CAJ | 학술논문

目的观察浓集自体骨髓单个核细胞(BMMCs)移植羟基磷灰石复合人工骨植入治疗中、早期股骨头坏死的临床疗效.方法自2006年6月至2010年1月采用髓芯减压BMMCs移植人工骨植入治疗ARCO分期Ⅰ期、Ⅱ期、ⅢA期股骨头坏死患者35例(57髋),年龄26 ～58(39.4±7.2)岁.对照组髓芯减压单纯人工骨植入治疗股骨头坏死患者17例(27髋),年龄26 ～51(38.0±6.0)岁.术后每半年及终末随访时摄髋关节前后位、蛙式位X线片,观察股骨头修复及坏死进展情况,采用Harris评分系统评估术后患髋功能改善情况,应用视觉模拟标尺法进行临床疼痛测定.结果两组患者整体术后终末随访Harris评分较术前显著提高.与单纯植骨组相比,BMMCs移植组术后终末随访Harris评分较术前提高幅度更明显.两组患者整体术后终末随访VAS评分较术前显著降低.与单纯植骨组相比,BMMCs移植组术后终末随访VAS评分较术前降低幅度更明显.BMMCs移植组临床成功率(75.4％)高于单纯植骨组(37.0％),差异有统计学意义(P＜0.01).BMMCs移植组放射学成功率(59.6％)高于单纯植骨组(40.7％),差异无统计学意义(P =0.1046).结论髓芯减压结合浓集自体BMMCs移植羟基磷灰石人工骨植入治疗股骨头坏死可有效改善患髋功能,显著减轻疼痛,适用于Ⅰ～ⅢA期股骨头坏死.
목적 관찰농집자체골수단개핵세포(BMMCs)이식간기린회석복합인공골식입치료중、조기고골두배사적림상료효.방법 자2006년6월지2010년1월채용수심감압BMMCs이식인공골식입치료ARCO분기Ⅰ기、Ⅱ기、ⅢA기고골두배사환자35례(57관),년령26 ～58(39.4±7.2)세.대조조수심감압단순인공골식입치료고골두배사환자17례(27관),년령26 ～51(38.0±6.0)세.술후매반년급종말수방시섭관관절전후위、와식위X선편,관찰고골두수복급배사진전정황,채용Harris평분계통평고술후환관공능개선정황,응용시각모의표척법진행림상동통측정.결과 량조환자정체술후종말수방Harris평분교술전현저제고.여단순식골조상비,BMMCs이식조술후종말수방Harris평분교술전제고폭도경명현.량조환자정체술후종말수방VAS평분교술전현저강저.여단순식골조상비,BMMCs이식조술후종말수방VAS평분교술전강저폭도경명현.BMMCs이식조림상성공솔(75.4％)고우단순식골조(37.0％),차이유통계학의의(P＜0.01).BMMCs이식조방사학성공솔(59.6％)고우단순식골조(40.7％),차이무통계학의의(P =0.1046).결론 수심감압결합농집자체BMMCs이식간기린회석인공골식입치료고골두배사가유효개선환관공능,현저감경동통,괄용우Ⅰ～ⅢA기고골두배사.
Objective To evaluate the efficacies of core decompression and implantation of concentrated autologous bone marrow containing mononuclear cells (BMMCs) with porous hydroxylapatite composite in the treatment of osteonecrosis of the femoral head.Methods A total of 35 patients with 57 osteonecrosis hips with ARCO stage Ⅰ,stage Ⅱ and stage Ⅲ A disease were treated by BMMCs with a porous hydroxylapatite composite.The mean age at surgery was 39.4 (26-58) years and the mean period of follow-up 28 (12-40) months.In the control group,cell-free porous hydroxylapatite composite was implanted into 17 patients (27 hips) with osteonecrosis of the femoral head and the outcomes were compared.Results At the last follow-up,postoperative Harris hip scores significantly increased in both groups (P＜0.0001).The magnitude of increase was significantly greater in the BMMCs group compared with the control group (28.3％ ±0.9％ vs 18.4％ ± 1.7％,P ＜0.01).Postoperative visual analog scale (VAS) scores significantly decreased in both groups (P ＜ 0.01).The magnitude of decrease was significantly greater in the BMMCs group compared with the control group (-70.2％ ±2.1％ vs-51.7％±2.9％,P ＜0.001).The clinical success rate was significantly higher in the BMMCs group compared with the control group (75.4％ vs 37.0％,P ＜0.01).The radiological success rates were similar between the BMMCs and control groups (59.6％ vs 40.7％,P =0.1046).Conclusion The combined regimen of core decompression and implantation of concentrated autologous BMMCs with porous hydroxylapatite composite appears to confer benefits in the treatment of in stages Ⅰ-Ⅲ A osteonecrosis of the femoral head.