富集自体骨髓干细胞骨移植治疗早中期股骨头缺血性坏死  

Evaluation of the clinical efficacy of enriched autologous bone marrow stem cells transplantation for early and middle stage avascular necrosis of the femoral head

作　　者：张景义[1] 白玉[1] 杨昊飞 陈红浩 海国栋[1] 刘宏建[2] Zhang Jingyi;Bai Yu;Yang Haofei;Chen Honghao;Hai Guodong;Liu Hongjian(Department of Bone Tumour&Bone Disease,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China;Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院骨肿瘤骨病科,450052 [2]郑州大学第一附属医院骨科,450052

出　　处：《中华实验外科杂志》2020年第10期1915-1918,共4页Chinese Journal of Experimental Surgery

基　　金：河南省2018年度科技攻关项目(182102310475)。

摘　　要：目的:探讨富集自体骨髓干细胞骨移植治疗早中期股骨头缺血坏死的临床疗效。方法:2013年1月至2015年10月,在郑州市骨科医院治疗ARCOⅡB-ARCOⅢA期单侧股骨头缺血坏死患者96例,按入选标准纳入研究,分为两组。对照组(A)患者采用股骨头粗通道髓心减压,死骨刮除同种异体骨打压植骨术。观察组(B)患者采用股骨头粗通道髓心减压、死骨刮除同种异体骨富集自体骨髓干细胞打压植骨术。其中A组男37髋,女11髋,年龄(34.96±6.27)岁,术前疼痛时间为7~12个月,平均疼痛时间9个月;B组男38髋,女10髋,年龄(35.09±5.55)岁,术前疼痛时间为7~13个月,平均疼痛时间9个月。采用Harris髋关节评分对A、B两组患者的治疗前后患髋关节功能进行评价,观察并记录手术时间、术中出血量及术后并发症。采用独立样本t检验。结果:96例均获得随访,随访时间36~60个月,平均42.6个月。末次随访时,A组和B组患者的患髋Harris评分较术前患髋Harris评分升高,差异有统计学意义(t=-17.771、-7.632,P<0.05)。末次随访时,B组患者的患髋Harris评分较A组患者患髋Harris评分高,差异有统计学意义(Z=-2.153,P<0.05)。前5例B组较A组患者平均手术时间长,出血量较多,差异有统计学意义(t=-3.390、-3.301,P<0.05)。术后康复时间B组患者较A组短,差异有统计学意义(Z=-9.106,P<0.05)。术后股骨头塌陷发生率B组患者较A组患者为低,差异有统计学意义(χ2=8.296,P<0.05)。无神经血管损伤、感染等并发症。结论:富集自体骨髓干细胞骨移植能促进植骨愈合,缩短康复时间,患髋的功能恢复更好。但手术时间相对较长、术中出血相应增加。Objective To investigate the clinical effect of the treatment of early and middle stage avascular necrosis of the femoral head by bone transplantation with enriched autologous bone marrow stem cells.Methods From January 2013 to October 2015,96 patients(96 hips)with avascular necrosis of the femoral head at ARCOⅡB-ARCOⅢA stage were treated in Zhengzhou Orthopedic Hospital.According to the inclusion criteria,they were divided into two groups.The patients in the control group(A)were treated with rough channel decompression,and dead bone curettage and allograft bone grafting.The patients in observation group(B)were treated with femoral head ischemic necrosis through rough channel decompression,dead bone curettage,allograft bone enrichment and autologous bone marrow stem cells to suppress bone grafting.In group A,there were 37 male patients and 11 female patients with an average age of(34.96±6.27)years(17-48 years).The preoperative pain time was 7-12 months(9 months).In group B,there were 38 male patients and 10 female patients with an average age of(35.09±5.55)years(16-47 years).The preoperative pain time was 7-13 months(9 months).Harris hip score was used to evaluate the hip joint function of patients in group A and B before and after treatment.The operation time,intraoperative hemorrhage and postoperative complications were observed and recorded.Results 96 cases were followed up for 36-60 months,with an average of 42 months.At the last follow-up,the Harris scores of patients in group A and group B were higher than those before operation,the difference was statistically significant(t=-17.771,-7.632,P<0.05).At the last follow-up,the Harris score of group B was higher than that of group A(Z=-2.153,P<0.05).In the first five cases,the average operation time of group B was longer than that of group A,the amount of hemorrhage was more,the difference was statistically significant(t=-3.390,-3.301,P<0.05).The recovery time of group B was shorter than that of group A(Z=-9.106,P<0.05).The incidence of femoral head collap

关 键 词：缺血性股骨头坏死 富集自体骨髓干细胞 髓心减压 打压植骨 

分 类 号：R687.3[医药卫生—骨科学] R457.7[医药卫生—外科学]