自体骨髓间充质干细胞移植在老年股骨头坏死髓芯减压术中的应用价值

Application value of autologous BMSCs transplantation in core decompression surgery for elderly femoral head necrosis

摘要:

目的 观察自体骨髓间充质干细胞（BMSCs）移植在老年股骨头坏死（ONFH）髓芯减压术中的应用效果。方法 该研究为前瞻性研究，选择平顶山市第一人民医院2022年1月至2023年5月收治的113例ONFH老年患者为研究对象，以计算机随机分组法将其分为试验组（57例）和对照组（56例），对照组予以传统髓芯减压术治疗，试验组经自体BMSCs移植联合髓芯减压术治疗，比较两组治疗前后的BMSCs表面分子、骨代谢水平、骨密度、骨坏死面积、髋关节功能及疼痛症状改善情况。结果 在不同治疗方案下，试验组的BMSCs表面分子CD34、CD105、CD166表达量分别为（2.48±0.76）%、（13.36±3.27）%、（37.49±5.28）%，均高于对照组［（1.92±0.36）%、（11.45±2.13）%、（34.23±5.16）%］（P<0.05）；试验组骨保护素（OPG）、骨钙素（BGP）、成纤维细胞生长因子（FGF-2）分别为（5.45±1.36）pg/mL、（6.27±1.45）μg/mL、（43.35±10.46）ng/L，均高于对照组［（4.41±1.36）pg/mL、（5.52±1.44）μg/mL、（37.25±10.41）ng/L］（P<0.05）；试验组术后1个月、术后3个月的骨密度分别为（0.32±0.11）g/cm²、（0.49±0.23）g/cm²，均高于对照组［（0.25±0.11）g/cm²、（0.35±0.16）g/cm²］（P<0.05）；骨坏死面积分别为（26.44±5.17）%、（20.45±5.23）%，均低于对照组［（29.12±5.33）%、（23.32±5.18）%］（P<0.05）；试验组术后1个月、术后3个月的视觉模拟疼痛量表（VAS）评分分别为（4.25±1.27）分、（2.82±0.46）分，均低于对照组［（5.33±1.77）分、（3.21±0.52）分］（P<0.05）；试验组术后1个月、术后3个月的髋关节Harris量表评分分别为（70.33±10.32）分、（85.66±10.45）分，均高于对照组［（65.22±10.36）分、（80.33±10.71）分］（P<0.05）。结论 自体BMSCs能通过上调骨髓干细胞表面分子而改善老年ONFH患者的骨代谢水平，自体BMSCs移植联合髓芯减压术可有效提升患者骨密度水平，并减少骨坏死面积，对缓解患者髋关节疼痛、促进髋关节功能恢复均有积极意义。

Abstract:

Objective To observe the application effect of autologous BMSCs transplantation in elderly osteonecrosis of the femoral head (ONFH) core decompression surgery.Methods This study is a prospective study that selected 113 elderly patients with ONFH admitted between January 2022 and May 2023 as the study subjects. They were randomly divided into an experimental group (57 cases) and a control group (56 cases) using computer randomization. The control group received traditional core decompression surgery, while the experimental group received autologous bone mesenchymal stem cells (BMSCs) transplantation combined with core decompression surgery. The surface molecules of BMSCs, bone metabolism levels, bone density, area of bone necrosis, hip joint function and pain symptoms before and after treatment were compared between the two groups.Results Under different treatment regimens, the expression levels of CD34, CD105, and CD166 molecules in BMSCs in the experimental group were 2.48%±0.76%, 13.36%±3.27%, and 37.49%±5.28%, higher than those in the control group (1.92%±0.36%, 11.45%±2.13%, and 34.23%±5.16%) (P<0.05). The OPG, BGP, and FGF-2 levels in the experimental group were 5.45±1.36 pg/mL and 6.27±1.45 μg/mL, 43.35±10.46 ng/L, higher than the control group (4.41±1.36 pg/mL, 5.52±1.44 μg/mL, 37.25±10.41 ng/L)(P<0.05). The bone mineral density of the experimental group at 1 month and 3 months after surgery was 0.32±0.11 g/cm² and 0.49±0.23 g/cm², higher than those of the control group (0.25±0.11 g/cm² and 0.35±0.16 g/cm²)(P<0.05). The area of bone necrosis was 26.44%±5.17% and 20.45%±5.23%, lower than that of the control group (29.12%±5.33% and 23.32%±5.18%)(P<0.05). The VAS scores of the experimental group at 1 month and 3 months after surgery were 4.25±1.27 points and 2.82±0.46 points, lower than those of the control group (5.33±1.77 points and 3.21±0.52 points)(P<0.05). The Harris scores of the experimental group at 1 month and 3 months after surgery were 70.33±10.32 points and 85.66±10.45 points, higher than those of the control group (65.22±10.36 points and 80.33±10.71 points)(P<0.05).Conclusion Autologous BMSCs can improve the bone metabolism level of elderly ONFH patients by upregulating the surface molecules of bone marrow hepatocytes. Autologous BMSCs transplantation combined with core decompression can effectively increase the bone density level of patients and reduce the area of bone necrosis, which has positive significance in alleviating hip joint pain, promoting hip joint function recovery.