自体骨髓干细胞移植治疗激素性股骨头坏死

The clinical effect analysis of autologous bone marrow stem cells transplantation treating the stermiod-induced articular necrosis of the femoral head

目的观察自体骨髓干细胞移植治疗激素性股骨头坏死的临床效果。方法52例激素性股骨头缺血性坏死患者经使用rhG-CSF进行骨髓干细胞动员后，第2天进行骨髓干细胞采集，在数字减影血管造影术（DSA）下行股动脉穿刺，导管超选择至闭孔动脉及旋股内外侧动脉，将干细胞悬液缓慢匀速注入动脉内；干细胞移植后随访观察患者髋关节疼痛程度、性质及持续时间变化，行走间距及步态变化，髋关节外展及内旋功能变化；6个月后行股骨头供血动脉造影术。结果52例患者随访12个月，髋关节疼痛有不同程度缓解67％，关节功能改善29．7％，行走间距延长32．5％。干细胞移植术后6个月，10例患者行股骨头供血动脉数字减影血管造影检查，均显示旋股内动脉，旋股外动脉及闭孔动脉管径增粗，新生血管增多，血流速度增快，与移植前血管造影相比较，股骨头血液供应明显改善。治疗中均未发生严重的并发症和不良反应。结论自体骨髓干细胞移植治疗激素性股骨头坏死方法简便，安全有效，适合Ⅰ-Ⅲ期早、中期股骨头坏死的患者。

Objective To observe the clinical effect of autologous bone marrow stem cells transplantation treating the stermiod-induced articular necrosis of the femoral head （SANFH）. Methods 52 patients of SANFH were mobilized by rhG-CSF to get bone marrow stem ceils. On the next day bone marrow was collected, then their femoral arteries were punctured by digital subtraction angiography（ DSA）, and the stem cell suspension was injected into the arteria circumflexa femoris medialis, laterlis and arteria obturateria through catheter by uhraselection. After transplantation, all the patients were followed up to observe the degree, property and duration of coxa joint pain and to observe walking distance, gait, abduction and internal rotation of coxa joint. After 6 months, arteriography of femoral head was carried out. Results After 12 months,the remission rate of coxa joint pain was 67% , the improvement rate of joint function was 29. 7% , walking distance was extended by 32. 5% and quality of life was improved. After 6 months 10 patients had arteriography of femoral head. The caliber of the arteria circumflexa femoris medialis, laterlis and arteria obturateria were thickening, new vessels grew more and blood flow rate became faster. Compared with pre-operation, the blood supply of femoral head was obviously improved. No severe complication and adverse effect occurred in 52 patients during the treatment. Conclusions Autologous bone marrow stem cells transplantation treating SANFH is convenient, safe and effective. It is suitable for the patients of SANFH from stage Ⅰ to stage Ⅲ, namely early or intermediate stage.