髓芯减压BMMCs移植羟基磷灰石复合人工骨植入治疗股骨头坏死

Efficacies of bone-marrow-derived mononuclear cells with a hydroxylapatite composite in the treatment of osteonecrosis of the femoral head

目的观察浓集自体骨髓单个核细胞（BMMCs）移植羟基磷灰石复合人工骨植入治疗中、早期股骨头坏死的临床疗效。方法自2006年6月至2010年1月采用髓芯减压BMMCs移植人工骨植入治疗ARCO分期I期、Ⅱ期、ⅢA期股骨头坏死患者35例（57髋），年龄26—58（39．4±7．2）岁。对照组髓芯减压单纯人工骨植入治疗股骨头坏死患者17例（27髋），年龄26～51（38．0±6．0）岁。术后每半年及终末随访时摄髋关节前后位、蛙式位x线片，观察股骨头修复及坏死进展情况，采用Harris评分系统评估术后患髋功能改善情况，应用视觉模拟标尺法进行临床疼痛测定。结果两组患者整体术后终末随访Harris评分较术前显著提高。与单纯植骨组相比，BMMCs移植组术后终末随访Harris评分较术前提高幅度更明显。两组患者整体术后终末随访VAS评分较术前显著降低。与单纯植骨组相比，BMMCs移植组术后终末随访VAS评分较术前降低幅度更明显。BMMCs移植组临床成功率（75．4％）高于单纯植骨组（37．0％），差异有统计学意义（P〈0．01）。BMMCs移植组放射学成功率（59．6％）高于单纯植骨组（40．7％），差异无统计学意义（P=0．1046）。结论髓芯减压结合浓集自体BMMCs移植羟基磷灰石人工骨植入治疗股骨头坏死可有效改善患髋功能，显著减轻疼痛，适用于Ⅰ-ⅢA期股骨头坏死。

Objective To evaluate the efficacies of core decompression and implantation of concentrated autologous bone marrow containing mononuclear ceils （BMMCs）with porous hydroxylapatite composite in the treatment of osteonecrosis of the femoral head. Methods A total of 35 patients with 57 osteonecrosis hips with ARCO stage Ⅰ , stage Ⅱ and stage ⅢA disease were treated by BMMCs with a porous hydroxylapatite composite. The mean age at surgery was 39.4 （26 -58 ） years and the mean period of follow-up 28 （12 -40） months. In the control group, cell-free porous hydroxylapatite composite was implanted into 17 patients （27 hips ） with osteonecrosis of the femoral head and the outcomes were compared. Results At the last follow-up, postoperative Harris hip scores significantly increased in both groups （P 〈0. 0001 ）. The magnitude of increase was significantly greater in the BMMCs group compared with the control group （28.3% ±0. 9% vs 18.4% ± 1.7% , P 〈0.01 ）. Postoperative visual analog scale （VAS） scores significantly decreased in both groups （P 〈 0.01 ）. The magnitude of decrease was significantly greater in the BMMCs group compared with the control group （ -70. 2% ±2. 1% vs -51.7%± 2. 9%, P 〈0. 001 ）. The clinical success rate was significantly higher in the BMMCs group compared with the control group （75.4% vs 37.0%, P 〈0. 01 ）. The radiological success rates were similar between the BMMCs and control groups （59. 6% vs 40. 7% , P = 0. 1046）. Conclusion The combined regimen of core decompression and implantation of concentrated autologous BMMCs with porous hydroxylapatite composite appears to confer benefits in the treatment of in stages Ⅰ-Ⅲ A osteonecrosis of the femoral head.