三通道髓芯钻孔减压加DBM、自体骨髓干细胞治疗早期股骨头坏死

Three-tunnels core decompression with implantation of bone marrow stromal cells(bMSCs) and decalcified bone matrix(DBM) for the treatment of early femoral head necrosis

目的:回顾性分析三通道髓芯钻孔减压技术加自体骨髓干细胞、DBM植入治疗早期股骨头坏死疗效,并探讨其适应证。方法:根据股骨头坏死宾夕法尼亚大学分型方法对87例103髋进行三通道髓芯钻孔减压技术加自体骨髓干细胞、DBM植入治疗早期股骨头坏死,其中男71例(86髋),女16例(17髋);平均年龄47岁;平均病程1.3年。临床主要表现为患髋疼痛、功能障碍、跛行,术前对患者进行分期评价,根据术前、术后症状,VAS及Harris评分,同时结合影像学表现对治疗结果进行评价。结果:随访超过2年,平均时间26个月。Harris评分由术前平均47.3分增至术后平均74.0分,平均优良率75.7%,Ⅰ型优良率88%(22/25),Ⅱ型优良率78.7%(37/47),Ⅲ型优良率61.3%(19/31)。无明显手术并发症发生。结论:三通道髓芯钻孔减压技术结合DBM、自体骨髓干细胞植入既去除了病灶,又利用DBM的骨诱导作用和自体骨髓干细胞的多向分化功能,可以恢复股骨头的负重结构,消除疼痛,改善关节功能,是治疗早期股骨头坏死塌陷前期的一种有效方法。

Objective ： To analyse retrospectively 3-tunnels core decompression with implantation of bone marrow stromal cells （bMSCs） and decalcified bone matrix （DBM） for treatment of femoral head necrosis in early stages, and to study its therapeutic results and indications. Methods：According to the University of Pennsyvania system of classification and staging,to treat the patients with 3-tunnels core decompression with implantation of bone marrow stromal cells （bMSCs） and decalcified bone matrix （DBM） for treatment of early femoral head necrosis. Among the total 87 patients （ 103 hips ）, the male was 71 （86 hips） and the female 16 （ 17 hips） with the average age of 47 years old. The average course of disease was 1.3 year. The effect was evaluated by the clinical symptoms ,the Harris scores and the manifestations of radiology before and after operation. Resuits ： All the patients were followed up more than 2 years （average 26 months ）.The average Harris scores increased from preoperation 47.3 to postoperation 74.0. The average rate of excellent and good results was 75.7%. The rate of excellent and good was 88% （22/25） in type Ⅰ ,78.7% （37/47） in type Ⅱ and 61.3% （19/31） in type Ⅲ. No severe complications were observed. Conclusion： Three-tunnels core decompression with implantation of bMSCs and DBM not only removal the focus of disease, but also use DBM the induction of bone and autologous bone marrow stem cells to differentiate the functions of the femoral head can be resumed loading structure, eliminate pain, improve joint function. It is an effective method for early femoral head necrosis.