自体髂骨植骨联合干细胞移植治疗早期股骨头坏死  

Autologous iliac crest grafting combined with stem cells transplantation in the treatment of early osteonecrosis of the femoral head

作　　者：郑越[1] 杨祥雷[1] 王辉[1] 李会杰[1] 

机构地区：[1]河北医科大学第三医院骨病科,河北省骨科研究所,河北省石家庄市050051

出　　处：《中国组织工程研究》2013年第23期4363-4370,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前对股骨头缺血性坏死的治疗方法有多种,提倡早期治疗是临床研究的热点之一。目的:观察头颈开窗减压自体髂骨联合外周血造血干细胞移植治疗早期股骨头缺血性坏死的效果。方法:自2009年2月至2012年3月采用头颈开窗减压自体髂骨联合外周血造血干细胞移植治疗股骨头缺血性坏死患者21例(36髋),单髋6例,双髋15例;年龄22-50岁,平均33.6岁;病史8个月-3年,平均1.4年;按ARCO分期标准,Ⅰ期7髋,Ⅱ期29髋。根据治疗前后症状、髋关节功能Harris评分、X射线及CT结果进行评价,分析其治疗效果。结果与结论:股骨头缺血性坏死患者21例(36髋)全部获得随访,随访时间12-48个月。其中29髋疼痛消失,活动自如,X射线、CT显示股骨头密度、骨小梁结构、髋关节间隙比治疗前明显改善,疗效为优;6髋病情缓解,疗效为良;1髋病情加重,疗效为差,治疗总优良率为97%(35/36)。患者髋关节Harris评分由治疗前平均(60.9±5.6)分增至治疗后平均(90.5±5.1)分,差异有显著性意义(P<0.05)。提示头颈开窗减压病灶清除自体髂骨联合外周血造血干细胞移植是治疗早期股骨头缺血性坏死的一种有效方法,若要取得完美的治疗效果有待于进一步临床观察。BACKGROUND： There are several existing treatments for osteonecrosis of the femoral head, and early treatment is widely suggested. OBJECTIVE： To study the curative effect of autologous itiac bone transplantation through decompression and fenestration over the femoral head and neck combined with implantation of peripheral bloodhemopoietic stem cells in the treatment of femoral head osteonecrosis at early period. METHODS： A total of 21 patients with osteonecrosis of the femoral heads （36 hips） were treated with autologous iliac bone transplantation through decompression and fenestration over the femoral head and neck combined with implantation of peripheral blood hemopoietic stem cells from February 2009 to March 2012. Their age ranged 22-50 years （mean 33.6 years）. Unilateral head necrosis occurred in six hips, and bilateral head necrosis occurred in 30 hips. The average medical history was 1.4 years ranging from 8 months to 3 years. According to the standard of ARCO staging, seven hips were in the stage Ⅰ, and 29 hips in the stage Ⅱ. The curative effect was analyzed according to clinical symptoms, Harris scores of hip joint function, X-ray film and CT before and after operation. RESULTS AND CONCLUSION： All the involved 21 patients （36 hips） were followed up for 12-46 months postoperatively. Among them, 29 hips obtained excellent results, showing the pain disappearance and free activities. The femoral head density, trabecular structure and hip joint gap were significantly improved after treatment compared with before treatment. Six hips got relief of clinical symptoms, and one hip had no improvement with exacerbation. The rate of excellent and good effects was 97.2% （35/36）. The Harris score increased averagely from preoperative （60.9±5.6） points to postoperative （90.5±5.1） points, with significant differences （P 〈 0.05） Experimental findings indicate that, bone transplantation through fenestration over the femoral head and neck combined with implantation of peripheral bl

关 键 词：干细胞 干细胞临床实践 干细胞移植 造血干细胞 外周血 股骨头坏死 缺血性 早期 髂骨 自体 髋关节 HARRIS评分 

分 类 号：R318[医药卫生—生物医学工程]