髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位治疗股骨头缺血坏死的比较

A Comparative Study on Treatment of Ischemic Necrosis of Femoral Head Using Decompression and Reconstituted Autologous Bone Marrow Cells Transplantation vs.Transplantation of Vascularized Bone Flap Grafting

目的对比研究髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位两种方法治疗成人股骨头缺血性坏死的疗效。方法对48例(60髋)成人股骨头缺血性坏死(ARCO分期:Ⅰc～Ⅱc期)分别采用带血管蒂骨瓣转位和髓芯减压自体骨髓细胞移植治疗。髓芯减压自体骨髓细胞移植治疗23例(30髋),带血管蒂骨瓣转位治疗25例(30髋)。术后采用髋关节的Harris评分及影像学稳定情况评定疗效。结果髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位两组的手术时间和出血量,分别为40.2±16.5min、57.4±18.5min(P<0.05)和180.0±20.5ml、260.6±19.5ml(P<0.05)。术中、术后无严重并发症发生。所有患者获平均36.5个月随访,髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位两组的优良率为别为83.3%、90.0%(P>0.05);两组影像检查学分别显示24髋、25髋保持稳定(P>0.05)。结论髓芯减压自体骨髓细胞移植和带血管蒂骨瓣转位治疗成人早期股骨头缺血性坏死的优良率相近,但前者较后者出血少并且手术时间短,是一种安全、有效的治疗早期股骨头缺血坏死的微创治疗方法。

Objective To compare the results of the treatment of ischemie necrosis of the femoral head using the decompression and the reconstituted autologous bone marrow cells transplantation vs. the transplantation of the vascularized bone flap grafting. Methods Two surgical procedures were performed in 60 hips in 48 patients with the isehemie necrosis of the femoral head （ARCO stage Ⅰc-Ⅱ c）. Thirty hips in 23 patients （group A） underwent the decompression and reconstituted autologous bone marrow cells transplantation and 30 hips in 25 patients （group B） received transplantation of vascularized bone flap grafting. The clinical outcomes of all patients were evalu - ated with Harris hip score and the radiologieal stability. Results The average blood loss was 80.0±20.5 ml and 260.6± 19.5 ml （ P 〈0.05） respectively and the operative time was 40.2± 16.5 min and 57.4 ± 18.5 min （P〈0.05） respectively in the two groups. No intraoperative or postoperative severe complications occurred. Forty - eight patients were followed up with an average period of 36.5 months. According to the standards of the mean Harris hip score, in group A and B, the excellent and good rate were 83.3 % and 90 % （P〉0.05） respectively, 24 hips were radiologieally stable in group A and 25 hips were radiologieally stable in group B （P 〉0.05）. Conclusion The excellent and good rate of group A is similar to that of the group B with less blood loss and shorter operative time. As a new minimally invasive technique, the decompression and reconstituted autologous bone marrow cells transplantation is an effective and safe treatment for ischemie necrosis of femoral head at early stage.