Curative effect of three-dimensional porous core decompression combined with autologous bone marrow transplantation on phase I, II avascular necrosis of the femoral head

doi:10.3969/j.issn.2095-4344.2017.25.011

Abstract

Abstract:

BACKGROUND: Hip-preserving treatment is advocated in the treatment of early avascular necrosis of the femoral head.
OBJECTIVE: To compare the clinical efficacy of simple core decompression and three-dimensional porous core decompression combined with autologous bone marrow transplantation on early avascular necrosis of the femoral head.
METHODS: Thirty patients (39 hips) with early avascular necrosis of the femoral head at phase I-II according to the staging criteria of the Association Research Circulation Osseuse (ARCO) who had been admitted to the First Affiliated Hospital of Luzhou Medical University between March 2011 and May 2016 were surgically treated and followed up. Seventeen patients (22 hips, trial group) were treated with three-dimensional porous core decompression combined with autologous bone marrow transplantation, including 10 cases of ARCO stage I and 12 cases of ARCO stage II; the other 13 patients (17 hips, control group) were treated with simple core decompression, including 7 cases of ARCO stage I and 10 cases of ARCO stage II. Harris scores, X-ray and magnetic resonance imaging were used to evaluate the surgical efficacy at 1, 3, 6, 9, 12, 18, 24, 30, 36 months after the operation.
RESULTS AND CONCLUSION: The incision healed primarily in all patients, and no infection occurred. The follow-up lasted for 1-3 years (average 2.5 years). At the last follow-up, the Harris scores in both trial group and control group were significantly improved compared with the baseline (P < 0.05); moreover, the Harris scores of ARCO stage I and II patients were significantly higher in the trial group than the control group (P < 0.05). Collapse of the femoral head was observed in one hip (stage I) and one hip (stage II) of the trial group, and in three hips (stage I) and five hips (stage II) of the control group, and then hip arthroplasty was performed. The number of the patients developing collapse of the femoral head in the trial group was significantly less than that in the control group (P < 0.05). Compared with simple core decompression, three-dimensional porous core decompression combined with autologous bone marrow transplantation is more adept to improve patient’s function and delay disease progression in the treatment of ARCO stage I and II early avascular necrosis of the femoral head.

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

Key words: Femur Head Necrosis, Arthroplasty, Replacement, Hip, Bone Marrow Transplantation, Tissue Engineering

CLC Number:

R394.2

Wang Sen, Tan Mei-yun, Liu Shao-feng, Wu Tian-hao, Fan Zhong-wei, Zhang Yue, Rao Yong. Curative effect of three-dimensional porous core decompression combined with autologous bone marrow transplantation on phase I, II avascular necrosis of the femoral head[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(25): 4001-4006.

Figures/Tables 3

2.4 治疗后临床效果比较通过随访时复查X射线片及MRI发现，2组患者术后骨髓水肿范围较术前明显消退。试验组ARCOSⅠ期患者随访期间1例患者股骨头缺血坏死进一步加重，并出现股骨头塌陷，行人工关节置换；ARCOSⅡ期患者随访期间1例患者股骨头缺血坏死进一步加重，并出现股骨头塌陷，行人工关节置换；手术总有效率为91%(20/22)，Ⅰ、Ⅱ期有效率分别为90%及92%。对照组ARCOSⅠ期3例患者股骨头缺血坏死进一步加重，并出现股骨头塌陷，行人工关节置换；ARCOSⅡ期患者随访期间5例患者股骨头缺血坏死进一步加重，并出现股骨头塌陷，行人工关节置换；手术总有效率为53%(9/17)，Ⅰ、Ⅱ期有效率分别为57%及50%。2组手术总有效率比较，差异有显著性意义(因样本总数n < 40，不符合χ2分布，采用确切概率法，P=0.011)；Ⅰ期有效率比较差异无显著性意义(因样本总数n < 40，不符合χ2分布，采用确切概率法，P=0.250)；Ⅱ期有效率比较差异无显著性意义(因样本总数n < 40，不符合χ2分布，采用确切概率法，P=0.056)，见表3。 2.5 典型病例男，31岁，右侧股骨头坏死，ARCOS Ⅱ期，术前Harris评分65分，行多小孔立体髓芯减压联合自体骨髓移植治疗后，末次随访Harris评分96分，见图2。术后病检：送检“股骨头”4份，主要为骨、软骨、骨髓组织、期间见少许炎细胞浸润，纤维组织增生及死骨形成，见图3。 2.6 不良事件试验组1例中年患者(Ⅱ期)术后6个月出现患侧股骨头塌陷，于院外行人工关节置换。综合分析后考虑术中定位不准确，克氏针未到达病灶组织，且对病灶周围正常结构造成了一定破坏，最终导致股骨头塌陷变形。余未见特殊不良事件发生。"

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