中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (22): 3464-3469.doi: 10.3969/j.issn.2095-4344.2017.22.004

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials • 上一篇    下一篇

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

谢  辉1，2，王子华2，赵德伟1，2，黄诗博2，王本杰2，王  威2，崔大平2
  

  1. 1大连理工大学电信学部生物医学工程系，辽宁省大连市  116023；2大连大学附属中山医院骨一科，辽宁省大连市 116001
  • 收稿日期:2017-07-05 出版日期:2017-08-08 发布日期:2017-09-01
  • 通讯作者: 赵德伟，博士，主任医师，大连大学附属中山医院骨一科，辽宁省大连市 116001
  • 作者简介:谢辉，男，安徽省宿州市人，汉族，大连理工大学在读博士，主治医师，主要从事髋关节疾病研究。
  • 基金资助:

    国家十三五“国家重点研发计划”项目(2016YFC1102000)

Autologous bone marrow stromal stem cells combined with vascular pedicle iliac bone flap and tantalum rob implantation for osteonecrosis of the femoral head

Xie Hui1, 2, Wang Zi-hua2, Zhao De-wei1, 2, Huang Shi-bo2, Wang Ben-jie2, Wang Wei2, Cui Da-ping2
  

  1. 1Department of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian 116023, Liaoning Province, China; 2First Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
  • Received:2017-07-05 Online:2017-08-08 Published:2017-09-01
  • Contact: Zhao De-wei, M.D., Chief physician, Department of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian 116023, Liaoning Province, China; First Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
  • About author:Xie Hui, Studying for doctorate, Attending physician, Department of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian 116023, Liaoning Province, China; First Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
  • Supported by:
    the National Key Research and Development Plan of China during the Thirteenth Five-Year Plan, No. 2016YFC1102000

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摘要：

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文题释义：
骨坏死的世界骨循环研究学会(Association Research Circulation Osseous，ARCO)分期：①0期：骨活检结果与缺血坏死一致，但其他所有检查均正常；②Ⅰ期：骨扫描阳性或MR阳性或两者均呈阳性，依赖股骨头累及的部位，病变再分为内侧、中央及外侧：ⅠA，股骨头受累<15%；ⅠB，股骨头受累15%-30%；ⅠC，股骨头受累> 30%；③Ⅱ期：X射线片异常(股骨头斑点状表现，骨硬化，囊肿形成及骨质疏松)，在X射线片及CT片上无股骨：ⅡA，股骨头受累< 15%；ⅡB，股骨头受累15%-30%；ⅡC，股骨头受累> 30%；④Ⅲ期：新月征，依股骨头受累位置，病变可细分为内侧，中央及外侧：ⅢA，新月征< 15%；或股骨头塌陷>2 mm；ⅢB：新月征15%-30%或股骨头塌陷2-4 mm；ⅢC：新月征>30%或股骨头塌陷> 4 mm；⑤Ⅳ期：X射线片显示股骨头关节面变扁，关节间隙狭窄，髋臼出现硬化，囊性变及边缘骨赘。
Harris髋关节功能评分：是一个广泛应用的评价髋关节功能的方法，常常用来评价保髋和关节置换的效果。满分100分，90分以上为优良，80-89分为较好，70-79 分为尚可，小于70分为差。
 
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。

关键词: 生物材料, 骨生物材料, 骨髓基质干细胞, 带血运骨瓣, 多孔钽棒, 股骨头缺血性坏死, 显微外科, 目测类比评分, Harris髋关节功能评分

Abstract:

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.

Key words: Femur Head Necrosis, Stem Cell Transplantation, Tissue Engineering

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