摘要
目的:观察经动脉骨髓干细胞移植治疗股骨头坏死的效果。方法:选择2004-08/2005-12在解放军第四六三医院细胞治疗中心收治的股骨头坏死接受动脉内骨髓干细胞移植治疗患者63例113髋。年龄12～54岁(平均33岁),曾经应用皮质激素史29例,外伤史17例,大量饮酒史11例,原因不明6例。63例患者均行髋关节X射线摄片检查确诊,15例同时行髋关节MRI检查,38例行髋关节CT检查。根据Ficat分期法Ⅱ期52髋(46.0%),Ⅲ期58髋(51.3%),Ⅵ期3髋(2.7%)。①采集自体骨髓200～400mL,Ficoll密度梯度离心,分离单个核细胞(1～4)×1011L-1,CD34+细胞1.4%～3.5%(2.4%),CD133+细胞1.13%～3.25%(1.88%),制备成单个核细胞悬液10～20mL。②在数字减影血管造影术下行股动脉穿刺,将导管超选插入旋股内动脉、旋股外动脉及闭孔动脉,将细胞悬液缓慢灌注入动脉内。③干细胞移植后随访观察患者髋关节疼痛程度、疼痛性质及疼痛时间变化、行走距离及步态变化、髋关节外展与内旋功能变化;6个月后复查股骨头供血动脉造影,观察血管新生及股骨头供血动脉充盈情况;观察干细胞移植后不良反应。12个月后行髋关节X射线摄片、CT,MRI扫描观察股骨头形态学变化。结果:63例患者关节疼痛、行走距离及关节功能平均随访3.2个月,其中5例行数字减影血管造影术,15例行X射线检查(2例同时做CT检查)。①随访时观察髋关节疼痛有不同程度的缓解54例(54/63,85.7%),关节功能改善19例(19/63,30.2%),行走间距延长34例(34/63,54%),生活质量提高。②干细胞移植术后6个月5例患者行数字减影血管造影术股骨头供血动脉造影检查,显示旋股内动脉、旋股外动脉及闭孔动脉管径增粗,新生血管增多,血流速度增快,与移植前血管造影结果比较,股骨头区血液供应明显改善。③2例18个月X射线摄片、CT扫描股骨头坏死区缩小,可见新骨形成。④63例患者在治疗中未发生严重并发症和不良反应。结论:经动脉干细胞移植治疗缺血性股骨头坏死方法简便、安全有效,在治疗中未发生不良反应,是治疗缺血性股骨头坏死的一种新手段。
AIM： To observe the curative effects of bone marrow stem cell （BMSC） transplantations on the avascular necrosis of femoral head （ANFH）,
METHODS： Totally 63 ANFH patients （113 coxae） aged from 12 to 54 with the mean of 33 years and treated by BMSC transplantations were enrolled from the Cell Treatment Center of The 463^rd Hospital of Chinese PLA between August 2004 and December 2005. Among them, there were 29 patients having cortex hormones application history, 17 of traumatic history, 11 of heavy drinking history and 6 of unknown reason. All the 63 patients were finally diagnosed by coxa X ray examination while MRI checks were given to 15 ones and CT checks were given to 38 ones simultaneously. Totally 113 coxae from 63 patients were divided into Ⅱ stage （n=52, 46.0%）, Ⅲ stage （n=58, 51.3%） and Ⅵ stage （n=3,2.7%） according to the Ficat staging method. ①200-400 mL autologous bone marrow were selected and Ficoll density gradient centrifugation was performed. Then （1-4）×10^11 L^-1 mononuclear cells, CD34^＋ cells with the concentration of 1.4%-3.5%（mean 2.4%） and CD133^＋ cells with the concentration of 1.13%-3.25%（mean 1.88%） were separated and used to prepare 10-20 mL mononuclear cell suspensions.②The puncture of femoral artery was conducted with digital subtraction angiography （DSA）, and the tubes were inserted into medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery with the cell suspensions were gradually poured into the arteries.③The level, character, time change of coxa paining, and walking distance, gait change, change of abduction and medial rotation in patients were observed in the follow-ups after BMSC transplantations; Six months later, the patients were re-examined with femoral head blood-supply artery angiography to observe the neonatal vessels, the filling of blood-supply artery and the adverse reaction after the BMSC transplantations; Twelve months later, the coxa X ray examination, CT and MRI scanning were performed to observe the morphological change of femoral head.
RESULTS： The joint paining, joint functions and walking distance of 63 patients were detected for the follow-up of average 3.2 months. There were 5 patients checked by DSA and 15 checked by X ray （2 of them were given CT examination meanwhile）. ①In the follow-ups, there were 54 patients showing the remission of coxa joint paining on different degrees （54/63, 85.7%）, 19 showing the improvement of joint functions （19/63, 30.2%） and 34 showing the longer walking distance （34/63, 54%）, with the life quality increased.②At 6 months after BMSC transplantations, the DSA results of femoral head blood-supply artery angiographies in 5 patients showed that the calibers thickened in the medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery, and the count of new vessels increased, blood velocity quickened. Compared with the angiography results before transplantation, the blood supply was remarkably improved in the femoral head.③After 18 months, the reduced areas of femoral head necrosis in 2 patients indicated the new bone formation. ④There was no severe complication and adverse reaction found in the treatment of 63 patients.
CONCLUSION： The BMSC transplantation is convenient, safe and effective in the treatment of the ANFH with no adverse reaction, and can be considered as a new therapy of ANFH.
出处
《中国临床康复》
CSCD
北大核心
2006年第13期3-5,共3页
Chinese Journal of Clinical Rehabilitation
