髓芯减压联合自体骨髓基质干细胞移植治疗兔激素性股骨头坏死实验研究

目的探讨髓芯减压联合自体骨髓基质干细胞(BMSC)移植对兔激素性股骨头坏死的治疗作用。方法建立早期激素性股骨头坏死动物模型后,随机分为三组,A 组为右侧髓芯减压组(10 只);B 组为右侧髓芯减压结合自体 BMSC 移植组(10 只);C 组为未治疗组(12 只)。 A、B、C 组都于使用激素后的第 12 周处死,所获股骨头标本组织切片行 HE 染色观察。分别在建模前,治疗前,治疗后采外周血化验凝血酶原时间(PT)、纤维蛋白原(Fib)、总胆固醇(TC)、甘油三酯(TG)。结果建立模型动物死亡率为 8.6%(3/35)。 A、B、C 组右侧股骨头坏死率分别为 50%(5/10)、20%(2/10)、75%(9/12)。 B 组与 A 组、C 组相比空骨陷窝率下降、骨髓坏死面积减少、骨小梁体积比增加(P0.05)。使用激素后 Fib 下降,PT、TC、TG 升高(P0.05),自体 BMSC 移植后这些结果恢复接近正常范围。结论髓芯减压联合自体骨髓基质干细胞移植对兔早期激素性股骨头坏死有治疗作用。     

动脉灌注髓芯减压干细胞移植治疗股骨头坏死

目的评价动脉灌注加股骨头髓芯减压后注射干细胞治疗成人股骨头缺血性坏死的疗效。方法对30例成人股骨头缺血性坏死（ARCO分期ⅠA～ⅢA期）分别采用单纯动脉灌注、动脉灌注加股骨头髓芯减压、动脉灌注加股骨头髓芯减压后行干细胞移植三种方法治疗。术后采用髋关节Harris评分及影像学（主要为MRI）情况评定疗效。结果动脉灌注加股骨头髓芯减压后注射干细胞较另外两组在MRI表现上有明显差异（P〈0．05）。结论通过对早期股骨头缺血性坏死进行血管灌注、股骨头髓芯减压及自体骨髓干细胞注射的治疗,可以延缓或阻止股骨头缺血坏死、塌陷、变形的病理过程。     

髓芯减压植骨并自体骨髓间质干细胞移植治疗股骨头坏死手术配合

对5例股骨头缺血性坏死患者采用髓芯减压并自体骨髓间质干细胞移植治疗。结果5例均于术后3周后下床活动，髋关节疼痛完全消失。3个月后复查示，50％股骨头死骨成活，HHS评分≥95分。提示自体骨髓间质干细胞移植治疗股骨头缺血性坏死创伤小、疗效好，早期股骨头坏死患者可恢复髋关节功能。手术室严格执行消毒隔离制度，巡回护士和器械护士熟悉手术配合步骤，充分准备物品，严格无菌操作，控制术中感染，才能确保手术顺利完成。     

髓芯减压打压植骨腓骨支撑术对改善早中期股骨头坏死患者髋关节功能的效果

目的探讨髓芯减压打压植骨腓骨支撑术治疗早中期股骨头坏死的效果。方法选择2016-01—2018-01间在西华县人民医院治疗的56例早中期股骨头坏死患者。随机分为2组,各28例。对照组行股骨头颈部开窗打压植骨术,观察组采取髓芯减压打压植骨腓骨支撑术。比较2组术前与术后6个月VAS疼痛评分、髋关节功能及股骨头塌陷程度。结果观察组治疗后VAS评分低于对照组,Harris评分高于对照组,差异有统计学意义(P0.05)。2组股骨头塌陷程度差异无统计学意义(P0.05)。结论髓芯减压打压植骨腓骨支撑术治疗早中期股骨头坏死,可缓解患者疼痛,改善髋关节功能,降低股骨头塌陷程度。     

髓芯减压术治疗股骨头缺血性坏死

1　髓芯减压术治疗股骨头缺血性坏死的依据股骨头缺血性坏死的机制尚未完全阐明 ,但有相当多的证据提示骨组织具有腔室的性质 ,骨内高压在股骨头坏死的发展中具有重要作用。Ｍｉｃｈｅｌｓｅｎ首先证明骨髓腔内有压力存在 ,Ｗｉｌｋｅｓ等的研究进一步证实 ,骨内循环具有腔室的性质 ,皮质骨为这个腔室的外壁 ,在这个腔室内有血管通过 ,在血管以外、皮质骨以内在相当多的软组织 ,如正常的造血组织、骨髓内的脂肪细胞、组织液等。当这些软组织在体内、外各种因素的作用下而体积增大时 ,髓腔内压力随之增高 ,通过髓腔内的血管的血流量因外界压…     

高压氧联合颈前路减压治疗早期外伤性颈髓损伤

[目的]探讨高压氧联合颈前路减压钢板固定对于早期外伤性颈髓损伤的治疗疗效。[方法]115例患者设治疗组（HBO＋ACSLP）、对照组。（ACSLP）、对照组：（HBO），分别治疗然后进行观察治疗效果，总结各组预后。其中HBO在伤后或术后平均4．3d接受3个疗程共30d治疗。ACSLP平均在伤后4．75d采用颈前路减压带锁钢板固定法接受治疗。[结果]治疗组显效率92．1％；对照组。显效率72．2％；对照组：显效率36．6％。治疗组优于对照组．（P〈0．05））和对照组：（P2〈0．01），差别有显著意义（P〈0．05）。[结论]HBO＋ACSLP治疗早期外伤性颈髓损伤较单纯ACSLP及HBO治疗有更好的疗效。     

骨髓水肿综合征

骨髓水肿综合征(bone marrow edema syndrome,BMES)是一种少见的病因不明自限性疾病，主要表现不伴有外伤史髋关节疼痛，早期X线平片无明显异常，1个月后出现股骨头颈骨骨质疏松，MRI早期呈骨髓水肿征象，目前多数人对该综合征不认识，常被漏诊或误诊，尤其是被误诊为缺血性坏死(avascu-     

髓芯减压植骨自体骨髓间充质干细胞移植治疗早期股骨头缺血性坏死

目的 探讨应用髓芯减压植骨自体骨髓间充质干细胞(BMSCs)移植治疗早期股骨头缺血性坏死(ANFH)的疗效.方法 对26例早期ANFH采用髓芯减压植骨自体BMSCs移植治疗.结果 随访6～30个月,患者疼痛明显缓解,采用Harris髋关节功能评分,术前平均(51.6±4.86)分,术后为(93.8±7.36)分,比较差...     

髓芯减压植骨并自体骨髓间质干细胞移植治疗股骨头坏死手术配合

对5例股骨头缺血性坏死患者采用髓芯减压并自体骨髓问质干细胞移植治疗.结果 5例均于术后3周后下床活动.髋关节疼痛完全消失.3个月后复查示,50%股骨头死骨成活,HHS评分≥95分.提示自体骨髓问质干细胞移植治疗股骨头缺血性坏死创伤小、疗效好,早期股骨头坏死患者可恢复髋关节功能.手术室严格执行消毒隔离制度,巡回护士和器械护士熟悉手术配合步骤,充分准备物品,严格无菌操作,控制术中感染,才能确保手术顺利完成.     

介入和髓芯减压植骨治疗股骨头缺血性坏死

目的探讨介入和髓芯减压、坏死区域掏空植骨治疗股骨头缺血性坏死的疗效。方法对57例患者采用介入和髓芯减压、坏死区域掏空植骨。结果57例经1~4·5年(平均2·9年)随访,效果满意。结论该方法损伤小,操作简便,是治疗股骨头缺血性坏死的有效方法。     

Core decompression with marrow stem cells

Association of core decompression with technique of bone graft is frequent and many different techniques have been described. In this series, grafting was done with autologous bone marrow obtained from the iliac crest of patients operated for hips osteonecrosis. The bone marrow was harvested under general anesthesia. A beveled metal trocar of 6 to 8 cm in length and a bore of 1.5 mm was pushed deep into the cancellous bone. A 10-mL syringe that has been flushed with heparin is used to aspirate the marrow. Once the needle has been inserted to the desired depth, the tip is swept around a full circle in 45° steps, with the bevel pointing in different directions at each step. This procedure is continued until a sufficient quantity of bone marrow has been harvested (150 mL). All the marrow aspirated is discharged into a plastic collection bag containing ACD (acid citrate dextrose) anticoagulant solution. It is then filtered, to remove fat aggregates and clots. The aspirated marrow was reduced in volume by concentration and injected in the femoral head after core decompression with a small trocar. To measure the number of progenitor cells transplanted, we used the fibroblast colony forming unit as an indicator of the stromal cell activity and performed in vitro cultures of the fibroblast progenitor cells. The average volume of bone marrow aspiration was 147 mL ± 12 mL per hip. The number of progenitor cells was average 12.4 ± 3.4 per 10⁶ bone marrow nucleated cells and the number of nucleated cells was estimated to be 16.4 million cells per milliliter of bone marrow.     

Core decompression with bone marrow aspirate concentrate in post collapse avascular necrosis of hip: A systematic review and meta-analysis

BackgroundAvascular necrosis (AVN) of femoral head is commonly seen in middle age groups and in its advanced stages, it is a common indication for total hip replacements (THRs). These patients invariably require revision surgeries in their lifetime and modalities to delay the first arthroplasty are necessary. Core decompression (CD) with bone marrow aspirate concentrate (BMAC) have proved successful in early stages of AVN, but their role in advanced stages remains unclear. The present review was done to assess the same.Research questionIs CD and BMAC combination effective in delaying radiographic progression and THRs in post collapse stages of AVN hip?MethodologyA systematic review and meta-analysis was conducted to determine the overall efficacy of CD and BMAC in post collapse stages of AVN hip and to specifically compare primary outcomes like radiographic progression along with need of THR, with CD alone.Three data bases (PubMed, EMBASE and SCOPUS) were searched to identify relevant articles.ResultsThe present review included 12 studies with 3 studies included in the meta-analysis. There were 270 hips across the 12 studies out of which 196 hips were treated with CD + BMAC.Primary outcomes39.8% cases worsened from stage 3 to stage 4, while the overall incidence of THR in stages 3 and 4 was 38.3%. On comparison with CD alone the combination of CD + BMAC did not show any enhanced efficacy in either delaying progression (Odds ratio of 1.41 (95% CI = 0.55–3.62) or in conversion to THR (Odds Ratio: 0. 92; 95% CI = 0.41–2.06)ConclusionCD can be considered in stage 3 of AVN in younger population to delay the need of arthroplasty, before severe head distortion and arthritis sets in, and can be supplemented with bone strut grafts or tantalum rods, for supporting the articular cartilage. BMAC that has shown better results in early AVN, has not shown any additional benefits when compared to CD alone in advanced cases.     

Outcome of painful bone marrow edema of the femoral head following treatment with parenteral iloprost

Background:

Bone marrow edema (BME) is a common cause of hip pain. The aim of the study was to assess the efficacy of the vasoactive drug iloprost in the treatment of BME of femoral head.

Materials and Methods:

We reviewed 27 patients (19 male, 8 female) with BME of the femoral head. Their mean age was 53.7 ± 10.8 years. All patients were treated with iloprost, a vasoactive drug that dilates arterioles and venules, reduces capillary permeability and suppresses platelet aggregation. The therapy comprised a series of five infusions with 20 to 50 μg iloprost over 6 h on 5 consecutive days each. Weight bearing was reduced for up to 3 weeks, depending on the severity of symptoms. Pain at rest as well as under stress was assessed with a semi quantitative scale from before and 4 months after therapy. MRI investigations were done before and repeated 4 months after therapy.

Results:

At the clinical follow up of four months after therapy, the pain level at rest had diminished by a mean of 58.3% (P < 0.0001). Pain under stress decreased by a mean of 41.9% (P < 0.0001). On MRI, 20 patients had a significant reduction of BME size or complete normalization and 4 showed no change. Worsening of the MRI pattern was found in 3 patients.

Conclusion:

The authors conclude that the use of parenteral iloprost might be a viable method in the treatment of BME of femoral head.     

Fatty marrow conversion of the proximal femoral metaphysis in transient bone marrow edema syndrome

Introduction In the proximal femoral metaphysis, hematopoietic marrow is predominant during the adult stage of life. The conversion of hematopoietic marrow to fatty marrow in the proximal femoral metaphysis has been suggested as an etiologic factor of ischemia in the pathogenesis of femoral head osteonecrosis. To determine whether the chronology of fatty marrow conversion of the proximal femoral metaphysis is related to transient bone marrow edema syndrome of the hip, a case control study was conducted on 10 patients with the disease.Materials and methods There were 8 men and 2 women with a mean age of 33 years (range 19–45 years). The 10 patients were matched with 20 controls for gender and age (5-year range). T1-weighted MRI scans of their hips were reviewed. Marrow of the greater trochanter becomes fatty before puberty, and thus, the greater trochanter can be used as a built-in control. The signal intensity of the proximal femoral metaphysis was compared to that of the greater trochanter.Results In all patients, the signal intensity of the proximal femoral metaphysis was isointense (fatty marrow) relative to that of the greater trochanter. In control subjects, the signal intensity was isointense in 8 (40%) and hypointense (hematopoietic marrow) in 12 (60%) (p<0.05).Conclusion The current study shows that the proximal femoral metaphysis is predominantly fatty in transient bone marrow edema syndrome. The conversion of hematopoietic to fatty marrow is known to correlate with decreases in intramedullary blood flow. Thus, the current study suggests that an ischemia of the proximal femur secondary to fatty marrow conversion of the proximal femoral metaphysis might be a cause of transient bone marrow edema syndrome of the hip.     

8例髋关节暂时性骨质疏松症的临床诊断与治疗

目的探讨髋关节暂时性骨质疏松症（transient osteoporosis of the hip,TOH）的临床表现、诊断、鉴别诊断、治疗及预后。方法2003年8月至2009年8月治疗8例TOH患者,男2例,女6例;年龄22—43岁,平均34．9岁。患者均为单侧发病,左侧5例,右侧3例。患者的患髋均表现有不同程度的突发急性疼痛或渐进性疼痛,同时伴有显著的跛行。患髋内旋轻度受限是主要的体征。症状出现后3—6周,x线片可见股骨头均匀广泛的骨质疏松,MR表现为弥散且一致的等低T1、长T2异常信号,脂肪抑制序列呈高信号。嘱患者在疼痛可忍受的条件下半负重行走,避免出现骨折等并发症;口服二膦酸盐和钙剂;剧烈疼痛时,可口服非甾体类抗炎药物缓解疼痛。结果临床治疗3个月后疼痛明显减轻,10个月后疼痛完全缓解,复查MR示病变完全消失。结论TOH是一种少见的疾病,无原因出现的髋关节疼痛和跛行是主要症状,X线片和MR可分别看到暂时性的骨质疏松和骨髓水肿。此病具有自限性,保守治疗可获得良好的结果,明确诊断是治疗的关键。     

Early results of core decompression and autologous bone marrow mononuclear cells instillation in femoral head osteonecrosis: a randomized control study

Fifty-one osteonecrotic hips in 40 patients were randomly divided into 2 treatment groups. Patients in group A (25 hips) were treated with core decompression, and those in group B (26 hips) received autologous bone marrow mononuclear cell instillation into the core tract after core decompression. Outcome between the 2 groups were compared clinically (Harris Hip score), radiographically (x-ray and magnetic resonance imaging), and by Kaplan-Meier hip survival analysis after 12 and 24 months of surgical intervention. The clinical score and mean hip survival were significantly better in group B than in group A (P < .05). Patients with adverse prognostic features at initial presentation, that is, poor Harris Hip score, x-ray changes, edema, and/or effusion on magnetic resonance imaging had significantly better clinical outcome and hip survival in group B than in group A.     

Effects of hyperbaric oxygen treatment on tendon graft and tendon-bone integration in bone tunnel: biochemical and histological analysis in rabbits.

Despite moderate success in clinical applications, outcome of tendon grafts employed for anterior cruciate ligament (ACL) reconstruction remains unsatisfactory. This study investigated the effects of hyperbaric oxygen (HBO) on neovascularization at the tendon-bone junction, collagen fibers of the tendon graft, and the tendon graft-bony interface incorporated into the osseous tunnel in rabbits. Forty rabbits were assigned to two groups. The HBO group was exposed to 100% oxygen at 2.5 atmospheres pressure for 2 h daily, 5 consecutive days in a week. The control group was maintained in cages exposed to normal air. Histological studies of 12 rabbits were performed postoperatively at 6, 12, and 18 weeks. Biomechanical studies of 24 rabbits were conducted postoperatively at 12 and 18 weeks. Electron microscopy (EM) analyses of four rabbits were performed postoperatively at 18 weeks. Experimental results demonstrated that a higher number of Sharpey's fibers bridged the newly formed fibrocartilage and graft in the HBO group than in the control group. In addition, HBO treatment increased neovascularization and enhanced the incorporation of the progressive interface between tendon graft and bone. Biomechanical analysis showed that the HBO group achieved higher maximal pullout strength than the control group. Examination by EM showed that HBO treatment resulted in regenerated collagen fibers with increased compaction and regularity. Based on experimental results, HBO treatment is a treatment modality that potentially improves outcome following ACL reconstruction.     

Chronic axial compression of the mouse tail segment induces MRI bone marrow edema changes that correlate with increased marrow vasculature and cellularity

Magnetic resonance imaging (MRI) of bone marrow edema (BME) has been found to be helpful in the diagnosis of back pain attributed to degenerative disk disease (DDD) and spondyloarthropathy (SA), but its interpretation is limited by a lack of knowledge of its nature and natural history. We assessed effects of compressive forces to mouse tail segments of WT and TNF‐Tg mice with SA, via contrast enhanced‐MRI and histology. Normalized marrow contrast enhancement (NMCE) of uninstrumented WT vertebrae significantly decrease, threefold (p < 0.01) from 8 to 12 weeks of age, while the NMCE of TNF‐Tg vertebrae remained elevated. Compressive loading (6× body weight) increased NMCE twofold (p < 0.02) within 2 weeks in WT tails, which was equal to 6× loaded TNF‐Tg tails within 4 weeks. Histology confirmed degenerative changes and that load‐induced NMCE corresponded to increased vascular sinus tissue (35 ± 3% vs. 19 ± 3%; p < 0.01) and cellularity (4,235 ± 886 vs.1,468 ± 320 cells/mm²; p < 0.01) for the loaded versus unloaded WT, respectively. However, micro‐computed tomography (CT) analyses failed to detect significant load‐induced changes to bone. While the bone marrow of loaded WT and TNF‐Tg vertebrae were similar, histology demonstrated mild cellular infiltrate and increased osteoclastic resorption in the WT tails versus severe inflammatory‐erosive arthritis in TNF‐Tg joints. Significant (p < 0.05) decreases in cortical and trabecular bone volume in uninstrumented TNF‐Tg versus WT vertebrae were confirmed by micro‐CT. Thus, chronic load‐induced DDD causes BME signals in vertebrae similar to those observed from SA, and both DDD and SA signals correlate with a conversion from yellow to red marrow, with increased vascularity. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1220–1228, 2010     

Cementless total hip arthroplasty for osteonecrosis of the femoral head after allogenic bone marrow transplantation

From 1998 until 2004, we performed 26 consecutive cementless total hip arthoplasties in 15 patients who had developed advanced avascular necrosis of the femoral head after allogenic bone marrow transplantation. The average age at transplantation was 31.1 years, and the mean age at implantation was 33.6 years. Follow-up period ranged from 2 to 8 years with an average of 56.4 months. The mean D'Aubigne-Postel score improved from 7.5 points preoperatively to 17 points postoperatively. The overall result was excellent in 92.3%, good in 3.8%, and fair in 3.8% of cases. There were no radiological signs of components loosening and no severe complications. Cementless total hip arthroplasty appears as a favorable alternative for the treatment of avascular necrosis of the femoral heads after allogenic bone marrow transplantation.