动脉药物灌注联合干细胞动脉移植治疗股骨头缺血性坏死的临床研究

Clinical Study of Arterial Drug Perfusion Combined with Arterial Autologous Bone Marrow Mesenchymal Stem Cells Transplantation for Avascular Necrosis of the Femoral Head

目的探讨动脉药物灌注联合自体骨髓间充质干细胞动脉移植治疗股骨头缺血坏死的疗效。方法收集2009年1月～2011年2月在我科接受自体骨髓间充质干细胞移植的75例(共126髋)股骨头缺血性坏死的患者,采用经皮股动脉穿刺将导管超选至股骨头供血动脉,先灌注罂粟碱30ml、尿激酶50万u、复方丹参30ml,最后将骨髓间充质干细胞悬液等量注入各支血管。术后第3、6、12、18、24个月,根据成人股骨头缺血坏死修复与再造评价标准评价疗效,影像学评价股骨头形态学变化。结果疼痛缓解率93.65%(118/126);步行距离延长84%(63/75);关节功能缓解率86.50%(109/126);影像学改善率72.73%(56/77)。结论经动脉药物灌注联合自体骨髓间充质干细胞动脉移植治疗股骨头缺血性坏死介入治疗方法简便、安全有效,能够有效的治疗股骨头缺血性坏死。

Objective To investigate the effect of arterial drug perfusion combined with arterial autologous bone marrow mesenchymal stem cells transplantation in the treatment of avascular necrosis of the femoral head. Methods Seventy-five patients were collected with avascular necrosis of the femoral head and treated with arterial autologous bone marrow mesenchymal stem cells transplantation from January 2009-February 2011 in our department. Percutaneous femoral artery puncture was used to send superselectively catheter to femoral head artery, and perfuse 30ml of papaverine,500000u of urokinase,30ml of salvia, the bone marrow mesenchymal stem cells （ bone marrow stem cells BMSC ） suspension 15- 20ml （BMSC amount is about 8.0x 107- 1.0x 10S）.After3,6,12,18,24 months, the efficacy was evaluated according to the adult avascular necrosis of the femoral head restoration and reconstruction of evaluation criteria. And imaging methods was used to observe the morphological changes of the femoral head every 6 months. Results Pain relief rate was 100%（75/75）; walking distance extension in 84%（63/75）; joint functional remission rate of 69.33%（52/75）; radiological improvement rate was 78.57%（33/42）. Conclusion Arterial drug perfusion combined with arterial autologous bone marrow mesenchymal stem cells transplantation for avascular necrosis of the femoral head is simple, safe and effective in the treatment of avascular necrosis of the femoral head.