CAJ | 학술논문

目的：观察髓芯减压联合自体外周血干细胞移植治疗结缔组织病（ CTD）合并早中期股骨头缺血性坏死（ ANFH）的临床疗效。方法选择福建医科大学附属龙岩第一医院血液风湿科2004年10月至2013年6月住院治疗的CTD合并ANFH患者58例。所有患者均有关节疼痛和功能障碍等症状，经影像学检查确诊为ANFH，均有长期服用糖皮质激素史（口服泼尼松5～15 mg/d，持续1～8年）。按照治疗方法的不同将患者分为髓芯减压联合自体外周血干细胞移植治疗组和单纯髓芯减压对照组，治疗组和对照组患者分别为32例和26例。根据世界骨循环研究学会（ ARCO）骨坏死分期标准，治疗组49髋分别为Ⅰ期7髋，Ⅱ期25髋，Ⅲ期17髋；对照组38髋Ⅰ期5髋，Ⅱ期21髋，Ⅲ期12髋。分别在术前及术后随访期间对两组患者进行髋关节Harris评分和疼痛视觉模拟（ VAS）评分，并对患者MRI检查结果进行评估。结果两组患者术后切口均Ⅰ期愈合，术后中位随访时间40个月（24～104个月）。治疗组和对照组患者术后3，6，12，24个月Harris和VAS评分与本组术前比较，差异均有统计学意义（P均＜0．05）。两组患者术前及术后3个月Harris评分差异均无统计学意义（t＝1．06和0．58，P均＞0．05）；治疗组患者术后6，12，24个月Harris评分均高于对照组，差异均有统计学意义（ t＝2．49，5．55和6．58，P均＜0.05）；术后24个月治疗组患者Harris评分优良率高于对照组（χ2＝8．59，P＜0．05）。两组术前及术后3，6个月VAS评分差异均无统计学意义（t＝0．61，0．73和1．74，P均＞0．05）；治疗组术后12，24个月VAS评分均低于对照组，差异均有统计学意义（t＝5．50和3．22，P均＜0．05）。治疗组术后12，24个月T1相低信号区占股骨头体积百分比与术前比较差异均有统计学意义（ P均＜0．05），与对照组术后12，24个月比较差异均有统计学意义（t＝3．41和2.07，P均＜0．05）。结论髓芯减压联合自体外周血干细胞移植治疗CTD合并早中期ANFH，可减轻患者关节疼痛，改善股骨头血液供应，恢复关节功能，有效防止股骨头进一步塌陷，可获得较好的临床疗效。目的：觀察髓芯減壓聯閤自體外週血榦細胞移植治療結締組織病（ CTD）閤併早中期股骨頭缺血性壞死（ ANFH）的臨床療效。方法選擇福建醫科大學附屬龍巖第一醫院血液風濕科2004年10月至2013年6月住院治療的CTD閤併ANFH患者58例。所有患者均有關節疼痛和功能障礙等癥狀，經影像學檢查確診為ANFH，均有長期服用糖皮質激素史（口服潑尼鬆5～15 mg/d，持續1～8年）。按照治療方法的不同將患者分為髓芯減壓聯閤自體外週血榦細胞移植治療組和單純髓芯減壓對照組，治療組和對照組患者分彆為32例和26例。根據世界骨循環研究學會（ ARCO）骨壞死分期標準，治療組49髖分彆為Ⅰ期7髖，Ⅱ期25髖，Ⅲ期17髖；對照組38髖Ⅰ期5髖，Ⅱ期21髖，Ⅲ期12髖。分彆在術前及術後隨訪期間對兩組患者進行髖關節Harris評分和疼痛視覺模擬（ VAS）評分，併對患者MRI檢查結果進行評估。結果兩組患者術後切口均Ⅰ期愈閤，術後中位隨訪時間40箇月（24～104箇月）。治療組和對照組患者術後3，6，12，24箇月Harris和VAS評分與本組術前比較，差異均有統計學意義（P均＜0．05）。兩組患者術前及術後3箇月Harris評分差異均無統計學意義（t＝1．06和0．58，P均＞0．05）；治療組患者術後6，12，24箇月Harris評分均高于對照組，差異均有統計學意義（ t＝2．49，5．55和6．58，P均＜0.05）；術後24箇月治療組患者Harris評分優良率高于對照組（χ2＝8．59，P＜0．05）。兩組術前及術後3，6箇月VAS評分差異均無統計學意義（t＝0．61，0．73和1．74，P均＞0．05）；治療組術後12，24箇月VAS評分均低于對照組，差異均有統計學意義（t＝5．50和3．22，P均＜0．05）。治療組術後12，24箇月T1相低信號區佔股骨頭體積百分比與術前比較差異均有統計學意義（ P均＜0．05），與對照組術後12，24箇月比較差異均有統計學意義（t＝3．41和2.07，P均＜0．05）。結論髓芯減壓聯閤自體外週血榦細胞移植治療CTD閤併早中期ANFH，可減輕患者關節疼痛，改善股骨頭血液供應，恢複關節功能，有效防止股骨頭進一步塌陷，可穫得較好的臨床療效。
목적：관찰수심감압연합자체외주혈간세포이식치료결체조직병（ CTD）합병조중기고골두결혈성배사（ ANFH）적림상료효。방법선택복건의과대학부속룡암제일의원혈액풍습과2004년10월지2013년6월주원치료적CTD합병ANFH환자58례。소유환자균유관절동통화공능장애등증상，경영상학검사학진위ANFH，균유장기복용당피질격소사（구복발니송5～15 mg/d，지속1～8년）。안조치료방법적불동장환자분위수심감압연합자체외주혈간세포이식치료조화단순수심감압대조조，치료조화대조조환자분별위32례화26례。근거세계골순배연구학회（ ARCO）골배사분기표준，치료조49관분별위Ⅰ기7관，Ⅱ기25관，Ⅲ기17관；대조조38관Ⅰ기5관，Ⅱ기21관，Ⅲ기12관。분별재술전급술후수방기간대량조환자진행관관절Harris평분화동통시각모의（ VAS）평분，병대환자MRI검사결과진행평고。결과량조환자술후절구균Ⅰ기유합，술후중위수방시간40개월（24～104개월）。치료조화대조조환자술후3，6，12，24개월Harris화VAS평분여본조술전비교，차이균유통계학의의（P균＜0．05）。량조환자술전급술후3개월Harris평분차이균무통계학의의（t＝1．06화0．58，P균＞0．05）；치료조환자술후6，12，24개월Harris평분균고우대조조，차이균유통계학의의（ t＝2．49，5．55화6．58，P균＜0.05）；술후24개월치료조환자Harris평분우량솔고우대조조（χ2＝8．59，P＜0．05）。량조술전급술후3，6개월VAS평분차이균무통계학의의（t＝0．61，0．73화1．74，P균＞0．05）；치료조술후12，24개월VAS평분균저우대조조，차이균유통계학의의（t＝5．50화3．22，P균＜0．05）。치료조술후12，24개월T1상저신호구점고골두체적백분비여술전비교차이균유통계학의의（ P균＜0．05），여대조조술후12，24개월비교차이균유통계학의의（t＝3．41화2.07，P균＜0．05）。결론수심감압연합자체외주혈간세포이식치료CTD합병조중기ANFH，가감경환자관절동통，개선고골두혈액공응，회복관절공능，유효방지고골두진일보탑함，가획득교호적림상료효。
Objective To study the clinical outcomes of the core decompression and autologous peripheral blood stem cell ( APBSC) transplantation for avascular necrosis of the femoral head ( ANFH) at early and middle stages in patients with connective tissue disease .Methods A total of 58 patients with ANFH at early and middle stages were treated in Affiliated Longyan First Hospital from October 2004 to June 2013 .The patients were divided into 2 groups:the control group ( n=26 ) , only the core decompression was used; the treated group ( n =32 ) , both the core decompression and APBSC transplantation were used .There were 12 males and 14 females with an average age of 39.5 years (range 22-58 years) in the control group and 15 males and 17 females with an average age of 40 years (range 21-60 years) in the treated group.According to the system of Association Research Circulation Osseous (ARCO):5 hips were classified as stage Ⅰ, 21 as stageⅡ, and 12 as stageⅢin the control group;7 hips were classified as stage Ⅰ, 25 as stageⅡ, and 17 as stageⅢin the treated group .The Harris score and visual analogue scale/score (VAS) were determined, imaging evaluation was carried out by MRI pre-and post-operatively.Results The followed-up time was 24-104 months with an median of 40 months.The Harris scores and VAS scores of all patients were significant difference at 3, 6, 12 and 24 months after operation (P <0.05).There was not significant difference between the treated group and the control group in Harris scores 3 months after operation ( P>0.05 ) , but there were significant difference between the treated group and the control group at 6, 12 and 24 months after operation (P<0.05).There was significant difference between the treated group and the control group in the excellent and good rate at 24 months after operation (χ2 =8.59, P <0.05).There was not significant difference between the treated group and the control group in VAS scores at 3 and 6 months after operation ( P >0.05 ) , but there were significant difference between the treated group and the control group at 12 and 24 months after operation (P<0.05).The necrosis area of femoral head in the treated group and the control group were significant difference at 12 and 24 months after operation ( P<0.05).Conclusion The method of core decompression combining with APBSC transplantation can remarkably relieve the pain , promote the blood transport in the necrosis area ameliorate the femoral bone density, prevent the collapse of the femoral head and improve the hip joint function in the patients with ANFH at early and middle stages .