经动脉骨髓间充质干细胞移植联合普伐他汀治疗早期股骨头缺血性坏死

Bone marrow mesenchymal stem cell transplantation and pravastatin treatment via artery for early femoral head avascular necrosis

背景:近年来干细胞移植治疗股骨头缺血性坏死逐渐兴起,股骨头坏死的发病除与各种原因引起的局部组织缺血有关以外,研究还发现股骨头坏死的发病可能与成骨细胞及骨髓基质细胞的功能下降有关。目的:观察经动脉自体骨髓间充质干细胞移植联合普伐他汀治疗Ⅰ～Ⅱ期股骨头缺血性坏死的可行性。方法:纳入股骨头缺血性坏死患者32例49髋,经集落细胞刺激因子动员后采集患者骨髓间充质干细胞,采用Seldinger穿刺技术,从非治疗侧股动脉成功穿刺后,通过非治疗侧的髂总动脉、腹主动脉至治疗侧髂总动脉,注射非离子对比剂15mL。将自体干细胞悬液通过导管分2次缓慢注射入旋股内、外侧动脉及闭孔动脉,每次注射时间大于5min。干细胞移植治疗术毕,口服普伐他汀联合治疗。治疗后随访,观察股骨头缺血性坏死临床症状改变情况和髋关节活动度。结果与结论:32例患者49髋均完成半年以上随访,患者髋部疼痛缓解,髋关节功能改善,关节活动范围明显扩大,尤其是外展功能恢复明显行走距离增加。16例21髋患者治疗6个月后股骨头血管造影结果显示,股骨头内新生血管增多,血供改善。提示骨髓间充质干细胞移植联合普伐他汀治疗早期股骨头缺血性坏死损伤小,可有效恢复髋关节功能,阻止或延缓疾病的进一步发展。

BACKGROUND：Stem cell transplantation has recently been used to treat avascular necrosis of the femoral head.The onset of femoral head necrosis is associated with various reasons-induced ischemia in local tissue.Studies have found that the onset of femoral head necrosis may be correlated with decreased function of osteoblasts and bone marrow stromal cells.OBJECTIVE：To investigate the feasibility of autologous bone marrow mesenchymal stem cell（BMSC） transplantation and pravastatin in treatment of avascular necrosis of femoral head in Ⅰ-Ⅱ phases via artery.METHODS：A total of 32 patients（49 hips） with avascular necrosis of femoral head were selected.BMSCs were collected following mobilization of colony cell stimulating factors.15 mL non-ionic contrast media were injected into the affected common iliac artery after successful puncture at the normal femoral artery by Seldinger technique.Autologous stem cell suspension was slowly injected twice through the catheter into the rotation,the lateral artery and obturator arteries,each injection longer than 5 minutes.After the surgery of interventional therapy,oral pravastatin was used.The patients were followed up after the operation.The clinical symptoms of avascular necrosis of femoral head and knee joint activity were evaluated.RESULTS AND CONCLUSION：All 32 patients（49 hips） were followed up over 6 months postoperatively.Hip pain was lessened.Significant improvement in hip function was seen after treatment.The scope of joint activities was significantly expanded,and walking distance was increased.The abduction function was resumed significantly.Angiography of the femoral head in 16 patients（21 hips） at 6 months after treatment revealed that new blood vessels in the femoral head became more,and blood supply was improved.These suggest that BMSC transplantation and pravastatin treatment via artery on early femoral head necrosis have little damage,are well effective in functional recovery,can prevent or delay disease progress.