间充质干细胞移植治疗股骨头坏死的临床疗效

doi:10.3969/j.issn.2095-378X.2021.04.003

摘要/Abstract

摘要： 目的股骨头坏死致高致残率和高髋关节置换手术率,目前缺乏有效逆转病情的治疗方法。通过观察超声引导下关节腔局部植入脐间充质干细胞治疗股骨头坏死的临床效果和安全性,探索股骨头坏死有效的治疗方法。方法选择2017年1月—2019年9月在徐州医科大学附属医院收治的股骨头坏死接受人脐间充质干细胞治疗的患者21例,男14例,女7例,共29个髋关节（髋）。根据世界骨微循环研究协会（ARCO）的分期系统：Ⅱ期17髋,Ⅲ期12髋。在超声引导下髋关节腔内植入脐间充质干细胞1×10⁷。VAS评分评估移植前、移植后3、6、12个月的疼痛变化,Harris评分法评估移植前、移植后3、6、12个月的髋关节功能,测算移植前、移植后12月MRI T1像上最大层面坏死面积评估影像学变化。采用SPSS 26.0对数据进行统计分析。结果患者移植后疼痛改善：移植后3个月（5.29±1.59）分、6个月（3.76±1.22）分、12个月（2.10±0.70）分,VAS评分较移植前（6.86±1.31）分好转（P<0.05）。患者临床症状改善：患侧髋关节疼痛改善共19例（90.4%）;步态改善或行走距离延长共17例（80.9%）;关节活动范围改善共14例（66.6%）。Harris评分：移植前（62.76±10.08）分,移植后3个月（74.62±9.70）分、6个月（76.90±8.21）分和12个月（77.48±7.54）分,均较术前明显提高（P<0.05）。股骨头坏死面积：移植后12个月平均（187.27±11.01） mm²,较移植前（236.31±23.43） mm²明显缩小（P<0.05）。不良事件：3例患者出现移植后短期患侧关节疼痛加重,非甾体类止痛药治疗后缓解。未发生发热、胃肠道反应、局部感染等不良反应。结论关节腔局部植入间充质干细胞可改善早、中期股骨头坏死患者的临床症状、关节功能,并可延缓或逆转影像学进展,有望成为股骨头坏死的新的治疗手段。

关键词: 间充质干细胞, 股骨头坏死, 局部移植, 坏死面积, 关节功能

Abstract: Objectives Osteonecrosis of the femoral head is a disease without effective treatment, and features a high disability rate and a high hip joint replacement rate. This study aims to observe the clinical effect and safety of local implantation of mesenchymal stem cells guided by ultrasound on femoral head necrosis, and explore an effective treatment method for the disease. Methods A total of 29 hip joints of 21 patients （14 males and 7 females） with osteonecrosis of the femoral head and undergoing treatment using umbilical mesenchymal stem cells were selected from January 2017 through September 2019 in the Affiliated Hospital of Xuzhou Medical University. According to the Association Research Circulation Osseous （ARCO） system, 17 hips were classified as stage II, and 12 hips as stage III. Umbilical mesenchymal stem cells （1×10⁷） were implanted intra-articularly under ultrasonic localization. VAS score was used to evaluate pain changes before and at 3, 6, and 12 months after transplantation, Harris score was used to evaluate hip function at 3, 6, and 12 months after transplantation, and imaging results were measured in low-signal area at the maximum level of necrotic area on MRI T1 images before and at 12 months after transplantation. Statistical analysis was performed by SPSS 26.0. Results Postoperative pain was improved： VAS scores at postoperative 3 months （5.29±1.59）, 6 months （3.76±1.22）, and 12 months （2.10±0.70） were lower than that before transplantation （6.86±1.31, P<0.05）. Clinical symptoms were alleviated： 19 cases （90.4%） showed reduced pain of the affected side; 17 cases （80.9%） had improved gait or extended walking distance; 14 cases （66.6%） showed greater range of motion. Harris scores at postoperative 3 months （74.62±9.70）, 6 months （76.90±8.21）, and 12 months （77.48±7.54） were higher than that before transplantation （62.76±10.08, P<0.05）. The necrotic area was （187.27±11.01） mm² at postoperative 12 months, which was significantly reduced compared with （236.31±23.43） mm² before transplantation （P<0.05）. There were 3 patients with aggravation of short-term joint pain on the affected side after transplantation, which was alleviated after non-steroidal anti-inflammatory drug treatment. No adverse reactions such as fever, gastrointestinal reactions, or local infections occurred. Conclusion Local implantation of mesenchymal stem cells can alleviate clinical symptoms, improve joint function, and delay or reverse the imaging progress of patients with early and middle-stage osteonecrosis of the femoral head, which is expected to be a new treatment for femoral head necrosis.

Key words: Mesenchymal stem cells, Osteonecrosis of the femoral head, Local transplantation, Necrosis area, Joint function

中图分类号:

R458⁺.8

张婷, 周冬梅, 蔡欣诺, 刘春梅, 宋远圆, 殷松楼. 间充质干细胞移植治疗股骨头坏死的临床疗效[J]. 外科研究与新技术, 2021, 10(4): 248-252.

ZHANG Ting, ZHOU Dongmei, CAI Xinnuo, LIU Chunmei, SONG Yuanyuan, YIN Songlou. Clinical effect of mesenchymal stem cell transplantation on osteonecrosis of the femoral head[J]. Surgical Research and New Technique, 2021, 10(4): 248-252.

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