Experimental Study On The Treatment Of Osteonecrosis Of The Femoral Head With Marrow Mesenchymal Stem Cell Transplantation And Deliquesce Bone Graft Supporting Therapy

BackgroundNowadays there are more than 20 million patients suffering osteonecrosis of the femoral head (ONFH) in the world, and 5-7.5 million patients in china, and now it become the first most of the hip disease. Osteonecrosis of the femoral head, ofen occur in young adults and have a hight rate of mutilation, so autograft thrapy is the first consideration clinically. Currently we use vascular anastomoses or with free segmented-fibula transpalntation, or grafting with pedicle muscle and bone flap,such as:grafting rectus femoris, vastus lateralis, sartorius, gluteus medius, and quadratus femoris. But-all these therapes take a long time for bone fusion, and lack of support for a wide range. Laterly some researchers use bone marrow cells or bone marrow stem cell transplantation, impacted morselized allografts for early ONFN, induce bone growth and promotion of osteogenesis, but all these are lack of support forces. So we designed the experiment using marrow mesenchymal stem cell transplantation and deliquesce bone graft Supporting therapy in order to obtain good results.ObjectiveTo study the usefulness of marrow mesenchymal stem cell transplantation and deliquesce bone graft Supporting therapy on earlier osteonecrosis of the femoral head, and provide experimental proof for clinical use.MethodsHalf leg of 20 goats were established of osteonecrosis of the femoral head models via liquid nitrogen frozen,8 weeks later 2 goat was sacrificed to make a pathological examination of femoral head, others were randomly classified into 3 groups. Marrow mesenchymal stem cell transplantation and deliquesce bone graft Supporting therapy group (group A), transplantation of bone marrow stromal cells inoculated in spongy bone group(group B), bone grafting pedicled with muscle group (group C), and the untreated half leg of 18 goats in 3 groups were taken as self control. 3 months after the operation, the goats were taken for X-ray scanning, histological and biomechanics inspection.Results 1.8 weeks later after established of osteonecrosis of the femoral head models via liquid nitrogen frozen, X-ray showed the uneven density of the femoral head operated side, showing that low-density cystic shadow, mild femoral head collapse. Histological examination:Specimens:irregular femoral head shape, slightly flat collapsed, and yellow circular spots appeared on cartilage surface. Microscope:thin trabecular bone, some broken, disordered, and a lot of empty lacunae.2. X-ray examination:3 months after operation, Group A:The shapes of femoral head were recovered, low-density cystic shadows were disappeared, and the original cave had been fixed. Group B:Irregular shape of femoral head, uneven bone density, with low-density cystic shadow, with a clear collapse, and the original collapse did not fix. Group C:The shape of the femoral head almost back to normal, no low-density shadow, and the original cave was recovered.3. Histological examination:3 months after operation, Group A:Specimens: The femoral head shape bacame regular, cartilage surface was smooth and with bright colors:Microscope:Trabecular bone arranged structured, no fracture, showed a large number of bone cells, no empty lacunae. Group B:Femoral head shape irregular, flat, cartilage surface rupture, color dark, brown-yellow; Sparse trabecular bone thinning, disordered, broken clear that there are a'large number of empty lacunae. Group C: Shape the basic rules of the femoral head, cartilage, smooth surface,Trabecular bone were irregularly arranged, only see a small fracture and a small number of empty lacunae.4. Biomechanical determination of the femoral head results:After 3 months, A group treatment side and normal side of the subchondral bone, cancellous bone elastic modulus maximum pressure and no significant difference; B, C groups the treatment side and normal side The subchondral bone, cancellous bone pressure and elastic modulus of the largest significant difference; A group of treatment side of subchondral bone, cancellous bone maximum pressure and elastic modulus and B group, C group were significantly differences.Conclusion1. Umbrella supporting bone marrow cells and graft necrosis of femoral head can be effectively treated to restore its biomechanical properties, preventing femoral head collapse to good effect.2. New ideas to create a "bone marrow stem cells-Transplantation of tissue engineering" new surgical treatment of ONFH, will have a broad prospect for clinical application and major social and economic benefits.