摘要
目的对比分析单纯股骨头髓芯减压与联合自体血清培养BMSCs移植治疗早期股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)的临床疗效。方法 2006年5月-2008年10月收治8例16髋双侧早期ANFH患者。男7例,女1例;年龄19～43岁,平均35.7岁。其中激素性2例,酒精性3例,无明显诱因3例。病程4个月～2年,平均1.1年。按左右侧随机分两组:A组采用单纯股骨头髓芯减压治疗,B组行股骨头髓芯减压结合自体血清培养的BMSCs移植治疗。按世界骨循环研究学会(ARCO)国际骨坏死分期标准:A组:Ⅱa期4髋,Ⅱb期2髋,Ⅱc期1髋,Ⅲa期1髋;B组:Ⅱa期2髋,Ⅱb期2髋,Ⅱc期3髋,Ⅲa期1髋。采用Harris评分和疼痛视觉模拟(VAS)评分对患者术前及术后进行临床随访;采用X线片及MRI进行影像学评估;检测红细胞沉降率、C反应蛋白、肝肾功、免疫球蛋白等指标,进行安全性评估。结果术后切口均Ⅰ期愈合。8例均获随访,随访时间12～42个月,平均23.5个月。术后3个月疼痛、跛行等临床症状逐渐改善。术前及术后3、6个月两组Harris评分及VAS评分比较差异均无统计学意义(P>0.05),术后12个月B组评分优于A组(P<0.05);术后各时间点组内Harris评分及VAS评分均较术前显著提高(P<0.05)。术后12个月X线片及MRI检查示,A组1例Ⅲa期患者出现股骨头塌陷;B组T1相低信号区所占股骨头体积的百分比为13.25%±2.12%,与A组(18.13%±2.59%)比较,差异有统计学意义(P<0.05);安全性评估显示所有患者术后均未出现发热、局部感染等不良反应。结论自体血清培养BMSCs移植结合髓芯减压与单纯髓芯减压治疗早期ANFH均有效,但前者缓解疼痛及延缓塌陷方面优于后者,安全可靠。
Objective To compare the clinical outcomes of the core decompression combined with autologous bone marrow mesenchymal stem cells（BMSCs） transplantation with the isolated core decompression for the treatment of early avascular necrosis of the femoral head（ANFH）.Methods From May 2006 to October 2008,8 patients（16 hips） with early ANFH were treated.There were 7 males and 1 female with an average age of 35.7 years（range,19-43 years）.According to the system of the Association Research Circulation Osseous（ARCO）：4 hips were classif ied as stage Ⅱ a,2 as stage Ⅱ b,1 as stage Ⅱ c,and 1 as stage Ⅲ a in group A;2 hips were classif ied as stage Ⅱ a,2 as stage Ⅱ b,3 as stage Ⅱ c,and 1 as stage Ⅲ a in group B.The average disease course was 1.1 years（range,4 months to 2 years）.The patients were randomly divided into 2 groups according to left or right side：group A,only the core decompression was used;group B,both the core decompression and autologous BMSCs transplantation were used.The Harris score and visual analogue scale（VAS） score were determined,imaging evaluation was carried out by X-rays and MRI pre-and post-operatively.The erythrocyte sedimentation rate,C-reactive protein,liver function,renal function,and immunoglobulin were detected for safety evaluation.Results All incisions healed by first intention.Eight patients were followed up 12-42 months（23.5 months on average）.The clinical symptoms of pain and claudication were gradually improved.The Harris scores and VAS scores of all patients were increased significantly at 3,6,and 12 months after operation（P〈 0.05）.There was no significant difference between groups A and B 3 and 6 months after operation（P 〉0.05）,but there was significant difference between groups A and B 12 months after operation（P 〈0.05）.The necrosis area of femoral head in groups A and B were 18.13% ± 2.59% and 13.25% ± 2.12%,respectively,showing significant difference（P 〈0.05）.In group A,femoral head collapsed 12 months after o
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第6期739-743,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨头缺血性坏死
髓芯减压
自体
BMSCS移植
Avascular necrosis of the femoral head Core decompression Autologous bone marrow mesenchymal stem cells transplantation
