超选择性股动脉内骨髓单个核细胞移植治疗股骨头坏死187例

Efficiency of arterial transplantation of autologous bone marrow-derived mononuclear cell on ischemic avascular necrosis of femoral head

目的研究自体骨髓单个核细胞移植对股骨头坏死患者缺血状态的改善程度和治疗效果。方法选取2004年7月至2010年11月期间187例252髋股骨头坏死患者,应用自体骨髓单个核细胞移植治疗,分别采集187例患者骨髓200～360ml,采用Ficoll密度梯度离心法分离单个核细胞,单个核细胞总数为(2.4～7.8)×108个,流式细胞仪检测CD34+细胞和CD133+细胞在所分离出的干细胞悬液中的含量分别为2.47﹪±0.58﹪和1.29﹪±0.35﹪,然后将单个核细胞用生理盐水制备成细胞悬液20～30ml,使用数字减影血管造影技术(DSA)行超选择性股骨头供血动脉内干细胞移植术。按世界骨循环研究学会(ARCO)对骨坏死分期,设自身前后对照观察疗效。移植术后第3、6、12、24、36和48个月,根据髋关节Harris评分评价疗效,移植术后6个月通过复查患者股骨头供血动脉DSA,观察其新生血管形成情况,以后每隔6个月采用影像学方法观察股骨头形态学变化。结果 (1)临床疗效:对接受自体骨髓单个核细胞移植治疗的187例患者随访3～48(24.2±4.5)个月,其中髋关节疼痛缓解者158例(占患者总数的84.5﹪),髋关节功能改善者146例(占患者总数的78.1﹪),行走间距延长者149例(占患者总数的79.7﹪)(;2)影像学检查:干细胞移植术后6个月187例患者中54例行股骨头供血动脉DSA检查,48例显示供血动脉较移植术前明显增多、增粗,血流速度增快,12～24个月后72例患者股骨头区骨质病变获得改善。结论超选择性动脉内骨髓单个核细胞移植方法简便、安全有效,对因缺血导致坏死的股骨头无再次损伤,能够有效治疗缺血性股骨头坏死。

Objective To investigate the safety and efficiency of super-selective arterial autologous bone marrow-derived mononuclear cell （ BMMNC ） transplantations on 187 patients with ischemic avascular necrosis of femoral head. Methods Totally 187 patients （ 252 coxas） were enrolled from July 2004 to November 2010 and treated by bone marrow -derived mononuclear cell （ BMMNC ） transplantation. 200-360 rnl of bone marrow were collected. Mononuclear cells were separated by Ficoll density gradient centrifugation. Mononuclear cells with the density of （2.4 - 7.8） ×l08 containing 2.47% ±0.58% CD34＋ cells and 1.29% 4-0.35% CD133（＋） cells were suspended with 20-30 ml of saline to form single-cell suspension. And then they were transplanted into femoral artery by digital subtraction angiography （DSA）. Results The patients were follow-up for 3- 48 months （mean 24.2 ± 4.5 months）. Hip joint pain was relieved in 158 cases （84.5 %）, joint function was improved in 146 cases （78.1%） and walking distance was increased in 149 cases （79.7 %）, respectively. After treatment, the calibers were thickened, the number of vessels increased and the blood velocity was improved. Blood-supply arteries checked by DSA were observed in 48 patients at 6 months. 72 patients showed reduction in the areas of femoral head necrosis and new bone formation betweenl2 and 24 months. Conclusion The bone marrow-derived mononuclear cell transplantation is convenient, safe and effective in the treatment of avascular necrosis of femoral head.