髓芯减压联合自体骨髓有核细胞移植治疗非创伤性股骨头缺血性坏死的前瞻性对照研究.pdf

汕头大学医学院硕士学位论文 中文摘要 研究目的：评价髓芯减压联合自体骨髓有核细胞移植治疗非创伤性股骨头缺血性坏死 的临床效果。 方法：将53 例（63 髋）非创伤性股骨头缺血性坏死患者分为2 组：有核细胞组（34 例，44 髋）采用髓芯减压联合自体骨髓有核细胞移植，单纯植骨组 （15 例，19 髋）采用 髓心减压并植骨，2 组术前各项指标比较无统计学差异，主要评价指标为安全性、临床症 状和影像进展。随访时间12~31 个月，平均21 个月。 结果：有核细胞组和单纯植骨组末次随访时WOMAC 骨性关节炎指数比较有显著性差 异，P=0.001 ；有核细胞组术后Ficat Ⅰ、Ⅱ期病例Lequesne 髋关节功能指数和WOMAC 骨 性关节炎指数比Ficat III 、IV 期病例明显改善，有统计学差异，P 值分别为0.008、0.001 ； 4 例（4 髋；有核细胞组 3 髋，单纯植骨组 1 髋）术后因病情进展需行全髋关节置换，其 中3 例术前、术后长期口服糖皮质激素。 结论：髓芯减压联合骨髓有核细胞移植治疗ANFH 的早中期临床效果明显，与单纯植 骨组比较，能够明显改善疼痛、僵硬和日常功能等，且创伤小、费用低、安全性高、并发 症少和患者耐受性好，适合临床推广。 关键词：股骨头坏死/外科治疗；骨髓移植；钻孔减压；骨坏死/外科治疗 I 汕头大学医学院硕士学位论文 Abstract Objective: To evaluate clinical outcomes of core decompression combined with autologous bone marrow nucleated cells (BMNCs) implantation for the treatment of nontraumatic avascular necrosis of the femoral head (ANFH). Methods: Forty-four hips in 34 patients with nontraumatic avascular necrosis of the femoral head were treated by core decompression combined with autologous BMNCs implantation (Nuclear cell group) , and 19 hips in 15 patients were treated by core decompression combined with bone graft (Bone graft group) . There were no significant differences of the preoperative indicators between two groups. The primary evaluated parameters included safety, clinical efficiency and pathological progression indicated by radiological examination. The mean follow-up was 21 months (range 12 to 31 months). Results: There was significant difference in the WOMAC index between Nuclear cell group and Bone graft group, P= 0.001; In the Nuclear cell group, patients with Ficat stage I/II osteonecrosis have better improvement of limb function than those with stage III/IV as indicated by the Lequesne (P=0.008) and the WOMAC