Effect Study Of Autologous BMSCs Implant Combined With Core Decompression And Allograft Free Fibular Column Grafting For ONFH In Early And Middle Stage

Background and Objective Osteonecrosis of femoral head(ONFH),a still conundrum to cope with in today's orthopaedics.Treatment for early or middle stage ONFH especially occurs in young patients may become more intractable.Currently,joint-preserving regenerative therapy the technique principle of which aims at reinforcing subchondral bone's supports so as to restore internal biomechanical strength of the femoral head has been clinically much more performed to cure ONFH in early and middle-stage.From the late 1990 s,cell transplantation technique using bone morrow-derived mesenchymal stem cells(BMSCs)has been progressively employed to treat ONFH as its further research,and to some degree has achieved certain therapeutic effect.The aim of this study was to evaluate the clinical efficacy and security of autologous BMSCs implant combined with impaction autologous cancellous bone grafting,which was simultaneously followed by allograft free fibular column grafting surgery.Moreover,difference for therapeutic effect between both groups of ONFH that are caused by steroids and alcohol respectively was compared,and effective approach treating ONFH in early or middle stage was also discussed in this study.Materials and methods First part : Chinese medicine hospital in henan province has treated 32 patients with the diagnosis of ONFH in early and middle stage being caused by alcohol during period september 2010-september 2012,randomly distributed into two groups,with 16 in each.Patients within experimental group were collected bone marrow blood 2 hours before surgery.BMSCs were in vitro isolated and sealed for standby application.Intraoperatively,all the patients were performed with core decompression of the femoral head followed by scratching partial necrotic bone.Cancellous bone was carried out of the iliac bone section with being premixed with isolated autologous BMSCs so that the cell of BMSCs may affix to the trabecula within cancellous bone.Then compound bone may be impacted into the region where necrotic bone had recently scratched.Finally,allograft free fibular column can be impacted into bone graft site to make supports.Patients in control group were treated with core decompression and impaction autologous cancellous bone grafting combined with tantalum rod support surgery.Both two groups were elevated with ESR?CRP?VAS scores?Harris scores at posttreatment 3?6?12?24 months;Totally therapeutic effect valuation,necrotic index,presence of secondary reaction or complication etc.for two groups were follow-up assessed at posttreatment 24 months so as to estimate long-term efficacy and security.Second part : 48 patients with the diagnosis of ONFH in early and middle stage have been treated in Chinese medicine hospital in henan province during period february 2013-september2014,of whom,steroids or alcohol caused was 24 cases respectively.Both two groups were treated with the surgery of autologous BMSCs implant combined with core decompression and allograft free fibular column grafting.Then,both two groups postoperatively accepted strengthening kidney and activating the blood Chinese medicine based on syndrome differentiation,with being elevated by ESR?CRP?VAS scores?Harris scores at posttreatment 3?6?12?24 months;Totally therapeutic effect valuation,necrotic index,presence of secondary reaction or complication etc.for two groups were follow-up assessed at posttreatment 24 months so as to estimate long-term efficacy and security.Results The procedure of bone marrow collection ?stem cell isolation and surgery worked very smoothly,and all the patients didn't appear special discomfort.During period of peri-operation and even the follow-up,none of patients appeared abnormal reaction.All VAS scores and Harris scores being assessed at posttreatment 3?6?12?24 months respectly for patients in experimental group are much more better than control group.Postoperative VAS scores and Harris scores for two groups were obviously improved when compared with those before operation.Theses scores of alcohol group being evaluated at postoperative 6?12?24 months respectively were all evidently higher to those of steroid group.Therapeutic evaluation and necrotic index which was assessed at postoperative 24 months of alcohol group was superior to that of steroid group.Conclusions Therapy of autologous BMSCs implant combined with core decompression and allograft free fibular column grafting for ONFH in early and middle stage has good therapeutic efficacy and security.Since different pathogenesis and inner repair pattern between different necrotic type of femoral head caused by steroids and alcohol,therapeutic effect of joint-preserving treatment for steroid-induced ONFH is worse than alcohol-related type.