计算机导航辅助自体干细胞回植治疗早期股骨头坏死

Treatment of early osteonecrosis of femoral head with autologous stem cells transplantation by computer navigation

背景:如何利用组织工程技术修复股骨头塌陷的软骨,是塌陷后股骨头坏死治疗的主要研究方向。目的:观察计算机导航辅助及关节镜监视下髓芯减压自体骨髓间充质干细胞体外培养自体回植治疗早期股骨头缺血性坏死的方法及疗效。方法:根据世界骨循环研究学会国际骨坏死分期标准,选取早期股骨头缺血性坏死患者104例,均在计算机导航辅助下实施髓芯减压术,同时关节镜监视下进行坏死病灶清除,其中53例在此基础上二期植入体外分离培养的1×109L-1自体骨髓间充质干细胞2mL。结果与结论:经平均30个月的随访及磁共振检查发现,所有患者股骨头坏死体积均明显减小,Harris评分明显提高(P<0.05);其中给予自体骨髓间充质干细胞回植的患者改善更明显(P<0.05),其临床成功率和影像学成功率分别达92%和90%,且未见明显的不良反应。说明计算机导航辅助及关节镜监视下髓芯减压自体骨髓间充质干细胞体外培养回植是一种安全、有效的治疗早期股骨头缺血性坏死的方法,效果优于单纯髓芯减压。

BACKGROUND： How to use the tissue engineering technique to repair the cartilage with femoral head collapse is the main research direction in the treatment of the femoral head necrosis after collapse. OBJECTIVE： To observe the therapeutic effect of in vitro cultured autologous bone marrow mesenchymal stem cells transplantation on the treatment of early osteonecrosis of femoral head by computer navigation and arthroscopy. METHODS： 104 patients with early osteonecrosis of femoral head were collected according to the international classification of osteonecrosis of Association Research Circulation Osseous, all the patients received the core decompression under the aids of computer navigation, and the necrosis debridement was performed under arthroscopy Among them, 53 patients received phase two transplantation of 2 mL in vitro isolated and cultured bone autologous bone marrow mesenchymal stem cells at 1×10^9L^-1 RESULTS AND CONCLUSION： After 30 months follow-up and magnetic resonance examination, the femoral head necrosis volume of all patients were reduced significantly, and the Harris score was increased significantly （P 〈 0.05）; the femoral head necrosis volume and Harris score of the patients with autologous bone marrow mesenchymal stem cells transplantation were improved more significantly （P 〈 0.05）, the clinical success rate and radiographic success rate was 92% and 90%, respectively; no obvious adverse reactions were observed. Core decompression and autologous bone marrow mesenchymal stem cells in vitro culture and transplantation by computer navigation and arthroscopy is a safe and effective method for the treatment of early avascular necrosis of femoral head, and the effect is better than the core decompression.