Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells

被引：106

作者：

Wang, Bai-Liang ^{[1
]}

Sun, Wei ^{[1
]}

Shi, Zhen-Cai ^{[1
]}

Zhang, Nian-Fei ^{[1
]}

Yue, De-Bo ^{[1
]}

Guo, Wan-Shou ^{[1
]}

Xu, Shu-Qing ^{[2
]}

Lou, Jin-Ning ^{[2
]}

Li, Zi-Rong ^{[1
]}

机构：

[1] China Japan Friendship Hosp, Dept Orthopaed Surg, Osteonecrosis & Joint Preserving & Reconstruct Ct, Beijing 100029, Peoples R China

[2] China Japan Friendship Hosp, Dept Pathophysiol, Beijing 100029, Peoples R China

来源：

ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY | 2010年 / 130卷 / 07期

基金：

中国国家自然科学基金;

关键词：

Osteonecrosis; Bone marrow; Bone mesenchymal stem cells; Implantation; Core decompression; HIP;

D O I：

10.1007/s00402-009-0939-0

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Since self-limited repair ability of the necrotic lesion may be a cause for failure of the technique, the possibility has been raised that bone marrow mononuclear cells (BMMCs) containing BMSCs implanted into a necrotic lesion of the femoral head with core decompression (CD) may be of benefit in the treatment of this condition. For this reason, we studied the implantation of the concentrated autologous bone marrow containing mononuclear cells in necrotic lesion of the femoral head to determine the effect of the method. The study included 45 patients (59 hips, 9 females, 36 males; mean age 37.5 years, range 16-56 years) with stages I-IIIA nontraumatic avascular necrosis of the femoral head according to the system of the Association Research Circulation Osseous. Concentrated bone marrow (30-50 ml) containing mononuclear cells has been gained from autologous bone marrow (100-180 ml) obtained from the iliac crest of patient with the cell processor system. Concentrated bone marrow was injected through a CD channel into the femoral head. The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 27.6 months (range 12-40 months). Pre- and post-operative evaluations showed that the mean Harris hip score increased from 71 to 83. Clinically, the overall success is 79.7%, and hip replacement was done in 7 of the 59 hips (11.9%). Radiologically, 14 of the 59 hips exhibited femoral head collapse or narrowing of the coxofemoral joint space, and the overall failure rate is 23.7%. The number of BMMCs increased from 12.2 +/- A 3.2 x 10(6)/ml to 35.2 +/- A 12 x 10(6)/ml between pre-concentration and post-concentration. The concentrated autologous bone marrow containing mononuclear cells implantation relieves hip pain, prevents the progression of osteonecrosis. Therefore, it may be the treatment of choice particularly in stages I-II nontraumatic osteonecrosis of the femoral head.

引用

页码：859 / 865

页数：7

共 15 条

[1] Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head [J].