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首页> 中文期刊> 《中国组织工程研究》 >自体骨髓基质干细胞联合带血管蒂髂骨瓣转移多孔钽棒植入治疗股骨头缺血性坏死

自体骨髓基质干细胞联合带血管蒂髂骨瓣转移多孔钽棒植入治疗股骨头缺血性坏死

         
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BACKGROUND:There are a variety of treatments for femoral head necrosis,but their efficacy is not confirmed and unified.How to improve the differentiation ability of osteoblasts in the femoral head and improve the biomechanical support after the repair of the femoral head is an urgent problem to be solved.OBJECTIVE:To explore the clinical outcome of stem cells combined with vascularized iliac bone flap and tantalum rod implantation for the treatment of osteonecrosis of the femoral head (ONFH).METHODS:Totally 28 cases (36 hips) of non-traumatic ONFH admitted at the Zhongshan Hospital of Dalian University from January 2010 to January 2011 were enrolled.Bone marrow samples were extracted from each patient to isolate bone marrow stromal stem cells which were cultured in vitro for 2 weeks.Tantalum rod implantation with vascularized iliac bone graft was conducted to restore the femoral head shape,and then,prepared stem cell suspension were injected into the iliac bone flap and into the subchondral space of the femoral head.RESULTS AND CONCLUSION:All the 28 cases (36 hips) were followed up for 6-20 months (average 12 months),and their Harris hip scores and visual analogue scale scores at postoperative 6 and 12 months were significantly higher than the baseline (P ＜ 0.05).The Harris hip score at postoperative 12 months was significantly higher than that at postoperative 6 months (P ＜ 0.05),but there was no significant difference in the visual analogue scale scores at 6 and 12 months postoperatively (P ＞ 0.05).At the end of 12-month follow-up,clinical outcomes were excellent in 13 hips,good in 15 hips,fair in 4 hips,and poor in 4 hips,with an excellent and good rate of 90％.These findings indicate that autologous bone marrow stromal stem cell transplantation with vascularized iliac bone flap and tantalum rob implantation is an effective method with high clinical success rate for the treatment of ONFH.%背景:股骨头坏死治疗方法繁多,但效果均未得到肯定及统一,如何提升股骨头内骨细胞成骨分化能力及提高股骨头修复后的生物力学支撑,是临床亟待解决的问题.目的:探讨采用预先提取自体骨髓基质干细胞,经体外培养扩增后联合带血运髂骨瓣转移及多孔钽棒植入治疗股骨头坏死的临床疗效.方法:收集2010年1月至2011年1月在大连大学附属中山医院就诊并符合纳入条件的28例成年非创伤性股骨头坏死患者.预先抽取自体骨髓液,离心提取骨髓基质干细胞,体外培养扩增2周后备用.采用带血运髂骨瓣转移、钽棒植入将骨瓣腾起恢复股骨头外形,并将预制的干细胞悬液注入植入髂骨瓣与股骨头软骨下间隙间.结果与结论:所有28例患者(36髋)均随访6-20个月,平均12个月.术后6个月及12个月随访时Harris髋关节功能评分、目测类比评分均显著优于术前(P＜0.05);术后12个月时Harris髋关节功能评分高于术后6个月(P＜0.05),而这2个时间点的目测类比评分差异无显著性意义(P＞0.05);术后12个月随访髋关节结果优13髋,较好15髋,良4髋,差4髋,优良率90％.说明自体骨髓基质干细胞联合带血管蒂髂骨瓣移植钽棒植入临床功能评价成功率高,是治疗股骨头缺血性坏死的有效方法.

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