非细胞型组织工程化异体骨复合骨形态发生蛋白和红骨髓治疗股骨头缺血性坏死  

Treatment of Avascular Necrosis of Femoral Head by Implanting a Composite of Bone Marrow,Bone Morphogenetic Protein,and Noncelluar Tissue Engineered Bone Allograft

作　　者：李亚非[1] 常红星[2] 姚建华[2] 郭永智[2] 张建政[2] 马文辉[2] 时述山[2] 陈喜顺 方崇瑞[1] 沈素华[1] 郭颖[3] 张路松[4] 汪琦[5] 齐立海 王瑞敏 孙国绍 

机构地区：[1]北京市健宫医院骨科 [2]北京军区总医院骨科,北京100700 [3]河北玉田县医院骨科 [4]唐山市工人医院 [5]唐山市骨科医院 [6]河南新乡辉县市医院骨科 [7]浙江瑞安市中医院骨科 [8]河南平顶山市人民医院骨科

出　　处：《中国医疗器械信息》2007年第2期13-17,共5页China Medical Device Information

基　　金：国家自然基金资助项目(39770745);全军十五课题项目

摘　　要：目的：观察非细胞型组织工程化异体骨复合骨形态发生蛋白（BMP）和红骨髓植入治疗青壮年股骨头缺血性坏死的疗效。方法：异体松质骨、异体腓骨为部分脱钙冻干骨。BMP为牛骨来源的用Urist方法部分纯化制品（bBMP）。首先进行髓芯减压，彻底刮除死骨。将异体松质骨混合bBMP和自体红骨髓植入死骨刮除区，部分脱钙冻干异体排骨植入髓芯减压孔道．直接支撑股骨头病变区软骨下骨。采用该治疗64例（78髋）股骨头缺血性坏死患者。结果：术后主要观察疼痛和功能情况，定期拍X线片、CT检查。本组患者均获得随访。随访时间3个月～6年。平均44个月。随访3年以上28例（36髋），其中18例（22髋）FicatⅠ，Ⅱ期患髋无明显疼痛及功能受限．CT显示形成密度较高的新骨，病变范围及程度无发展：4例（6髋）Ficat Ⅰ、Ⅱ期患髋症状无加重．但病变进展一期。在6例（8髋）Ficat Ⅲ病例，其中2例无明显疼痛及活动受限，4例因症状无明显改善而行人工关节置换术：结论异体腓骨可提供直接的机械支撑力，阻止股骨头病变进展和塌陷。BMP困可诱导红骨髓和异体骨增强其成骨能力．所以该方法可作为治疗青壮年FicatⅠ、Ⅱ期股骨头缺血性坏死的一种选择。Objective： To investigate the effect of treatment of avascular necrosis of femoral head in adolescence by implanting a composite of red bone marrow, bone morphogenetic protein, and noncelluar tissue engineered bone allograft. Method： The bone allograft chips （sponge bone） and allograft fibula segments were partial dematerialized and then freeze-dried, steriled by radiation. The bone morphogenetic protein was partial purified from bovine cortical bone（bBMP） by Urist method. The bone allograft chips were mixed with bovine bone morphogenetic protein and red bone marrow was implanted into the necrotic area of the femoral head after core decompression. Then, partial deminerallized allograft fibula segments were settled in the core decompression holes to support the necrotic area to prevent from being collapsed in 64 adolescent patients （78 hips）. Results： Preoperatively, pain, joint function, and CT scanning was evaluated in deferent time intervals. 55 cases（67 hips）were followed up form 3 months to 6 years（mean 44 months）. 28 case（36 hips） in Ficat I, II were followed up over 3 years, of whom there were no obvious pain and dysfunction 18 cases （22 hips）, high density new bone was shown in core decompression area in CT scanning, and no evidence of progressing necrosis. There is no progressing in the symptoms in 4 cases（6 hips）in Ficat Ⅰ, Ⅱ, but the lesion progressed. In 6 cases （8 hips） in Ficat Ⅲ, there no obvious pain and dysfunction in 2 cases, but 4 cases undergone total hip replacement because of persistent pain and progressing lesion. Conclusion： The partial dematerialized allograft fibula can provide direct mechanical support to prevent the necrotic femoral head from progressing and collapse, red bone marrow and bone morphogenetic protein promote new bone formation. The method can be used as an alternative for the treatment of osteonecrosis of femoral head at stage Ⅰ, Ⅱ.

关 键 词：股骨头坏死 骨移植 骨形态发生蛋白 骨组织工程学 

分 类 号：R687[医药卫生—骨科学]