移植治疗早期股骨头缺血性坏死

目的探索骨髓基质细胞移植更完善的方法，观察对于早期股骨头骨坏死治疗的有效性。方法32例ARCO分期0-2期患者，采用自体骨髓基质细胞移植及髓心减压，细胞分离前后分别检查血常规测量白细胞计数。透视下将细胞悬液直接注入股骨头内。对于骨内压高及疼痛明显患者均行髓心减压术。结果32例患者均获得随访，平均随访18．6月。50髋中42髋x片均未见坏死面积增大及股骨头高度下降，占84％。Harris评分术前平均85分，随访终期为89分。结论自体骨髓基质细胞移植是治疗早期股骨头缺血坏死安全简单有效方法，降低骨内压力，控制关节炎症是治疗有效辅助手段。     

松质骨复合浓缩自体骨髓移植修复早期股骨头缺血性坏死

2004年5月～2010年3月,我科采用自体浓缩骨髓复合松质骨修复50例早期股骨头坏死患者,效果较满意,报道如下。1材料与方法1.1病例资料本组50例,男37例,女13例,年龄21～45岁。     

自体骨髓移植治疗股骨头无菌性坏死

目的 探讨自体骨髓移植治疗股骨头坏死的疗效及其作用机制.方法 选用成年新西兰雄兔60只,造模后随机分为A、B、C三组.左侧股骨头作为对照组,不予处理,右侧为实验组.A组用米托蒽蓖按0.1 mg/kg量在数字减影型x射线机(DSA)导视下注入右侧股骨头内;B组在DSA下直接注入自体骨髓1 ml;C组先予以化疗(方法同A组),72h后注入自体骨髓1 ml.4个月后处死所有动物,取股骨头进行组织病理学及电镜观察.结果 A、B组内左右股骨头对比破骨细胞坏死数差异无统计学意义(P>0.05),而c组左右股骨头坏死数分别为40.60±4.11、21.23± 2.16,差异有统计学意义(P<0.05).C实验组镜下见大部分骨细胞结构清晰、完整,偶见坏死.结论 局部化疗+自体骨髓移植在细胞水平上对股骨头无菌性坏死具有一定的治疗作用.     

中药干预骨髓间充质干细胞成骨分化治疗非创伤性股骨头坏死研究进展

非创伤性股骨头坏死（nontraumatic osteonecrosis of the femoral head，NONFH）作为一种骨结构和生物力学的发生改变可导致髋关节功能丧失的一种难治性骨关节病，主要可分为糖皮质激素性和酒精性两大类。骨髓间充质干细胞（bone marrow mesenchymal stem cells，BMSCs）作为保持骨稳态的主要干细胞，具有分化为成骨细胞、软骨细胞的能力。通过调控BMSCs向成骨细胞、软骨细胞分化对NONFH的进行修复和重建意义重大。中药在中医学“整体观念、辨证论治”理论指导下防治“骨蚀、骨痹”历史悠久、疗效显著。中药通过促进BMSCs向成骨细胞、软骨细胞分化，避免其向脂肪细胞分化，对NONFH的治疗有着重要意义。基于此，该文将中药调控BMSCs分化功能治疗NONFH最新研究进展进行综述，旨为NONFH相关研究的深入及临床防治提供思路和参考。     

自体骨髓移植治疗股骨头无菌性坏死

Objective To investigate the effectiveness and mechanism of transplantation of autol-ogous bone marrow in treating femoral head necrosis. Methods Sixty New Zealand rabbits were randomly divided into groups A,B,and C after establishment of the models of femoral head necrosis. The left femoral head served as the control one,and the right as the experimental group. The mitoxantrone (0.1 mg/kg) with the help of DSA was injected into the femoral head of group A. One ml autologous bone marrow was injected into the femoral head of group B. In group C,mitoxantrone (0. 1 mg/kg) was injected,and 72 h later,1 ml autologous bone marrow was injected. Four months later,all rabbits were killed,and the femoral heads were removed and observed histologically and electron microscopically. Results The number of necrotic osteoclasts in groups A and B showed no significant difference ( P > 0.05 ), ande in group C, the number of necrotic femoral heads at the left and fight sides was 40. 60±4.11 and 21.33±2.16 respec-tively ( P < 0.05 ). At the experimental side of group C, the structure of majority bone cells was clear and intact,and necrosis was occasionally seen. Conclusion At the cellular level, local chemotherapy and au-tologous hematopoietic stem cell transplantation had certain effectiveness for aseptic necrosis of the femoral head.     

自体骨髓移植治疗股骨头无菌性坏死

Objective To investigate the effectiveness and mechanism of transplantation of autol-ogous bone marrow in treating femoral head necrosis. Methods Sixty New Zealand rabbits were randomly divided into groups A,B,and C after establishment of the models of femoral head necrosis. The left femoral head served as the control one,and the right as the experimental group. The mitoxantrone (0.1 mg/kg) with the help of DSA was injected into the femoral head of group A. One ml autologous bone marrow was injected into the femoral head of group B. In group C,mitoxantrone (0. 1 mg/kg) was injected,and 72 h later,1 ml autologous bone marrow was injected. Four months later,all rabbits were killed,and the femoral heads were removed and observed histologically and electron microscopically. Results The number of necrotic osteoclasts in groups A and B showed no significant difference ( P > 0.05 ), ande in group C, the number of necrotic femoral heads at the left and fight sides was 40. 60±4.11 and 21.33±2.16 respec-tively ( P < 0.05 ). At the experimental side of group C, the structure of majority bone cells was clear and intact,and necrosis was occasionally seen. Conclusion At the cellular level, local chemotherapy and au-tologous hematopoietic stem cell transplantation had certain effectiveness for aseptic necrosis of the femoral head.     

自体骨髓移植治疗股骨头无菌性坏死

Objective To investigate the effectiveness and mechanism of transplantation of autol-ogous bone marrow in treating femoral head necrosis. Methods Sixty New Zealand rabbits were randomly divided into groups A,B,and C after establishment of the models of femoral head necrosis. The left femoral head served as the control one,and the right as the experimental group. The mitoxantrone (0.1 mg/kg) with the help of DSA was injected into the femoral head of group A. One ml autologous bone marrow was injected into the femoral head of group B. In group C,mitoxantrone (0. 1 mg/kg) was injected,and 72 h later,1 ml autologous bone marrow was injected. Four months later,all rabbits were killed,and the femoral heads were removed and observed histologically and electron microscopically. Results The number of necrotic osteoclasts in groups A and B showed no significant difference ( P > 0.05 ), ande in group C, the number of necrotic femoral heads at the left and fight sides was 40. 60±4.11 and 21.33±2.16 respec-tively ( P < 0.05 ). At the experimental side of group C, the structure of majority bone cells was clear and intact,and necrosis was occasionally seen. Conclusion At the cellular level, local chemotherapy and au-tologous hematopoietic stem cell transplantation had certain effectiveness for aseptic necrosis of the femoral head.     

自体骨髓移植治疗股骨头无菌性坏死

Objective To investigate the effectiveness and mechanism of transplantation of autol-ogous bone marrow in treating femoral head necrosis. Methods Sixty New Zealand rabbits were randomly divided into groups A,B,and C after establishment of the models of femoral head necrosis. The left femoral head served as the control one,and the right as the experimental group. The mitoxantrone (0.1 mg/kg) with the help of DSA was injected into the femoral head of group A. One ml autologous bone marrow was injected into the femoral head of group B. In group C,mitoxantrone (0. 1 mg/kg) was injected,and 72 h later,1 ml autologous bone marrow was injected. Four months later,all rabbits were killed,and the femoral heads were removed and observed histologically and electron microscopically. Results The number of necrotic osteoclasts in groups A and B showed no significant difference ( P > 0.05 ), ande in group C, the number of necrotic femoral heads at the left and fight sides was 40. 60±4.11 and 21.33±2.16 respec-tively ( P < 0.05 ). At the experimental side of group C, the structure of majority bone cells was clear and intact,and necrosis was occasionally seen. Conclusion At the cellular level, local chemotherapy and au-tologous hematopoietic stem cell transplantation had certain effectiveness for aseptic necrosis of the femoral head.     

自体骨髓移植治疗股骨头无菌性坏死

Objective To investigate the effectiveness and mechanism of transplantation of autol-ogous bone marrow in treating femoral head necrosis. Methods Sixty New Zealand rabbits were randomly divided into groups A,B,and C after establishment of the models of femoral head necrosis. The left femoral head served as the control one,and the right as the experimental group. The mitoxantrone (0.1 mg/kg) with the help of DSA was injected into the femoral head of group A. One ml autologous bone marrow was injected into the femoral head of group B. In group C,mitoxantrone (0. 1 mg/kg) was injected,and 72 h later,1 ml autologous bone marrow was injected. Four months later,all rabbits were killed,and the femoral heads were removed and observed histologically and electron microscopically. Results The number of necrotic osteoclasts in groups A and B showed no significant difference ( P > 0.05 ), ande in group C, the number of necrotic femoral heads at the left and fight sides was 40. 60±4.11 and 21.33±2.16 respec-tively ( P < 0.05 ). At the experimental side of group C, the structure of majority bone cells was clear and intact,and necrosis was occasionally seen. Conclusion At the cellular level, local chemotherapy and au-tologous hematopoietic stem cell transplantation had certain effectiveness for aseptic necrosis of the femoral head.     

体外冲击波疗法联合自体骨髓干细胞移植治疗股骨头坏死

目的应用体外冲击波疗法（ESWT）联合自体骨髓干细胞移植治疗股骨头坏死（ONFH）,分析其治疗效果,探索该病新的保髋治疗方法。方法收集2006年1月至2009年6月在武警总医院收治的股骨头缺血性坏死患者120例180髋,分为空白对照组,单纯ESWT组,单纯干细胞移植组以及联合治疗组,采用髋关节功能评分标准（Harris评分）对患者进行电话随访以及书信随访,对治疗前后髋关节功能进行评价;统计所收集患者的股骨头塌陷情况,比较随访3年时各组股骨头塌陷率。结果ESWT联合自体骨髓干细胞移植治疗ONFH在harris评分明显优于单纯ESWT组（P〈0．05）,以及单纯骨髓干细胞移植术（P〈0．05）,联合疗法3年时股骨头塌陷率明显低于单纯治疗组。结论ESWT联合自体骨髓干细胞移植在治疗ONFH上具有疗效显著,创伤小,患者易于接受等特点,是ONFH保髋治疗的理想方法。     

钽棒联合富集骨髓干细胞治疗早期股骨头坏死的近期疗效

目的观察钽棒联合富集骨髓干细胞治疗早期股骨头坏死临床疗效。方法选取2008年1月至2010年7月期间符合ARCO分期早期标准的患者共22例（35髋）,ⅠB期6髋,ⅠC期10髋、ⅡA期4髋,ⅡB期7髋,ⅡC期7髋,ⅢA期1髋,采用骨髓血采集,骨髓干细胞富集,干细胞移植联合钽棒植入治疗。随诊观察患髋疼痛缓解程度,手术前后Harris评分和影像学进展情况。结果 19例（31髋）患者获2年以上（25～54个月,平均37个月）的随访。（1）髋关节功能行Harris评分：由术前（76.92±9.11）分升至术后（89.09±8.21）分,两组比较有统计学差异（t=7.160,P〈0.01）;（2）髋关节影像学检查：术后继续塌陷ⅠC期1髋,ⅡB期1髋,ⅡC期1髋,最终行全髋关节置换,术后随访25个月的生存率为90.32%。MRI测得股骨头坏死表面积比,由术前的（31.89%±7.95%）降至术后的（11.20%±5.69%）,两组比较有统计学差异（t=-11.494,P〈0.01）。结论钽棒联合富集骨髓干细胞治疗早期股骨头坏死近期疗效肯定,远期疗效有待进一步观察。     

带血管骨移植治疗股骨头无菌性坏死进展

股骨头无菌性坏死是骨科临床较常见的疾病，如能早期做出诊断（股骨头塌陷前），可采用钻芯减压（植骨或不植骨）、截骨、以及带或不带血管的骨移植治疗，尽力保存髋关节功能。局部带蒂骨移植与和游离带血管的骨移植能将带血运的骨组织植入股骨头骨坏死区，除用健康骨组织替代坏死骨外，还重建了股骨头新的血供来源。经5年观察，对各期患者治疗成功率为80％。应用游离带血管的骨移植治疗股骨头无菌性坏死，可获得较高的成功率。     

Treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell infusion

Osteonecrosisfrequentlycausesfemoralheadcollapseanddisablingarthritis,whichultimatelyleadstototaljointreplacement.Ahighfailurerateofjointreplacementunderscoresthejoint preservingprocedures.Varioussurgicaltechniques havebeenusedasatherapyforosteonecrosisofthe femoralhead,whichincludecoredecompressionalone orwithnonvascualrizedorvascularizedbonegraft(DBM,IBG,vascularizedfibulaetc.).1Sofar,the mechanismoftheosteonecrosisisstillunclear(except traumatic),andthereisnouniversalmethodforit especiall…     

髓芯减压联合自体骨髓干细胞移植治疗股骨头坏死的早期临床观察

目的 观察髓芯减压植骨联合自体骨髓干细胞移植治疗早期股骨头坏死的临床疗效.方法 根据国际骨循环研究学会(Association Research Circulation Osseous,ARCO)骨坏死分期标准,选取Ⅰ、Ⅱ期股骨头坏死32例(39髋),治疗组18例(24髋),对照组14例(15髋).治疗组经过自体骨髓干细胞采集、分离、髓芯减压后,骨髓干细胞和松质骨混合植入;对照组行髓芯减压松质骨植入.结果 所有患者均获18个月的随访,行Harris评分和影像学检查.(1)髋关节Harris评分:治疗组由(55.90±9.71)分升至(81.86±7.95)分,优良率为87.5%;而对照组由(56.69±8.32)分升至(68.14±8.65)分,优良率为60.0%,两组比较差异有统计学意义(P<0.01);(2)髋关节影像学检查:治疗组仅1例(1髋)发展为Ⅲ期塌陷,而对照组2例(2髋)发展为Ⅲ期塌陷;MRI测得坏死面积百分比,治疗组由31.88%±7.59%降至13.20%±9.56%,而对照组由32.64%±6.32%降至21.18%±8.83%,两组比较差异有统计学意义(P<0.05).结论 髓芯减压植骨联合自体骨髓干细胞移植治疗早期股骨头坏死是一种安全、有效的方法,但还需要大样本临床试验及长期随访以进一步验证.     

骨髓间质干细胞移植治疗股骨头缺血性坏死

近年随着干细胞技术的兴起和对股骨头坏死发病机制的深入认识，利用骨髓干细胞移植治疗股骨头缺血性坏死呈现了良好的发展前景。     

高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死

 目的 探讨高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死的近期疗效。方法 2009 年 1 月至 2011 年12月采用高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死 26例（35髋）,男 11例,女 15例;年龄 18~65岁,平均 37.4岁。股骨头坏死 ARCO分期ⅡA期 6髋、ⅡB期 13髋、ⅡC期 16髋。采用高位股骨头颈开窗植骨支撑术治疗,开窗位置位于股骨头颈交界处靠近股骨头方向,累及部分股骨头软骨。术后第 1个月及以后每 3个月定期门诊随访,依据 Harris髋关节评分及优良率评估疗效。结果 25例 33髋获得随访,失访 1例 2髋。随访时间 18~32个月,平均 24个月。随访期间未出现感染及神经损伤等并发症。总体 Harris 髋关节评分由术前（73.42±7.30）分提高至末次随访的（85.85±11.63）分;其中ⅡA 期患者由（74.50±1.76）分提高至（91.17±1.60）分;ⅡB 期患者由（73.92±8.03）分提高至（86.00±10.49）分;ⅡC 期患者由（72.60±8.29）分提高至（83.60±14.29）分。总体优良率由术前 36.4%提高至 84.9%;ⅡA 期患者由 33.3%提高至 100.0%;ⅡB 期患者由 41.7%提高至 91.7%;ⅡC 期患者由 33.3%提高至 73.3%。手术前后 Harris 髋关节评分及优良率的差异均有统计学意义。结论 高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死近期疗效好,能促进坏死修复,改善髋关节症状。     

带肌蒂骨瓣移植术治疗股骨头坏死

目的探讨带股方肌蒂骨瓣移植术治疗股骨头坏死的临床疗效。方法应用双支撑骨柱移植术治疗ONFH获5年以上随访者186例206髋，ARCO分期为ⅡB、ⅡC、ⅢA、ⅢB、ⅢC、Ⅳ期者分别为36、30、40、40、32、28髋。单纯股方肌蒂骨瓣移植术治疗ONFH获得3年以上随访者82例94髋，ARCO分期6ⅡB、Ⅱc、ⅢA分别为36、30、28髋。参照百分法评价疗效。结果患者术后的髋关节疼痛明显缓解或消失，股骨头高度有不同程度的增加，关节活动度改善，双支撑骨柱移植术组平均随访时间10．5年（5—16年），术前术后的临床评价、x线评价、总分数比较，两者间的差异均有统计学意义（P〈0．01）。ⅡB～Ⅳ期优良率分别为83．3％、80．0％、75．0％、65．0％、40．6％、28．6％，总优良率为63．6％。期别间疗效依次降低，差异有统计学意义（P〈0．01）。单纯股方肌蒂骨瓣移植术组平均随访时间3．2年（0．5～5．5年），ⅡB、ⅡC、ⅢA期的优良率分别为94．4％、93．3％、89．3％，总优良率为92．6％。结论两种带股方肌蒂骨瓣移植术治疗股骨头坏死的疗效良好，远期效果与坏死期别有关，适用于Ⅱ期和Ⅲ早期的年轻患者。     

股骨头坏死修复反应区的骨髓水肿及其病理改变

目的探讨股骨头坏死修复反应区骨髓水肿的病理基础和临床意义。方法随机取20个因股骨头坏死行全髋关节置换的股骨头标本，取修复反应区制作成病理切片。根据MRI脂抑像表现分为骨髓水肿组和非水肿组。将两组病理切片的显微镜下结构随机取5个视野，对于所见坏死和崩解骨组织、脂肪组织、造血组织、肉芽组织、纤维组织，进行比较。结果本研究显示骨髓水肿组肉芽组织明显较常见（x^2=13．107，P〈0．05），而无水肿组脂肪组织（x^2=17．755，P〈0．05）和造血组织（x^2=2．838，P〈0．05）较多，两组差异有统计学意义。而坏死骨小梁（x^2=0．457，P〉0．05）、崩解组织（x^2=0．037，P〉0．05）、纤维组织（x^2=0．428，P〉0.05）在两组分布相似，差异无统计学意义。结论股骨头坏死修复反应区的骨髓水肿是一种炎性反应表现，其产生机制可能与股骨头内微骨折有关，对于临床治疗的相关性尚需进一步研究。     

Clinical result of structural augmentation with cannulated bone screws for the treatment of osteonecrosis of the femoral head

Objective: To evaluate the results of treatment of osteonecrosis of the femoral head by structural augmentation through a routine core decompression procedure combined with insertion of cannulated bone screws incorporating autogenous bone graft and biomaterial containing decalcified bone matrix. Methods: F rom February 2002 to February 2005, 31 patients (33 hips) with femoral head necrosis were treated in our hospital using insertion of cannulated bone screws incorporating autogenous bone graft. There were 18 men and 13 women with an average age of 37 years (range, 27–49). The Steinberg classification was stage I for 20 hips (61%) and stage II for 13 hips (39%). Clinical and radiographic evaluations were performed on all patients. The patient's satisfaction was also assessed. Results: All 31 patients (33 hips) were retrospectively studied after a mean follow‐up of 38 months (range, 18–48). The average Harris hip score was 76 before surgery and 91 at the final follow‐up. All patients stated that they were satisfied and had significantly reduced pain. According to the Harris hip score system, 21 cases were excellent, 8 good and 2 fair. No complications, such as wound infection, subtrochanteric fracture, neuropathy and deep vein thrombosis, were found. Conclusion: Structural augmentation using the insertion of cannulated bone screws incorporating autogenous bone graft is an effective option for Steinberg I–II stages of femoral head necrosis. Further study is needed to confirm mid‐ and long‐term results.