CXCL13-transfected Bone Marrow Mesenchymal Stem Cell Therapy For Femoral Head Necrosis And Minimally Invasive Hip Replacement Surgery

Part 1 A Preliminary Study On The Efficacy of Bone Marrow Mesenchymal Stem Cells Transfected With CXCL13 Gene For Treatment Of Rat Models Of Glucocorticoid-induced Osteonecrosis Of Femoral HeadObjective To preliminary evaluate the efficiency of bone marrow mesenchymal stem cells transfected with CXCL13 gene to treat the rat models of glucocorticoid-induced osteonecrosis of femoral head.Methods Firstly construct the of CXCL13 gene lentivirus plasmid to transfect to rat bone marrow mesenchymal stem cells.Lipopolysaccharide combined high-dose methylprednisolone is used to establish rat model of glucocorticoid-induced osteonecrosis of femoral head,observe whether of bone marrow mesenchymal stem cells transfected with CXCL13 gene can increase of capability of migration of MSCs.Results CXCL13 lentivirus plasmid was constructed successfully.Early glucocorticoid-induced avascular necrosis of femoral head model is established successful by injection of LPS combination with large dose methylprednisolone.By Boyden chamber method bone marrow mesenchymal stem cells transfected CXCL13 can significantly enhance mobility of normal MSCs in vitro.Conclusion 1 cxcl13 lentivirus plasmid have the ability to infect bone marrow mesenchymal stem cells.2 lipopolysaccharide combined high-dose methylprednisolone can successfully established model of femoral head necrosis.3 Bone marrow mesenchymal stem cells transfected CXCL13 gene in vitro can enhance the ability of MSCs migration.Further research of the effect and molecular mechanism.in vivo is needed.Part 2 Obeservation On The Therapeutic Efficacy Of Total Hip Resurfacing Arthroplasty in Treatment Of Femoral Head Osteonecrosis In Yong And Middle-aged PatientsObjective It is controversial that total hip resurfacing arthroplasty is used in treatment of femoral head osteonecrosis.The aim of the study was to evaluate the clinical and radiographic outcomes of hip resurfacing arthroplasty in patients under 5 5-year-old with femoral head osteonecrosis.Methods 34 hip resurfacing arthoplasties were performed because of femoral head osteonecrosis between January 2008 and April 2009 in Shanghai General Hospital of Nanjing Medical University.There were 19 males and 15 females with an average age of 54 years(range 33?59 years),including 16 left hips and 18 right hips.The causes were alcohol(9 cases),glucocorticoid(8 cases),trauma(7 cases)and unknown origin(10 cases).According to modified Ficat classification system of osteonecrosis of the femoral head,there were 26 stage ?,8 hips at stage ?.The Harris Hip Score(HHS)and University of California,Los Angeles activity score-UCLA activity score were used to evaluate the clinical results.Migration of prosthesis components was assessed in immediate anteroposterior postoperative radiographs and 6.5 years after the operation.The abduction angle was measured on the acetabular side.On the femoral side,varus-valgus shift was determined by measurement of stem-shaft angle.Detection of axial collapse of femoral component was assessed with the use of the component-lateral cortex ratio.Results 32 patients were followed up for 78 months(70?84 months).Healing by first intention are achieved in all incisions without complication of infection and thrombosis of deep vein of lower extremities.No implant loosening,infection,femoral neck fracture,dislocation and pseudotumor was observed.At last follow-up,the abduction angle,stem-shaft angle and compotent-lateral cortex ratio showed no significant difference between immediately operation and 6.5 years postoperatively(p>0.05).The mean HHS increased from 50.1±2.27 to 95.22±1.47(p<0.05).UCLA activity score improved from 3.9±0.9 to 7.700±1.13(p<0.05).Conclusion If the patients were selected strictly,hip resurfacing arthoplasty seems to be effective in treatment for femoral head osteonecrosis staged as Ficat ? and ?in young and middle-aged patients.More cases and long-term follow-up are needed to investigate long-term clinical outcomes.Part 3 Treating Osteonecrosis of Femoral Head Through Mini-invasive Direct Anterior Approach in Learning Curve and Posterolateral ApproachObjective:To compare clinical results of treating osteonecrosis of femoral head staged Ficat ? or ? with total hip arthroplasty(THA)between mini-invasive direct anterior approach and posterolateral approach.Methods:48 cases of patients with osteonecrosis of femoral head staged Ficat ? or? treated with THA from January 2008 to December 2009 have been compared and analyzed.There were 21 patients in mini-invasive direct anterior approach group including 11 males and 10 females with an average age of(65.2±4.3),while there are 27 patients in posterolateral approach group including 16 males and 11 females with an average age of(63.6±4.0).Operative time,blood loss during operation,bed rest time and complications were observed and compared.Acetabular abduction and stem shaft angle were measured one month after operation and compared between the two groups.Postoperative Harris Hip scoring and VAS scoring were applied for evaluate function of hip joint and pain at 1 month,6 months and 5 years postoperative respectively.Results:All patients have been followed up for 48 to 73 months with an average of 60.4 months.Operative time,blood loss in DAA group was(78.30±5.08)min,(351.30±21.46)ml respectively,and not better than that of in posterolateral approach group which was(75.61 ± 10.60)min,(362.20±26.15)ml and.Bed rest time in DAA group was(2.05± 1.10)days,better than that of in posterolateral approach which was(3.30±1.35)day.No significant differences were found between the two groups in acetabular abduction and stem shaft angle.There was no significant differences between two groups in HHS and VAS score at one month,six months and 5 years after operation.There was 1 case with injury of ascending branch of the lateral circumflex femoral artery,1 case with great trochanter fracture and 1 case with superficial infection in DAA group,1 case with dislocation in posterolateral group.No prosthesis loosening occurred both of two groups.Conclusion:Both DAA and posterolateral approach are effective in treating osteonecrosis of femoral head staged Ficat ? or ?,and can obtain excellent outcomes.However,DAA seemed to has disadvantage in learing curve compared posteriolateral approach in complex cases.