Yamasaki Takuma, Yasunaga Yuji, Terayama Hiroshi, Ito Yohei, Ishikawa Masakazu, Adachi Nobuo, Ochi Mitsuo
Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Japan.
Med Sci Monit. 2008 Apr;14(4):CS23-30.
Bone marrow derived mononuclear cells (BMMNCs) have the advantage of promoting both angiogenesis and osteogenesis. In this report, BMMNCs were transplanted into the affected area of one hip using interconnected porous calcium hydroxyapatite (IP-CHA) in two patients, while the other hip was simultaneously treated with transtrochanteric rotational osteotomy (TRO). This case report documents the potential of BMMNCs with IP-CHA for bone repair at the lesion of osteonecrosis of the femoral head.
Two patients whose progression of osteonecrosis was stage 3 at one hip and stage 2 at the other hip. Firstly, TRO was performed on the collapsed side. Bone marrow aspirates were obtained from the iliac crest and were centrifuged with a cell separator during the procedure of TRO. BMMNCs were seeded into the IP-CHA and were transplanted to the lesion of osteonecrosis. Bone consolidation of transition zone on the cell-seeded femoral head was observed postoperatively at three or six months. The radiographs more than 22 months after surgery demonstrated shrinking of the extent of osteonecrosis, and no progression of collapse was observed.
We described two case reports of simultaneous surgical treatment for osteonecrosis of the bilateral femoral head using TRO for one hip in combination with transplantation of BMMNCs for the other hip. Short term results of this procedure are satisfactory without progression of collapse. Transplantation of BMMNCs may be a beneficial treatment for bone repair in the condition of osteonecrosis.
骨髓来源的单核细胞（BMMNCs）具有促进血管生成和成骨的优势。在本报告中，两名患者一侧髋关节的坏死区域被植入了相互连通的多孔羟基磷灰石（IP - CHA）并移植了BMMNCs，而另一侧髋关节同时接受了经转子旋转截骨术（TRO）。本病例报告记录了BMMNCs联合IP - CHA在股骨头坏死病灶处进行骨修复的潜力。
两名患者，一侧髋关节的坏死进展为3期，另一侧为2期。首先，对塌陷侧进行TRO。在TRO手术过程中，从髂嵴获取骨髓抽吸物并用细胞分离器进行离心。将BMMNCs接种到IP - CHA中，并移植到股骨头坏死病灶处。术后三到六个月观察到植入细胞的股骨头过渡区骨愈合。术后超过22个月的X线片显示坏死范围缩小，未观察到塌陷进展。
我们描述了两例双侧股骨头坏死的同期手术治疗病例，一侧髋关节采用TRO，另一侧髋关节联合移植BMMNCs。该手术的短期结果令人满意，未出现塌陷进展。BMMNCs移植可能是股骨头坏死情况下骨修复的一种有益治疗方法。
