髓芯减压术自体髂骨移植术与骨髓间充质干细胞移植术联合治疗战创伤致早期成人股骨头坏死
|
摘要
目的:探讨应用髓芯减压术+自体髂骨移植术+自体骨髓间充质干细胞移植术联合治疗早期成人股骨头缺血性坏死的疗效。方法:回顾分析我院2009年1月—2013年6月的病例,男性36例,年龄19~29岁,平均25.5岁。股骨头坏死按ARCO分期:Ⅰ期17例,Ⅱ期12例,Ⅲ期7例。术前均有髋关节疼痛、跛行、活动受限等症状。治疗方案:髓芯减压术+自体髂骨移植术+自体骨髓间充质干细胞移植术。结果果:术后随访12~18个月(平均12.4个月),疼痛症状消失、行走正常、髋关节活动范围正常或接近正常。MRI检查均提示:股骨头轮廓清晰,无进一步塌陷或坏死趋势,无囊性变,骨密度均匀,硬化骨消失,关节间隙正常。术后无感染和血管神经损伤等并发症,无一例股骨头加重坏死或关节塌陷现象。患者随访6个月,12个月,在ARCO分级Ⅰ、Ⅱ、Ⅲ患者与术前评分比较,差异显著(P<0.05)。术后Harris评分:优25例,良8例,可3例,差0例,优良率为91.7%。术后疼痛评分、术后Harris髋关节评分及股骨头坏死体积患者随访6个月,12个月与术前比较,差异均显著(P<0.05)。结论论::髓芯减压术+自体髂骨移植术+自体骨髓间充质干细胞移植术联合治疗战创伤致早期成人股骨头缺血性坏死疗效显著。
Objective:To investigate the curative effect of core decompression and autologous iliac bone grafting and autologous bone marrow-derived mesenchymal stem cells transplantation in treatment of early avascular necrosis of the femoral head in adult wounded. Methods:A total of 36 adult male patients with early avascular necrosis of the femoral head admitted in the 421 Hospital of Chinese PLA between January 2009 to June 2013 were retrospectively analyze,aged 25.5 years old( range 19-29 years old).The avascular necrosis of the femoral head was classified according to Association Research Circulation Osseous classification, including 17 cases of stage I, 12 of stage II, and 7 of stage III. All wounded exhibited hip joint pain,limping and limited activities prior to operation. They were treated with core decompression and autologous iliac bone grafting and autologous bone marrow-derived mesenchymal stem cells transplantation.Results:All patients were followed up for 12.4 months(range 12-18 months). The pain symptoms disappeared, the walking was normal, the range of hip joint activity was normal or close to normal. MRI examination showed that the contour of femoral head was clear, no further collapse or necrosis trend, no cystic change, bone density was homogeneous, sclerotic bone disappeared, and the joint space was normal. No complication such as infection and vascular nerve injury after operation, no case of aggravated necrosis of the femoral head or joint collapse. Patients were followed up for 6 months and 12 months.The difference was significant(P<0.05)in the ARCO grade I, II, and III. The postoperative Harris score was excellent in 25 cases,good in 8 cases, fair in 3 cases and poor in 0 cases, with an excellent rate of 91.7%.Postoperative pain scores, Harris hip scores and volume of necrotic femoral head were significantly improved compared with preoperative result wounded(P<0.05). Conclusion:Core decompression and autologous iliac bone grafting and autologous bone marrow-derived mesenchymal stem cells transplantation has significant curative effect in treatment of early avascular necrosis of the femoral head in adult wounded.
Objective:To investigate the curative effect of core decompression and autologous iliac bone grafting and autologous bone marrow-derived mesenchymal stem cells transplantation in treatment of early avascular necrosis of the femoral head in adult wounded. Methods:A total of 36 adult male patients with early avascular necrosis of the femoral head admitted in the 421 Hospital of Chinese PLA between January 2009 to June 2013 were retrospectively analyze,aged 25.5 years old( range 19-29 years old).The avascular necrosis of the femoral head was classified according to Association Research Circulation Osseous classification, including 17 cases of stage I, 12 of stage II, and 7 of stage III. All wounded exhibited hip joint pain,limping and limited activities prior to operation. They were treated with core decompression and autologous iliac bone grafting and autologous bone marrow-derived mesenchymal stem cells transplantation.Results:All patients were followed up for 12.4 months(range 12-18 months). The pain symptoms disappeared, the walking was normal, the range of hip joint activity was normal or close to normal. MRI examination showed that the contour of femoral head was clear, no further collapse or necrosis trend, no cystic change, bone density was homogeneous, sclerotic bone disappeared, and the joint space was normal. No complication such as infection and vascular nerve injury after operation, no case of aggravated necrosis of the femoral head or joint collapse. Patients were followed up for 6 months and 12 months.The difference was significant(P<0.05)in the ARCO grade I, II, and III. The postoperative Harris score was excellent in 25 cases,good in 8 cases, fair in 3 cases and poor in 0 cases, with an excellent rate of 91.7%.Postoperative pain scores, Harris hip scores and volume of necrotic femoral head were significantly improved compared with preoperative result wounded(P<0.05). Conclusion:Core decompression and autologous iliac bone grafting and autologous bone marrow-derived mesenchymal stem cells transplantation has significant curative effect in treatment of early avascular necrosis of the femoral head in adult wounded.
引文
[1]黎佼,胡明,李国强,等.年青人骨髓间充质干细胞来源生物活性因子对年老人骨髓间充质干细胞功能的影响[J].广东医学,2015,5(10):1501-1504.
[2]谢辉,王子华,赵德伟,等.自体骨髓基质干细胞联合带血管蒂髂骨瓣转移多孔钽棒植入治疗股骨头缺血性坏死[J].中国组织工程研究,2017,21(22):3464-3469.
[3]傅维民,王本杰.基于影像学技术股骨头坏死病灶范围、血液供应与病理变化关系:诊断性动物实验方案[J].中国组织工程研究,2017,21(7):1086-1091.
[4]Mont MA,Jones LC,Hungerford DS.Nontraumatic osteonecrosis of the femoral head:ten years later[J].J Bone Joint Surg Am,2006,88(5):1117-1132.
[5]Garrigues GE,Aldridge JM 3rd,Friend JK,et al.Free Vascularized Fibular Grafting for treatment of osteonecrosis of the femoral head secondary to hip dislocation[J].Microsurgery,2009,29(5):342-345.
[6]费腾,阎作勤.激素性股骨头坏死发病机制的研究进展[J].中华关节外科杂志(电子版),2011,5(4):504-508.
[7]Suh KT,Kim SW,Roh HL,et al.Decreased osteogenic differentiation of mesenchymal stem cells in alcohol-induced osteonecrosis[J].Clin Orthop Relat Res,2005,(431):220-225.
[8]张铭杰,何伟,张庆文,等.骨髓间充质干细胞在股骨头坏死治疗中的应用进展[J].实用骨科杂志,2011,17(5):434-441.
[9]邢更彦,张鹏礼,姜川,等.体外冲击波疗法联合自体骨髓干细胞移植治疗股骨头坏死[J].中华关节外科杂志(电子版),2011,5(4):413-418.
[2]谢辉,王子华,赵德伟,等.自体骨髓基质干细胞联合带血管蒂髂骨瓣转移多孔钽棒植入治疗股骨头缺血性坏死[J].中国组织工程研究,2017,21(22):3464-3469.
[3]傅维民,王本杰.基于影像学技术股骨头坏死病灶范围、血液供应与病理变化关系:诊断性动物实验方案[J].中国组织工程研究,2017,21(7):1086-1091.
[4]Mont MA,Jones LC,Hungerford DS.Nontraumatic osteonecrosis of the femoral head:ten years later[J].J Bone Joint Surg Am,2006,88(5):1117-1132.
[5]Garrigues GE,Aldridge JM 3rd,Friend JK,et al.Free Vascularized Fibular Grafting for treatment of osteonecrosis of the femoral head secondary to hip dislocation[J].Microsurgery,2009,29(5):342-345.
[6]费腾,阎作勤.激素性股骨头坏死发病机制的研究进展[J].中华关节外科杂志(电子版),2011,5(4):504-508.
[7]Suh KT,Kim SW,Roh HL,et al.Decreased osteogenic differentiation of mesenchymal stem cells in alcohol-induced osteonecrosis[J].Clin Orthop Relat Res,2005,(431):220-225.
[8]张铭杰,何伟,张庆文,等.骨髓间充质干细胞在股骨头坏死治疗中的应用进展[J].实用骨科杂志,2011,17(5):434-441.
[9]邢更彦,张鹏礼,姜川,等.体外冲击波疗法联合自体骨髓干细胞移植治疗股骨头坏死[J].中华关节外科杂志(电子版),2011,5(4):413-418.