自体外周血干细胞移植治疗股骨头缺血性坏死21例

Autologous peripheral blood stem cell transplantation for the treatment of avascular necrosis of the femoral head in 21 cases

背景：近年来，随着对骨髓单个核细胞成果及血管新生作用认识的深入，骨髓移植在早期股骨头缺血性坏死治疗上已取得了一些较好的成果。目的：评价动员后自体外周血干细胞移植对早中期股骨头缺血性坏死的治疗效果。设计、时间及地点：病例自身对照观察，于2004—10／2008—03在龙岩市第一医院血液风湿科完成。对象：选择确诊的股骨头缺血性坏死患者21例，按ARCO和Ficat股骨头坏死放射线分期标准分期：Ⅰ期2例，Ⅱ期11例，Ⅲ期8例。方法：股骨头缺血性坏死患者均予重组人粒细胞集落刺激因子300ug皮下注射，2次，d，进行外周造血干细胞动员，连续4d，第5天用血细胞分离机单采干细胞，配成造血干细胞混悬液。股骨头经髓心减压或隧道减压后注入自体干细胞混悬液。主要观察指标：术后定期随访，参照股骨头缺血性坏死疗效评价法对疼痛、行走距离、关节功能、X射线评价等指标进行综合评估。评估标准：优〉90分，良75～90分，可60～74分，差〈60分。结果：2例患者术后随访不足6个月未进行X射线或CT复查被剔除，其余19例患者全部完成6～41个月随访，总优良率为84.2％。Ⅰ，Ⅱ期优良率为100％，Ⅲ期优良率为62．5％，Ⅰ，Ⅱ期优良率明显大于Ⅲ期（x^2=4．92，P〈0．05）。结论：应用动员后自体外周造血干细胞移植可以有效治疗早中期股骨头缺血性坏死，早期诊断并及时进行有效的治疗是提高其治疗效果的关键。

BACKGROUND： With deep understanding of bone marrow mononuclear cell outcome and angiogenesis effects, bone marrow transplantation has obtained some outcomes for treating avascular necrosis of the femoral head during early period. OBJECTIVE： To evaluate the therapeutic efficacy of mobilized autologous peripheral blood stem cell （APBSC） transplantation for avascular necrosis of the femoral head （ANFH） in early and middle stages. DESIGN, TIME AND SETTING： The retrospective case analysis was performed at the Department of Hematology and Rheumatology, Longyan First Hospital from October 2004 to March 2008. PARTICIPANTS： Totally 21 patients with ANFH were selected. According to ARCO and Ficat staging, the patients were divided into 2 cases at stage Ⅰ, 11 cases at stage Ⅱ, 8 cases at stage Ⅲ. METHODS： Patients with ANFH were injected subcutaneously with recombinant human granulocyte colony-stimulating factor （rhG-CSF） 300 ug, twice a day, to mobilize peripheral blood hematopoiefic stem cells for four days. At 5 days, APBSC cells were collected with a blood-cell separator and the stem cell suspension fluid was achieved. Following core decompression and tunnel decompression in the bone marrow, APBSC was infused. MAIN OUTCOME MEASURES： After follow-up, degree of pain, walking distance, function of the joints and feature of x-ray were determined according to ANFH outcomes. Criteria： excellent 〉 90 points, good 75-90 points, average 60-74 points, and poor 〈 60 points. RESULTS： Two patients with 〈 6 months follow-up, who did not receive X-ray or CT reexamination, were excluded. A total of 19 patients had finished 6-41 months follow-up, resulting in total excellent and good rate of 84.2%. The excellent and good rate was 100% in stages Ⅰ and Ⅱ, 62.5 % in stage Ⅲ.The excellent and good rate was significantly higher in the stages Ⅰ and Ⅱ compared with that in stage Ⅲ （x^2=4.92, P 〈 0.05）. CONCLUSION： Mobilized APBSC transplantation can effectively treat ANFH in early and middle stages. Early diagnosis and treatment is the key point to the improvement of the clinical effects.