骨髓间充质干细胞和伞状支撑骨移植术治疗股骨头坏死的实验研究

目的 探讨骨髓间充质干细胞和伞状支撑骨移植术治疗股骨头坏死的疗效.方法 42只山羊用液氮冷冻法建立单侧股骨头坏死模型,8周后分为3组,A组行骨髓间充质干细胞和伞状支撑骨移植术;B组行单纯股方肌骨柱移植术;C组行骨髓间充质干细胞和松质骨移植术.三组的健侧均作为自身正常对照.分别于术后3、6个月行放射学、组织学观察.结果 治疗术后3个月:①X线检查:A组、B组手术侧股骨头外形恢复,囊性低密度区消失,原塌陷已修复,股骨头无再塌陷.A组植骨愈合良好,骨柱影已模糊;B组植骨愈合欠佳,骨柱影仍较清晰.C组手术侧骨修复效果明显较A组、B组差,股骨头轮廓不规则,扁平塌陷,密度不均.②组织学观察:A组骨小梁成熟,排列规则;B组骨小梁幼稚,排列不规则;C组骨小梁变细、稀疏、断裂.A组空骨陷窝计数百分比降低、骨小梁面积分数百分比增高,与B组、C组相比差异有统计学意义(P＜0.05),与正常侧相比差异无统计学意义(P＞0.05).治疗术后6个月:X线检查A组、B组手术侧股骨头已为正常股骨头X线表现,而C组手术侧股骨头完全塌陷.组织学检查A组、B组手术侧股骨头空骨陷窝计数百分比、骨小梁面积分数百分比与正常侧相比差异无统计学意义(P＞0.05),且A、B组差异亦无统计学意义(P＞0.05).结论 骨髓间充质干细胞和伞状支撑骨移植术治疗股骨头坏死效果良好,优于松质骨移植术和单纯股方肌骨柱移植术.

Experimental study on the treatment efficacy of femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells

Objective To discuss the treatment efficacy of the femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells. Methods The femoral-head osteonecrosis models on one side were established in forty-two goats using liquid nitrogen, which were randomly classified into three groups after 8 weeks. Group A were conducted umbrella strut bone grafting and bone marrow mesenchymal stem cells transplantation, group B were conducted simple unit side muscle bone flap grafting, and group C were conducted umbrella strut bone grafting and Cancellous bone grafting transplantation. The health side of three groups was treated as self-control. The radiological and histology examination were made at 3,6treated lateral femoral-head shape restored,cystic cnlow-density area disappeared, the original collapse had repaired, and no further collapse of the femoral-head shaped for both group A and B. Bone fusion was good and bone column shadow had been vague for group A, while the bone fusion healed somewhat less and bone column shadow still clear for group B. Group C had irregular contour of femoral head, flat collapse, uneven density, and fracture cracks could be seen at weight-bearing area of femoral head, obviously was the poorest bone had different states: mature and arranged ruled for group A, childish and irregular arrangement for group B, thinning, sparse and fracture for group C. The percentage of empty lacunae counts decreased, while the percentage of trabecular bone area fraction increased for group A. In contrast with group B, and C, the difference was statistically significant (P ＜ 0.05), but the difference was no longer statistically significant when contrast with healthy sides (P ＞ 0.05). 6 months later, the radiological and histology examination showed that:group A and group B had been no significant difference comparing to normal femoral heads, while the femoral head of group C collapsed and disappeared completely. Group A and group B were no difference comparing the healthy side (P ＞ 0.05)in the area fraction of trabecualr bone and percentage of empty lacunae counts, neither it was between group A and group B(P ＞ 0. 05). Conclusion The treatment efficacy of the femoral-head osteonecrosis by umbrella strut bone grafting and bone marrow mesenchymal stem cells was good and was better than cancellous bone grafting transplantation and simple unit side muscle bone flap grafting.