Clinical Observation Of Platelet-rich Plasma Combined With Bone Grafting Through A Femoral Neck Window At High Location In The Treatment Of Osteonecmsis Of Femoral Head During Peri-suibsidence Peirod

Objective1.To obserb the platelet-rich plasma(PRP)in combination with the bone grafting through a femoral neckwindow at high location during peri-suibsidence peirod in the treatment of osteonecmsis of femoral head.2.To investigate the impact of PRP in combination with drynaria total flavonoid on the proliferation of rats bone marrow mesenchymal stem cells.And to promote its transformation into osteoblasts.MethodsPart of clinical research:We retrospectively reviewed 50 patients Linyi People’s Hospital from June 2016 to March 2018.25 hips of the 25 patients received the PRP and the bone grafting through a femoral neck window at high location classified as support for the observation group,25 hips of 25 patients were only deal with high head and neck support window bone graft surgery.We taken 21 months of follow-up,In the follow-up,the excellent and good rate of the Harris score at 3,6,12 months and the last follow-up,the patients’imaging findings,the pain score before and at 1,5,7 and 14 days after the surgery,the postoperative drainage volume,and the degree of the swelling of the affected limb wereobserved.The inflammatory indexes of the patients before and after the surgery and the healing grade of the surgical incision two weeks later were observed for statistical analysis.Experimental Research:Using density gradient centrifugation,adherent cells separation and purification method of rat bone marrow mesenchymal stem cells.Subculture and proliferation in vitro,after being spread to the third generationidentification of ectomesenchymal cells from bone marrow,and cultivate good between bone marrow mesenchymal stem cells can be divided into two parts,each part of the group(the control group,group A:0.5ml platelet rich plasma,group B:0.5ml 10mg/L drynaria total flavonoid,group C:0.5ml platelet rich plasma and 0.5ml lOmg/L drynaria total flavonoid).According to the above group cultured in different medium,at 37℃ and 5%CO2 culture to 1d,3d,7d,10d.Also,we use CCK-8 assay to measure the proliferation of each group.Another part the corresponding medium was added according to the above groups,and the osteogenic induction drugs were added for 2 weeks.The osteogenic results were analyzed by alizarin red staining.ResultsClinical part:(1)The last postoperative Harris score was significantly higher than the preoperative one(P<0.05).The Harris score in the observation group(82.76±2.03)was higher than the control group(P=0.00).(2)The preoperative VAS score was signifciantly lower than the postoperative one in both groups(P<0.05).Also,the VAS score(2.32±0.69)of the last follow-up in the observation group was remarkably lower than that(4.16±0.80)in the control group(P=0.04).(3)The(95.00%)hips turn into excellence and the(75.00%)radiographs improved in the observation group which were higher than those in the control group(65.00%)and(56.00%),respectively,with significant difference(P<0.05).(5)The drainage flow(200.50±25.40)in the control group was higher than that in the observationgroup(165.90±25.37)(P<0.05).No postoperative complications were found in both groups,such as nonunion of incision,infection,nonunion of osteotomy and venous thrombosis.2.Expermental part:(1)Part:after 3 generations of bone marrow mesenchymal stem cells,CD44,CD29 and CD45 were used for cytologieal identification.Among them,CD44 and CD29 were positive,and the positive rate was about 75%.CD45 is negative.After grouping culture,CCK-8 was used to detect the proliferation activity of bone marrow mesenchymal stem cells that induced and promoted by each group.It was found that PRP combined with drynaria total flavonoid was the group with the strongest proliferation activity.The PRP group was the second and the drynaria total flavonoid were the third.PartⅡ:The results of alizarin red test for osteoblast were similar to partⅠ,the number of osteoblasts was the highest in the combination PRP with drynaria total flavonoid,and the drynaria total flavonoid was the third,and the control group was the lowest.Conclusions1.That PRP combined with bone grafting through a femoral neck window at high location in the treatment of femoral head necrosis during peri-suibsidence peirod is superior to which without PRP.It provides a new method for the treatment of osteonecrosis of the femoral head.2.PRP and drynaria total flavonoid have synergistic effects on the proliferation of bone marrow mesenchymal stem cells.And the function of PRP is higher than that of drynaria total flavonoid.