中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (6): 1065-1069.doi: 10.3969/j.issn.1673-8225.2011.06.025

• 干细胞临床实践 clinical practice of stem cells • 上一篇    下一篇

自体骨髓间充质干细胞动脉灌注联合局部注射治疗股骨头坏死

史  跃1，尹文洲2，陈启忠3，王安明1，刘军权4，刘宏宾5，高从敬1   

  1. 1解放军第九七医院介入放射科，江苏省徐州市  221004
    2徐州市中医院介入放射科，江苏省徐州市　221003
    3解放军第九七医院急诊科，江苏省徐州市221004
    4解放军第九七医院实验科，江苏省徐州市221004
    5解放军第九七医院骨科，江苏省徐州市221004
  • 收稿日期:2010-09-03 修回日期:2010-10-18 出版日期:2011-02-05 发布日期:2011-02-05
  • 作者简介:史跃，男，1966年生，江苏省徐州市人，解放军第一军医大学医学影像专业毕业，副主任医师，主要从事微创介入治疗工作。 shiyue66@126.com

Arterial perfusion combined with regional injection of autologous bone marrow mesenchymal stem cells for femoral head necrosis 

Shi Yue1, Yin Wen-zhou2, Chen Qi-zhong3, Wang An-ming1, Liu Jun-quan4, Liu Hong-bin5, Gao Cong-jing1   

  1. 1Department of Interventional Radiology, the 97th Hospital of Chinese PLA, Xuzhou  221004, Jiangsu Province, China
    2Department of Interventional Radiology, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou  221003, Jiangsu Province, China
    3Department of Emergency, the 97th Hospital of Chinese PLA, Xuzhou  221004, Jiangsu Province, China
    4Department of Medical Laboratory, the 97th Hospital of Chinese PLA, Xuzhou  221004, Jiangsu Province, China
    5Department of Orthopedics, the 97th Hospital of Chinese PLA, Xuzhou  221004, Jiangsu Province, China
  • Received:2010-09-03 Revised:2010-10-18 Online:2011-02-05 Published:2011-02-05
  • About author:Shi Yue, Associate chief physician, Department of Interventional Radiology, the 97th Hospital of Chinese PLA, Xuzhou 221004, Jiangsu Province, China shiyue66@126.com

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611

被引次数

37

摘要：

背景：细胞水平研究发现，股骨头缺血坏死患者股骨近端成骨细胞增殖能力降低，股骨头内间充质干细胞的数量减少。因此，对股骨头缺血坏死的治疗应在改善血供的同时，还应在坏死区局部补充具有成骨能力的种子细胞。
目的：观察自体骨髓间充质干细胞动脉灌注联合局部穿刺注射介入治疗股骨头缺血性坏死的临床疗效。
方法：研究组32例股骨头缺血死患者，采用seldinger技术经皮-股动脉穿刺将导管选至股骨头供养动脉，灌注脲激酶30× 104 U，罂粟硷30 mg；然后经旋股内动脉灌注骨髓间充质干细胞悬液10 mL，经皮穿刺股骨头坏死区多点注射骨髓间充质干细胞悬液10 mL，骨髓间充质干细胞数量为2×107~2×108个。同期对照组34例股骨头缺血死患者，单纯采用动脉溶栓介入治疗进行比较。两组间隔2，4周再进行第2，3次介入治疗，3次为1个疗程。
结果与结论：研究组32例患者，股骨头、颈区域狭窄闭塞血管再通，股骨头血管染色区域明显增大，坏死区域逐渐缩小29例；治疗后研究组关节活动度改善程度优于对照组；研究组疼痛缓解有效率为93.8%、临床治愈率为84.4%，均高于对照组。结果显示经动脉溶栓后灌注自体骨髓间充质干细胞，联合经皮穿刺局部多点注射介入治疗股骨头缺血性坏死可以提高疗效、缓解疼痛、改善关节功能。

关键词: 股骨头缺血坏死, 骨髓间充质干细胞, 动脉灌注, 局部穿刺多点注射, 数字减影血管造影, 介入治疗

Abstract:

BACKGROUND: Cellular level studies have demonstrated that the proliferative ability of osteoblasts at the proximal end of the femur of patients with femoral head avascular necrosis was decreased, and the number of mesenchymal stem cells (MSCs) was diminished in the femoral head. Therefore, the treatment of femoral head avascular necrosis was done simultaneously when the blood supple was improved. Seed cells with osteogenic ability should be supplemented in the local necrotic region.
OBJECTIVE: To observe clinical curative effect of autologous bone marrow MSCs (BMSCs) arterial perfusion in combination with interventional therapy of local puncture injection for treatment of femoral head avascular necrosis.
METHODS: In 32 patients with femoral head avascular necrosis in the research group, the catheter was placed on the femoral head to support the artery using seldinger technique via percutaneous-femoral artery puncture. Urokinase 30×104 U and papaverine 30 mg were perfused. 10 mL BMSCs suspension was perfused via the medial femoral circumflex artery. 10 mL BMSCs suspension was infused via multiple points of percutaneous puncture at the necrotic region of the femoral head. The number of BMSCs was 2×107-2×108. The 34 patients with femoral head avascular necrosis of the concurrent control group were compared using interventional therapy of artery thrombolysis. The second and third interventional therapy was performed with an interval of 2 and 4 weeks, three times as a course, in both groups.
RESULTS AND COMCLUSION: Stenosis, occlusion and revascularization were observed in the femoral head and neck regions of 32 patients of the research group. The vessel dying region of the femoral head was obviously enlarged. Necrotic region was gradually shortened in 29 cases. Following treatment, the improvement degree of range of motion was better in the research group than the control group. The effective rate of pain easement was 93.8%, and the clinical recovery rate was 84.4% in the research group, which were greater compared with the control group. Results demonstrated that perfusion of autologous BMSCs in combination with interventional therapy of multiple injection of percutaneous puncture for treatment of femoral head avascular necrosis following artery thrombolysis can elevate curative effect, pain release and improve joint function.

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