髓芯减压联合自体骨髓间充质干细胞移植治疗股骨头坏死

Core decompression combined with bone marrow mesenchymal stem cell transplantation for treating osteonecrosis of the femoral head

背景:治疗早期股骨头坏死的保髋方法有多种,最佳的保髋方法仍在努力探索中,髓芯减压联合干细胞移植是治疗早期股骨头坏死的一种保髋方法,其有效性及影响因素临床报道差异较大。目的:评估髓芯减压联合骨髓间充质干细胞移植治疗股骨头坏死的中远期效果。方法:此项回顾性研究获得河北医科大学附属邢台市人民医院伦理委员会同意,批准号:2018-JS037。经查阅病例系统,2008至2012年有95例患者被诊断为股骨头坏死,纳入符合标准的65例股骨头坏死患者接受了髓芯减压和骨髓干细胞移植,男53例,女12例,平均年龄43.1(20-61)岁,共65髋,ARCO分期1期29髋,2期36髋;ARCO分型A型15髋,B型33髋,C型17髋。平均随访时间为7.5(6.5-10.1)年,评估治疗后股骨头塌陷率和髋关节置换率,用logistic多因素回归分析治疗后股骨头塌陷的危险因素。结果与结论:在随访的65例髋中,塌陷30例,塌陷率46%(30/65),在1期和2期的塌陷率分别为34.5%(10/29),55.6%(20/36),在A、B、C型中的塌陷率分别为26.7%(4/15),42.4%(14/33),70.1%(12/17)。在65例髋中,髋关节置换率为23%(15/65)。体质量指数、治疗前ARCO分期和ARCO分型与治疗后塌陷率明显相关,差异有显著性意义(P<0.05),是股骨头塌陷的危险因素。

BACKGROUND:A variety of hip-preserving treatments for early osteonecrosis of the femoral head have been emerged.However,the favorite hip-preserving method is still under investigation.Core decompression combined with stem cell transplantation is a hip-preserving treatment for early osteonecrosis of the femoral head.However,its effectiveness and influencing factors are quite diverse reported in existing clinical studies.OBJECTIVE:To evaluate the mid-long-term effects of core decompression combined with stem cell transplantation in the treatment of osteonecrosis of the femoral head.METHODS:This was a retrospective study with the approval by the Ethics Committee of Xingtai People’s Hospital Affiliated to Hebei Medical University,China(approval No.2018-JS037).From 2008 to 2012,65 of 95 patients with osteonecrosis of the femoral head were treated with core decompression with bone marrow mesenchymal stem cell transplantation.There were 53 males and 12 females,with the mean age of 43.1(20-61)years.There were 65 hips,including 29 defined as ARCO stage I and 36 as ARCO stage II,as well as 15 as ARCO type A,33 as ARCO type B,and 17 as ARCO type C.The mean follow-up period was 7.5(6.5-10.1)years.Post-treatment collapse rate and hip replacement rate were assessed,and risk factors for post-treatment collapse were analyzed through a multivariate logistic regression analysis.RESULTS AND CONCLUSION:The overall collapse rate of the femoral head was 46% (30/65).For stage I and stage II collapses,the collapse rates of the femoral head were 34.5% (10/29)and 55.6% (20/36),respectively.For ARCO type A,B and C,the collapse rates of the femoral head were 26.7% (4/15),42.4% (14/33),and 70.1% (12/17),respectively.The hip replacement rate of the 65 hips was 23% (15/65).In the multivariate logistic regression analysis,postoperative rate of femoral head collapse was significantly correlated with body mass index,preoperative ARCO stage and type(P<0.05),which are defined as the risk factors for femoral head collapse.