应用髋关节镜髓芯减压并自体外周血干细胞移植治疗早期股骨头缺血性坏死38例

Arthroscopic debridement and medullary core decompression combined with autologous peripheral blood stem cell transplantation in the treatment of early avascular necrosis of the femoral head in 38 cases

目的:髋关节镜检查清理、髓芯减压已应用于股骨头缺血性坏死的治疗。观察髓芯减压术并自体外周血干细胞移植治疗早期股骨头缺血性坏死的疗效。方法:①试验对象:选择2004-12/2006-12本科应用髋关节镜及自体外周血干细胞移植手术的股骨头缺血坏死患者38例(48髋)。男性28例,女性10例,年龄34～57岁。纳入标准:根据临床症状、体征、CT及MRI诊断为早期股骨头缺血性坏死;所有患者经谈话后自愿接受髋关节镜及自体外周血干细胞移植手术治疗并签署知情同意书。术前Ficat分期Ⅰ期25髋,Ⅱ期13髋。②试验方法及评估:采用Harris髋关节评分对术前及术后关节功能进行评估,优:>80分,良:>60分,可:>40分。同时X射线观察患髋的术后恢复情况及有无并发症。结果:38例患者,均进入结果分析。术后随访10～30个月,平均20个月。①术后80分以上(优)31例,60分以上(良)5例,40分以上(可)2例,平均(90.1±3.6)分,优良率达94.7%,与术前比较,差异有显著性意义(P<0.01)。②所有患者疼痛消失,行走正常,髓关节活动范围正常或接近正常,X射线片示股骨头轮廓清晰,囊性变消失,骨密度均匀,关节间隙正常。无感染和血管神经损伤等并发症的发生。结论:髋关节镜下清理、髓芯减压及自体外周血干细胞移植手术治疗早期股骨头缺血性坏死具有损伤小、简便、准确、有效的优点。

AIM： Arthroscopic debridement and medullary core decompression have been applied to treating avascular necrosis of femoral head. This article is aimed to investigate the curative effect of medullary core decompression and autologous peripheral blood stem cell transplantation in the treatment of early avascular necrosis of femoral head. METHODS： （1）Totally 38 patients with avascular necrosis of femoral head （48 coxae）, who received arthroscopy and autologous peripheral blood stem cell transplantation, were enrolled at our department from December 2004 to December 2006, including 28 males and 10 females, aged from 34 to 57 years. Inclusive criteria： All the patients were diagnosed as having earlier avascular necrosis of femoral head by clinical symptom, physical sign, CT and MRI. All the patients were treated by arthroscopy and autologous peripheral blood stem cell transplantation by conversation and signed informed consent. There were stage Ⅰ （25 coxae） and stageⅡ （13 coxae） according to the Ficat staging methods. （g）Preoperative and postoperative joint function of all the patients were assessed. There were excellent （〉 80 points）, good （〉 60 points） and fair （〉 40 points） according to the Harris evaluating methods. The postoperative recovery and complications of patients were observed by X-ray. RESULTS： Totally 38 patients were involved in the result analysis. Follow-up was performed for 10-30 months, averagely 20 months. （1）Harris evaluated scores were excellent in 31 cases （〉 80 points）, good in 5 cases （〉 60 points） and fair in 2 cases （〉 40 points） with the mean of （90.1 ±3.6） points. The excellent and good rate was 94.7%. There were significant differences between preoperative and postoperative joint function （P 〈 0.01 ）. （2）The pain of all patients disappeared and all the patients could walk normally. The movement range of the hip joint was normal or approximate normal. X-ray films showed the outline of the femoral head being clear and cystic degeneration disappeared. The density of the femoral head was well distributed and the joint space was normal. All the patients had no infection, vascular-nerve injury or others complications. CONCLUSION： The operative treatment of avascular necrosis of femoral head under the arthroscopic debridement, medullary core decompression and autologous peripheral blood stem cell transplantation has the advantages of light damage, simplicity accuracy and effectiveness.