髓芯减压联合自体外周血干细胞移植治疗结缔组织病合并早中期股骨头缺血性坏死

Core decompression and autologous peripheral blood stem cell transplantation for avascular necrosis of the femoral head at early and middle stages in patients with connective tissue disease

目的观察髓芯减压联合自体外周血干细胞移植治疗结缔组织病（CTD）合并早中期股骨头缺血性坏死（ANFH）的临床疗效。方法选择福建医科大学附属龙岩第一医院血液风湿科2004年10月至2013年6月住院治疗的CTD合并ANFH患者58例。所有患者均有关节疼痛和功能障碍等症状,经影像学检查确诊为ANFH,均有长期服用糖皮质激素史（口服泼尼松5~15 mg/d,持续1~8年）。按照治疗方法的不同将患者分为髓芯减压联合自体外周血干细胞移植治疗组和单纯髓芯减压对照组,治疗组和对照组患者分别为32例和26例。根据世界骨循环研究学会（ARCO）骨坏死分期标准,治疗组49髋分别为Ⅰ期7髋,Ⅱ期25髋,Ⅲ期17髋;对照组38髋Ⅰ期5髋,Ⅱ期21髋,Ⅲ期12髋。分别在术前及术后随访期间对两组患者进行髋关节Harris评分和疼痛视觉模拟（VAS）评分,并对患者MRI检查结果进行评估。结果两组患者术后切口均Ⅰ期愈合,术后中位随访时间40个月（24~104个月）。治疗组和对照组患者术后3,6,12,24个月Harris和VAS评分与本组术前比较,差异均有统计学意义（P均〈0.05）。两组患者术前及术后3个月Harris评分差异均无统计学意义（t=1.06和0.58,P均〉0.05）;治疗组患者术后6,12,24个月Harris评分均高于对照组,差异均有统计学意义（t=2.49,5.55和6.58,P均〈0.05）;术后24个月治疗组患者Harris评分优良率高于对照组（χ2=8.59,P〈0.05）。两组术前及术后3,6个月VAS评分差异均无统计学意义（t=0.61,0.73和1.74,P均〉0.05）;治疗组术后12,24个月VAS评分均低于对照组,差异均有统计学意义（t=5.50和3.22,P均〈0.05）。治疗组术后12,24个月T1相低信号区占股骨头体积百分比与术前比较差异均有统计学意义（P均〈0.05）,与对照组术后12,24个月比较差异均有统计学意义（t=3.41和2.07,P均〈0.05）。结论髓芯减压联合自体外周血干细胞移植治疗CTD合并早中期ANFH,可减轻患者关节疼痛,改善股骨头血液供应,恢复关节功能,有效防止股骨头进一步塌陷,可获得较好的临床疗效。

Objective To study the clinical outcomes of the core decompression and autologous peripheral blood stem cell（ APBSC） transplantation for avascular necrosis of the femoral head（ ANFH）at early and middle stages in patients with connective tissue disease.Methods A total of 58 patients with ANFH at early and middle stages were treated in Affiliated Longyan First Hospital from October2004 to June 2013.The patients were divided into 2 groups：the control group（ n=26）,only the core decompression was used;the treated group（ n=32）,both the core decompression and APBSC transplantation were used.There were 12 males and 14 females with an average age of 39.5 years（ range 22-58 years） in the control group and 15 males and 17 females with an average age of 40 years（ range 21-60 years） in the treated group.According to the system of Association Research Circulation Osseous（ ARCO） ：5 hips were classified as stage Ⅰ,21 as stage Ⅱ,and 12 as stage Ⅲ in the control group;7 hips were classified as stage Ⅰ,25 as stage Ⅱ,and 17 as stage Ⅲ in the treated group.The Harris score and visual analogue scale / score（ VAS） were determined,imaging evaluation was carried out by MRI pre-and post-operatively.Results The followed-up time was 24-104 months with an median of 40 months.The Harris scores and VAS scores of all patients were significant difference at 3,6,12 and 24 months after operation（ P〈0.05）.There was not significant difference between the treated group and the control group in Harris scores 3 months after operation（ P〈0.05）,but there were significant difference between the treated group and the control group at 6,12 and 24 months after operation（ P〈0.05）.There was significant difference between the treated group and the control group in the excellent and good rate at 24 months after operation（ χ2= 8.59,P〈0.05）.There was not significant difference between the treated group and the control group in VAS scores at 3 and 6 months after operation（ P〈0.05）,but there were significant difference between the treated group and the control group at 12 and 24 months after operation（ P〈0.05）.The necrosis area of femoral head in the treated group and the control group were significant difference at 12 and 24 months after operation（ P〈0.05）.Conclusion The method of core decompression combining with APBSC transplantation can remarkably relieve the pain,promote the blood transport in the necrosis area ameliorate the femoral bone density,prevent the collapse of the femoral head and improve the hip joint function in the patients with ANFH at early and middle stages.