组织工程化异体骨复合BMP和自体骨髓治疗股骨头缺血性坏死

Treatment of avascular necrosis of femoral head by implanting a composite of autogenous bone marrow and noncelluar tissue engineered bone allograft with BMP

目的探讨非细胞型组织工程化异体骨复合骨形态发生蛋白(BMP)和自体骨髓植入治疗青壮年股骨头缺血性坏死的疗效。方法首先进行股骨头髓芯减压,彻底刮除死骨。将异体松质骨混合bBMP和自体骨髓植入死骨刮除区,部分脱钙冻干异体腓骨植入髓芯减压孔道,直接支撑股骨头病变区软骨下骨。采用该方法治疗64例(78髋)股骨头缺血性坏死患者。结果所有患者均获随访,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期病例,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)FicatⅠ、Ⅱ期病例,患髋症状无加重,但病变进展了一期。6例(8髋)FicatⅢ期病例,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,阻止股骨头病变发展和塌陷;BMP可诱导骨髓和异体骨以增强其成骨能力。异体骨复合BMP和自体骨髓可作为治疗青壮年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 autogenous bone marrow, bone morphogenetic protein(BMP), and noncelluar tissue engineered bone allograft. Methods The BMP was partially purified from bovine cortical bone (bBMP) by Urist method. The bone allograft chips were mixed with bBMP and bone marrow. The composite was implanted into the necrotic area of the femoral head after core decompression, then partial deminerallized allograft fibula segments were inserted in the core decompression holes to support the necrotic area in preventing the collapse in 64 adolescent patients (78 hips). Results 55 cases (67 hips) were followed up for 3 months to 6 years(mean 44 months). 28 case(36 hips) in FicatⅠ,Ⅱ were followed up over 3 years, of whom there were no obvious pain and dysfunction in 18 cases(22 hips), high density new bone was shown in core decompression area in CT scanning, and no evidence of progressive necrosis. There was no worsening of the symptoms in 4 cases(6 hips) in Ficat Ⅰand Ⅱ, but the lesion progressed. In 6 cases (8 hips) in Ficat Ⅲ, there were no obvious pain and dysfunction in 2 cases, but 4 cases underwent total hip replacement because of persistent pain and progressive lesion. Conclusion The partial demineralized allograft fibula can provide direct mechanical support to prevent the necrotic femoral head from progress and collapse, autogenous bone marrow and BMP is able to promote new bone formation. The method can be used as an alternative for the treatment of osteonecrosis of femoral head at stage Ⅰ,Ⅱ.