髓芯减压联合自体骨髓干细胞移植治疗股骨头坏死的早期临床观察

Core decompression combined with implantation of autologous bone marrow stem cells for early stage osteonecrosis of the femoral head： a preliminary report

目的观察髓芯减压值骨联合自体骨髓干细胞移植治疗早期股骨头坏死的临床疗效。方法根据国际骨循环研究学会（Association Research Circulation Osseous，ARCO）骨坏死分期标准，选取Ⅰ、Ⅱ期股骨头坏死32例（39髋），治疗组18例（24髋），对照组14例（15髋）治疗组经过自体骨髓干细胞采集、分离、髓芯减压后，骨髓干细胞和松质骨混合植入；对照组行髓芯减压松质骨植入。结果所有患者均获18个月的随访，行Harris评分和影像学检查。（1）髋关节Harris评分：治疗组由（55．90±9．71）分升至（81．86±7．95）分，优良率为87．5％；而对照组由（56．69±8．32）分升至（68．14±8．65）分，优良率为60．0％，两组比较差异有统计学意义（P〈0．01）；（2）髋关节影像学检查：治疗组仅1例（1髋）发展为Ⅲ期塌陷，而对照组2例（2髋）发展为Ⅲ期塌陷；MRI测得坏死面积百分比，治疗组由31．88％±7．59％降至13.20％±9．56％，而对照组由32．64％±6．32％降至21．18％±8．83％，两组比较差异有统计学意义（P〈0．05），结论髓芯减压植骨联合自体骨髓干细胞移值治疗早期股骨头坏死是一种安全、有效的方法，但还需要大样本临床试验及长期随访以进一步验证。

Objective To observe the early clinical outcome of core decompression combined with implantation of autologous hone marrow stem cells （BMSCs） at early stage osteonecrosis of the femoral head. Methods Thirty-two patients （39 hips） with stage Ⅰ or Ⅱ osteonecrosis of the femoral head according to the system of the Association Researeh Circulation Osseous （ARCO） were included in this study. The patients were divided into the experimental group and control group. Eighteen patients with 24 hips in the experimental group underwent core decompression, implantation of the mixture of autologous BMSCs and bone grafting. The collection and centrifugation of autologous BMSCs were performed in Good laboratorv Practice. Fourteen patients with 15 hips in the control group were treated with core deeompressioll and bone grafting. Results All patients were followed up for 18 months. The outcomes were determined by changes in Harris hip scores and radiographic progression detected by X-ray and MRI. The Harris scores of patients in experimental group increased significantly from 55.90±9.71 to 81.86;6±7.95 compared with that increased from 56.69±8.32 to 68.14±8.65 in the control group（P〈 0.01）. The rate of excellent and good results was 87.5% in experimental group compared with that of 60.0% in control group. In experimental group, 1 hip had aggravated to femoral head collapse as stage llI, while 2 hips in control group. The average percentage of necrotic area diminished significantly from 31.88%±7.59% to 13.20%±9.56% in experimental group compared with that declined frum 32.64%±6.32% to 21.18%±8.83% in control group （P〈 0.05）. Conclusion Core decompression combined with implantation of autologous BMSCs is a safe and effective treatment for early stage osteonccrosis of the femoral head. Long-term follow-up and more cases are needed to confirm the results.