背景：大量临床试验研究发现，股骨头坏死患者的股骨头颈及股骨近端骨髓干细胞的数量明显减少，同时伴随着活性减弱，这就使得此处成骨能力明显下降，即坏死骨在得到吸收后仍不能有效修复，从而导致股骨头的塌陷。目的：分析自体外周血单核细胞移植联合多孔髓芯减压治疗股骨头坏死的早期临床疗效。方法：选取45例(49髋)股骨头坏死患者作为研究对象，采用自体外周血单核细胞移植联合多孔髓芯减压治疗，治疗后进行疼痛、髋关节功能、患者满意度评估，并进行X射线片、CT及MRI等检查。结果与结论：所有患者均获得随访，随访时间11-14个月，平均随访(12.5±0.6)个月，在随访期间未发生并发症与严重不良反应。治疗后疼痛评分、Harris评分较治疗前均有明显改善，差异有显著性意义(P <0.05)。治疗后12个月患者满意度优良率为92%。MRI检查低信号区所占股骨头体积的百分比：治疗前为(40.1±7.34)%，治疗后6个月为(20.23±5.4)%，治疗前后差异有显著性意义(P <0.05)。结果表明自体外周血单核细胞移植联合多孔髓芯减压治疗股骨头坏死的早期临床疗效显著，可明显减轻关节疼痛，改善并恢复髋关节功能，延缓病情发展恶化。%BACKGROUND:A large number of clinical trials have found that the number of bone marrow stem cels at the femoral neck and proximal femur in patients with osteonecrosis of the femoral head is significantly reduced, accompanied by decreased activity, which causes a significant decrease in osteogenic capacity that the necrotic bone cannot be effectively repaired after absorption, leading to the colapse of the femoral head. OBJECTIVE:To probe into the early clinical efficacy of autologous peripheral blood mononuclear cel transplantation with porous core decompression for treatment of avascular necrosis of the femoral head. METHODS:Forty-five patients with avascular necrosis of the femoral head (49 hips) were enroled in this study, and underwent autologous peripheral blood mononuclear cel transplantation with porous core decompression. After treatment, pain scores, Harris hip score, scores on the satisfaction of patients were evaluated, as wel as X-ray, CT and MRI examinations. RESULTS AND CONCLUSION:Al the patients received a folow-up visit of 11-14 months, averagely (12.5±0.6) months. During the folow-up, there were no complications and serious adverse reactions. Postoperative pain scores and Harris scores were both improved significantly compared with preoperative ones (P < 0.05). At 12 months after treatment, the excelent satisfaction rate was up to 92%. Patient’s MRI low signal region accounting for a percentage of the volume of the femoral head was decreased from (40.1±7.34)% preoperatively to (20.23±5.4)% at 6 months postoperatively, and there was a significant difference (P < 0.05). These findings indicate that autologous peripheral blood mononuclear cel transplantation with porous core decompression for treatment of avascular necrosis of the femoral head has significantly clinical effects at early stage, which can obviously reduce joint pain, improve and restore hip joint function, and delay progression of disease.
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