Treatment of early osteonecrosis of the femoral head with debridement, bone grafting and bone marrow mononuclear cells transplantation: functional evaluation of the hip joint

doi:10.3969/j.issn.2095-4344.2014.50.017

Abstract

Abstract:

BACKGROUND: Several studies have indicated that reduced number and viability of bone marrow stem cells is closely related to the pathogenesis of osteonecrosis. Therefore, a sufficient number of transplanted bone marrow stem cells are more conducive to the reconstruction of necrotic area.
OBJECTIVE: To analyze the clinical effect of debridement, bone grafting combined with autologous bone marrow mononuclear cells transplantation for the treatment of early avascular necrosis of the femoral head.
METHODS: From March 2011 to June 2012, 25 patients (33 hips) were treated, including 15 males and 10 females, aged 18-55 years old (34.6 on average). The average disease course was 14 months (range, 8-20 months). Based on the etiology, there were 5 steroid-induced cases (7 hips), 4 alcohol-induced cases (5 hips), 16 idiopathic cases (21 hips). According to the system of the Association Research Circulation Osseous (ARCO), 8 hips were classified as stage IIA, 15 hips as stage IIB, 9 as stage IIC, 1 as stage IIIA. Before treatment, the Harris score was (55.2±6.5) points, visual analog scale score was (6.81±1.19) points, and the volume of the necrotic femoral head with MRI was (13.38±5.1) cm3. After treatment with debridement, bone grafting combined with autologous bone marrow mesenchymal stem cells transplantation, the Harris score, visual analog scale score and the volume of the necrotic femoral head with MRI were measured.
RESULTS AND CONCLUSION: All incisions healed by first intention. All the 25 patients (33 hips) were followed up for 12-18 months (15 on average). The Harris score was significantly higher, but the visual analog scale score and the volume of the necrotic femoral head were significantly lower at 3, 6, 12 months after operation compared
with baseline data (P < 0.05). At postoperative 1 year, the Harris score was (85.6±7.8) points, the visual analog score was (2.38±0.73) points, and the volume of the femoral head necrosis was (7.23±3.3) cm3. There were 15 hips of excellent, 11 of good, 4 of fair and 3 of poor. Three poor hips were subjected to total hip arthroplasty at last. These findings indicate that the debridement, bone grafting combined with transplantation of autologous bone marrow mononuclear cells is an effective method to treat early early osteonecrosis of the femoral head, but the long-term effect needs to be observed further.

中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

全文链接：

Key words: bone marrow, stem cells, femur head necrosis, decompression, bone transplantation

CLC Number:

R394.2

Hu Qin, Yin Zong-sheng, Lu Ming, Zhang Hui, Ma Zhi-xiang. Treatment of early osteonecrosis of the femoral head with debridement, bone grafting and bone marrow mononuclear cells transplantation: functional evaluation of the hip joint[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(50): 8135-8139.

Figures/Tables 3

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