自体外周血干细胞移植联合髓芯减压治疗早中期股骨头缺血性坏死的临床研究

目的对比研究单纯股骨头髓芯减压与联合自体外周血干细胞移植治疗早中期股骨头缺血性坏死（ANFH）的临床疗效。方法 2004年10月至2012年3月期间就诊于福建省龙岩市第一医院,经影像学检查及术后病理检查确诊为ANFH的患者90例。A组采用单纯髓芯减压共34例,男22例,女12例,年龄22~62岁（中位年龄41.5岁）。B组采用髓芯减压联合自体外周血干细胞移植（用rhG-CSF皮下注射4 d进行外周血干细胞动员,第5天分离外周造血干细胞混悬液。在髓芯减压基础上沿减压隧道注入自体外周血干细胞10~15 ml）56例,男35例,女21例,年龄21~62岁（中位年龄39岁）。按世界骨髓循环研究学会（ARCO）国际骨坏死标准：A组：Ⅰ期7髋,Ⅱ期26髋,Ⅲ期17髋;B组：Ⅰ期10髋,Ⅱ期50髋,Ⅲ期29髋。术后及随访期间进行Harris评分和疼痛视觉模拟（VAS）评分,对X线片、CT及MRI检查结果进行评估。两组Harris评分和VAS评分比较用成组t检验。结果 A组34例,B组49例随访13~89个月,平均38.5个月。术后3、6、12个月与术前的Harris评分比较有明显提高,VAS评分有明显的下降;术前、术后3个月两时间点的A、B组Harris评分比较差异无统计学意义（t=0.342、0.628,P=0.781、0.516）;术后6、12个月的B组评分优于A组（t=2.991、7.753,P=0.009、0.001）。术后12个月A、B两组T1相低信号区所占股骨头体积的比例分别为（17.24±3.71）﹪和（12.11±3.14）﹪,差异有统计学意义（t=4.360,P=0.001）。结论髓芯减压联合自体外周血干细胞移植治疗早中期ANFH,可显著减轻关节疼痛,改善股骨头血液供应,明显恢复关节功能,加速病灶区骨组织修复,有效防止股骨头进一步塌陷。

Clinical observation of core decompression and autologous peripheral blood stem cell transplantation for the treatment of avacscular necrosis of the femoral head in early and middle stages

Objective To compare the clinical outcomes of the core decompression combined with autologous peripheral blood stem cell（APBSC） transplantation with core decompression alone for the treatment of avascular necrosis of the femaral head（ANFH） in early and middle stages. Methods From October 2004 to March 2012, 90 patients with ANFH in early and middle stages were enrolled. The patients were divided into 2 groups. Patients in group A received only core decompression therapy. Patients in group B received both core decompression therapy and APBSC transplantation. There were 22 males and 12 female with an average age of 41.5 years（rang, 22-57 years） in group A and 35 males and 21 female with an average age of 39 years（rang, 21-62 years） in group B. The Harris score and visual analogue scale（VAS） score were determined, imaging evaluation was carried out by X-rays, CT and MRI pre-and post-operatively. Results A total of 83 cases were followed up for 13 ~ 89 months with an average of 38.5 months. The Harris scores and VAS scores of all patients were similar at 3month between the 2 groups（t = 0.342 and 0.628（P = 0.781 and 0.516）. At 6 and 12 months after operation, there was significant difference between groups A and B in Harris scores（t = 2.991and 7.753,P = 0.009 and 0.001）. The necrosis area of femoral head in groups A and B were（17.24± 3.71） ﹪ and （12.11 ± 3.14） ﹪, respectively, with significant difference（t = 4.360, P = 0.001）.Conclusions Core decompression combining with APBSC transplantation can remarkably relieve pain, promote circulation in the necrosis area, prevent the collapse of the femoral head and improve the hip joint function in the patients with ANFH in early and middle stages.