干细胞移植改善股骨头坏死缺血状态122例临床观察

目的探讨经动脉自体骨髓干细胞（BMSC）和外周血干细胞（PBSC）移植改善股骨头坏死缺血状态的临床疗效。方法2004年7月至2006年12月对122例（211髋）成人缺血性股骨头坏死（ANFH）患者施行自体BMSC或PBSC移植治疗,按国际分期标准（ARCO）分期,设自身前后对照方法进行疗效观察。BMSC组90例和PBSC组32例在DSA下行股骨头供血动脉干细胞移植术,移植后第3、6、12、24个月进行髋关节Harris评分做疗效评价,6个月复查股骨头供血动脉造影观察血管新生情况。每间隔6个月复查影像学变化。结果122例患者随访3～24个月（平均10．2个月）,髋关节疼痛缓解104例（85．1％）,关节功能改善76例（62．0％）,90例（73．9％）行走间距延长。干细胞移植术后6个月,15例患者股骨头供血动脉造影检查见供血动脉较移植前明显增多、增粗,血流速度增快;12～24个月20例股骨头区可见骨质病变获得改善。结论经动脉自体BMSC和PBSC移植方法简便,安全有效,对缺血性股骨头无再次损伤,患者依从性好,是治疗缺血性股骨头坏死的一种新途径。

Clinical study on the improvement of ischemia condition with stem cell transplantation in 122 cases necrosis of femoral head

OBJECTIVE: To observe the curative effects of bone marrow stem cell (BMSC) and peripheral blood stem cell (PBSC) transplantations on the avascular necrosis of femoral head (ANFH). METHODS: Totally 122 ANFH patients (211 coxae) treated by BMSC or PBSC transplantations were enrolled from July 2004 to December 2006. All of them were classed to different stages according to the ARCO. Control group were desired as themselves before and after treatment. The puncture of femoral artery was conducted with digital subtraction angiography (DSA), and the tubes were inserted into medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery with the cell suspensions were gradually poured into the arteries. RESULTS: The joint paining, joint functions and walking distance of 122 patients were detected for the follow-up. Compared with before treatment, the calibers thickened; vessels increased and blood velocity quickened of femoral head blood-supply artery were observed in 15 patients after 6 months checked by DSA. The reduced areas of femoral head necrosis in 8 patients indicated the new bone formation between 12 and 24 months. CONCLUSIONS: Autologus BMSC and PBSC transplantation results in the new bone formation and improvement of ischemia in areas of femoral head necrosis at 6 months. The change of angiography was observed about 12 to 24 months after cell transplantation. The stem cell transplantation is convenient, safe and effective in the treatment of the ANFH with no adverse reaction, and can be considered as a new therapy of ANFH.