干细胞移植在中晚期股骨头坏死治疗过程中的应用

Stem cell transplantation for middle and late stages of femoral head necrosis

青壮年因股骨头坏死而行人工关节置换术后,其失败率明显比由于其他原因而行关节置换的病例高,故术前应选择保留股骨头的姑息性治疗,理想的治疗结果是避免关节面塌陷,推迟甚至免去行关节置换。2005-06/2006-12解放军第四六三医院骨科共收治股骨头坏死患者38例,其中成人股骨头坏死34例,儿童股骨头骨骺缺血性坏死4例,所有病例均经术后病理证实诊断,对治疗均签署知情同意书。脐血干细胞来源于足月正常分娩产妇捐赠的脐带,由北科细胞工程生物研究所提供,产妇对本实验知情同意,实验经医院医学伦理委员会批准。成人股骨头坏死采用滑膜切除+股骨钻孔+死骨刮除+植骨+血管植入+自体骨髓干细胞移植的综合治疗方法,儿童股骨头骨骺缺血性坏死仅将移植过程中的自体骨髓干细胞更换为脐血干细胞。术后9个月,放射线检查示股骨头、骨质、骨小梁清晰,股骨头内新骨大量生长,塌陷区域明显改善,骨质密度接近正常;VAS疼痛评分由术前6.2分降至2.2分;Harris髋关节功能评分由术前(54.3±5.32)分升高至(89.6±10.5)分。无一例发生血管、神经损伤等并发症,髂骨采血部位无感染及血肿等不良反应发生。证实采用干细胞移植结合滑膜切除、股骨钻孔、死骨刮除、植骨、血管植入等方法能够明显缓解股骨头坏死患者的疼痛程度,改善股骨头坏死区域的血运及股骨头骨质的坏死状况,改善髋关节功能。

Artificial joint replacement has been carried out in the youths and adults due to femoral necrosis, and the failure rate is obviously higher than those in cases due to other reasons, thus palliative therapy of preserving femoral head is strongly recommended before surgery to obtain the satisfactory effect, that is to prevent articular surface collapse and delay joint replacement. Totally 38 patients, including 34 adults of femoral necrosis and 4 children of epiphyseal ischemic necrosis, were adopted in the study at Department of Orthopaedics, the 463 Hospital of Chinese PLA from June 2005 to December 2006. They were all diagnosed pathologically after surgery. Each patient or their guardians signed an informed consent. Cord blood stem cells were donated by puerperant after full term normal delivery, which was offered by Beike Institute. Informed consents were obtained from all the puerperants, and this experiment was approved by the hospital ethical committee. Adult cases received the treatments, including synovectomy, femoral drilling, sequester erasion, grafting, blood vessel implant, and autogenous bone marrow stem cell transplantation. While the child cases were treated identically, except cord blood stem cell transplantation at the last step. At month 9 after surgery, radiography results showed the distinct femoral head, sclerotin and bone trabecula. A large amount of new bones were found in the femoral head, and collapse appeared obvious improvements, bone density was approximal to the normality; VAS score for pain decreased from 6.2 points before surgery to 2.2 points after surgery; Harris scores for hip joint function increased from （54.3±5.32） points before surgery to （89.6± 10.5） points after surgery. No complications, such as vessel or nerve injuries, occurred in each patient. There was no adverse effect of the infection and hematoma in the blood collection area of iliac bone. It is indicated that the synovectomy, femoral drilling, sequester erasion, grafting, blood vessel implant, in combination with autogenous bone marrow stem cell transplantation can remarkably relieve the pain, promote the blood transport in the necrosis area, ameliorate the femoral bone density and improve the hip joint function in the femoral necrosis patients.