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

doi:10.3969/j.issn.2095-4344.1813

Abstract

Abstract:

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.

Key words: bone marrow mesenchymal stem cells, femoral head necrosis, core decompression, femoral head collapse, hip replacement, body mass index, ARCO staging, ARCO typing, risk factors

CLC Number:

Liu Jiangfeng. Core decompression combined with bone marrow mesenchymal stem cell transplantation for treating osteonecrosis of the femoral head[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(29): 4599-4604.

Figures/Tables 3

2.3 随访塌陷及髋关节置换手术情况在随访的65例髋中，塌陷30例，占46%，非塌陷35例，占54%，平均发生塌陷时间2.5年(0.8-9.1年)，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)。在塌陷的髋中，发展到3a、3b、3c和4期的例数分别为4例，7例，5例，3例，占比分别为13.3%(4/30)，23.3%(7/30)，16.7%(5/30)，10%(3/30)。髋关节置换手术15例，再次使用坦棒植入手术1例，占比分别为50%(15/30)，3.3%(1/30)。在65例髋中，髋关节置换率为23%(15/65)，非置换率即髋关节保存率为77%(50/65)，平均置换时间为3.3年(0.9-8.8年)。非塌陷的髋中，处于1，2a，2b，2c期的髋分别为3例，8例，14例，10例，占比分别为8%(3/35)，23%(8/35)，40%(14/35)，29%(10/35)。 2.4 术后目测类比评分、Harris髋关节评分及MRI片坏死区变化在非置换的50例患者中，目测类比评分为(2.3± 0.5)分，Harris髋关节评分平均为(79.5±11.9)分，大于75分的35例，临床成功率70%(35/50)，18%(9/50)患者需要辅助负重行走，目测类比评分、Harris 髋关节评分与术前[(5.1±0.5)分，(55.6±5.2)分]比较，差异有显著性意义。非塌陷的患者行髋关节MRI检查，MRI片上坏死面积最大层面上计算坏死面积大小平均(24.3±3.5) mm2,较术前(31.0±5.3) mm2明显减小，差异有显著性意义。 2.5 不良事件及副反应术后有2例患者出现伤口渗液，经过积极换药及局部理疗，伤口渗液消失，逐渐愈合。无术后关节疼痛及关节内积液等不良事件发生。随访到有1例患者患有肾炎。 2.6 Logistic多因素回归分析塌陷组和非塌陷组各因素情况在塌陷组和非塌陷组中，体质量指数、ARCO分期和类型之间有明显区别，性别、年龄、侧别、随访时间、致病原因之间无明显区别，见表1。体质量指数、术前ARCO分期和ARCO分型与术后塌陷明显相关，OR值分别是2.32 (95%CI：1.11-3.34)、3.12(95%CI：1.98-5.01)和4.29 (95%CI：1.34-8.05)，见表2。"

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