体外冲击波联合自体骨髓间充质干细胞移植治疗早期股骨头坏死的疗效观察

Extracorporeal shock wave therapy combined with autologons bone marrow stem cells transplantation for treating early-stage osteonecrosis of the femoral head

目的观察体外冲击波联合自体骨髓间充质干细胞移植治疗早期股骨头坏死的临床疗效。方法根据股骨头坏死国际骨循环研究学会（ARCO）的股骨头坏死的分期标准，选取I期和Ⅱ期股骨头坏死患者40例，按随机数字表法分为治疗组20例（29个髋关节），对照组20例（27个髋关节）。2组患者均采用BMSC移植术进行治疗，治疗组患者于BMSC移植术后第2天行ESWT治疗。2组患者均于治疗前和术后3、6、12、24个月采用髋关节Harris评分评定患者的髋关节功能、疼痛程度和疗效，同时采用骨盆正位、蛙式位X线片对患者进行ARCO分期评定。结果术后3、6、12、24个月，2组的Harris评分以及Harris量表中的疼痛程度评分与组内治疗前比较，差异均有统计学意义（P〈0．05）；且术后6、12、24个月，治疗组的Harris评分以及Harris量表中的疼痛评分与对照组治疗后比较，差异均有统计学意义（P〈0．05）。治疗12个月后，治疗组髋关节优8个，良18个，中1个；对照组髋关节优5个，良13个，中8个，组间差异有统计学意义（P〈0．05）。术后12个月，2组换ARCO分期评定组间比较，差异有统计学意义（P〈0．05）。结论体外冲击波联合自体骨髓间充质干细胞移植治疗早期股骨头坏死可明显缓解疼痛，改善患者的关节功能。

Objective To observe the therapeutic effects of extracorporeal shock wave therapy （ESWT） combined with autologous bone marrow stem ceils （BMSC） transplantation in treating early-stage osteonecrosis of the femoral head （ONFH）. Methods Forty patients diagnosed as stage I or II according to the classification of osteonecrosis of the femoral head put forward by the Association Research Circulation Osseous were randomly divided into a treatment group and a control group with 20 cases in each group. Both groups were treated with BMSC transplantation, while the treatment group was further treated with ESWT the next day. Harris scores were assigned before the treatment and 3, 6, 12 and 24 months after the treatment to evaluate hip function, the degree of pain and tbe effects of the treatment. Frog-bit X-rays of the anteroposterior pelvis were taken to assess the stages. Results There were significant differences in the Harris scores and pain degree of the two groups before and at the different time points after the treatment. After 6, 12 and 24 months, significant differences were observed in the two values between the two groups. After 12 months the number of hips rated excellent, good and medium level were 8, 18 and 1 in the treatment group and 5, 13 and 8 in the control group, showing significant differences. Conclusion Extracorporeal shock wave therapy along with autologous bone marrow stem cell transplantation can be used to treat patients with early stage osteonecrosis of the femoral head, relieving their pain and improving their joint function.